I’ve always thought it to be an odd feature of the American healthcare system that nurses play such a subordinate role to doctors. These caregivers spend for a longer period with patients than physicians do, and they’re generally considered more trustworthy. Yet it’s the doctors who bring in the big salaries and exert probably the most influence on your diagnosis and treatment protocols.
For geezers much like me, this power disparity is particularly galling when you consider the cluelessness most general practitioners display when dealing with elderly patients suffering from multiple chronic conditions. It’s no coincidence, it seems to me, that in-home healthcare is so popular among the senior set. The majority of that care is delivered by nurses.
That’s why we might want to pay some attention to the nation’s looming nursing shortage.
As Susan Gubar reports in the New York Times, healthcare facilities in a handful of states are already suffering from a dearth of nurses, which trend is likely to accelerate in the next decade. The American Association of Colleges of Nursing estimates that as much as 1 million of the 3.8 million rns will leave the workforce by 2030.
It’s not like there’s no interest in the profession; nursing schools are inundated with qualified applicants. But budget cuts and a lack of teachers holding the required advanced nursing degrees (who are able to earn substantially more beyond academia) have limited the number of available courses. In 2021, Gubar notes, these institutions turned away some 75,000 candidates.
With that academic pipeline reduced to a trickle and retirements shrinking nursing staffs, workload has expanded — with predictable consequences. Gubar recounts a friend’s experience in an Indiana hospital coping with staff and budget cuts. Rushed towards the emergency room with a bowel blockage, she was instructed to spend the night there because administrators had closed a whole floor due to a lack of nursing staff. When she’d finally settled right into a room, she found herself waiting for 45 minutes before a nurse answered her call button. Apologizing, the nurse explained she’d been assigned two extra patients and was also expected to staff another area of the clinic.
Gubar, an ovarian cancer survivor, is no stranger to these conditions. During an appointment for a blood draw, she encountered a particularly frustrated nurse who noted that hospital administrators were hesitant to replace a departing receptionist. She and her colleagues would be required to fill the role — with their other duties. “It’s gone from the human touch to ‘get it done and get it billed,’” she said.
More recently, Gubar was shocked to understand that her longtime oncology nurse was quitting. The workload and culture had simply become too much for her and her colleagues, one of whom told her, “I’d prefer to be a greeter at Walmart than work under these conditions.”
What makes this occupational crisis so tragic is the fact that there’s plenty of evidence suggesting that effective nursing care can extend the health span of the elderly. A November 2021 New York University study, published within the Gerontologist, reviewed 27 years of research on the nurse-led eldercare program and found it significantly improved older adult care.
The program, Nurses Improving Care for Healthsystem Elders (NICHE), serves 580 acute-care hospitals and nursing facilities in the United States, Canada, Singapore, and Bermuda. Those facilities, researchers found, were able to improve their quality of care in many areas, including patient safety and length of hospital stays. And, by implementing a “geriatric resource nurse model” that helped nurses assume leadership roles, the program also enhanced workplace culture.
“Evidence on the NICHE program is promising, though more research examining patient outcomes and the impact on healthcare professionals is needed to better help healthcare organizations to meet their goals and improve outcomes for older adults,” lead study author Allison Squires, PhD, RN, said inside a statement.
Meanwhile, we may need to hear more from physicians like Haider Warraich, MD. The Duke University Medical Center cardiologist, writing in STAT News, lamented the lack of nurses at a 2021 conference concentrating on patient distrust of doctors. “The consequence of such an omission is underscored by what happens when nurses and doctors collaborate,” he notes. Such collaboration improves both patient outcomes and job satisfaction. And it might just be the key to saving the healthcare system.
“If we are to reshape medical care and just how it is perceived,” he adds, “the ability dynamics between physicians and nurses need to be evened out.”
