Sandy Williams, MBA, RN
assistant administrator
Sutter Tracy Community Hospital, Tracy, Calif.
Solution snapshot: On-the-job training.

“What we need to do is provide on-the-job training. Everybody thinks the solution is marketing and advertising. I think it’s mentoring and coaching and encouragement. There are too many barriers” to nursing, Williams said.

She has personal experience with—and admiration for—the military model. Although it was not her son’s primary field, he was cross-trained as a medic in the Army and that experience has him headed for a nursing career in California now that he has returned from duty in Iraq.

Williams, 49, advocates a bachelor’s degree for RNs, but said, “A lot of people can’t afford to go through a four-year program. Nor can health care and hospitals wait for four-year degrees to come out.” On-the-job training, beginning with strict standardization of nurse assistant programs, could provide the dual benefit of staffing facilities and cutting the cost of an education, she said.

There’s another benefit, too. “I believe there are certain applicants that go through nursing for monetary motivation and don’t realize it truly is about the need to nurture and be compassionate with people, to take care of their illness and listen to them. If they don’t have those skills, they don’t belong in the field of nursing,” Williams said.

On-the-job training, initiated after a battery of tests such as the military uses to screen candidates for aptitude and desire, would help weed out those not committed to a nursing career. Ultimately, that would free space in crowded schools for RNs who will stay in the profession, she said.

“Salary has improved so much over the past few years that it’s kind of hard to say anything about that,” but it still doesn’t compensate nurses for the stress they endure, said Shelton, who works on a 45-bed med/surg floor.

Shelton, 44, said she’d reduce the exodus from her facility, a microcosm of bedside nursing nationwide, by reducing stress on nurses with adequate ancillary staff and by streamlining paperwork. “In the last six months, we’ve had nine nurses leave.”

Support positions have been cut as budgets have been slashed in what amounts to a double-whammy for the nursing shortage.

Requiring more and more of staff nurses not only makes nursing less attractive to those who might consider it as a career, but it also drives RNs to roles other than direct care or out of the profession altogether, she said.

“Working conditions would be so much better if you had the supplies available to take care of the patients, and you weren’t so overworked that when you left at the end of the day you felt like you didn’t provide adequate care to anybody,” she said.

“We don’t just get to do nursing. I thought that I would be providing patient care.”

“I’d like to go back in time about 20 years—not in technology, but a time when nurses were plentiful, our paperwork was minimal and our reimbursement was profitable.”

But because that’s not possible, Creek said she would love to narrow the gap between the values of today’s generation and her generation to fix the nursing shortage.

Herself a baby boomer at age 52, she said that each generation brings different skills to the table—and that is a positive—but the generations also have different values.

“I don’t think that really means that either one is right or wrong, it’s just sometimes a little difficult to narrow the gap in our work ethics.”

Creek said she’d instill in all nurses the mind-set of her emergency room RNs who have 20 or 25 years’ experience. It’s an attitude she carried out of nursing school: If a job requires 40 hours a week or 60 hours a week, “you do it. You don’t think anything about it.