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NURSING INFORMATICS

Nursing at a Crossroads— Education, Research, Training, and Informatics

Brian Gugerty, DNS, MS, RN

This column will explore and society, the country can be experi- Not being able to accommodate make suggestions about two key encing a worsening chronic nursing nearly 42,000 qualified applicants is a education and training issues affecting shortage with the law of supply and terrible waste of precious resources. nursing and the healthcare industry— demand in play. The market tried to Had nursing academia been able to the nursing shortage as well as its correct the shortage as it did the last handle the surge in demand for major underlying contributor, the nursing that ensued as a nursing faculty shortage, and the result of the dot-com crash and the significant lack of informatics knowl- “The fundamental aftermath of the September 11 edge and skill among the present terrorist attacks, the free market nursing workforce. cause of the nursing would have been able to correct shortage, at this the nursing shortage. The Nursing Shortage The nursing shortage is not news, point, is the nursing Reasons for the Faculty Shortage and the reasons behind it are well The fundamental cause of the known. Nursing is a largely female faculty shortage.” nursing shortage, at this point, is the profession, and for most of the nursing faculty shortage. Two signifi- previous century, the majority of time, in the 1980s, as well as the time cant reasons are at the bottom of the women had two professional before that. Why did it fail this time? faculty shortage. First, the surge in choices—teaching and nursing. In the Adam Smith’s “invisible hand” tried applicants in 2002 last quarter of the 20th century, to move the pendulum back toward a and after followed a steady 12-year womens’ career choice constraints balanced supply of nurses, but the decline in nursing school applications were blown away, to the great benefit pendulum was held back by an even and enrollments. Nursing academia of our society and economy. stronger force—a new, profound simply had been dealing with Many other reasons exist for the nursing faculty shortage. The declining enrollments for too long continuing and chronic nursing American Association of Colleges of and could not respond to the shortage. About 70,000 nurses are Nursing reports U.S. nursing schools unprecedented demand. graduating each year in America, but turned away 41,683 qualified appli- The other and perhaps more even at that rate, the country will cants from baccalaureate and graduate important reason was, and is, need about 1 million more nurses by nursing programs in 2005 because of money—especially as it applies to 2020, about the time the average insufficient numbers of faculty, clinical RNs who pursue the education reader of this column turns 65. sites, classroom space, clinical precep- necessary to achieve RN designation Some wonder how, in a capitalist tors, and budget constraints.1 at the baccalaureate level. The NIH

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budget for nursing research in 2006 200,000 nurses in the , convene a summit to address the was $139 million, about 50 percent of and that deficit will quintuple in less profound lack of training in schools the total of all nursing research funds, than 15 years. of nursing and in the workplaces of with the rest coming from foundations practicing nurses on informatics and other sources. By contrast, the Informatics Competency principles and practices. By the NIH budget for biomedical research in for all Nurses time you read this, the Technology 2006 was about $20 billion. Simple Many suggest competency in using Informatics Guiding Educational math suggests our country annually healthcare IT by nurses is one way Reform (TIGER) Invitational supports 300,000 practicing to gain efficiency to deal with staffing Summit, “Evidence and Informatics with $66,666 in research funding per shortages. However, it appears nurses Transforming Nursing,” will have , while annually supporting aren’t getting needed training. A been held. 3 million practicing nurses with $92 survey released by CDW Healthcare If the country is going to meet in research funding per nurse.3 This President George W. Bush’s call for a is a crucial problem for nursing highly functional and widely used faculty, nurses, and healthcare “…healthcare delivery electronic health record to be avail- delivery organizations. able to all Americans by 2014, the Nursing schools that grant organizations might alarming lack of informatics knowl- baccalaureate and graduate degrees be in danger of falling edge and skill by 54 percent of the count on funding to fuel their healthcare workforce must be research and scholarship missions. As apart for lack of addressed now. a result of chronic under funding, “The summit will yield a vision for nursing research faculties are seriously nursing glue.” transforming nursing practice and constrained in accomplishing what education over the next 10 years to society wants them to do. The success in September 2006 of 559 nurses prepare nurses to practice in an rate for funding nursing research found about 25 percent of respon- increasingly automated, informatics- proposals submitted to the National dents indicated they had not received rich and consumer-driven healthcare Institute for Nursing Research is about IT training in the last year, while 56 environment,” said Diane Skiba, 15 percent, and much of that is percent had received only one to TIGER chair. “This vision will be “repeat business” for a small commu- eight hours of training.2 supported by the active participation nity of researchers. A new nursing Some 55 percent of respondents of leading experts, guidelines for researcher trying to obtain funding said more IT training would have the integrating information technology has a practically insurmountable greatest impact on improving their use into practice and education, and challenge to overcome. of IT. Despite the profound lack of commitments to a three-year local Many potentially promising nursing training in IT, 44 percent said they and global action plan.” faculties do not even choose to go in spend three or more hours per day to academia because they have seen using it on the . Despite the How the HIMSS Community their academic mentors swimming current disparities, 86 percent of Can Help against the current for years. These nurses in the study remained There are ways the healthcare potential faculty members can optimistic regarding the potential for informatics community can impact immediately make the same or more IT to improve care. A survey current nursing education and money in advanced positions in I conducted in 2001 of 50 schools of training issues. healthcare delivery organizations or nursing revealed only 15 percent of The current situation brings to industry, and have more chances for schools of nursing had an informatics mind the quote by Lewis Thomas, a advancement. As a result, it’s difficult course, and most of those courses famous physician, who said in 1978, for nursing schools to attract research were not required. “Nurses are the glue that holds hospi- faculty, and they struggle with funding The findings of these studies did tals together.” Today, Dr. Thomas in general. The nursing faculty not surprise a group of nursing and most likely would expand that to say shortage is the fundamental reason nursing informatics leaders who have nurses hold much of the rest of why there’s a current shortage of been working in 2005 and 2006 to healthcare together as well. Because

