Managed Care Term Paper

Excerpt from Term Paper :

Nursing Tasks, Methods, And Expectations

State of the Industry

The Art and Science of Nursing

Relative Pay Scales

Male Nursing Roles

Sex Stereotypes

The Influence of the Nationalized Healthcare Debate

Proposed Methods toward Recruiting Nurses

Joint Corporate Campaigns

Steps to Recruiting Men

Wages issues

Recent employment trends in the nursing field have demonstrated a disconcerting drop in the number of employed and employable nurses. In what has been traditionally a female dominated filed, the exit rate of both men and women, as well as the approaching retirement of a majority of existing nurses, threaten the long-term care quality of hospital and other in-patient care facilities.

This paper examines some of the factors behind the current nursing shortage, and offers suggestions as to how to reverse the trends which, if left unchecked, threaten our nation's health care delivery system.


Since the days of Florence Nightingale, patients in hospitals around the world depend on the care of nurses. These trained professionals assist doctors and specialists in virtually every area of medicine. In addition the 'extra set of hands' needed for many medical procedures, nurses provide a special type of one-on-one contact that is outside of the scope of a doctors daily responsibilities. The special, intimate contact offered by nurses has built significant value in the field of nursing. This hands on; personal touch is a needed component to the overall health and well being of in-patient care.

In most modern medicinal institutions, as well as practical training programs, nurses are taught to provide skillful services, as well as compassion and caring. Patients and doctors alike realize the value of the services nurses provide. After Florence Nightingale revolutionized the profession in the 1850's, deaths in hospitals dropped dramatically, from 420 per 1000 to 22 per 1000 (Kurzen, 1997). Since that time, hospitals and rehabilitation centers have depended on the skilled nurses in addition to the doctoral staff. Soon thereafter, practical nursing programs developed in the late 1800's were designed to increase the opportunities for women (Kurzen, 1997). These institutions soon became vital to the growth and effectiveness of hospitals and health facilities. The demand for nursing services grew so dramatically that national organizations flourished by providing supervision and planning for the growing profession. Within a relatively short period of time, nursing had evolved from a pink-collar employment to a female dominated, respected profession.

For many nurses, the daily chores and duties begin long before sunrise. After receiving briefs and updates on hospital conditions, nurses must check the charts of their patients (Wolkomir 1998). Patient charts include crucial information about the administration of medications and special notes from physicians. Any mistakes in the administration of medicine can be fatal, so it is the responsibility of nurses to give precise dosages (Wolkomir 1998). After completing orders from doctors, nurses perform more ordinary tasks. Many patients are unable to complete simple acts of daily hygiene, so nurses are responsible for these care giving tasks as well. A nurse featured in the article "The Quality of Mercy" said that she did not "mind her work- despite the high tech gear and the life-and-death responsibility- requires services as humble as Jesus' washing of his disciples' feet" (Wolkomir, 1998).

Patient care studies detail treatment and therapies provided by nurses for treatment of various illnesses (Livesay, 1998). In addition, care studies outline problems and expected outcomes or goals due to a particular treatment. Nursing is a highly skilled profession with huge amounts of responsibility. Nurses perform these numerous duties daily for not one, but a large population of needy patients.

Statement of the Problem

At a time in which medical care costs are accelerating along with the demand for additional care, the number of applicants for career nursing positions is in a steady decline. For over 6 years, numerous studies have identified this trend which will leave the nursing profession over 100,000 nurses short by the year 2020. Like a monster thunderstorm which created by the combination of many weather factors and front, many factors are combining to create this impending 'storm' for our health care delivery system.

The problem is not limited to the United States. During the recent SARS outbreak in Toronto, the shortage of nurses in our northern neighbor exacerbated the crisis. (Silas, 2003) When hospital beds fill, and the conditions are life threatening, if the hospital, or in the current climate, the entire North American continent, cannot meet the demand with trained professionals, the results can affect the entire population. The shortage of nurses during this particular crisis meant they were overworked and exhausted at a time when they needed all of their powers of observation. Though it's not known exactly how they contracted the disease, but two Toronto-area nurses did lose their lives in the fight against SARS. Had adequate nursing staff been less in number, or the SARS outbreak proven more difficult to halt, the potential for a cataclysmic epidemic loomed over the entire city. (Silas, 2003)

Nursing Tasks, Methods, and Expectations

The field of nursing is not only concerned for the physical care of sick and injured patients. The field of nursing also seeks to address the emotional wellness of their patients also. "Nurses practice medicine as an art, marshaling compassion and skill in equal measure" (Wolkomir 41). Because of Florence Nightingale's efforts in the 1800's nursing has formed itself into a profession which seeks to address the emotional and psychodynamic well being of the patient as well as the physical health. While dealing with an oncology patient, Vanessa Livesay stated "comfort is the most important gift [my patient] can be given. Support must be offered, whether accepted or not. If the spirit is in distress, there is usually little comfort for the body" (Livesay, Care Study).

As a result, nurses are instructed and trained to "discuss various modes of therapy encountered by patients" (Guidelines for Rehabilitative Nursing 3). Nurses are trained to look beyond the medical science, and seek to combine efforts which calm and comfort the patient in order to facilitate healing. Because of this dimension, nurses cannot be classified as "doctor's helpers," or glorified gophers who know alittle bit about medicine, but not enough to be a doctor. The desires if the nursing profession are different than the physician in that they seek to comfort and nurture the patient toward current health so that their bodies are more able to process whatever long-term healing is needed.. Nurses in modern hospitals also work to promote a team unit between the doctors, staff, patient and patients family as the group strive together to overcome the patient's illness. "The patient and family as the core of this team will require the assistance of physicians, nurses, and other professionals. Therefore it is the nurse's responsibility to identify measures to facilitate cooperation between the nursing staff and the rehabilitation team" (Guidelines for Rehabilitative Nursing)

Nurses are further instructed to be perceptive of the feeling of patients. "Guidelines for Rehabilitative Nursing" states that the nurse will be able to "observe relationships/interactions among patient, family and staff members and discuss the effect of these relationships on the patient's rehabilitation" ("Guidelines for Rehabilitative Nursing" 3). Toward this end, nurses are also trained extensively in communication with patients. Often it is what the patient doesn't know how to say, or want the patient is unsure of how to communicate that can be the key to their treatment. Nurses are instructed to use broad opening statements and acknowledge a patient's thoughts, often through silence and not verbal sympathy. No other person in the hospital carries the holistic view of healing other than the nurse. Without their talented and professional care, the health care delivery system, including the quality of care and the quality of life for the patient suffers.

Literature Review

The declining roles for those applying for nursing degrees have been of growing concern for the past half decade. The nursing population has also been slowly aging without new nurses coming into the profession equal to the rate of those who are retiring, and making career changes. As a result, the nursing industry faces significant challenges in the near future. Unlike finding additional workers for entry level jobs to address seasonal business fluxuations, or hiring new workers for a factory which opens a new facility, producing talented and qualified nurses is a 2-4-year process. The science of nursing must be taught. The art of empathic care must also be present in the new nurses if they are to make a valuable contribution to their field. Other factors are adding to the impending nursing shortage crisis. The average age of the nursing population is over 40, and the median retirement age is 50. Nurses over the age of 50 find that they loose the ability to provide care for patients that often involves moving and lifting them. A third factor influencing the nature of the shortage is that the aging baby boomer population is likely to require extended health care. As this largest segment of our population ages, the…

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