Cries of Crisis: Rethinking the Health Care Debate

4. The Nurse Staffing Crisis

84 C O N T E M P O R A R Y D I S C U S S I O N S of the nursing shortage bear an uncanny resemblance to earlier warnings of a nurse staffing crisis over the past half century. American hospitals faced similar nurse staffing shortfalls on several occasions since the 1940s. Hospital administrators, nurses, and public officials framed each nursing shortage using cries of crisis. Although some observers argue that the contemporary nursing shortage is fundamentally different from those in the past, the way Americans talk about the supply of nurses has changed little over the past five decades.1 As a political symbol, the nursing crisis plays on public anxieties. Illness is a stressful time for most individuals and their families. Crisis talk targeted the fears of vulnerable patients and families who worried that care would not be available when they were sick or unable to care for themselves. Each time the nursing labor market tightened, reformers employed stories of decline to build support for recruiting nurses by citing worrisome trends, making dire predictions, and highlighting the plight of visible victims whose care was compromised by the nursing shortage. The common element in these stories—and, indeed, the connective tissue in narratives of crisis—was fear. Crisis narratives portrayed each emerging shortage as a matter of life or death, warning that sick patients might not receive lifesaving care in their most desperate hour. Each time the nursing shortage in American hospitals became acute, talk of an emerging crisis reinforced the notion that the health care system had reached a “tipping point.” Reformers painted a bleak picture of the future unless dramatic steps were taken. In recent years, advocates for The impending crisis in nurse staffing has the potential to impact the very health and security of our society. —Joint Commission on Accreditation of Healthcare Organizations, Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis There has been a shortage of nurses for years, but now the situation has reached critical condition. —Wyatt Andrews, “Nursing Shortage May Be Putting Lives at Risk,” CbS Evening News, May 24, 2006 c h a p t e r f o u r the Nurse Staffing crisis t h e N u r S e S t a f f i N g c r i S i S 85 reform described the nursing shortage as “a ‘perfect storm’ brewing. We have aging nurses and aging nursing faculties. We have fewer people choosing to come into nursing . . . and we have millions of baby-boomers whose health needs will grow exponentially.”2 In this story, nurses were innocent victims of circumstances beyond their control. Heart-wrenching profiles of nurses in newspapers, nightly news programs, and periodic “special reports” on television all reported different variations of the same crisis story: too few nurses caring for too many patients. More than 750 nursing strikes have been recorded in recent decades, making nursing among the most strike-prone professions in the United States. In the spring of 2010, more than twelve thousand nurses in Minneapolis– St. Paul staged a one-day strike—the largest nursing walkout in US history— to protest staffing levels in Minnesota hospitals. Carrying signs demanding “Safe Staffing Now” nurses described understaffed hospitals as a threat to the quality of care for all patients. Although hospital administrators dismissed such claims and argued that nurses’ demands were both unaffordable and unnecessary, striking nurses maintained that their actions were designed to protect the public from unsafe care. As one union leader declared, “They’ve had enough. It’s time to say that we’re going to do what we have to do to protect our patients.” After a tense standoff that lasted for weeks, the Minnesota Nurses Association agreed to a new contract that provided modest wage increases and preserved existing health and retirement benefits, but abandoned its call for mandatory nurse-staffing ratios.3 Public deliberation about nurse staffing illustrates Wittgenstein’s notion that “we are misled by the imagery embedded in our language.” Repeated warnings of a nursing crisis failed to resonate with the public, for during each shortage the overwhelming majority of Americans continued to receive high-quality care, and few patients were denied treatment or turned away because of a lack of nurses. To address the ongoing and recurring shortage of nurses in an aging society, reformers must first cut through the conceptual clutter used in public debates about nurse staffing. To do...