With the ubiquitous talk about the nursing shortage on everyone's lips, forecasts of doom and gloom are rampant. I recognize the gravity of the situation on a global scale, but let us pause for a moment to consider ways that organizations, nurses, governmental bodies and facilities are formulating responses to the all-too-familiar shortage of nurses.

Many intelligent and well-meaning people and organizations are working to stem the tide of the nursing shortage. As government fails to meet expectations, facilities, individuals, organizations and educational institutions must be creative in their search for workable, economical and viable solutions. It is the hope of all nurses---and those who rely on nursing care---that the shortage can be aggressively addressed from multiple angles by a wide variety of organizations in the interest of the common good and general public health.

I am personally quite hopeful that the nursing shortage can be addressed adequately if the nursing community can use its collective voice to stimulate debate, discussion and consumer demand for solutions. If we nurses can convince the public that their very health and well-being is in jeopardy in the face of an unmitigated nursing shortage, perhaps then government and private enterprise will react in pragmatic ways in order to stem the tide.

In speaking with nurses and other individuals, I have found that many people are using creativity and critical thinking to address the issue of the nursing shortage. Administrators at a local long-term care facility are awarding scholarships and promises of nursing jobs to CNA's who enroll in Associate degree nursing programs in our area. A local business has pledged grants to African American and Hispanic pre-nursing students to continue their studies, and some businesses are underwriting scholarships at local nursing schools.

I am encouraged by these initiatives, but also recognize that a great deal more must be done both in the and abroad in order to rectify a situation that puts both healthcare workers and consumers at increased risk.

Here is simply a "snapshot" of several creative and interesting ways that the nursing shortage is being addressed in the Perhaps subsequent articles on NurseConnect could compare, contrast or simply report on similar efforts underway abroad. It is my hope that such recognition will spark further conversation (whether here on NurseConnect or beyond) and subsequent innovation and inquiry.

Nursing Education

In terms of educating new nurses, a new California law will take effect on January 1st, 2009 with the hopes of easing the nursing shortage. The law, Senate Bill 1621, provides student loan forgiveness for practical nurses who want to become nursing instructors. The law will also extend loan forgiveness to current nursing students and recent graduates, as well as seasoned nurses who desire to become nursing instructors. Since nurses working in clinical fields earn significantly more money than nursing school instructors, it is hoped that additional incentives for nurses to consider taking teaching positions will decrease the number of qualified students who are turned away from nursing schools each year due to the lack of adequate faculty.

As a former adjunct nursing professor for a LPN program at a community college, I can attest to the fact that the adjunct faculty salary, and the less-than-stellar support provided by the school, caused me to leave teaching behind. As a nurse who relies on my income to put food on the table and pay monthly bills and mortgage, I need to feel that my time is valued and my work is well compensated. Unfortunately, teaching in a practical nursing program turned out to be time-consuming and relatively poorly paid, decreasing the amount of time available for more financially rewarding clinical work.

From the corporate side of the equation, Johnson and Johnson's Campaign for Nursing's Future has apparently raised millions of dollars in multiple states across America for nursing student scholarships, faculty fellowships and nursing school grants for "expanding program capacity".

And in Texas, a pragmatic response to the need for more new nurses to be educated, minted, and released into the needy health care system has been operationalized: build a new nursing school. Although the new nursing school at will open in 2010, the university is already enrolling students in the pre-nursing track, scheduling classes so that students will complete their prerequisites smoothly and efficiently in preparation for entry into the nursing program. According to an article on the Web site of The Statesman, "Concordia's nursing students will be required to work in health clinics and intern at health care centers that serve a primarily Spanish-speaking population to demonstrate their service capability."

The Alabama Nursing Home Association Education Foundation has funded 44 scholarships for LPN students in an effort to increase the number of LPNs in a state that relies heavily on practical nurses for the staffing of nursing homes and other facilities.

Technology

The California Healthcare Foundation (CHCF) recently commissioned a study of technology and its role in supporting nurses by decreasing workloads or streamlining systems. The study, conducted by The First Consulting Group, has been published in pdf form and can be downloaded for free at CHCF's Web site. Some highlights of their findings regarding systems that support nurses in their work:

Staff scheduling technologies: internet- or intranet-based nurse scheduling programs allow nurses and facilities to fill shifts, request time off, and assess staffing needs in a comprehensive way. Scheduling systems can be programmed with staffing algorithms to assist in ensuring adequate staffing for key shifts as inpatient censuses fluctuate.

Communication

1. Wireless phones carried by nurses during their shifts enable ease of communication, easier care coordination, and eliminate the noise pollution of overhead paging.

2. Automated messaging is another way that streamlines referrals for ancillary services and allows for the elimination of duplicate paperwork and unnecessary "desk time."

3. Internal e-mail systems also ease communication and leave a "digital paper-trail" of conversations. With e-mail, multiple care providers can receive identical copies of messages, and "Reply to All" functions create opportunities for "virtual case conferences" without the need to arrange face–to-face meetings (always a challenge in busy health care facilities).

4. Automated patient education systems allow nurses to download language-appropriate patient education materials, document which materials have been given to the patient in the patient's electronic medical record, and what educational areas require follow-up.

5. Computer-based Clinical Decision Support (CDS) allows for automatically generated alerts and access to evidence-based research on best practices.

6. Computerized Physician Order Entry (CPOE) provides applications wherein physicians enter orders electronically into a patient's online medical record. This functionality provides yet another "virtual paper trail" for orders and communications, allows for multiple disciplines to view all orders generated for each patient, does away with handwriting errors, and can automatically evaluate orders for relevancy, medication dosage errors, and med interactions. This function also allows all providers involved in a patient's care to see new orders in "real time," avoiding potentially dangerous miscommunication about medications, symptoms and treatments.

7. Automated nursing documentation gives nurses the ability to enter findings and other crucial nursing data into an electronic medical record that can collate related data and automatically create flow sheets, graphs and other visual records for ease of comparison and review by all disciplines.

8. Automated medication management systems have, by all accounts, become more widely utilized in hospitals around the world. Robots at nursing stations are loaded with medications and keep accurate records of narcotics and other medications, decreasing the need for manual documentation and time-consuming pill counts.

For more information, please visit CHCF's Web site to download the study, which includes an excellent review of the nursing shortage and its ramifications.

Professional Associations/Organizations

Various organizations, such as the Association of peri-Operative Registered Nurses (AORN), are engaged in active campaigns to recruit new nurses, generate scholarships, and provide grant funding for evidence-based research that can decrease nurse workloads by streamlining nursing functions, work flows and clinical practices.

Government

Although President Bush signed into law the Nurse Reinvestment Act in 2002 in order to stem the tide of a growing nursing shortage, it is apparent that the U.S. government's response to the crisis has been wholly inadequate. With a presidential election pending for November, this writer notes that both Barack Obama's and John McCain's health policy statements do not adequately address the nursing shortage (or ignore it completely) giving woefully short shrift to the issue as they bandy about ideas for health care reform.

I believe that nurses are essential to the functioning of the worldwide health care system, and there is no end to the creative energy and economic wherewithal that could be invested in relieving our current plight as a global society. When it comes down to it, every patient does indeed deserve a nurse, and every nurse deserves to work in an environment wherein she or he can perform nursing duties safely, efficiently and effectively.

We all hold out hope that the nursing shortage will not continue to balloon at a historical moment when nurses are needed more than ever. We can each in our own way contribute to the conversation and pressure those in power to do all they can to reign in a problem that can only have dire consequences for people around the world.

NurseKeith is a writer, blogger, consultant and nurse. Please feel free to visit his blog, Digital Doorway.