Who Will Take Care of Us?
By Sean Martin
May 9, 2001 (Washington) -- Americans sometimes boast that we have the best healthcare system in the world, but several disturbing trends are highlighting some critical weaknesses.
Emergency room overflows, which force ambulances to be redirected to other hospitals, are becoming common year-round in cities around the nation, says a report released Wednesday from the nonprofit Center for Studying Health System Change.
Meanwhile, a current nursing shortage may already be hampering healthcare and forecasting dire possibilities for the coming explosion in the elderly population.
According to the new report, demand for ER services has grown, partly as HMOs more loosely manage visits, thanks to the consumer backlash against managed care. At the same time, however, health industry factors such as hospital mergers have cut the number of ER facilities, even as an ongoing nursing shortage threatens hospitals' ability to staff their beds.
The center's findings are based on in-depth visits it conducted to 12 communities around the country.
Managed care firms are under pressure to keep access to emergency rooms relatively open, but hospitals are squeezed enough financially to try to save money in their nursing operations, says Paul Ginsburg, PhD, president of the center.
"Hospitals always find it much more difficult to affect how physicians practice in the hospital, than to squeeze the services directly under the control of the hospital administrator," he tells WebMD.
Earlier this week, an international survey of nurses revealed widespread dissatisfaction and concerns over patient safety within the health system. Fewer than 20% of nurses in the U.S. are younger than 30, and one-third of these nurses reported that they intended to leave their jobs within a year. Meanwhile, two-thirds of nurses said there were not enough nurses in their hospitals to provide adequate care to patients.
Sean Clarke, RN, a researcher with the University of Pennsylvania School of Nursing and a co-author of the nurse survey, tells WebMD, "Physicians in some areas are already finding that surgeries have to be cancelled because there aren't nurses to look after the patients once they come out of the surgery." He warns, "The nursing shortage has the potential to cause real problems and to decrease the quality of care available in the U.S. healthcare system."
With the nation already in a nursing shortage, a separate report released Wednesday by the University of Illinois at Chicago's Nursing Institute suggests even deeper problems down the road. According to Lynn Martin, who chaired the university's effort, the coming boom in the over-65 population will find America with not enough healthcare workers "to care for the people who will need it most."
Between 2010 and 2030, the report noted, the ratio of potential caregivers to the people most likely to need care will decrease by about 40%.
What's to be done to head off that crisis?
The nursing institute concluded that the U.S. needs a cultural shift, a "fundamental change in how nursing careers are perceived." It also called for better wages and benefits for nurses as well as a more desirable work environment.
Ginsburg tells WebMD, "As long as our economy is good and there are opportunities elsewhere, this problem is going to continue -- unless hospitals can redesign the job to make it an attractive job once again. Hospitals are going to have to reinvent their working environment. That's how hospitals are going to compete in the labor market."
Meanwhile, there are federal legislative efforts afoot to mandate that hospitals keep certain nurse-to-patient ratios and to prevent nurses from having to work mandatory overtime shifts.
But Clarke tells WebMD, "These things are only small pieces of the pie. Nursing is an occupation for which you can't train people quickly, and that doesn't seem to resonate with people making career choices now."
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