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Volume 3, Issue 12 - February 2001The Nursing Shortage - A Reflection on Underlying Values
Current nursing vacancies and anticipated shortfalls in the number of nurses required in years to come are dominant problems in the health system today. When working in the midst of such challenge, we often do not reflect on the deeper dimensions of the problem or on how such reflection may assist with resolving the crisis over the long term.
I will argue in this article that our conceptualization of, and response to, the "nursing shortage" requires a field of inquiry that questions both the nature and values of nursing and the impact of our treatment of nurses over the last decade. Widgets on a line?In talking with a senior official about the stated mission and values of a major Alberta health region, I asked why the values expressed - such as efficiency, appropriateness and effectiveness - did not include concepts such as compassion. I suggested that people who work in health care, people such as nurses, may be more encouraged and "at home" if their values are expressed by the organizations they work for. The official said that including a statement such as "we will serve patients and clients in a spirit of caring compassion" was not possible because compassion is not measurable. This approach belies the fact that we have relegated our understanding of health care to the business context where things must be measurable, deliverable, and definable. The environment of modern health care is focused on cure over care and technology over touch. Cost pressures in recent years have tended to promote a view of health care service as a commodity that can be defined and delineated like a widget on an assembly line. Chris Ceci nicely captures the resulting concern in the following way: [When the] problem in nursing is conceptualized simply in terms of a shortage - a temporary and seemingly easily addressed issue of mismatched supply and demand - not only do mainly instrumental solutions seem to suggest themselves but there is an element of nurses' distrust that remains unaccounted for, a suffering that may arise not only from the condition of nurses' work but more existentially, from having one's way of understanding the world unacknowledged.1 Such an approach may be at the heart of the nursing shortage because it negates the very essence of nursing care. That is, nursing care is at its core about more than a service offered in any marketplace. Reducing it to the status of a good among many may itself be a reason why we are struggling to secure its supply in sufficient quantities. The Heart of NursingIn Ronald Reagan's autobiography, he speaks of his experience arriving at the hospital shortly after being shot in an assassination attempt. By some stroke of luck, a group of the best physicians in the Washington area were having a conference in the facility and many of them assembled in the emergency room to tend to the President. Yet, the President's recollection of the event is centred not on this skilled technical expertise, but rather on an emergency nurse who held his hand and the profound sense of hope he had due to this simple act of kindness. In the midst of some of the best technology and medical teams available in the world, it was the simple compassionate act of a nurse holding his hand that sustained him through the ordeal. And it is this type of compassionate act that epitomizes the nursing profession. People encounter the health system at times of profound struggle with disease, pain and suffering. Beyond the technically proficient delivery of the tools and technology of the health system, they seek a connection with someone who genuinely cares for them. We want compassionate care when we enter the health system and desire a system that fosters this style of caring. In long term care settings, we hear from residents that they are far more concerned about being cared for in a respectful and dignified manner than whether the technical aspects of their personal care are always right. There is a profound sense that their humanity is preserved and fostered by having someone else care for them, which supercedes their need for basic personal care. Caring suggests being in place; providing meaning and order to one's life; qualifying relationships with the other; and subsuming the characteristic of devotion - a convergence between desire and ought. Caring is used to describe those rare, precious moments of unique encounter when the participants recognize their common base of humanity. To be is to care; care constitutes this being as human.2 Caring, thus, is both central and crucial to the healing experience. It is at the heart of nursing, but it is not confined to nursing. Milton Mayeroff suggests that only through "caring can man be at home in the world." In fostering a culture of caring in hospitals, we enrich the lives of nurses and, perhaps through this enrichment, attract people to this type of vocation. Yet we are moving from seeing the experience in the light of care to seeing it as an economic enterprise. Serving in this environment without genuine caring dehumanizes both nurses and residents. Again, the suggestion is that this dehumanization may have a key place in the human resource challenges that we face in our health system today. Strategic WithdrawalOur society may indeed not be short of men and women who have skills to serve as nurses. Ceci more aptly suggests that nurses have made a "strategic withdrawal" from the workplace because it no longer meets with their values or responds to their concerns. This shift may not be limited to the external work environment. That is, it may also be because nursing itself has moved away from its core of caring. This possibility must also be examined both from within and outside the nursing profession. Concluding ThoughtsTo summarize this line of reasoning: it is important to recognize that nursing is caring - caring is the heart of nursing and care can be a powerful means for healing. As we continue to respond to the challenges presented by the nursing shortage, it is important to consider how the modern health care industry fails to foster or recognize fundamental values at the core of nursing. As we change our thinking and foster caring in our system, though it is not measurable, we will promote environments and experiences that attract and retain those who devote their lives to such worthy ideals. We should not undervalue the benefits of scholarly research in nursing practice or the advanced skill nurses provide in environments of ever increasing technology. However, to get it right we have to reinforce the fundamental human foundation of nursing throughout the system. All of this is borne out in the stories of our loved ones. As a friend who suffered through several bouts of cancer once told me: the occasions of suffering he endured when accompanied by someone who cared for him seemed much less severe than similar incidents that he bore alone. References:1. Ceci, C. (2000) A "quiet" Crisis in Health Care: Developing our Capacity to Hear. (unpublished) 2. Roach, S. (1992) The Human Act of Caring. (Canadian Hospital Association)
Announcements
PHEN Conference 2001
Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.
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Updated February 9, 2012
In Touch
This month we are very pleased
to have as our Guest Writer, Joe MacGillivray, MHSA.
PHEN's
Annual Conference and General Meeting has been scheduled to take
place this year on May 25, 2001 at the Capri Convention Centre in
Red Deer, Alberta. This year's conference will explore justice and
fairness in the health system. What does equality mean? and How does
one decide what is fair? will be the central questions posed to four
prominent North American bioethicists through dramatic presentation,
cross-examination style sessions and interactive workshops. For more
information on the conference, please consult the PHEN website at