Nursing: A Challenging Past and a Bright Future!
Beth Ulrich, EdD, RN, CHE

The beginning of a new year is a great time to look back on the previous year and look forward to the year ahead. The year 2005 will certainly be remembered as the year of the hurricanes. We will remember them not only for what they damaged and destroyed, but also for the opportunities they presented to help others in meaningful ways. Our ANNA President, Suzanne VanBuskirk, in her President’s Message in this issue, highlights many of the ways the nephrology community worked together to help people affected by Katrina and Rita. Though the 2005 hurricane season is officially over, the effects are with us still and will be with us for many years.
Last year also marked the first ever Nephrology Nurses Week. In September, nephrology nurses across the country celebrated our specialty and the work we do. Too often in the hectic pace we keep, we forget to pause and appreciate ourselves and our nursing colleagues and Nephrology Nurses Week provided the perfect opportunity. We had more to celebrate in November, when ANNA was honored to receive official recognition from the American Nurses Association as a nursing specialty.
There were a number of recent noteworthy events in nursing as a whole, including research supporting the value of RNs, increasing enrollments in schools of nursing, and the value the public places on nurses.
 
More RNs Equals Better Outcomes at a Lower Cost
Needleman, Buerhaus, Stewart, Zelevinsky, and Mattke (2006) recently published an article entitled “Nurse Staffing in Hospitals: Is There a Business Case for Quality?” that addressed the question of whether the presence of more RNs for more time made a difference in patient outcomes and in the cost of care. They studied licensed (RN and LPN/LVN) hours of care and mix of staff and three options of changing the hours and mix: 1) raise the proportion of RNs without changing the licensed hours of care, 2) raise the amount of licensed hours of care without changing the mix of RNs and LPNs/LVNs, and 3) raise both the proportion of RNs and the hours of licensed care. The overall result was that fewer in-hospital patient deaths and fewer other adverse outcomes were associated with all options.

Additionally, the researchers found that “decreases in urinary tract infections, pneumonia, and shock or cardiac arrest are associated most with increasing the proportion of RNs,” “failure to rescue in surgical patients is more sensitive to the number of licensed hours of care,” and that “length of stay is associated more with hours of nursing care than with the RN/LPN mix” (Needleman et al., 2006, p. 207). The largest cost savings were associated with increasing the RN mix without changing the licensed hours of care. This study was conducted using hospital data and thus is clearly applicable to inpatient nephrology settings, but a case also can be made for its applicability in outpatient nephrology settings as well.

More People Want to Be Nurses
The American Association of Colleges of Nursing (AACN) collects data on the number of students enrolled in Bachelor’s, Master’s, and Doctoral nursing programs. In recent years, they have also collected information on the number of qualified applicants who apply, but are not admitted. Beginning in 1995, AACN found a steady decrease in enrollment. The trend began to change in 2000, and enrollment and the number of qualified applicants has increased every year since. In their most recent report, AACN found that, in 2005, there was an enrollment increase of 13% over 2004 and a graduate increase of 19.1% in baccalaureate programs (AACN, 2005). The sad news was that 32,617 qualified applicants were turned away mainly due to a shortage of faculty (underfunding of faculty positions and inadequate faculty salaries). That’s in addition to the many qualified applicants who are turned away from associate degree programs. Imagine the impact on the current nursing shortage if all of those individuals could have been admitted to schools of nursing!

Honesty and Ethics – RNs are #1
We ended 2005 with good news –nurses are once again atop the annual Gallop Poll on the honesty and ethics of members of professions (Gallup Organization, 2005). Each year in November, the Gallup organization conducts a random national sample survey of adults in the U.S. and asks the participants to rate the honesty and ethical standards of people in various professions. Not only are nurses the highest-rated profession in the 2005 survey, the percentage of people who rated the honesty and ethics of nurses as very high or high increased from 2004 (82% vs. 79%). The second highest ranked profession was pharmacists, whose honesty and ethics 67% of the respondents rated as very high or high followed by physicians (65%) and high school teachers (64%). Nurses have been the highest-rated profession since being added to the poll in 1999 with the exception of 2001 when firefighters were included, and, in that year, nurses ranked second.

The Year Ahead
The past year provided a good base on which to build in 2006. We found new ways of working together and supporting each other in the wake of the hurricanes. We established a week to celebrate ourselves and our contributions and we were recognized by ANA. The Needleman et al. research, that looked at hospital nursing in general, can be used by the nephrology nursing community as the foundation for establishing the value of nephrology nurses to both patient outcomes and the financial bottom line. The increases in nursing school enrollments provide many opportunities for us to help student nurses discover nephrology nursing, and the need of nursing schools for additional faculty provides an opportunity for us to contribute as preceptors or part-time faculty. And finally, the results of the Gallup survey on honesty and ethics shows that the public trusts nurses more than any other profession to do the right thing and to tell the truth. That’s a great compliment and also a huge responsibility, and it is surely a good place to start this new year.

Beth Ulrich, EdD, RN, CHE
Editor
E-mail: BethUlrich@aol.com