Significant efforts to address the shortage are under way in California. Every nursing school I know of is working diligently to meet the needs of nursing students, expanding enrollments in whatever way they can. Hospitals are doing their part as well. Almost every nursing program is receiving a subsidy from one or more hospitals or health care systems. Hospitals and schools are finding ways to share resources, most importantly faculty. Tuition assistance and loan forgiveness programs are increasing in frequency and value. Work-study programs are available to interested students.

Hospitals are taking the new-grad culture shock seriously, implementing intern and extern programs. Improving the work environment is a priority in every corner of the nursing community that I know, and it remains the most important area of effort for us to address.

Many foundations, including The California Endowment, are dedicating funds to vital workforce development projects in areas of the state that need special attention. Unfortunately, we have been able to secure only a $60 million commitment from our governor-not much when compared to other states, such as New York's $500 million-or the millions that our health care systems have already committed to subsidize nursing education in California.

To date, our public university systems-the University of California and California State University-have not stepped forward with significant responses to the needs of our profession, despite the individual efforts of nursing program directors. UCLA, our best hope, has done all the homework required, but without funding, it seems futile. Particularly so, given the politics, misaligned priorities and budgetary paralysis of our state government and educational systems.

Another critical source of support nurses must pursue is that of our physician colleagues. Their absence from our coalitions has been a nagging concern.

Although almost all aspects of patient care-ERs, ORs, inpatient and long-term care-are being affected by the nursing shortage, we have yet to see any visible support from our local medical community. For example, in the recent closure of an important university nursing program in the Los Angeles area, the university medical school and local medical community remained appallingly silent.

It is time to persuade our physician colleagues that their support and voice are critically needed. Whether it's the physician working with you across the bedside or the California Medical Association leadership, all physicians need to understand the dire reality of a future health care system without nurses.

There is no doubt that physicians know and value the critical importance of well-educated, competent and available nurses in patient care. For all of you who willingly offered your arm to medical students learning how to start IVs, it's time to call in your favors and ask for their support.

Discuss this and other topics with your colleagues at www.nurseweek.com/rnvillage.