“The first thing I would do would be to change the public perception to make nursing’s image accurate,” Dracup said. She recalled a Los Angeles Times editorial in December about the most trusted and respected professions. The article was meant to praise nurses, but called them “angels in white” and talked of “the endearing value of wearing a neat white hat at work.”

“I could hardly get past that,” Dracup said.

“Most of the American public doesn’t realize that nurses and nurse practitioners can write prescriptions, and nurse-midwives deliver babies. They don’t understand the roles that nurses play in health care, nor do they understand the complementary roles between medicine and nursing.

“It’s that public perception that nursing is the assistant to medicine, which is historical but so inaccurate in today’s health care system. I think it is one of the major stumbling blocks to having very talented, smart men and women choose nursing today.”

When prospective students appreciate that nursing is science-based and not a stepchild of health care, it will be up to legislatures to ensure school funding and faculty to accommodate increased enrollment, she said.

In California, “the combination of state budget cuts 85 and faculty shortages have combined to make it very challenging to get into schools of nursing,” Dracup said.

“I would start at the most basic level, which is educating the public and the youth of America about who nurses really are. This is a very passionate subject for me,” said Begeny, whose master’s thesis centers on bringing high schoolers to an understanding of the array of nursing opportunities. Begeny suggested that many young people just see bedside nursing because the media stereotypes don’t feature RNs as clinical nurse specialists, health care and nursing lobbyists and nurse lawyers.

One research question shows that most teens believe a bachelor’s degree is the top level of education for registered nurses, said Begeny, who earned her BSN at Michigan, entered the master’s program and at age 24 has applied to the university’s doctoral program. There, she plans to focus on nursing recruitment and retention, the image of nursing and policy that affects it.

“I think one of the things we forget to tell nurses, especially the ones that work on the units, is how important they are and how much of an impact they do make in everyday life,” Begeny said. Reinforcing that message is the second thing she’d do to alleviate the nursing shortage, and given the chance to take a third action, she would encourage nurses into education.

“I believe in Michigan only 5 percent of nurses have their master’s degree and only one-tenth of 1 percent have their Ph.D. We don’t have a lot of people coming in to teach our future nurses.”

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.

Jenkins would like to see nursing work to change the attitudes “that prevent us from working together as a team,” she said. “I have more people quit because they can’t get along with their neighbor or co-worker.”

At last, she said, “We’re more like a family as opposed to people who just come to work. We worry about each other and we all work together as a team,” but it took her five years as director of nursing to create that.

Jenkins, 50, said she would incorporate into nursing students’ curricula a way “to show them what 10 years in the future would be like. If they had a little glimpse of what they’re getting into, maybe only the people who think they can handle that would do it. That would make room for the people who have a sincere calling,” she said.

Jeanna Bozell, RN
former recruiter, founder of NurseQuest, author
Solution snapshot: Foster nurses as leaders.

“You can recruit till the cows come home, and that’s what we see nurse recruiters in hospitals doing. Pull out all the stops, do the sign-on bonuses, basically bribe them in some way to get them in the door. But until you can stop the bleeding, they’re coming in the front door and leaving out the back door,” Bozell said.

“It’s not a quick fix,” but “I would provide leadership training in every facility. What I learned when I was a recruiter is the top 10 reasons nurses leave their jobs. 85 More than half of their reasons had to do with their direct supervisor.”

Bozell, 51, said the impetus for her latest book, The Nurse Leader’s Little Instruction Book: The Ultimate Resource for Retaining Staff, came from the role of clinical nurse specialist, the resource person to whom nurses, physicians and management turn because of expertise and research.

“My idea was to have a leadership resource specialist” to train management to bring people up through the ranks to be leaders. 85 They need to know how to build trust with their staff,” Bozell said. “It’s all about relationships.

“Recruitment is sales, retention is leadership.”

Contact Phil McPeck at getpjm@aol.com.