1. Woods, Anne RN, CRNP, APRN,BC, MSN

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In Pennsylvania, physicians recently went on strike. They'd rather call it by another name, but that's what it is. Doctors closed up their offices, some for the day and some for the week; they told their patients they'd be available only for emergencies and any such cases would be seen in the nearest emergency department. And then they marched in the big cities and the small towns. They marched from the local hospitals down several blocks to the local court houses, where they held up picket signs reading, "Less doctors=less care." They did this in protest of the rising costs of liability insurance, which they say has driven some of them into retirement or to other states to practice, jeopardizing patient access to quality health care.


Physician liability insurance has become astronomically overpriced. According to the American Hospital Association's professional liability survey, professional liability insurance costs have doubled in almost half of the hospitals in crisis states. Consequently, being a physician isn't as lucrative a career as it once was. The AHA survey reports that 53% of the hospitals in crisis states find it more difficult to recruit physicians, and 45% report a loss of physicians and/or reduced coverage in emergency departments. 1 Nevertheless, physicians have gained support from the public and their state legislators and now clamor for the government to step in to solve this one facet of the health care crisis.


Looming issues

What about the bigger health care crisis-the nursing shortage? According to statistics released by the Health Resources and Services Administration, by the year 2010 we'll have a deficit of 275,215 nurses, and by 2020 this deficit will increase to 808,416. The population is aging; by 2020 the percentage of people age 65 and over is projected to grow by 54%. 2 The average age of practicing nurses has increased right alongside that of the rest of the population. We're older now and we don't have the stamina to work 3 consecutive 12-hour shifts. Who's going to take care of us when we're older, and who's going to take care of the sick?


Will the physicians' protest solve their woes over the liability insurance dilemma? I doubt it, but at least it brought the problem to the foreground. Will marching make the nursing shortage go away? I think not, but alerting every health care consumer and legislator to the problem is a start.


Taking action

What steps can we take as nursing professionals to make health care consumers more aware of the shortage?


[white diamond suit] Write to legislators at the local, state, and federal levels. Tell them about the impact nurses make and how the nursing shortage negatively impacts patient care.


[white diamond suit] Enlist patient support. Encourage patients to write to legislators and local papers about how nurses influence their health care.


[white diamond suit] Have a voice. Write to your local paper about the nursing shortage. Make people aware of the latest studies that demonstrate how nurse-to-patient ratios affect patient outcomes.


[white diamond suit] Learn to talk the bottom line. We've done ourselves a disservice because we've never learned to speak the language of "bean counters." We can't justify our need for replacement or additional staff if we can't speak the language of finance.


[white diamond suit] Open your arms to students. Though having students on the unit may be more difficult, these are the nurses of tomorrow, so encourage your staff to nurture and teach them. Talk to prospective students, as well. Volunteer to speak to elementary, middle, and high school students on career days.


[white diamond suit] Know your worth. Be able to tell people that as a nurse manager and health care leader, you ensure adequate staffing to care for each patient. Because you're a nurse, you know better than anyone what nurses need to provide quality patient care. Consult Nursing Management 's salary survey on page 28 to determine the average salary that you and your colleagues command.



The physicians marched to bring attention to the rising costs of liability insurance and its impact on health care. It's our turn to have a voice now-our patients need us!




1. American Hospital Association:Survey of Hospitals on Professional Liability Experience. Available on-line at: [Context Link]


2. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professionals, National Center for Healthcare Workforce Analysis:Projected Supply, Demand and Shortage of Registered Nurses: 2000-2020. Available on-line at[Context Link]

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Guest editorial