(Circulation. 2001;103:e9017.)
© 2001 American Heart Association, Inc.
Cardiovascular News
The specter of a national nursing shortage brought nurse educators and nursing leaders before the aging subcommittee of the US Senate Committee on Health, Education, Labor, and Pensions on February 13, 2001. The message they brought was that the working situation of many of the nation’s nurses must be improved before the healthcare industry can hope to draw younger people into the profession.
"Healthcare providers across the nation are experiencing a crisis in nurse staffing, and we are standing on the precipice of an unprecedented nursing shortage," said Kathryn Hall, MS, RN, CNAA, executive director of the Maryland Nurses Association and representative of the American Nurses Association (ANA).
She cited several examples of staffing shortages affecting major hospitals and medical centers, which included the following:
- In November 2000, 10% of the surgical beds at Johns
Hopkins Hospital went idle as a direct result of the nurse staffing
shortage, which caused delays and cancellations of
surgeries.
- In August 2000, the Maryland Hospital Association reported that nearly 15% of the nursing jobs in that state were vacant—up 33% from January of the same year.
- The Water View Health Care Facility is a long-term care facility in Salisbury, Maryland that is licensed for 150 beds. Because of staffing shortages, Water View is currently only filling 50 of these beds.
- Recently, 54 of the 102 members of the Arkansas Hospital Association responded to a nurse staffing survey. These hospitals reported 752 budgeted, vacant RN positions. Projections from the Arkansas Nurses Association show that there will be no more than 657 students graduating from Arkansas nursing schools in 2001.
- In August 2000, the Maryland Hospital Association reported that nearly 15% of the nursing jobs in that state were vacant—up 33% from January of the same year.
However, Ms Hall said that the current shortage can be attributed in part to the aggressive cutting of nursing positions in the 1990s. "In fact, as recently as the mid-1990s, many RNs were being laid off from hospitals and were replaced by lower-salaried assistive personnel."
The cutting of nurse positions made nurses’ jobs harder and adversely affected the image of nursing as a career. "As a professional who has worked as a staff nurse as well as a nurse administrator, I know that the current staffing problems are directly related to the reluctance of nurses to accept positions where they will not be supported by appropriate staff," Ms Hall said.
At the same time, the average age of nurses is growing, many are retiring, and fewer are entering the field. "After all, how many of us would want to work in an environment where we have little to no control over the number of hours we work, the quality of the work we produce, or our ability to change our work environment?"
At present, said Katherine Kany, senior policy fellow for the ANA, "we do not have a national nurse shortage. Some states have shortages, but we do have a shortage of nurses willing to work in acute care facilities or nurses who have the expertise needed to fill some positions. About 83% of licensed nurses are in practice, but they are not in acute care hospitals. We need to differentiate a nursing shortage from a staffing shortage."
"Nurses are interested in doing what they went to school for. The main frustration they are experiencing now is that they don’t have staff or other resources they need to do a good job," said Ms Kany. The ANA is concentrating on improving the work and practice environment. In the long run, that is the answer to the nursing shortage.
The California Nurses Association has taken a more direct approach and saw its legislation requiring minimum staffing ratios for nurses in hospitals signed by Gov Gray Davis in 1999. "It sent shockwaves through the industry," said Jill Furillo, RN, director of government relations for the California association.
The past decade saw the rush of managed care into the state, and hospitals responded with "a race to the bottom" to negotiate the lowest deal they could. Nursing positions were cut, and those nurses left ended up with more and sicker patients, said Ms Furillo.
"We provided a good bit of data to the California legislature and the governor to prove that there needed to be intervention to stop the continual erosion of the quality of patient care," she said. Parts of the bill that dealt with unlicensed personnel providing nursing functions have already gone into effect. However, nurses and hospital administrators are now in a tug-of-war over what the minimum ratios in hospital units will be. That will go into effect in January 2002.
Jan Emerson, spokeswoman for the California Healthcare Association, said her hospital organization is fearful that the staffing ratios will put healthcare institutions in an impossible situation when combined with the nursing shortage. "One of our real concerns in this whole discussion is that if you set the ratios really high and you cannot find the nurses, what happens? If you don’t have the numbers that the law requires, is the department (of health) going to shut down the hospital?"
Ms Emerson said that the California situation is approaching critical. "By 2006, we will be short at least 25 000 nurses and by 2020, we will be short almost 60 000."
The California attitude is moving across the country. Pennsylvania nurses contacted the California Nurses Association for help with the same issues. "They would like to use us as a model," said Ms Furillo. "We are finding that now throughout the country. We are networking with nurses who want to have a more assertive approach."
VEGF Grows More Than Blood Vessels
Dermatologists at the Massachusetts General Hospital have found that mice genetically engineered to express large amounts of vascular endothelial growth factor (VEGF) also grow thicker fur, according a report in the Journal of Clinical Investigation (2001;107:409–417). "Applying it to humans will be the big challenge," Michael Detmar, MD, told the Boston Globe in its February 15, 2001, edition.
When Dr Detmar and his colleagues shaved the fur from the genetically engineered mice and normal controls, they found that the mice expressing high amounts of VEGF grew the hair back faster and that their hair follicles were 30% wider. Dr Detmar said he had studied the patterns of hair growth in humans. Approximately 85% of hairs on the head are growing at any one time. The rest are dormant. The follicles in actively growing hairs were thicker and the blood vessels were larger.
"If anyone could find a way to make follicles bigger, men might grow hair again," Dr Detmar told the Globe. VEGF has been used by other researchers attempting to stimulate blood vessel growth in limbs or in the heart when arteries are blocked.
Australian Surgeons Demand Patients Stop Smoking
Surgeons at the Alfred Hospital in Melbourne, Australia, want patients to stop smoking before they undergo major heart or lung surgery, according to Reuters Health wire service. Quoting the Australian daily newspaper The Age, Reuters Health said the proposed ban on smoking patients has raised hackles Down Under.
Reuters Health quoted Michael Sedgley, MD, president of the Victoria Branch of the Australian Medical Association as saying, "We can’t make blanket statements about people who smoke and how we will or will not treat them. However, as far as heart-lung transplants are concerned, it’s blatantly obvious that a smoker will not do as well as someone who doesn’t (smoke)."
In response to the controversy, the hospital on February 8, 2001, released a statement that said, "The Alfred’s selection criteria is consistent with the published policy of the International Society of Heart and Lung Transplantation."
Fewer Strokes When Coronary Artery Bypass Done "Off-Pump"
Patients who undergo coronary artery bypass but who are not placed on cardiopulmonary bypass during the surgery have a lower incidence of stroke but did not have a significantly different survival rate than patients who underwent bypass on the pump.
Jacob Bergsland, MD, of Buffalo General Hospital presented the results of his study on January 30, 2001, in New Orleans at the 37th annual meeting of The Society of Thoracic Surgeons. He compared the stroke rates of 292 patients who underwent "on-pump" coronary artery bypass to the rates among 124 "off-pump" patients. All patients had a previous stroke, which he said was a risk factor for stroke during the procedure.
The postoperative stroke rate in the on-pump patients was 9.2%; it was 5.6% in the off-pump patients. Other postoperative complications and the mortality rate did not differ significantly among the patients.
"The heart-lung machine seems to be an important variable in the causation of strokes," Dr Bergsland told Reuters Health.
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