NurseWeek: Heart of the Matter - Specialties such as cardiac care feel the effects of nursing shortage

Heart of the Matter
Specialties such as cardiac care feel the effects of nursing shortage

By Melissa Gaskill
February 19, 2001
Photo: Photodisc

The ramifications of the nursing shortage are becoming more apparent in areas such as cardiac care where the readily available services of a trained nurse can be a matter of life and death.


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In cardiac care units across the country, nurses are taking on extra shifts. They’re staying late, taking extra calls. After a while, people grow tired and tempers run short. "You stay and carry the load," said Donna Wray, RN, a certified operating room nurse at Bayshore Medical Center in Pasadena, Texas. "Then, you eventually burn out and go somewhere else."

The nursing shortage, it turns out, hits specialized areas such as cardiac care particularly hard.

"In various parts of the country, on various days, we are reaching a crisis," said Ann Evans, MS, MBA, RN, executive director of the Tallahassee Memorial Healthcare Heart and Vascular Institute in Florida.

"We are at the point where hospitals are closing beds, which limits the number of patients we can care for. We are full now, and there are bed shortages in some areas. If we had the beds open, we’d fill them," Evans said.

"Patient care is not suffering yet, but people are working overtime, doing what they have to do to provide the care, and I don’t know how long we can do that."

Wray agreed. "Sometimes you just aren’t able to give someone the quality of care that you want to," she said. "When you work so hard, the possibility of making mistakes is always there. In the airline industry, there are restrictions on the number of hours pilots and flight attendants can work and programs to help reduce stress. But there is none of that here."

Agency nurses brought in to take up the slack aren’t familiar with the setting, and that can affect the quality of care, too.

Life and death
The nursing shortage and its causes are old news to those in the profession. But the ramifications are becoming more apparent in areas where the readily available services of a trained nurse can be a matter of life and death.

Cardiovascular disease is the No.1 killer of men and women in the United States, claiming a life every 33 seconds. A recent CDC study found that the absence of cardiac care facilities was among the factors linked to higher death rates from heart disease in some California counties.

When hospitals close cardiac beds because not enough nurses are available to serve them, it isn’t difficult to assume a connection between a shortage of trained specialists in cardiac care and a greater risk of death from the disease.

Another study found that as many as
11 percent of women who had heart attacks were misdiagnosed in emergency rooms. The lead author of the study, Harry Selker, MD, director of the Center for Cardiovascular Health Services Research at New England Medical Center in Boston, suggests that poorly staffed hospitals are a factor. There simply is less time for every patient to be carefully evaluated.

Take responsibility
This is a looming crisis that cardiac nurses themselves will need to help solve. Susan Housholder, MSN, NP, RN, clinical director of the coronary alternative treatment strategy program at the University of Michigan Health System, said, "Why is nursing a nondesirable career? I think we have done it to ourselves to a degree. We have to take some responsibility for our own profession.

"Understand your discipline and articulate it. Be a cheerleader. Hype it up; talk about how it works for you."

Evans also encourages cardiac nurses to talk up their profession. "Tell people nursing takes someone with brains and guts. You can make a good living. You can make a difference. I think people are looking not just for a job but a career, a meaningful one. Sell yourself and your career."

Opportunities abound
Unlimited opportunities exist in cardiac nursing, said Kathleen King, Ph.D., RN, FAAN, chair of the Council of Cardiovascular Nursing, one of 13 scientific councils within the American Heart Association.

"You have nurses providing home care to people awaiting transplants, chronic care, acute care, bypass surgery, primary and secondary preventive care, nurses in hospital units that deal with heart failure," King said. "There are opportunities from the very basic level all the way up to nurse practitioners running clinics. There are positions in research at the doctoral level. Any nurse at any level and training can find an opportunity in cardiac care."

Attracting new nurses won’t solve the problem if those recruits end up abandoning the field for other opportunities or because of stress, unreasonable schedules or too much overtime, the experts agree. "There are so many opportunities out of the acute care setting," King said. "Why put up with that setting when you can work 9 to 5?"

Some areas of cardiac nursing are by their very nature high-pressure settings, but the lack of hands to share the work makes things worse. "People end up looking for positions that are less stressful," Wray said.

Hospitals need to take care of their nurses and help them deal with stress, the way the airline industry does for pilots, the experts believe. Strategies can be as simple as good management, which Cheryl Foley, RN, credits for a lower-than-usual turnover rate among the nursing staff in the medical telemetry department at Johns Hopkins Hospital in Baltimore. Long-term solutions, of course, are more complicated.

"With nursing, there is so much competition. We’re losing out to other professions, other avenues. But many nurses see cardiac care as a very desirable field. It can be very satisfying," said Barbara Fletcher, MN, RN, FAAN, a clinical associate professor at the University of North Florida College of Health Department of Nursing.

"Cardiac nursing is exciting," Evans said. "It is flexible and fluid and there is plenty to do. You have a wonderful relationship with patients and their families, and you know you’ve made an impact––and you’ll always have a job."