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Healthcare Upside/Down: What Would Florence Think?

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ECG’s radio show and podcast, Healthcare Upside Down, offers unfiltered perspectives on what’s working in US healthcare and what’s not. Hosted by ECG principal Dr. Nick van Terheyden, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.

The origins of nursing care date back at least to antiquity. But the profession as we know it was born in 1860, when Florence Nightingale established a training school at St. Thomas’ Hospital in London. Informed by Nightingale’s research in sanitation and her experience caring for wounded soldiers in the Crimean War, the program became the foundation of modern nursing. Nightingale’s expertise, and her popular portrayal as the “Lady with the Lamp,” brought attention and status to the profession and inspired people from all walks of life to become nurses.

The profession has certainly evolved since Florence’s day, but one thing hasn’t changed—there are never enough nurses. Nurses have been in short supply since the 1930s, at least, and nothing has shaken the profession more than COVID-19. The pandemic has led to a rash of early retirements among nurses, while others have left their hospital jobs for higher compensation as traveling nurses. And the incoming generation of nurses has different priorities than the nurses they’re replacing.

“The nursing workforce going forward in the next decade is going to look very different from the nurse workforce over the last couple of decades,” warns Ralph Egües, Jr., Executive Director of the Nursing Consortium of South Florida.

On episode 13 of Healthcare Upside Down, Ralph is joined by Maria Suarez, President of the Nursing Consortium of South Florida; Assistant Vice President of Nursing at the Miami Cancer Institute, Baptist Health South Florida; and an experienced nurse. Together they talk about the effects that the pandemic has had on nursing shortage and how they expect the profession to change. Here are three takeaways from our conversation.

On the origins of the nursing shortage and how it’s affecting Florida.

Healthcare organizations were grappling with a shortage of nurses long before the first case of COVID-19 was diagnosed. But the pandemic has undoubtedly exacerbated the shortage—or “catapulted it to another level,” in Maria’s words. “What we expected to see maybe years down the road, with the retirement of the baby boomers, we’re seeing it a lot early.”

Behind the wave of retirements are issues that have become painfully familiar over the past two years: the uncertainty of the pandemic, fear of contracting coronavirus and infecting others, and of course, burnout. But Ralph points to other factors as well, particularly in Florida. “In South Florida, we have become the newest bedroom community of New York City, with all these professionals being able to work from home,” he says. “So we’ve had sharp increases in the cost of housing, and that’s also created a sense of urgency for those nearing retirement to say, ‘this is the time.’ “It just became an opportune time [for retirement], and certainly at a very inopportune time for hospitals and the broader healthcare community.”

And Maria notes that the retirements have resulted not only in a smaller workforce, but also a greener one. “We have lost many of our experienced nurses,” she says. “The talent that we had either left for traveling assignments or retired, and right now what we have at the bedside are nurses that are newer in their career.”

Changing the way we train nurses.

There’s no quick fix for losing a seasoned workforce, but Maria sees an opportunity to rethink the way nurses are trained. Exposing nursing students to patient care earlier in their training could help build a sense of continuity between retiring nurses and recent graduates. “Nursing students could start training while they’re in nursing school to be able to bridge that gap,” she says. “It would provide them more exposure to clinical rotations and patient care than they would get in their traditional program. We need to partner with our universities and colleges to come up with creative ways to bridge that gap, and have nurses be more ready to practice safely when they graduate.”

There’s another potential benefit to that approach, Ralph suggests, beyond simply bolstering the workforce. “Let’s not forget that nursing truly is a calling,” he says. “There is a magic to nursing when you can make a difference in people’s lives. That’s something special, and when you have new nurses coming into an environment, and experiencing that for a first time, it reminds some of the experienced nurses why they came into the profession. It can be an energizing influence.”

A new model for the next generation of nurses.

Changing traditional models for training nurses is no small task, but it may be an essential one. Ralph says that nurses’ expectations and ambitions are evolving, and the way we think about the profession needs to evolve, too. “The [incoming] generation of nurses is very different than the ones that they’re replacing. And we have to look at that desire for greater work-life balance, as well as making sure that our compensation is appropriate.”

Maria agrees that incoming nurses have different motivations, and a better work-life balance is only one of their expectations. “This generation wants advancement and recognition,” she says. “When I started my nursing career, nurses at the bedside were there for 30 and 40 years; that’s no longer the case. The newer generation wants to advance. They want leadership roles, they want advanced practice roles. And we have to get creative and find opportunities for them.”

Nursing motivations are changing.

Maria and Ralph talk more about the need to consider innovative models to help ensure a robust nursing workforce.

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