 2003 AJN Table of Contents
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Issues Update
American Journal of Nursing -
April, 2003 - Volume 103, Issue 4
Show Bedside Nurses the Money
New UAN poll offers solutions to the staffing crisis.
The media has cited possible solutions to the nursing shortage in
studies conducted by health care groups ranging from the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
to the American Hospital Association (AHA), but nurses’ own
solutions have received far less attention. Results of a new survey,
Nurses’ Solution to the Nurse Shortage, released in January
by the United American Nurses (UAN), AFL-CIO, the labor arm of the American
Nurses Association, sheds light on what staff nurses, who deliver direct
care at the bedside, see as the most effective ways of putting a dent in
the shortage.
Of the 600 hospital staff nurses polled nationwide in
November 2002 for the UAN survey, 82% indicated that increased wages would
be an effective solution to the nurse staffing shortage. A reduced
nurse-to-patient ratio was also a highly rated solution (85%), as were
greater autonomy and control for staff nurses (66%) and safer working
conditions (65%).
Few dispute that the shortage is a problem. The AHA
reports that there are 126,000 RN positions currently unfilled, and
government experts estimate there will be a deficit of between 800,000 to 1
million bedside nurses by 2020. Of respondents to the UAN survey, eight out
of 10 said that there is already a serious shortage at their hospitals, and
three out of 10 answered that it is unlikely that they will continue to be
hospital staff nurses in five years. The survey cited the top three reasons
nurses leave the profession: work-related stress, patient load, and
inadequate pay.
Perhaps the most surprising result in the survey was
the emphasis respondents placed on increased wages. In a profession that
historically has emphasized dedication to patients above the nurse’s
personal well-being, salary has often been of low priority.
That is changing, however, as some unionized nurses
have negotiated double-digit pay increases at the bargaining table and base
pay rates in the low $60,000 range in high cost-of-living areas such as New
York City. In most cases, these wage boosts came after years of little or
no pay increases and in some were won only after lengthy strikes that
enabled nurses to demonstrate dangerous staffing practices, poor working
conditions, and inadequate compensation.
Overall, nurses responding to the UAN survey suggested
that salary is clearly a consideration when they evaluate whether to stay
in the profession. Six out of 10 said they earn less than $46,000 a year,
and 55% with more than 10 years of experience earn less than that amount.
Some two-thirds of those polled felt that they make less money than the
demands their jobs warrant, and of those, a third believed their
appropriate yearly salary is in the range of $70,000 or more.
“No one is suggesting that nurses throw aside
concern for patients as a motivating factor in what we do,” said UAN
chairperson Cheryl Johnson, RN, a nurse at the University of Michigan
Medical Center in Ann Arbor. “But the cold reality is that we must
make bedside nursing an attractive career choice—including offering
pay that stacks up against other jobs—or more young people will opt
not to become staff nurses and those already in bedside nursing will leave.
And 10 years from now we’ll still be here wringing our hands over how
to recruit and retain nurses.”
According to the National Sample Survey of Registered
Nurses, staff nurses in March 2000 earned an average annual salary of
$42,133.40. Nurses rank 115th among the 292 major occupational groups in
the Bureau of Labor Statistics National Compensation Survey, behind such
jobs as sheet-metal duct installers, tile setters, editors and reporters,
and funeral directors. Elementary and secondary school teachers earn more,
too.
“While all these and many other jobs with higher
pay are important and far reaching, nothing equates with the critical
impact staff nurses have on patient outcomes,” said UAN director
Susan Bianchi-Sand.
Since 1996 pay for hospital staff nurses has increased
only 2.2% per year, according to a February 2002 U.S. Department of Health
and Human Services Bureau of Health Professions Report. By most accounts,
this increase fails to even keep pace with the cost of living. Staff nurse
pay increases also lagged behind that of other RNs, with higher increases
going to RN administrators (3.7%), instructors (3.7%), and
supervisors–head nurses (3.3%).
Last year a JCAHO report, Health Care at the
Crossroads: Strategies for Addressing the Evolving Nursing Crisis,
identified “a fair and competitive compensation and benefits packages
for nursing staff” as a key solution to staffing shortage and called
on hospitals to implement this tactic. But the JCAHO report also stated,
“hospitals have few incentives to invest in nursing staff, and to
improve patient safety and health quality . . . They [nurses] are paid the
same whether . . . their medical–surgical nurse-to-patient ratios
are 1:4 or 1:10.” Opponents to increasing RN salaries have been quick
to latch on to this reasoning and say that hospitals are paying nurses as
much as they can, and that higher nursing costs will likely be passed on to
patients.
For Bianchi-Sand, the balance sheet belies those
arguments: “When I pick up a paper and read that the CEO [Harvey
Holzberg] of Robert Wood Johnson University Hospital [in New Brunswick, New
Jersey,] made $2.15 million in his 2001 compensation package, it’s
hard to fathom how anyone could suggest that paying a staff nurse—who
will be at your bedside and providing critical care for you when
you’re a patient—isn’t worth at least $70,000 a
year.” Holzberg’s $2.15 million package included $1.2 million
in salary and bonuses and $925,199 in deferred compensation and other
benefits, reported the January 12, 2003, issue of the
Home News Tribune.
Johnson agrees. “We know that when staffing
isn’t at safe levels, our patients are at risk and they’re not
getting full value for their money. In this [UAN] poll, nurses have given
us their professional assessment that the nursing shortage is the biggest
problem in hospitals today. More to the point, they’ve told us what
it will take to cure it. Now, as nurses we’ve got to work
collectively with hospitals to implement these solutions and ensure that
there are enough bedside nurses to give patients the care they need in the
future.”
To read the full results of the UAN staff RN poll, go
to www.UANNurse.org.
Suzanne Martin is associate director of communications, United American Nurses, AFL-CIO, the labor arm of the ANA.
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