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Furthermore, the international professional services
firm Watson Wyatt Worldwide found in a 2002 survey that
80 percent of Americans aged 55 and older say that their
anticipated standard of living in retirement is directly
tied to a pension and retiree health benefits.
Health benefits are so valuable that they have become
a major focus of contract negotiations by United American
Nurses, the AFL-CIO collective bargaining organization
that represents 100,000 RNs in 24 states, the District
of Columbia and Virgin Islands, National Executive Director
Susan Bianchi-Sand said.
"We know that nurses have a fairly high percentage
of some kind of health care, but have none after they
retire. We know that they're staying in the job just
to maintain those benefits," she said.
Bianchi-Sand said she hasn't tested it, but she suspects
that many nurses stay on the job and in increasingly
difficult situations because a spouse in a less recession-proof
industry has lost work and benefits. "As unemployment
goes up, the index of opportunity to become sole supporters
goes up," she said.
"Their jobs are fairly secure, but around them-in
the hospital and in their family situation-the economy
has put a greater stress on the nurse. We know the rate
of people who are uninsured or are underinsured is growing,"
meaning people delay appropriate medical care. "The
patients are sicker in some part because they don't
have health insurance," Bianchi-Sand said.
Budget cuts as a result of recession-whether federal,
state or local-also make RNs' jobs more difficult by
pulling money from the system-money that in good economic
times provides equipment and proper nursing and support
staff, Bianchi-Sand said. "The employers are not
really hiring adequately to cover the needs of their
hospitals, so more responsibility, more pressure is
placed on the nurse," she said.
Shindul-Rothschild, whose doctorate degree is in social
economics and who teaches graduate-level health economics
at Boston College's School of Nursing, has long studied
the relationship between the economy and nursing.
"I have been following trends in the quality of
nurses' worklife since 1989," she said. In 1989,
1994 and 2002, she surveyed 1,000 Massachusetts RNs
about their perceptions of work and particularly staffing.
"What I've seen is that we're not back to the
levels we were in '89, but we're not as bad off as we
were in '94. We've gained some ground from the mid-1990s,
when the corporatization of health care and managed
care was going on at a frenzied pace; [when] the downsizing
of hospitals and improving the competitive edge of providers
by cutting back staff and replacing nurses with unlicensed
assistive personnel was really at its peak.
"I think people recognize now, with some strong
research, that not only did this not make economic sense,
it certainly did not make sense for patient outcomes,"
she said.
Although Bianchi-Sand said that nurses have been behind
the curve on pay, a New York University professor lists
pay as a factor that highly recommends nursing as a
career, in and out of recession.
"Think about a 22-year-old who just graduated
with a degree in psychology and gets a job in an advertising
agency for $24,000 a year or somebody who gets a computer
degree and gets a job ... for $30,000," nursing
school professor Christine Kovner, Ph.D., MSN, RN, said.
"Graduates from a nursing program in New York are
going to get $58,000 for working 48 weeks out of the
year-four weeks' vacation, 10 sick days and the opportunity
that anytime they want more money, they can just say
I'll work on Saturday or Sunday."
Kovner is in the second round of interviews and research
into factors in RNs' decision to work full time, part
time and not at all. Findings of her study are to be
published later this year.
In the meantime, Kovner said she would like to say
that the move to nursing, including what she described
as a dramatic increase in the second-degree program
at NYU, is because it's an interesting profession and
not just because of the recession, job security and
pay.
But only time will tell.
Her assessment, though, is that for whatever reason-the
recession included-nursing school enrollments are up
sufficiently to make a significant impact on the nursing
shortage. The question is: Are the enrollments going
to be for just the next two or three years? Are they
going to be sustained over time?
The risk, Kovner said, is that in a post-recession
economy, "as soon as word gets out that there seem
to be enough nurses, applications tend to go way down
and you have another crisis."
Contact Phil McPeck at getpjm@aol.com
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