The Nursing Shortage and RN Salaries

Dana Norris, RN

Topics in Advanced Practice Nursing eJournal. 2003;3(2) 


Dear Editor:

I have a comment about the article I just read, "The Nursing Shortage: A Call to Action."[1] The current and future nursing shortage can be summed up in one word -- money. Registered nurses (RNs) are grossly underpaid. The article cited "staffing" as nurses' primary complaint for leaving (or possibly not entering) the nursing field. Insufficient staffing is directly related to money.

When the budget gets tight, nurses are often the first people to go, and they are replaced with nonprofessional "nurse-extenders" who cannot work independently and who are not trained/educated enough to make adequate patient assessments, from the most basic situation to the most life-threatening. That is precisely why the morbidity and mortality rate of hospitalized patients is dramatically increasing. Without the constant, watchful eye of an RN, patients are left to be cared for by nurse-extenders, and the opportunity to intervene quickly when a patient's condition changes is lost.

RNs who are charged only to pass medications, assist with procedures, change sterile dressings, chart, take orders, and supervise a large nurse-extender staff are not physically present with a patient often enough to intervene or prevent a problem when it arises. What has become completely lost, especially in a hospital environment, is the time and opportunity to teach patients and family about their disease, how to care for a patient postdischarge, how to take medication correctly, how to use community services, and when to call a physician after a patient goes home.

RNs now must absorb the liability and legal ramifications of care rendered by nurse-extenders, as required under their licensure. RNs must now take the hit for care they did not give, decisions they did not make, and scenarios they were not involved in. This does not generally happen with physicians.

The grossly underpaid RN is now refusing to endanger her career, herself, or her family for the income she receives. In other words, it's just not worth it. The lousy hours, the understaffing, and the pressure on RNs to be all things to all people at all times does not pay enough. We have just completed Nurses' Week, where many institutions tried their best to thank us for our heroic efforts and their acknowledgment of our influence to patient safety and health. While all of that is much appreciated, it does not address income.

For the job we are required to do, with all of its liabilities, we must be compensated accordingly. If you compare the average RN salary to other community providers (plumbers, landscapers, garbage men, electricians, city workers, government employees, etc.), you would be sickened by the salary discrepancy. In order to attract more students into the nursing field, they must be satisfied that their educational efforts will be well rewarded.

I am constantly surprised that most nurses will not address salary as the main reason we will not stay in this profession and will not recommend it to anyone, even our children. I admit that caring for the lives of human beings and trying to put a price tag on this care is foreign to most nurses who truly want to make a difference in healthcare. However, every other profession I can think of does not work for free, and will demand adequate payment for services rendered. (Try negotiating with your auto repairman!)

The majority of nurses are women, and we must stop absorbing more and more financial abuse to try to provide the highest quality of patient care. I would love to see an article written about "Salary Vs the Nursing Shortage". I suggest we stop trying to focus on "how rewarding nursing is" and get to the brass tacks of making a living.

For the record, I am an RN with a BS, and I also hold a Certified Case Manager designation. I have been a nurse for 25 years. I bailed out of the hospital staff nursing routine after 8 years in the 1980s. I now work for a Physicians' Corporation as a Medical Resource Manager and Claims Analyst. I was a very good and highly skilled staff nurse on a specialized unit. It was a shame to lose me. I thoroughly enjoy my work, and more and more nurses like me are leaving the trenches for all of the reasons cited above. I know I am not alone in my comments. Perhaps other nurses would agree with me.

Dana Norris, RN
Rochester, Michigan


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