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of the worsening nursing shortage, be given to numerous government, be full participants in the electronic which appears to be refractory to insurance, provider, and other health record and the digital age market correction because the supply initiatives in many states that are of healthcare. of nurses is severely impacted by an attempting to address the nursing and Nursing is at a crossroads. We even more profound nursing faculty nursing faculty shortages at local and are all stakeholders, many of us on shortage, healthcare delivery organiza- state levels. HIT professionals can multiple levels, in nursing’s service to tions might be in danger of falling reach out to schools of nursing and society. It behooves us to engage with apart for lack of nursing glue. nursing faculty to provide access to nursing leaders, ask tough questions, This is a serious situation that data researchers could use. HIT and offer our time and talents to a calls for careful study and dialogue professionals should redouble efforts transformation that is within the larger among a wide array of stakeholders. to increase nursing effectiveness and transformation of healthcare that is The industry has essentially two efficiency by providing applications occurring—the transformation of the options—support the profession of that can facilitate care planning, profession of nursing. nursing with a large and rapid nursing documentation, barcode- infusion of funding for nursing assisted administration, About the Author research and education, or, relatively nurse scheduling, and many other Brian Gugerty, DNS, MS, RN, is a quickly, come up with human clinical and administrative duties. clinical informatician in a research and resources and wide-ranging profes- By the time you read this, the innovation group at Siemens Medical sional practice changes to replace preliminary report and perhaps the Solutions, where he models, designs, what nurses have traditionally done. complete report from the TIGER develops, and prototypes advanced If healthcare informatics profes- Summit will be out. Get a copy of nursing and clinical applications. sionals choose to support the nursing the reports, read them and begin to Before coming to Siemens in 2005, Dr. profession, there are many other ways support the many initiatives that will Gugerty was a faculty member at the to help, besides a large and rapid be getting started to help all nurses University of Maryland School of infusion of funding for nursing and nursing students get the Nursing, Nursing Informatics Program. research and education. Support can knowledge and skill they need to

References 1. American Association of Colleges of Nursing (AACN). The Nursing Shortage Fact Sheet. Available at http://www.aacn.nche.edu/Media/Backgrounders/shortagefacts.htm. Accessed on September 1, 2006. 2. CDW Healthcare. As reported in e-week.com. Available at http://www.eweek.com/article2/0,1895,2012751,00.asp. Accessed on September 13, 2006. 3. National Institutes of Health. FY 2006 Budget in Brief. Available at http://www.hhs.gov/budget/06budget/nih.html. Accessed on September 1, 2006.

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