move into nurse education or manage-
ment, Holtschneider felt she needed to
spend time at the bedside. "I wanted
to see what the war was like," she said,
so she went to work immediately after
graduation as a staff nurse in the N.C.
Jaycee Burn Center at UNC Hospitals,
later moving into the cardiothoracic
intensive care unit at Duke. "I thought
I'd have the time and the energy to be
with patients, to ease the process of
getting in and out of the hospital. But
it was hard." A job opportunity in
education opened up at Duke, and she
made the switch.
Longer hours and shift work are
prompting younger nurses to research
their options. Those trained 20 years ago
were more willing to make personal
sacrifices for professional achievement,
Cronenwett said. "But today," she
added, "younger nurses don't have the
same expectations as I did. They won't
make that sacrifice, and the older nurses
are finding they [physically] can't."
"It's harder to keep nurses at the
bedside," says Caldwell, who began her
nursing career 20 years ago at the same
hospital she now helps run."Other jobs
are Monday to Friday, 8-5."
Also, says Caldwell, "the increased
body ofknowledge nurses have to
have is much more demanding today
that sometimes it's overwhelming."
'A million ways' to help
To respond to the changing work
environment, the School of Nursing -
ranked sixth among the nation's grad-
uate schools by
in 1998 and ninth among all
schools ofnursing with undergraduate
progran1s - has implemented an
internship program with nursing col-
leagues in the UNC Health System.
BSN students work with a nurse on
staffat the hospital to receive first-hand
experience with the organizational
problems associated with providing
care to many patients at a time.
Many Families Won't Leave
Linda Cronenwett, dean of UNC's School of Nursing, learned last summer that the nation would be facing
another nursing shortage by this spring, and ever since she has
been working to inform both nurses and the public about it.
While the subject has been in the medical media for some
and the ABC News program
publicized the shortage in November, discussion of the nursing
shortage in the mass media was almost nonexistent. Since
then, doctors in North Carolina have made public their
concern. In January, Rex Healthcare physicians appealed for
a suspension in elective surgeries during a peak weekend of
the flu season. They said they had been concerned about a
nursing shortage for a year.
"I attended a national meeting of nurse executives last
June:' Cronenwett said."All participants admitted they could
not speak out about their fears related to RN staffing. They
were expected, as leaders of their health systems, to reassure
the public about the safety of their patient care operations.
Yet, in any given week, nurse executives and staff nurses know
that somewhere in their institutions or agencies, there are
situations where nurses will call in sick and a replacement can't
be found or the extra staff are not available anymore. The
nurses on duty do their best but often feel incredibly stressed.
"In many of
the patients are,
in fact, safe,
either by luck
or the heroic
efforts of avail-
able staff," she
providers often Linda Cronenwett
extend themselves beyond expectations in order to assure
"I have heard nurses tell patients or family members that,
'Oh yes, I had lunch earlier: rather than admit that the families
were correct to suspect that no one was getting a break.
"Furthermore, until recently, we had no hard evidence
that quality of care was associated with RN staffing levels.
Now, that evidence is accumulating. In the beginnings of the
RN layoff period [1993-94], we started seeing parents
insisting on spending the night with their children. Now,
many families prepare 'around-the-clock' coverage during
their loved one's hospitalizations."
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