The nationwide nursing shortage continues to be regarded as a peculiar mystery for which solutions are difficult and elusive. But the mystery is actually quite thin and the answer glaringly apparent: Pay nurses what they're worth, rather than the miserly wages that prevail in their vital work.
Does that sound too simple? If so, for illumination, compare two very different professions--law and nursing.
In reality, there is no shortage of trained nurses. The shortage is of nurses willing to work as nurses. According to the latest government figures, there are about 1.9 million registered nurses in the United States, but only 1.5 million are employed in nursing. The shortfall, estimated at several hundred thousand, can be seen in solid pages of help-wanted ads for nurses in virtually every community.
The situation is bound to get worse. With the aging of the population and the growing complexity of medical technology, nursing needs are on the upswing, even though hospital usage has been reduced by tighter payment rules. But enrollments in nursing schools are slumping, to the point where several major schools have shut down, and others face that prospect. In 1984 nursing schools produced 80,312 graduates. On the basis of present enrollments, the 1990 graduating class will drop to 66,800.
In contrast, despite the scorn that's routinely showered on the legal profession, it is awash with career professionals and eager recruits. According to the American Bar Assn., of 715,000 law graduates in the United States, a mere 40,000 are not working as lawyers. Law school enrollments, steady at around 118,000 since 1983, suddenly soared last year by 17%. Yale received 4,000 applications for 175 openings.
What accounts for the heavy traffic into law and the thinning flow into nursing, followed by heavy exits?
Nursing is often dirty and depressing. The hours are difficult. Traditionally a women's profession, nursing must now compete against expanded job opportunities for women. And today's young people gag on the subordinate place of nursing in the hierarchy of doctor-dominated health care.
These factors are all present and relevant. But so is something else. Nursing, in return for hard, useful work, pays its recruits a pittance, and offers very little more for experience on the job. Law, in return for what many of its practitioners come to regard as mind-numbing drudgery, pays its recruits handsomely, and the future is boundless for successful careerists.
Starting pay in nursing averaged $20,340 last year, according to the American Nurses Assn. The average maximum for nurses was $27,774. Starting pay in law averaged $33,000, according to the American Bar Assn. Starting salaries of $70,000 a year are not unusual at top law firms. And to give promising law students a sniff of the future, summer jobs at $1,000 a week are offered by many major firms.
Not surprisingly, in our consumption-driven culture, bright youngsters flock to dull law work that pays mere students double the salary of veteran nurses.
The health industry, persisting with its hand-wringing over the nursing shortage, prefers to focus on the problems of the working environment, rather than the outrageously inadequate pay.
Indeed, the working conditions of nurses are often unavoidably difficult. But 80 hours a week of picayune research in a stressful law office has its own kind of unpleasantness. The difference is in current material rewards and long-term potential.
One of the nation's bountiful health foundations could test this proposition with a few simple, limited experiments, such as $1,000-a-week summer jobs for nursing students and starting salaries of $70,000 for nursing recruits at top hospitals. As if by magic, the shortage would disappear.
It will be argued that the strained finances of health care cannot afford attractive salaries for nurses. The answer is that health care will have to do without or rearrange its spending priorities.
Nurses respond to many demands, but there's no reason to expect them to subsidize the health industry.