1. Alexander, Mary BS, CRNI(R), CAE, INS Chief Executive Officer, Editor

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The nursing shortage gets a lot of press. In the world of healthcare, it has become something close to James Carville's famous "It's the economy, stupid," the thing that seems to be at the heart of many of the nursing profession's troubles. It seems an obvious enough problem that writing about it here seemed, at first, redundant. But I started to think about the nursing shortage again after meeting with Senator Richard T. Moore, a member of the Massachusetts legislature and chairman of the Joint Committee on Healthcare for the state.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander, BS, CRNI(R), CAE, INS Chief Executive Officer, Editor, Journal of Infusion Nursing.

I had the privilege of meeting Senator Moore in April, just as the state legislature was reviewing a bill that would offer incentives to nursing students and nursing schools with the hope that it would attract more nurses into the profession. We talked about the multi-system failure that was allowing the profession to falter: Nursing schools lack sufficient numbers of faculty to teach incoming students, so they turn qualified applicants away. Students lack the funds to attend nursing school, and with the federal Nurse Reinvestment Act's funding slashed, the promise of more scholarships has dwindled. Hospitals clamor for better-trained nurses, and lament the retirement of nursing veterans. Ultimately, patients suffer-hospital lengths of stay go up, infection rates go up, medication errors increase. And we wonder why healthcare costs so much.


I also talked with the senator about the vital role that infusion nurses play in the complex structure of healthcare. Because we are a subspecialty of nursing, it's easy to pass over the contributions of infusion nurses as we talk about the larger issues facing our profession. However, infusion nurses can help guard against many of the medication errors that make risk managers shudder and drive up the cost of healthcare.


Infusion nurses have been touched by the nursing shortage. But we now have another important role to play in health policies that affect the reimbursement of infusion medications delivered in the home. The implementation of Medicare Part D (a part of the Medicare Modernization Act of 2003 that covers drug prescriptions for Medicare patients) will have serious consequences for home infusion patients because it covers only the cost of certain infusion drugs, but makes no provision for the services or supplies that are necessary for reconstituting or injecting them. How can Medicare homecare patients be expected to maintain sterile technique and safety procedures if they cannot pay for the proper medical equipment? We know that home infusion care goes a long way in controlling medical costs because of its lower infection rates and greater patient participation. But controlling costs should not mean sacrificing patient safety or delivering incomplete care.


As infusion nurses, we must raise our voices to address this issue. INS intends to support a new initiative by the National Home Infusion Association (NHIA) to ask that the Centers for Medicare and Medicaid revise this legislation and make provisions for medical supplies and services that are used to safely deliver infusion medications in the home. I urge all of you to learn more about this aspect of the Medicare Modernization Act and consider the impact it will have on your patients. Simply log on to


Legislators must also become more educated on the impact their decisions have on the patients and their safety. I encourage you to write or e-mail your legislators and ask them to act on behalf of you and your patients, particularly if you live in any of the following states: Arizona, Kentucky, Massachusetts, Maine, New Mexico, Oregon, Pennsylvania, Tennessee, West Virginia, or Vermont. Senators from these states sit on the Senate's finance subcommittee on healthcare, and have direct influence on the amount of money that will be allocated to the infusion drug benefit. As we continue to follow this issue, look for information in INS publications and on our Web site, where we will provide links to NHIA.


As nurses dealing with a shortage, and with reimbursement issues that will adversely affect our patients, it can all seem a bit overwhelming. The good news is that you can do something about it. Contact your local representatives, do some research online, and talk to administrators within your organization and ask for their support. Download INS' free Guide to Public Policy from our Web site to learn how to get started.


If we, the experts in our field, do not act, we are leaving these important decisions to those who may not fully understand all that is at stake. Remember, every voice makes a difference.


Mary Alexander