Registered Nurses from across the state of Tennessee will gather on November 9-11, 2001 for annual convention, TNA’s biggest event of the year. Linda Stierle, the CEO of ANA will open the convention with the keynote presentation. Recently, Linda spoke about the upcoming convention by telephone with Sally Solesby, TNA Assistant Executive Director.
Sally Solesby: Thank you, Linda, for speaking with me today. We are delighted that you will be with us in November to deliver the keynote address for our state convention. Hearing your thoughts on several nursing issues will better prepare those who attend – issues such as ANA membership, the nursing shortage, the value of nursing and of course our convention theme, Nursing Economics: Exploding the Myths.
Other than the nursing shortage, which we will discuss later, how has the healthcare climate changed in the past fifteen months since you have been at ANA? What is the forecast for quality patient care? And, how do you see nursing’s role in the bigger picture?
Linda Stierle: Sally, there has been a deterioration in our healthcare system that has implications for the quality of care, patient safety, and nursing safety. We have a public health crisis that has been growing the past few years, and while the nursing profession is the largest segment, it cannot resolve the crisis. For the sake of patients, what nurses can do and what nursing’s role can be is to take control of our own destiny. If we don’t do it, someone else will and it may not be for the better. We have an opportunity to unify, and we can make a difference because we still have the public’s trust. We should capitalize on that. We should continue to stay focused and not allow our differences to consume and divide us.
SS:What initiatives are being planned by ANA to better serve nurse educators, advanced practice nurses and nursing administrators in the next two years?
LS: One of ANA’s strengths is that it is a multipurpose organization. During the last decade we have focused on the advanced practice nurse. Now, CRNAs are under attack from the medical community and it looks like President Bush is not going to help, so we need to continue to focus there. We are increasing the presence of nurse administrators within the ANA structure through, for example, the American Nurses Credentialing Center’s Magnet Program.* Through this program ANA is giving administrators tools they can use. Another example is the Quality Indicator Study. It is showing hospitals how quality can equal excellent outcomes. ANA is partnering with the Tri-Council to serve nurse educators. We always want to attract the best and the brightest in nursing education.
SS: What new and different strategies has ANA already developed to help recruit members? Are there future strategies?
LS: In ANA there are three primary areas that are our foundation: 1) The five core issues (Workplace Rights, Appropriate Staffing, Workplace Health and Safety, Continuing Competence, and Patient Safety/Advocacy); 2) Code of Ethics and 3) Membership. Of these, membership is our life’s blood. Currently, we have static membership and one of our goals is to expand our Membership Department and we can do that with a dues increase. We want to put in place several new incentive programs for the states. What I mean by that is that as a state grows its membership, perhaps the dues could go down in that state. My vision is that all 2.7 million nurses in America will one day belong to ANA. If we could do this, then we really could realize our potential as the largest sector of the healthcare workforce. Then we really could make a difference not only for ourselves, but for the public as a whole. It can be done – one step at a time.
SS: The primary issue in healthcare today, for both the nursing profession and the public, is the shortage of nurses. What is ANA’s role in addressing both the short-term crisis as well as the dire long-term implications for the delivery of healthcare services to US citizens?
LS: We have embarked upon a call to the profession.It comes from the report that came out of last year’s House of Delegates around the nursing shortage, the current staffing crisis, and the fact that the public impact is that we have a healthcare crisis. So, on September 8-11, there will be a nursing summit: a Call to the Nursing Profession. This will be a national level effort. We have sent invitations to all 175+ stakeholders from the larger nursing community across the country inviting them to join us at the table in addressing this issue. When we talk about the nursing shortage and crisis, really what’s at the center of that is what you and I have been talking about, the image and value of nursing. Until we change the image and value of nursing, the best and brightest of young people are not going to continue to be attracted into this profession. And, if for some reason, they are, they are not going to stay. So until we get to the heart of the issue, all we are going to be doing is putting band-aids on symptomatic issues and not getting to the root cause in terms of turning this around.
