In the late 1800s nursing students enrolled in training schools and spent their entire education as an apprentice in a hospital. When they graduated they were not hired by hospitals, they engaged in private duty nursing. Hospitals didnt worry about recruiting and retaining nurses; they simply created their own training schools to get free labor. Flash forward a few more decades and, for the first time, nurses could get a graduate degree in a college setting. Graduate nurses were hired by hospitals and three wars would emphasize the shortages of well-prepared nurses.
While we in academe have celebrated the transition of nursing education into colleges and universities, we must now face the cruel facts. We are unable to produce nurses without the assistance of hospitals and other healthcare institutions. We cannot function as separate entities any longer. There is too much at stake.
When interest was dwindling in the profession of nursing, Johnson & Johnson created an ad campaign that was very successful – so successful, that thousands of qualified applicants continue to be turned away. We are making little progress in the goal to enroll and graduate more nurses. What seems to be the problem? The two most commonly reported reasons according to the Florida Center for Nursing are a critical shortage of qualified nursing faculty and limited clinical slots. While hospitals are open 24 hours a day, seven days a week, they are over-run with nursing students from well-established and newly opened nursing programs. Hospital administrators promise every school that if they expand, they can accommodate their new students. Sounds simple, but it is very complicated to get all the clinical spaces every school needs for their entire student body.
Nursing students at all levels (LPN, RNs from associate and baccalaureate degree programs) need clinical experiences, and their faculty are competing for fewer slots. If nurses on a specific unit are not perceived as supportive and interested in students, they become barriers to recruitment upon graduation. Who wants to work with grouchy and impatient nurses? While recruitment into nursing schools is no longer the problem, recruitment to certain units or hospitals continues.
Retention is an equal challenge. We are hearing that graduates are leaving the profession within three years of graduation. We in academe are very discouraged that we have accepted and educated students who are not committed to the profession. Did we waste that slot or was the environment too toxic? The paradigm for nursing practice has not changed since the early 1970s when team nursing was introduced. While we in academic would like to blame hospitals, let us not forget that we have not changed our teaching methods for decades.
Dr. Patricia Benner, known for her work published as From Novice to Expert, is working to change that. She is trying to convince educators that teaching students to memorize signs and symptoms of every disease, while memorizing drug actions and side effects, will no longer be adequate. Students must learn to critically think their way through patient situations that target the most pressing medical diagnoses, not the obscure diseases that are rarely encountered. While we applaud her in theory, until NCLEX changes the licensing exam to embrace this new thinking, we will not deter from our methods that yield high board scores.
So, we are equally at fault and finger pointing no longer works. What can we do to make sure the state has all the qualified nurses it needs now and within the next 5-10 years when the boomers will retire? We must work together to identify qualified and experienced nursing who can serve as clinical and classroom instructors. This means nurses will need to be released from their regular patient assignments in order to teach and/or supervise students. Nursing schools need to invest in orienting and mentoring these nurses to become competent faculty. Hospitals need to invest in the education and mentoring of their nurse managers, as research is demonstrating they are the key to staff retention. Dissatisfied nurses leave their nurse manager on a specific unit, not the hospital at large.
There are graduate programs across the state that can academically prepare current and future nurse managers, but nurses need encouragement and support from hospital administrators in order to enroll and complete the program. Nursing schools need to revitalize their programs, methods of offering their programs, and use of innovative teaching strategies. The technologically savvy student is not thrilled with lecture format. Hospitals need to create supportive environments for novice nurses and aging nurses who need fewer hours and more attention to ergonomics.
As partners we need to revolutionize nursing education and the clinical environment. Generation X and Y will rely heavily on technology to access information and communicate with others. Lets face the facts: There are few nurses interested in becoming nurse managers or nurse educators. We have what the other one needs to succeed. We cant move forward until we move together.
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