1. Hogan, Patricia MA, RN, NEA-BC

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The American Organization of Nurse Executives (AONE), along with many other nursing specialty organizations, has been on a strategic journey to ensure public safety through an aggressive plan to minimize the nursing shortage. Partnerships with industry leaders such as Johnson & Johnson, the National Student Nurses Association, business groups and schools of nursing reinvigorated an interest in nursing, and we proudly proclaimed success. Within a relatively short time, we had a pipeline full of the best and brightest. We then switched our attention from that of recruitment to the current concerns related to faculty shortages. Advocacy groups across America were actively pursuing innovative solutions to increase both numbers of and salaries for our colleagues practicing in academia.


Fast forward to the current economy, Wall Street, and of course, Main Street. Americans are experiencing layoffs, foreclosures, and greatly diminished retirement funds.


The American Hospital Association (AHA) recently reported a survey of 658 hospitals, which found that greater than 50% had negative profit margins in the fourth quarter of 2008 (Modern Healthcare, 2009). The 2009 annual meeting of AONE reaffirmed the economic conditions. Many of the anecdotal conversations centered around the latest challenges in nursing with themes that included decreased retirements, inability to recruit leaders necessitating relocation because of the real estate market, and new grads unable to get positions that they assumed would be plentiful. Overarching all of the above is the continued inability to mandate baccalaureate education, making excellence in practice all that more difficult to achieve.


Is this landscape due to the recession? Absolutely!! Is this a long-term condition? Perhaps not!! However, it warrants attention and planning so that the problems do not evolve into serious patient safety concerns.


Evidence based leadership practice dictates the need to plan staffing based on the balance between academic preparation and experience. We have been planning for the constant yet steady retirement of baby boomers for years. We did not plan, however, that baby boomers would postpone retirement until the economy rebounds, and so we now face the potential of an insidious mass exodus of these experts followed by onboarding of novice nurses. Patient safety, insufficient numbers of preceptors and overall market instability will make evidence-based administrative practice challenging unless proactive and forward thinking innovations are developed (Roche, Morsi, & Chandler, 2009).


In my opinion, nursing is not recession-proof. It is imperative that we assess our practice environments and determine, using parameters of age, years of experience and academic preparation, who will be practicing in the next 2 to 5 years. Will the majority of our night staff be novice nurses, including those in critical care? How will this affect our patients? Who will mentor? What resources will they have at 3 a.m.? How many new nurses can one unit safely hire?


I urge you to consider the future. What if, in the interim, to soften the impact of the baby-boomer exodus, we:


* standardized nursing internship programs across the country


* build the business case for overhires from a risk management, safety focus rather than recruitment/retention


* redirected expert nurses to a formal mentoring role as an alternative to retirement


* adjusted pay scales to allow diploma and associate degree new grads to be oriented and attend a baccalaureate program simultaneously


* partnered the advance practice nurses more closely with nurse managers to ensure sound outcomes on units with too many novice nurses


* mandated BSN education, creating capacity for growth of faculty as well as improved patient outcomes (Gess, Manoglovich, & Warner, 2008).



Nursing is in a recession. We are called to action and should be the masters of our destiny!! What will our leadership legacy be?




Gess, E., Manoglovich, M., & Warner, S. (2008). An evidence-based protocol for nurse retention. Journal of Nursing Administration, 38(10), 441-447. [Context Link]


Modern Healthcare. (2009). AHA Survey. Retrieved April 20, 2009, from Article/20090311/Reg/303119964. [Context Link]


Roche, J., Morsi, D., & Chandler, G. (2009). Testing a work empowerment-work relationship model to explain expertise in experienced acute care nurses. Journal of Nursing Administration, 39(1), 115-122. [Context Link]