New UAN poll offers solutions to the staffing crisis

Show bedside nurses the money: New UAN poll offers solutions to the staffing crisis

Martin, Suzanne


The media has cited possible solutions to the nursing shortage in studies conducted by health care groups ranging from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to the American Hospital Association (AHA), but nurses’ own solutions have received far less attention. Results of a new survey, Nurses’ Solution to the Nurse Shortage, released in January by the United American Nurses MAN), AFL-CIO, the labor arm of the American Nurses Association, sheds light on what staff nurses, who deliver direct care at the bedside, see as the most effective ways of putting a dent in the shortage.

Of the 600 hospital staff nurses polled nationwide in November 2002 for the UAN survey, 82% indicated that increased wages would be an effective solution to the nurse staffing shortage. A reduced nurse-to-patient ratio was also a highly rated solution (85%), as were greater autonomy and control for staff nurses (66%) and safer working conditions (65%).

Few dispute that the shortage is a problem. The AHA reports that there are 126,000 RN positions currently unfilled, and government experts estimate there will be a deficit of between 800,000 to I million bedside nurses by 2020. Of respondents to the UAN survey, eight out of 10 said that there is already a serious shortage at their hospitals, and three out of 10 answered that it is unlikely that they will continue to be hospital staff nurses in five years. The survey cited the top three reasons nurses leave the profession: work-related stress, patient load, and inadequate pay.

Perhaps the most surprising result in the survey was the emphasis respondents placed on increased wages. In a profession that historically has emphasized dedication to patients above the nurse’s personal well-being, salary has often been of low priority.

That is changing, however, as some unionized nurses have negotiated double-digit pay increases at the bargaining table and base pay rates in the low $60,000 range in high cost-of– living areas such as New York City. In most cases, these wage boosts came after years of little or no pay increases and in some were won only after lengthy strikes that enabled nurses to demonstrate dangerous staffing practices, poor working conditions, and inadequate compensation.

Overall, nurses responding to the UAN survey suggested that salary is clearly a consideration when they evaluate whether to stay in the profession. Six out of 10 said they earn less than $46,000 a year, and 55% with more than 10 years of experience earn less than that amount. Some two– thirds of those polled felt that they make less money than the demands their jobs warrant, and of those, a third believed their appropriate yearly salary is in the range of $70,000 or more.

“No one is suggesting that nurses throw aside concern for patients as a motivating factor in what we do,” said UAN chairperson Cheryl Johnson, RN, a nurse at the University of Michigan Medical Center in Ann Arbor. “But the cold reality is that we must make bedside nursing an attractive career choice-including offering pay that stacks up against other jobs-or more young people will opt not to become staff nurses and those already in bedside nursing will leave. And 10 years from now we’ll still be here wringing our hands over how to recruit and retain nurses.”

According to the National Sample Survey of Registered Nurses, staff nurses in March 2000 earned an average annual salary of $42,133.40. Nurses rank 115th among the 292 major occupational groups in the Bureau of Labor Statistics National Compensation Survey, behind such jobs as sheet-metal duct installers, tile setters, editors and reporters, and funeral directors. Elementary and secondary school teachers earn more, too.

“While all these and many other jobs with higher pay are important and far reaching, nothing equates with the critical impact staff nurses have on patient outcomes,” said UAN director Susan Bianchi-Sand.

Since 1996 pay for hospital staff nurses has increased only 2.2% per year, according to a February 2002 U.S. Department of Health and Human Services Bureau of Health Professions Report. By most accounts, this increase fails to even keep pace with the cost of living. Staff nurse pay increases also lagged behind that of other RNs, with higher increases going to RN administrators (3.7%), instructors (3.7%), and supervisors-head nurses (3.3%).

Last year a JCAHO report, Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis, identified “a fair and competitive compensation and benefits packages for nursing staff” as a key solution to staffing shortage and called on hospitals to implement this tactic. But the JCAHO report also stated, “Hospitals have few incentives to invest in nursing staff, and to improve patient safety and health quality … They [nurses] are paid the same whether… their medical-surgical nurse-to-patient ratios are 1:4 or 1:10.” Opponents to increasing RN salaries have been quick to latch on to this reasoning and say that hospitals are paying nurses as much as they can, and that higher nursing costs will likely be passed on to patients.

For Bianchi-Sand, the balance sheet belies those arguments: “When I pick up a paper and read that the CEO [Harvey Holzberg] of Robert Wood Johnson University Hospital [in New Brunswick, New Jersey,] made $2.15 million in his 2001 compensation package, it’s hard to fathom how anyone could suggest that paying a staff nurse– who will be at your bedside and providing critical care for you when you’re a patient-isn’t worth at least $70,000 a year.” Holzberg’s $2.15 million package included $1.2 million in salary and bonuses and $925,199 in deferred compensation and other benefits, reported the January 12, 2003, issue of the Home News Tribune.

Johnson agrees. “We know that when staffing isn’t at safe levels, our patients are at risk and they’re not getting full value for their money. In this [UAN] poll, nurses have given us their professional assessment that the nursing shortage is the biggest problem in hospitals today. More to the point, they’ve told us what it will take to cure it. Now, as nurses we’ve got to work collectively with hospitals to implement these solutions and ensure that there are enough bedside nurses to give patients the care they need in the future.”

To read the full results of the UAN staff RN poll, go to

Suzanne Martin is associate director of communications, United American Nurses, AFL-CIO, the labor arm of the American Nurses Association.

Copyright Nevada Nurses Association Aug 2003

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