Authors

  1. Brown, Barbara J.

Article Content

The Changing Workforce

The health care world is changing so rapidly that the workforce is in a constant whirlwind of swirling turmoil, not knowing what to expect next from the leaders and especially the government. Some changes are beneficial; others can be harmful. In most situations change can be planned for and guided by leaders. The planning process is crucial to ensure that change is appropriate. Leaders seeking to control change are visionaries who determine what is to be accomplished and then involve the staff in setting the goals to be reached.

 

As nurse executives, we plan for patterns of organization, budget, staffing, personnel, recruitment, retention, orientation, policies, work schedules, and a multitude of organizational demands, oftentimes determined by external forces. The ability to change these in the process of planning for appropriate quality and quantity of patient care is the hallmark of an exemplary nursing leader. Gaining the greatest return for each nurse's effort in time, energy, skill, and profit requires avoidance of surprise and too rapid a pace of change. A nurse executive who has demonstrated the ability to obtain orderly results in organizational change is Sue Driscoll, Vice President of Patient Services, Exempla Saint Joseph Hospital, Denver, Colorado, issue editor for this timely topic.

 

As corporate mergers and changes were mandated, Sue worked to provide financial training for clinical managers to enhance budgetary expertise and fiscal management of assigned areas. She also redesigned patient care services to enhance administrative structure and provide more decision making at point of service. Sue completed postmaster's course work in health policy and public administration at the University of Colorado, Denver. She received her master's of science from the University of Colorado, Boulder, and her bachelor's of science in nursing from Northern Illinois University of DeKalb.

 

Sue acknowledges that quality patient care is not easily accomplished. "It is increasingly difficult to remain personal and person-oriented in the high-tech, fast-paced environment in which we live. Yet we must provide the patient with the sense that he or she is the only concern of the health caregiver at that moment; that he or she is an individual with particular concerns and needs; and that we sincerely care." She also feels passionately about building trust with her employees and responds to their need to feel cared for, so they can care for the patients.

 

Who are these employees? What are the conflicts and issues that are preventing staff nurses from being loyal to nursing and to practice environments? Why do nurses run away from nursing practice? The staff nurse today is angry and frustrated. The work environment is often referred to as "hostile." How can nurses be expected to practice in today's environments, when physicians behave in erratic, angry, nonunderstanding, or noncaring moods? We expect more knowledge and greater skill level in staff nurse practice, yet we fail to recognize-through appropriate economic rewards-the increased level of competency that nurses are willing to demonstrate. There are many nurses who do not want to provide direct patient care and who see their rewards through increased tasks away from the patient and in other than hospital settings, where 24 hours, seven days a week are not required.

 

The workforce today is changing so rapidly that the increased shortage of nurses and diminishing numbers of nurses in acute care are truly crises. This is especially true in critical care, operating room, and other specialties. Even medical-surgical nurses are not readily available. So what are we to do? Can we accept the increased stress, technology, science, and competence needed on the part of each nurse to function in this increasingly stressful environment?

 

There is much work to do, administratively and educationally, to resolve the conflicts between the systems of nursing education and practice. We waste RN talent by continuing to have gaps between what is taught and what is reality in the practice settings. We set nurses up for frustration as they enter the practice environment because we are not changing the environment fast enough, nor are we preparing nurses realistically to face that stressful acute care environment.

 

How do we define support systems for nursing with trust building in the practice environment? Supports that nurses need include comprehensive employee health systems to address illness and wellness-both physical and emotional factors-to maintain nurses in a satisfactory state of health. Nurses also need professional development that can be individualized through peers, managers, and personnel, with significant career counseling support systems available, such as developing their own career portfolio. The provision of stress management activities through group and individual counseling, chaplaincy services, clinical psychology, personal financial planning, peer support, and good mentorship is absolutely essential for nurses to continue to survive in this stressful environment.

 

Congruence of values in trust building can be enhanced through strong educational support to advance the clinical expertise of every nurse. Nursing research should be utilized and integrated in all areas of practice to enable nurses to explore their growth potential through the application of new knowledge in evidence based practice. Nurses need expert clinical nurses available to them, either through collaboration with a school of nursing or through advanced practice nurses in the organization of care delivery.

 

Nurse executives are the key touch points in managing the inevitable changes in the workforce, that occur in all health care settings. It is our responsibility to create a climate of trust that will allow each nurse to grow through creativity and innovation at all levels. If each nurse leader took care of each nurse, applying nursing process in the same way we take care of patients, we could considerably reduce the stress in the work environment and enhance the capability of nurses to practice more comfortably in their chosen field: the profession of nursing.