BECAUSE this is a government town, a genuine shortage of nurses willing to work in hospitals in some parts of the country has been translated into a debate over federal funding for nurse-training programs and the overall supply of nurses. In reality, the reasons that hospitals can't find the nurses they need are much more closely related to professional status, pay and working conditions than to the number of nursing graduates. Although there is some technical dispute, most agree that the number of nurses graduating from school is not the problem. The problem is that for many years nurses have been the enlisted troops of the medical profession, keeping hospitals going while physicians came and went. Head nurses run hospitals much as seargeants in a sense run the army. And, as is the case with the armed services, hospitals are discovering that retaining their skilled "non-commissioned" personnel is very difficult. Other jobs with higher pay, easier hours and more community respect lure them out of the field.
The work of a hospital nurse is less attractive than it might have been in years past. This is in part because of the opening of other career opportunities to women. Most nurses are women who have not caught up with changes in the job market, and who still see nursing as one of their few available career opportunities. When they discover other possibilities, a number can be expected to go off to do what suits them better. Those who do stay in the field tend to be more outspoken in their desire to be treated seriously than was the case several decades ago. So there is either high turnover at hospitals or some rearranging of the way jobs are done. Shortages of hospital nurses around the country tend to occur in areas where the cost of living is high or the hospital system is rigid, old-fashioned and hierarchical in the extreme. These rigidities don't produce only physician-nurse tensions; interestingly, one major source of discontent among nurses is the autocratic behavior of the head nurse to whom they report.
Some changes are being tried.For example, in hospitals where a single nurse is given responsibility for organizing the care of each patient, turnover rates for nurses have gone down and both patients and staff have been more satisfied with the proceedings.
Nurses themselves have organized to solve the problems in their field, with two groups going in two different directions. The senior, college-trained or graduate-school leaders of the nursing associations are working to increase professional standing for nurses: to set higher academic stardards, to control entry into the profession, to require that nursing students be taught only by nursing educators, and so on. Many of the staff-level, non-college-trained nurses feel that they will be excluded if the academic standards are raised, and are moving toward trade unionism and direct demands for better working conditions.
Both groups are at work in Washington, and are in competition to be seen as the more effective representative for rank-and-file nurses. This competition directs even more heat into the debate over funds for nurse training, because that is the area in which there is a federal program, even though the federal effort in this area is largely removed from the changes needed to fix shortages around the country. Politicians are suckers for flattery, and they have been flattered into thinking that the federal government can and should play a major role in eliminating the problems in the field of nursing. It is not true.