Nursing's Identity Crisis

"Where Have All the Nurses Gone?" by Ronald W. Dworkin, in _The Public Interest_ (Summer 2002), 1112 16th St., N.W., Ste. 140, Washington, D.C. 20036; "Diagnosis: Shortage" by Carrie Conaway, in Regional Review (2001: 3rd quarter), Federal Reserve Bank of Boston, P.O. Box 2076, Boston, Mass. 02106–2076.

The nation’s registered nurses have been increasing in number every year but not fast enough to keep up with demand. Hospitals, which employ more than half of the nation’s 2.7 million RNs, have 11 percent of their positions vacant. Nursing homes, visiting nurse associations, and other employers of RNs are also hard-pressed.

What accounts for the nurse shortage? "The culprits," writes Conaway, an associate editor at the Federal Reserve Bank of Boston’s Regional Review, "are both long-term trends, such as expanded opportunities for working women and the aging of the population, and new factors like the effects of the cost-cutting imperatives of managed care." Dworkin, an anesthesiologist at the Greater Baltimore Medical Center, acknowledges that there is "some truth" in such explanations, but finds more in the frustrations nurses now face because their profession has been "swept up in a cultural avalanche."

From the time of Florence Nightingale, he argues, nursing "stood on two pillars"—feminine virtue (compassion and empathy) and medical science. But starting in the late 1970s, progressives, particularly feminists, sought to rid the nursing ideal of virtue and base it instead solely on its own distinct body of scientific knowledge. In truth, contends Dworkin, nursing has no such independent body of knowledge. "Nurses are taught the same material as physicians, only less of it. When nursing tries to distinguish itself on the basis of scientific knowledge alone, nursing loses status among doctors and paraprofessionals." And "bright young people," he claims, now "see a nursing career as relatively undistinguished." (Be that as it may, Conaway notes that nursing schools had to turn away 5,000 qualified applicants last year because of insufficient faculty and facilities.)

The change in the professional ideal of nursing also has meant frustration for husband-hunting nurses, Dworkin observes, as male doctors have come to pair off instead with female MDs. And nursing’s traditional appeal as a part-time job has meant little to the many single mothers in need of the income from a full-time job, who must work nights and weekends for that income. For various reasons, Dworkin says, nursing has become more difficult than ever, with "long hours, inadequate resources, demanding patients, and mediocre pay." The frequent result is "burnout," he asserts. Many frustrated, emotionally exhausted nurses quit.

One answer to the nurse shortage might be to offer nurses better pay. But, says Dworkin, "tight health-care budgets prevent" hospitals from doing that. Conaway, however, reports a little progress along that line: "RN wages are starting to escalate after years of stagnation." Average inflation-adjusted weekly wages for full-time RNs, she notes, declined from $819 in 1993 to $762 in 1997, but then climbed to $790 in 2000.