Nurse recruitment and retention: Imperatives of imagining the future and taking a proactive stance

Abstract

The need to imagine, examine, study, take a proactive stance in regard to and make a steadfast commitment to the future of nursing has never been more imperative. As Bezold et al. (1999: 4) persuasively argue, the nursing profession (and others) have:never had a greater need to understand the future, to envision a preferred future, and to develop strategies to create the preferred future than it does today. Vision and commitment are needed more than ever.The reasons for this are twofold. First, the nursing profession world-wide is facing a crisis in recruitment and retention. This crisis, widely recognised as involving 'the worst nursing shortage in the last 50 years' (Hodges et al. 2002), is having a significant and negative impact on health care and the capacities of the health care systems around the world (including the Australian health care system) to respond appropriately, safely, and effectively to the health needs of the individuals, groups and communities they serve. There is a critical need for stakeholders to collectively and creatively 'think and work' their way out of this crisis.A second key reason is that the health, welfare and well-being of both current and future generations depends on the access, equity, quality and viability of professional nursing services. The accessibility and sustainability of quality nursing services, in turn, depend on nursing futures work and the capacity of this work to 'confront the will to act' in regard to the realisation ol a preferred healthier future for all (Bezold et al. 1999: 4). In sum, the future of nursing is imperative because:Nursing's future is inextricably, and rightly so, bound to society's future and the future of health care. (Bezold et al. 1999: 8)AUSTRALIAN HEALTH CARE CRISISFew would disagree that Australian health care is in a crisis. Despite policies that advocate access and equity to Australia's health care services, thousands of Australians do not have timely access to appropriate and effective health care. Furthermore, as is the case in the United States of America, in Australia:* health care costs are increasing, in spite of efforts to contain costs;* quality of care is decreasing in spite of increasing regulations to enhance quality care; and* the existing health care system is reactive rather than proactive (Jardin 2001: 615).A key contributor to the present crisis in Australian health care is the local and global shortage of registered nurses (Duffield & O'Brien-Pallas 2003; Preston 2006). This shortage is not only affecting patient care delivery, but also the education of nurses on account of their being a commensurate decline in the nurse educator workforce - a problem that has not yet been formally recognised or strategically addressed in Australia.In Australia, nurses constitute the largest group of health care professionals, with 30% being employed in the health care sector (National Review of Nursing Education 2001 : 10). Nurses provide care across the continuum of care and work within a wide range of models of service 'which are constantly evolving due to advances in science and technology, consumer expectations, an aging population and the drive to find efficiencies in an industry where expenditure continues to increase' (National Review of Nursing Education 2001: 10).The current nursing shortage is serious. Not only does the shortage of nurses threaten the quality and safety of patient care (Duffield & O'Brien-Pallas 2003), but also 'the economic viability of the hospitals and other health care agencies where [nurses] are employed' (Hodges et al. 2001: 15). As the Key Performance Indicators (KPIs) of most Australian hospitals currently demonstrate, when there are insufficient numbers of registered nurses available, beds have to be closed, wait times in emergency departments increase, ambulance by-pass rates increase, delays are experienced in elective surgery as well as emergency surgery, intensive care admissions, and general medical-surgical admissions - all of which have a significant (negative) effect on a health care facility's funding entitlements and overall economic performance. …