Daily Editors' Notes

New respect for nurses

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A new report underscores what many nurses already know: They play an increasingly important role in the practice of medicine.

The report released this week from the Institute of Medicine insists that nurses take a larger, more independent role in providing healthcare. It calls for government to remove “scope of practice” obstacles that prevent advanced practice nurses from taking more active roles in administering care. That would include allowing nurses to admit patients to the hospital or to a hospice. It also could mean allowing nurse anesthetists to work without doctors' oversight. Currently, 16 states allow this practice.

Whatever the repercussions of this report (and many doctors aren't too thrilled about more autonomy for nurses), it is clear that nurses are wielding more authority than they have before.

At least one nurse already knows all this.

“There are so many positives about my profession,” Valerie McCarthy, assistant professor at the School of Nursing at the University of Louisville, told me this week by phone.

She talked about how nurses help to heal the whole person—physically and spiritually—while doctors address diseases.

“Doctors do disease; we do health,” she said. “I think our society is becoming more and more interested in health and I think that's an exciting opportunity for nursing.”

Professor shortage

Of course, for nurses to help to make an even bigger dent in care in the future, there must be an adequate supply of them—which cuts to the reason for my call with McCarthy. A well-documented shortage of professors is affecting the number of nurses who enter the field.

McCarthy knows this firsthand. Her school “desperately” needs faculty, she said. Recently, the school had about 60 openings for nursing students and more than 100 applicants. That means the school had to turn away around 40.

“We do that consistently,” she said.

And because of the competition, the school is rejecting some pretty worthy candidates—those who have GPAs in the 3.4 range and higher, she said. The school currently requires that juniors entering the program have a minimum GPA of 2.8.

One of the consequences of not having enough nurses in the future is more non-licensed people or fewer adequately trained people who are practicing, she said.

So why is there such a shortage when there is a clear demand for nurses? The answer is the same as it was 15 years ago, McCarthy said. That is, money.

“The biggest reason there is a shortage of faculty is you can make more clinically,” she said.

McCarthy had always wanted to teach but could never afford to do so raising a family. She finally decided she could in 2005. That was when she turned 55, and her husband was retiring. The veteran nurse had already worked nearly 15 years in critical care, eight years in home health, six in long-term care and eight in her own business.

It took her four years to earn a Ph.D.—one year to receive a master's degree, two years of coursework and then a year for the dissertation. (Hers was a faster track. It usually takes three to six years, she said.)

A full-time professor on tenure track, she is making about one-third of what she was making in her own business.  

It's worth it, she says. She has always loved teaching and is also now researching aging.

“I would have loved it 15 years ago, but it's a difference in pay raise and there's a lot of people like me,” she said. 

Sadly, the pay differential is wider than it was 20 years ago, she believes, as hospitals have been paying more to accommodate the nursing shortage. Meanwhile, schools now are hiring fewer faculty members because of budget cuts.

One of the unfortunate parts about this situation is that because nurses don't become professors until their late 40s and 50s, their careers as teachers are relatively short-lived.

“I'm not going to be around that many more years,” she noted.  

Seeing the bright side

Looking on the positive side, lawmakers and the administration are aware of the problem. Last month, the Department of Health and Human Services awarded $159.1 million to support healthcare workforce training. The healthcare reform law also includes provisions to bolster the healthcare workforce. The American Association of Colleges of Nursing has proposed strategies to help young nurses become professors. These include creating opportunities for nurses to work and go to school at the same time.

While the nurse shortage bothers her, McCarthy generally feels positive about her profession.

The fact that people are even calling nursing a profession is a major step forward. It wasn't considered so when she started nearly 40 years ago.

“We moved past the technical and handmaiden stage,” she said.

“What we're able to do and the opportunity we have and the difference we can make to people is just expanding,” she added.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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