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In the past 18 months, concern over the hospital shortage of registered nurses and the future supply of RNs has grown to the point where these worries have captured the attention of the media, health policy-makers and Congress. National news media have carried numerous stories about the problems facing hospital-employed RNs. In addition, special task forces and workforce commissions have been established by virtually every national nursing and non-nursing health professional organization, and by more than a dozen states, labor unions and the Joint Commission on Accreditation of Healthcare Organizations.

Furthermore, many states have introduced legislation aimed at resolving nurse shortages. Congress has introduced four separate bills to increase enrollment in nursing education programs and improve the image of nursing, federal health agencies have made millions of dollars available for research on the nurse workforce, and the secretary of Health and Human Services recently announced that 82 colleges, universities and other organizations will receive $27.4 million in grants and contracts to increase the number of RNs and the quality of nursing services.

Clearly, the problems affecting hospital RNs are no longer on the agenda of the nursing profession alone, but occupy a position high on the social policy agenda.

Still, it is unwise to rely solely on others to solve nursing's problems. I believe nurses must be actively engaged in helping create a better workplace and a better nursing profession. A look to the future shows that we will face many important challenges above and beyond those connected to the present RN shortage.

2010 and beyond
A recent study on the aging of the RN workforce found that the average age of employed RNs increased more than twice as fast as all other occupations in the U.S. workforce in the past 15 years.

Today, more than 60 percent of working RNs are older than 40. By 2010, more than 40 percent of the RN workforce will be older than 50. Between 2010 and 2020, many RNs will begin to retire and the largest group of RNs remaining in the workforce will be between ages 50 and 60. In that same period, many of the nation's 80 million baby boomers will turn 65 and enroll in the Medicare program.

Thus, both the demand for health care and the demand for RNs will rise significantly at the same time that the number of RNs in the workforce will be declining. The gap between demand and supply is expected to be so large that future shortages could cripple the health care system.

While Congress, the states and other public policy-makers are trying to develop and pass measures to avert this long-term scenario, much can be done now to improve and strengthen today's workforce. Each of us needs to become involved in our own way; we can't wait for someone else to make the first move.

Community survey
Do you know the knowledge and perceptions that people in your community hold about the nursing profession? Without first knowing how people perceive nursing, it is difficult to know what to do to make positive changes. You can address this by persuading your colleagues to form a journal club and read up on the image of nursing, learn how public opinion is shaped and become informed about efforts underway throughout the country to bolster the image of nursing.

Next, find out if a faculty member in a nearby school of nursing has experience in survey research and would help develop a community survey. (The local newspaper might also have an interest in helping.)

The next step is to determine the number of people to be surveyed, if there are any groups you particularly want included (for example, high school-aged boys or minorities), the procedures to get the survey to people in the community and how people will return completed surveys.

While working on these activities, you can develop the questions to be included in the survey. Conduct a short pilot test of 15 to 20 people to identify the questions that are confusing and make modifications where needed.

The results will provide information about how people in your community view nursing, stigmas about nurses that lead to an unfavorable image and how informed citizens are about the profession. In turn, this information can be used to guide the development of strategies to change negative perceptions and provide facts and positive images that promote nursing.

Change your community
Nurses should write letters to the editor and develop opinion pieces for the local newspaper explaining the results of the survey, describing the work of nurses and how nurses make contributions to patients and people throughout the community (not just in the hospital), the issues in health care that have brought so much change to nursing and what people can expect will occur in the future.

The letters and opinion pieces should provide objective and factual information and avoid an accusatory or negative tone. Ideally, physicians and health care executives should write letters that complement those written by nurses. As this campaign to provide information to the community via the newspaper develops, don't be surprised if a reporter from the newspaper, local talk radio show or television station becomes interested and wants to produce a story. If they don't come to you, go to reporters with your story.

Equipped with information on your community's knowledge and attitudes about nursing obtained from the community survey, it will be much easier to talk with reporters and, in turn, the stories they write will be much more effective and interesting.

It also will be easier to approach community leaders to ask for financial support and other resources to help develop and implement a counterinformation strategy aimed at replacing inaccurate knowledge about nursing with facts and reshaping negative opinions of nursing with positive ones.

Consider approaching philanthropists, city leaders, business and civic groups and foundations to provide money to develop and broadcast television and radio commercials. If a celebrity lives in town, see if you can get his or her involvement in public campaigns.

All of this can be done within a relatively short time and, before you know it, someone in your community will step forward and start a scholarship program to increase enrollment in nursing education programs, and hospitals and other care organizations will accelerate actions to improve the work climate for their nursing staff.

Track patient outcomes
You can improve the nursing profession and its relationships with others by identifying a set of patient outcomes produced on your nursing unit and tracking it over time.

Begin by forming a group consisting of nurses on your unit, individuals from the human resources and medical records department, a physician, a member of management and the labor union representative (if applicable).

Identify three to six patient outcomes that are directly related to nursing, some of them positive outcomes (patients feel well cared for, demonstrate appropriate self-care for their conditions at discharge, etc.) and others could be adverse patient outcomes that you want to prevent (e.g., urinary tract infections, falls, etc.). Develop written descriptions of each outcome, determine the data needed to measure the outcome and design a strategy to collect and analyze the data on a routine basis.

The information obtained from this effort will tell you whether the outcomes improve or worsen in time. Feed this information to: the nursing staff, so that they can find ways to make improvements in caregiving processes; human resources, so that they can better understand the contributions of nurses and become more supportive of the profession and more effective in recruiting nurses and interacting with them; medical records, so that they better understand the need for better data and will help design improved data collection strategies; and management, so that they will better appreciate the value of nurses and view nurses as actively engaged in finding solutions to improve patient care rather than as change resistors and complaining employees; and physicians, to build their support of nurses.

Tracking and monitoring patient outcomes can lead to new actions to improve the safety and quality of patient care and improve nurses' relationship with others in the organization. In addition, it can provide information to those engaged in community survey-and-change strategies.

The media will be interested in stories about how local hospitals and other care organizations are improving patient care. Information on patient outcomes and steps nurses can take to improve them can be provided to the community's representatives in the state Legislature and in Congress.

Recruit a waiter
If none of the above strikes you as interesting or achievable, there is one thing you can do. The next time you eat out and are impressed by the waiter's abilities, talk with that person about going into nursing. I have been doing this for about two years. At first, I was not very good at it, but the more I kept at it, the more comfortable I became.

Today, I expect that I'll get the wait staff to stop, ask questions and engage in a conversation about nursing and listen to me describe the benefits and wonderful opportunities in nursing. (Lately, I have been doing the same with flight attendants who are increasingly concerned about their jobs.)

To get started, you might develop a list of all the positive aspects of nursing and place it in your purse or wallet for a quick refresher before you make your first recruitment contact. Think about the reasons why you entered into nursing or the vows you may have made to yourself long ago when you were becoming a nurse.

People want their lives to have meaning, and the nursing profession provides that on an hourly basis. Don't be shy. As you perfect your skills and demonstrate them in front of your nursing friends, they, too, will begin doing the same.

Becoming involved in the actions described here or in some other way is important for the well-being of nurses and is essential for creating a better future for the nursing workforce. There is no better time to become personally engaged in finding constructive solutions to the problems that are challenging our profession. The nursing profession is worth fighting for.

Get positive, become creative, develop a new role for yourself and you soon will experience a new source of personal and professional satisfaction. Your profession needs you.