Letter to the Editor by Ingram, Wilcox, Rose on "The American Health Care System at a Crossroads..."

The Endangered Health System: A Progress Report on Workforce and Work Environment Issues

May 11, 2005

in response to The American Health Care System at a Crossroads: An Overview of the American Organization of Nurse Executives Monograph
with reply by the author

Dear Editor:

We write in response to Dr. Reid Ponte's very informative and inspiring article, "The American Health Care System at a Crossroads," which addresses nursing shortages and describes what nurses individually can do to promote recruitment and retention in their own facilities. It is hard to believe that more than 60% of the RN workforce is over 40 years in age and not far from retirement, and that the percent of RNs under age 30 has decreased by 40% since 1980. We offer several suggestions for alleviating nursing shortages. Specifically we propose first that nurses provide a better environment for new RNs; secondly, that facilities reward nurses who mentor new nurses; and thirdly, that we work to inspire nurses to focus on health promotion.

Improving the work environment to retain more nurses starts at the unit level with better communication between all personnel. It is important that unit managers and nurses get together to find ways to create the coherent environment Dr. Reid Ponte describes. Managers need to hear what their staff members think or feel is important to them. It is also important that managers meet with staff nurses at least monthly, and in these meetings discuss matters important to the nurses, rather than matters dealing only with various procedures. We recommend that upper management attend these staff meetings, perhaps, once every six months. Improving communication between staff nurses and middle managers can help units to become more pleasant places in which to work, thus motivating nurses to remain as employees on the unit.

Secondly, the mentoring programs we have been involved with are not working very well; they need resuscitation. New nurses share the horror stories of situations they encounter when they first became a nurse. This increased stress can contribute to unpleasant and unsafe working conditions. Seasoned nurses believe that they do not get enough credit for the knowledge they have and share with orientees. Because mentoring requires hard work and commitment, we recommend extra compensation for this work of mentoring. Two benefits of improving mentoring programs are a more productive environment and improved job satisfaction for both parties. Mentoring needs to be a win-win situation with the new RNs encountering a healthier learning environment and the seasoned nurses' work being rewarded for its valuable contributions to the organization and the profession.

Thirdly, we need to inspire more nurses to teach patients and families health promotion behaviors. Attention to health promotion may, in turn, alleviate some of the burden that appears at times to fall solely on the already overworked nurse. Frequent and costly hospital admissions can be prevented when patients take steps to prevent injury and disease, thus decreasing the need for nursing care.

Thank you Dr. Reid Ponte for your time and your continued effort to the improvement of the well being of nurses.


Sheryl Ingram, RN
Student, BSN Program - Clarion University of Pennsylvania
Staff Nurse at Jefferson Regional Medical Center
Pittsburgh, PA

Jennifer Wilcox, RN
Student, BSN Program - Clarion University of Pennsylvania
Staff Nurse at Jefferson Regional Medical Center
Pittsburgh, PA

Pamela Rose, RN
Student, BSN Program - Clarion University of Pennsylvania
Staff Nurse at The Western Pennsylvania Hospital
Pittsburgh, PA