May 3, 2004
I found the article titled “The
Apprentices” (April
5) by Cathryn Domrose interesting and
encouraging. Ms. Domrose took time to
catalog the many reasons for the seeming
inability and unwillingness of nurses
to take managerial roles.
More often than not, the unwillingness
of nurses to assume management roles may
be due to lack of relevant management
knowledge. It is a welcome development
that nursing is finally coming to grips
with the real issues that face the profession
and all of us who identify with nursing.
I am encouraged that some nurse leaders
are offering the most needed and valuable
support for clinical nurses (i.e., training
and mentoring).
The leadership programs/workshops, camps,
and the like serve as good support for
nurses who graduated without exposure
to the business side of health care. While
these programs are helpful, the curriculum
of nursing education needs to be reviewed,
reevaluated, and redesigned to include
business courses. This will ensure that
new nursing graduates will have not only
clinical, but administrative skills in
their repertoire to deal with the challenges
of the business aspects of the dynamic
health care environment.
A nurse with a strong business orientation
is invaluable to any health care organization.
Traditionally, nursing has always focused
on excellent clinical training with minimal
or no business training. It is sad that
often those with neither the clinical
training nor the appropriate business
background make decisions that affect
the life and career of not only nurses,
but other members of the health care profession.
Nurses are perceived as weak in business
affairs. Hence, some organizations justify
their lack of appropriate representation
in the executive and administrative structures
of some health care organizations.
Even at such levels, they are either
viewed as tokens or merely elevated or
glorified “bedsiders.” Overall,
nurses are not taken seriously because
of the public’s demeaning perception
of the profession and the way nurses are
sometimes seen by other health care professionals.
The points raised in the article couldn’t
have been more timely. Hence, we must
seize the moment to introduce changes
that will enhance nurses’ understanding
of business principles.
I am putting the finishing touches on
a how-to handbook for nurses aspiring
to make the transition from clinical to
managerial/supervisory roles, and am seeking
publishers for the handbook. Let us hope
that as nurses ascend the administrative
or executive ladder in health care and
related organizations, we can begin to
shed some of the negative images or public
perceptions of the profession. This is
our challenge and our problem, and the
solution is in our hands.
CHRISTIE OSUAGWU,
RN, MSN, MPA, FNP-C
via e-mail
I am responding to Rosalee Yeaworth’s
thoughts about “limiting
shifts to eight hours with reasonable
meal breaks” in order
to fight fatigue in the nursing field
(“Spend less time on theory and
more time on practice,” Readers
Forum, April 19).
It is unreasonable to think that 12-hour
shifts contribute to fatigue more than
eight-hour shifts. Twelve-hour shifts
give you more days off to rest and recuperate
and enjoy family and friends. Of course,
this is when eight-hour shifts mean that
the nurse works five shifts a week, and
12-hour shifts mean that the nurse works
three and sometimes four shifts a week.
The real culprit in nurse fatigue is
not the number of hours the nurse works,
but the number of patients, the number
of medications, IV starts, dressings,
treatments, phone calls to and from doctors,
doctors’ orders to transcribe, and
ancillary services to be contacted that
the nurse is responsible for during the
shift. This all translates to not being
able to sit down for even 10 minutes and
eat when you’re hungry, not being
able to get out of work on time, not being
able to see the children before they leave
for school (if you work the night shift),
not being home when the children get home
from school (if you work the day shift),
and being too tired to really enjoy your
days off with your family and friends.
So what’s the solution? It’s
simple, really. The physical units on
the hospital need to be better organized
to reduce the amount of wasted time the
nurses spend running around to two or
three different storage rooms to collect
supplies for patient care; supplies and
linens need to be properly ordered and
stocked. Nurse managers need to be nurse
advocates when dealing with the doctors
in order to reduce the amount of time
that hospital nurses spend acting as the
doctors’ personal secretaries. And,
of course, the acuity of the patient needs
to be considered when making assignments.
But the “critical factor in recurring
nursing shortages” is simply not
enough nurses. So, let’s solve that
problem, too. Let’s stop wasting
taxpayer dollars on research into the
nursing shortage; let’s stop throwing
our good money down the rat hole of studies
and polls and opinions and surveys about
how to solve the nursing shortage. Let’s
throw that money instead to nursing schools
so that anyone wanting to be a nurse can
complete the LVN or associate RN program
at no cost. Let’s give educational
loans that will cover all the costs of
books, uniforms, and tuition, then deduct
5% of the loan for every 1,000 hours worked
as a nurse after graduation.
In two to three years, there will be
an influx of new nurses that will alleviate
the nursing shortage, thereby eliminating
the “fatigue” that plagues
the nursing profession today.
MARY BAIN,
RN
Mission, Texas
Please spare your working nurse readers
further admonitions from our highly educated
brethren advocating “limiting shifts
to eight hours.” The 12-hour shift
is one of the godsends of employment in
nursing. It allows four days a week to
“breathe” after completing
the physically, psychologically, and spiritually
draining work we perform on the other
three.
I note that the letter writer in this
case includes “PhD” after
her name, which leads me to wonder when
in her life she last worked a “shift.”
She is more than welcome to return to
the dinosaur days of eight-hour scheduling,
which usually ended on night shift Friday
with return to work on day shift Monday.
We working stiffs need to keep a watchful
eye on what “leaders” like
this have in mind for us.
PAUL DAVID
LIEHR, BSN
Los Angeles
The argument is not whether specialty
hospitals siphon revenue away from the
financing of unprofitable medical services
of general hospitals (“Chic
Boutiques,” April 5).
They do. The argument is whether this
is OK.
The reason specialty hospitals are “safer”
is not because of more focused care. The
reason is that the criteria for admission
include low-risk patients (high volume
+ quick turnover = greater return on investment).
By extension, the “safer”
a specialty hospital is by dumping its
riskier patients on the community hospital,
the “more dangerous” the community
hospital becomes.
I doubt that the wonderful staffing ratios
cited are the norm rather than the exception.
They aren’t here. That kind of staffing
would cut into the corporate and physician-owners’
profits.
CHARLES GREGORY,
RN
Albuquerque, N.M.
