Nursing Faculty Development in America: A Determinant of Health Outcomes Domestically and Globally

USPHS Scientific and Training Symposium San Diego, CA  Barbara A. Anderson, DrPH, CNM, FACNM, FAAN  Director, Doctorate in Nursing Practice  Frontier School of Midwifery and Family Nursing  May 27, 2010

The Global Health Agenda: Millennium Development Goals  Eradicate extreme poverty and hunger  Achieve universal primary education  Promote gender equity and empower women  Reduce child mortality  Improve maternal health  Combat HV/AIDS, malaria, tuberculosis  Ensure environmental sustainability  Develop global partnerships for development

The Global Nursing Shortage: A Determinant of Global Health  “We are seeing serious adverse impacts on the health and well-being of both developed and low-income countries due to the nursing shortage. “ ICN, 2006

The Global Nursing Shortage: A Determinant of Global Health  Global deficit-4 million health care professionals in 57 nations  87% of the workforce are nurses  Biggest impact in Sub-Saharan Africa 11% of world’s population 24% of the global burden of disease 3% of the world’s health care professionals International Council of Nurses, 2006; Lancet 2006; New England Journal of Medicine 2003

The American Nursing Shortage:  126,000 current vacant nursing positions  400,000 by 2016  1,000,000 by 2020, (25% of the nursing workforce in America)  Short term effect of retention of older nurses in the current economic slump  ( 1) Hinshaw, 2008, p.4  Also Chaguturu & Vallabhaneni, 2003; Kuehn, B. 2007; Spacracio, 2003).

The American Nursing Shortage  Inadequate staffing  High acuity/adverse outcomes  Poor job retention/burnout  Aging—the U.S. population, the nursing workforce  AACN, Ensuring access, 2008; Aiken, et al, 2002, Buerhaus, et al, 2007, Gibson and Singh, 2003; Hinshaw, 2008, IOM, 2001; Page, 2004; The Joint Commission, 2008

The American Nursing Shortage Gone missing The Students The Faculty

But we have too many student applications!!!!  150,000 qualified applicants denied admission-all program levels (AY 2005)  40,285 qualified applicants were denied admission to baccalaureate and graduate level programs (AY 2007)  “Education abroad”-American students seek basic nursing education in low income nations  AACN, Nursing faculty shortage, 2008; Dugger, 2006; ICN, 2006: Yordy, 2006

The American Faculty Shortage  Not enough nursing educators  Too many qualified students applicants for available spots  Limited inpatient clinical teaching facilities  Need to develop community-based teaching facilities

Gone missing--the Faculty  Low salaries compared to clinicians  Age-delayed trajectory for higher education entry into nursing education  Few young nurses in educative roles  Retirement of nursing educators  AACN, Nursing faculty shortage fact sheet, 2008; AACN, Addressing the nursing shortage, 2008; Aiken, 2007; Allen, 2008 American Academy of Nursing, 2006; International Council of Nurses, 2006; Kuehn, 2008; Ross, Polsky, & Sochalski, 2003; The Joint Commission, 2008; Yordy, 2006

The Linkage to Global Health- Nursing Migration:  The poor subsidize the rich—in the case of nursing education, $500 million dollars annually from Africa alone. United Nations, 2006

The Linkage to Global Health: Nursing Migration:  Result: Stagnation and Collapse of Health Care Delivery Systems and Public Health Programs  Aiken, 2007; Anderson & Isaacs, 2007; Buchan, 2006; Clark, Stewart, & Clark; Dugger, 2006; ICN, 2006; Kamal-Yanni, 2006.

Playing Catch-Up: Voices from the Third World  “The biggest challenge to nursing care is the inadequacy of staff. Guyana and other Caribbean countries continue to be feeders to the nursing services to the North of us. We have just embarked on an effort to double the output of nurses.”  Dr. Rudolph Cummings, Chief Medical Officer, Guyana Ministry of Health, August 2, 2006 in Anderson & Issacs, 2007.

The Workforce Shortage: The Ethical Question What are the ethics of “outsourcing” nursing education to poor nations, i.e. expecting poor nations to educate excess numbers of nurses to compensate for migration, driving them to finance large, unreimbursed pre-service education budgets, while qualified nursing applicants in the U.S. are rejected?

Global Linkages: Effects of Migration *Cash flow to individual families *Information sharing across nations *Erosion and closure of health care systems in poor nations “The nursing workforce is the most in-demand health care resource across the globe.” Joint Commission, 2008 p. 29

The Workforce Shortage Premise #1 When rogue nations or failed states have neglected to protect their citizens and have abandoned nation building, individual citizens may serve their nation better by leaving areas of insecurity, conflict and oppression.

The Workforce Shortage Premise #2 Every nation has the responsibility to build and plan for the future of its people.

Response to Premise #2: Voices from the Third World “Unless we have remuneration and other services which give them a comfortable livelihood in the countries of their births, we are going to have this problem of migration.” Dr. Rudolph Cummings, Chief Medical Officer, Guyana Ministry of Health in Anderson & Isaacs, 2007

Response to Premise #2: WHO Plan:Workforce Sustainability  Preparation National capacity for and quality of education  Maintenance Supervision and support systems Adequate compensation and continuous learning  Attrition Managed migration Workplace security  WHO, Why the workforce is important, 2006.

The Workforce Shortage Premise #3 Citizens have a responsibility to contribute to the development of their nation and the protection of their people.

Response to Premise #3: Voices from the Third World “The nurses and midwives could give at least 5 years… Remember these people in Guyana are ours.” Sister Charan, Guyana Public Health Hospital Corporation in Anderson & Isaacs, 2007

Response to Premise #3: Voices from the Third World  “Once we are satisfied with our jobs, we will stay in our country, we will not run for we just love this beautiful place, Guyana.”  Nurse-midwife Eunice Smith, Georgetown Primary Health Care Clinic in Anderson and Isaacs, 2007.

The Workforce Shortage Premise #4 Human resources are a treasure for the nation and all nations should respect the integrity of other nations to retain adequate human resources for the development and sustainability of their countries.

Response to Premise #4: Voices from the Third World “The Filipino people will suffer because the U.S. will get all our trained nurses.But what can we do?” George Cordero, President, Philippine Nurses Association Dugger, 2006, p 1.

The Workforce Shortage Premise #5 National planning should not be held hostage by unfair advantage or lack of planning by other nations. Justice demands that collaboration, capacity building, and planned migration are necessary in order to avoid structural violence against less economically powerful countries.

Response to Premise #5: Voices from the Third World “There is no one to carry on. The nurses and midwives are simply not there. They have retired or migrated.” Grace Bond, Chief Nursing Officer, Guyana Ministry of Health, Georgetown, Guyana, 2006 in Anderson & Issacs, 2007.

American Faculty Shortage— Who is at Risk???  Health care facilities and staff  Public health programs  The American people  American universities,students,nursing faculty  Ministries of Health in low income nations  Migrating nurses  The peoples of low income nations

Directions in Nursing Education— Determinant of Global Health “By developing and implementing an action plan to ensure the availability of enough nurses to meet future needs in the United States, we will ensure access and quality of care for our own citizens in addition to making a very important contribution to global health.” Linda Aiken (2007) Health Services Research, 42, p. 1317

Directions in Nursing Education— Determinant of Global Health  “The United States has the capacity, in terms of human and economic resources, to become largely self-sufficient in its nurse workforce.” Linda Aiken (2007) Health Services Research, 42, p. 1313

American Nursing Faculty Development - Determinant of Global Health “Simply not there” is simply not fair