The idea behind the summit is to take ourselves into the future to the year 2025, and the nursing profession is being interviewed by 60 Minutes. Imagine we are being asked about the fact that nursing has become the healthcare choice of individuals in terms of professions and what caused that change? What we will tell them is, “Back in September, 2001, we had a call to the profession and the larger community came together around the nursing shortage issue, a dilemma that impacted every one of us at a personal level as consumers of healthcare. We knew it was nursing’s obligation to address this issue so we identified seven domains and put forth simultaneous effort for improvement. The seven domains were 1) education 2) financing/compensation/reimbursement 3) work environment 4) technology 5) delivery system as a whole 6) health policy/regulation and 7) diversity.”
Now, back to the present. What will come out of the summit will be a master plan.** A master plan will demonstrate not only to ourselves and other healthcare sectors, but to society at large, that we do know how to fix the shortage. But, it is bigger than nursing. Once we have our master plan, have agreed upon the driving forces, and each organization has determined its own mission, priorities and resources in this endeavor, we can use the plan to engage in a capital campaign to carry the message to corporate America. The message will be that the nursing shortage impacts all citizens, personally and individually, as well as the corporate level. We hope to raise $100 million to invest in implementing the master plan to remedy the nursing shortage.
The second step will be a Call to the Nation where other healthcare partners, corporate America and the public are invited to the table to, again, get to the heart of the issue – the value and image of nursing. So, it’s important to have this master plan to avoid the cycles of shortage we have had in the past. Getting to the root cause is what we have to do if we want this to be a preferred profession in the future. We must take control of our destiny and have a common message. We cannot continue to focus on our differences. That’s what one united strong voice means. It does not mean that ANA is the only voice speaking, but we want to be the convener, as the largest multipurpose nursing organization, and create that “house of nursing” where there is room for everyone. There is tremendous excitement about this.
SS: The theme of TNA’s annual convention this November is Nursing Economics: Exploding the Myths. What are some of the myths nurses should recognize?
LS:Myth #1: The nursing shortage is national. If we are not careful, we will allow the healthcare industry to convince everyone, ourselves included, that there is a shortage across the nation and there isn’t! It is not national, yet. There are pockets of shortages now. But a shortage perception promotes practices such as mandatory overtime. The shortage is on the horizon, but there is still time to turn it around. The truth is that rather than not enough nurses, they are simply choosing not to work in nursing.
Myth #2: Nursing is a drain on the hospital budget. Patients are in the hospital because they need nursing care. They are there because they need a nurse to monitor and evaluate their progress and to intervene in a timely fashion and make a difference in their outcomes. Nursing needs to be seen as a revenue producer and not a drain. A connected myth is what some employers think, A nurse is a nurse is a nurse, thus promoting the idea that the nurse is interchangeable with other healthcare jobs. This is just absolutely not true. Healthcare today is as complex as it has ever been.
Myth #3: Nurses are not career minded. I believe we are. We take our work seriously. Our challenge is to communicate to the public the pride we have in our profession, so that a more supportive environment can be established.
SS: Since nursing is still predominantly a women’s profession, how do women’s economic issues compare or contrast with nursing’s economic issues?
LS: Because we are a predominantly women’s profession, we are undervalued. We have made a lot of progress and I hesitate to say this in 2001, but in every aspect of our society from the moment we are born, there are subtle messages that women are undervalued. Whether it is in our homes, our churches, or the media, there are still gender differences. These differences are a good reason why we need to increase the number of men in nursing and make the nursing profession “look” more like the populations we serve. Salary compression continues to be an issue. New nurses’ salaries start out comparable to other professions, but then go nowhere. A thirty-year nurse sees very little difference between her salary and the salary of a new nurse. That doesn’t happen in other professions. Unless we change the pay inequity, bright young people of today will not choose nursing as a career. Young people have pressure from their families and their peers not to choose nursing, and that is a value we must change.
SS: Which leads me to the next question. When considering economics, our planning committee has used other terms such as value . How are nurses valued in the larger healthcare community? Has this always been true?
