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chapter 15 | Nursing Yesterday and Today 253 CikguOnline
worse, two-thirds of the working-age population O’Brien, 2007). Ninety-percent of nurses are still
have a health-care–related financial problem such female, although the number of men is gradually
as unpaid medical bills, being uninsured, or being increasing (Dougherty, 2008). Concerns about the
underinsured. A survey of over 26,000 Americans, supply of RNs and staffing shortages persist in
half of whom belonged to a union, found that 1 in both the United States and Canada.
3 had decided to do without care because of the The related issues of excessive workload, manda-
cost. Half had stayed in a job just to keep their tory overtime, scheduling, abuse, workplace vio-
health-care benefits. More than half reported that lence, and lack of professional autonomy contribute
their health-care insurance did not cover the care to these concerns (Villeneuve & MacDonald,
they needed at a price they could afford (Currie, 2006). On the bright side, there are also some indi-
2008b). More detail about the survey can be found cations of increasing interest in a nursing career as
at www.healthcaresurvey.aflcio.org salaries improve and job opportunities expand.
The quality of the care provided is a second major Safe staffing, defined as the appropriate number
concern. A 1999 report issued by the Institute of and mix of nursing staff, is a critical issue for nurs-
Medicine estimated that 100,000 deaths in hospitals es and the people who need their care. A series of
every year were due to errors that could have been research studies has demonstrated the importance
prevented (ANA, 2008a). Hospital-acquired drug- of adequate nurse staffing. There is powerful evi-
resistant infections have become a major problem, dence that nurses save lives: there is a 7% increase
having increased a hundredfold over the last 10 years in the likelihood of a patient dying within 30 days
or so. In 1993 there were 3000 hospital discharges of admission for each additional patient assigned to
that included a diagnosis of drug-resistant microor- a nurse (Aiken et al., 2002; Potter & Mueller,
ganism. In 2005 there were 394,000 of these 2007). Nurses cannot gain in-depth understanding
discharges (Currie, 2008a). of their patients, protect their patients, or catch
Additional concerns include fragmented, early warning signs of trouble if they are over-
impersonal care; failure to consider the whole per- whelmed by the number of patients for whom they
son when treating a problem; and continuation of are responsible. Adequate numbers of nurses affect
disease focus rather than prevention focus. patient mortality, length of stay, urinary tract infec-
Furthermore, the United States face what Buchan tions, fall rates, incidence of hospital-acquired
called a “demographic double whammy” of an pneumonia, and more. For further information, see
aging population that will need more health care www.safestaffingsaveslives.org
and, at the same time, an aging workforce
(Hewison & Wildman, 2008). Health Care in the Future
In Canada, a debate over privatization versus
Ideally, a new model of health care is needed that
public funding of health care continues (Villeneuve
offers the following:
& MacDonald, 2006). Health care is still illness-
and disease-focused as in the United States. ■ Holistic, person-centered care
Although there is interest in complementary and ■ Seamless connections across community, acute-
alternative treatments, they have not been integrat- care, and long-term care settings (Pogue, 2007)
ed into general care. Disparities in care of members ■ Elimination of health disparities
of minority groups threaten to increase if not ■ Guaranteed accessible, affordable care for
addressed more effectively. everyone (ANA, 2008b)
Global interconnectedness has brought new con- ■ Safe care that heals and does not harm the
cerns about how quickly and easily infectious diseases patient
can cross national borders. HIV, severe acute respira- ■ Equal support for prevention, health promotion,
tory syndrome, and the annual waves of influenza and mental health care
that cross the globe are just a few reminders. ■ Healthy environment from green buildings
(Trossman, 2007) to the elimination of air,
Nursing Today water, soil, and other forms of pollution
Issues specific to nursing reflect the problems and ■ Acknowledgement and addressing of global
concerns of the system as a whole. The average health concerns: global warming, hunger, poverty,
bedside RN is in her middle to late 40s (Lillis & and disease at home and in developing countries