LS: At the core of the nursing shortage is the value and image of nursing. Until this nation does something to change the value and image of nursing, I do not believe we can ultimately fix our current staffing and nursing shortage. We have talked about the fact that nurses enjoy high public trust. But, value and trust are so different. When I think about the American culture, how we place value on things, how we prioritize things is based on several factors such as money, position, and title. What I would throw out is this example: when a patient receives a hospital bill, every single service that was provided is listed with a dollar amount, except there is nothing on the bill called “nursing service.” Nobody knows how to value it, given the criteria I mentioned that society uses to place value. We must do a better job of helping society understand how nursing is a separate healthcare discipline and the role is unique in the healthcare delivery system.
SS: Has the value of nurses changed as healthcare delivery has changed?
LS: I think, again, that is something that we must work on. Today, since nursing is one of many options, it is less valued than in the past. When I chose nursing as a career, it was one of five or six options and therefore had more value. But, there is still the finance piece. During the Depression and World War II, there was private duty nursing and a dollar amount was placed on private duty nursing service. In time, nurses became employees of hospitals. When that happened, nursing started on a downhill slope. Until we reverse that, I don’t think the value will change. There are many new models that are being talked about such as contracting nursing services and outsourcing, and we need to seriously consider them.
SS: How can nurses be proactive in sustaining or elevating their value to the delivery of healthcare?
LS: In the past there have been many wonderful campaigns to promote nursing. Some may not agree, but I believe that one of the most powerful messages was Every Patient Deserves a Nurse. The problem is that we don’t stay with a campaign long enough to reverse society’s perceptions. We must stay over the long haul. Remember, about ten years ago the public relations campaign, If Caring Was Enough, Anyone Could Be a Nurse was a very powerful message. And, we need to learn how to respond on an individual level. For example, when comments are made like, “you are such good nurse, you should have been a doctor,” do we answer tactfully that someone bright and capable chose to become a nurse? If the nurse were not there, what would it mean for the patient?
SS: Another term bounced around in planning our convention was worth. In 2001, no longer does the idea of becoming a nurse have the sense of “calling or mission” to the degree it once had to beckon young people to the profession. How does ANA affirm the worth of nurses, both individually as well as collectively, that encourages entry into the profession?
LS: One of the things ANA must do is to give visibility to what nursing care costs. So, that society and we, ourselves, can feel we have worth. Nurses must feel worthwhile first. We are in a period now where our own sense of worth is at a low point. For the first time in nursing history, mothers are telling their daughters not to enter the nursing profession. There is no stronger testimonial and wakeup call than that. This attitude has to do with compensation, but also to turn it around there must be a place at the table for nurses to participate in organizational decision making and recognition that professional nursing care yields better patient outcomes, therefore saving the industry billions of dollars. In addition, a career ladder that acknowledges skill and expertise by rewarding increased educational level and national certification would enhance the worth of nurses.
SS: How should we compete with other professions in today’s society and economy to recruit men and women into nursing?
LS: We need to have a national image campaign – some colorful messages. Teaching has a wonderful campaign going on now and teaching is a profession with a lot of similarities to nursing. Nurses for a Healthier Tomorrow is focusing on nursing – a career that can last a lifetime. It is aiming to show the breadth and diversity of the profession called nursing. There is a lot of information out there and there is a lot going on. We must continue to keep our eyes open, read, get as much information as we can, and continue to be diligent. I am looking forward to being with you in November.
Linda Stierle has been the CEO and Executive Director of the American Nurses Association since March, 2000. Retired as a Brigadier General in the United States Air Force Nurse Corps, Stierle was a long time member of the Texas Nurses Association prior to coming to Washington, DC where she joined the Maryland Nurses Association. Stierle is a nurse leader with more than 30 years diverse management experience in health care operations.
* To learn more about the American Nurses Credentialing Center’s Magnet Program for Excellence in Nursing Services or for an application, contact Jennifer Matthews, PhD, RN, CS, Director, Accreditation and Magnet Programs, 600 Maryland Avenue, SW, Suite 100 West, Washington DC 20024-2571