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When You’re 94
You’re getting older, nurses are getting fewer.
Yes, you should worry.

by Thomas Weaver

As America’s median age tracks ever upward, there’s another line we should be concerned with on the Great Graph of Being and it’s down-bound. It’s the measure of the percentage of nurses available to fill the myriad roles demanded in the field today. Those two lines — our advancing age and nursing’s thinning numbers — are on a collision course. When they meet, you or I just might be lying in a hospital bed pressing a red button to summon an over-stretched nurse.

You won’t find anyone — dean, professor, or student — in UVM’s Rowell Building who doesn’t have direct experience with the nursing shortage, ideas for addressing it, or anticipation of what it might mean for the career ahead. It is the issue of the hour, shaping the research and teaching, and driving a number of new initiatives at the university’s College of Nursing and Health Sciences.

Selling a Profession
The U.S. Department of Labor warns that the nursing shortage could reach 450,000 job vacancies by 2010; ten years later, it’s projected that little more than one-third of the nurses needed in the United States will be available. Scary stats are one thing, but there is no surer proof that the nursing shortage has hit home than its entry into the sacred realm of prime time television. There it is one evening, a Johnson & Johnson public service spot, not designed to sell Band-Aids or baby powder, but professional nursing. All kinds of smiling faces telling you they are nurses, and implicit in their smiles is the suggestion that you might want to be one, too. Like most ads these days, the spot is mainly about image.

There is some good reason for that. Though nursing has largely shed the misperceptions sown by cheap-laugh sitcom caricatures, inaccurate images still exist. Lost on many — the intellectual challenge of the field, the range of job opportunities, the reality that many nurses make good salaries and love their jobs, and the truth that men can be nurses, too. Yet, on the positive side of the perception coin, nursing annually ranks as one of America’s most trusted professions.

Dean Betty Rambur admits that her early impression of nurses, even as she started to consider nursing as a career, fit into a tidy couplet — “they wore white and worked nights.” Rambur has worn white in her 24-year career, but these days she is more likely to be in a stylish business suit working long days as she oversees the schools of Nursing and Allied Health, consolidated into one college this summer. She leads a school that has in the past several years added a major scholarship program to address Vermont’s nursing shortage and notched near 75 percent increases in both applications and enrollments.

More nurses entering the field at UVM is good news, of course. But Rambur and her faculty colleagues approach their work as educators with the knowledge that more nursing graduates will mean little if they aren’t prepared for the rigors of a tough job at a tough time.

“One of our challenges is to prepare graduates to work in complex, fast-paced environments,” Rambur says. “At the same time, nurses must retain the closeness to patients and compassion that’s really at the heart of healing.”

Field Lessons
Both need for and evidence of compassion are on vivid display at Project Independence, a Middlebury-based adult day care for the elderly. A month before graduation, UVM nursing student Anne Scollins spends the better part of two days a week here as she completes the sixth clinical rotation of her undergraduate experience.

Microphone in hand, Scollins stands before a semi-circle of clients, leading a word game designed to stimulate both fun and memory. The participants range from Dubie, a one-time New York Times foreign correspondent who suggests “Aphrodite” for a girl’s name beginning with the letter A, to those who miss turns because they are sound asleep.

Scollins’ innate patience and caring are at work as she interacts with Matt, who is anxious he will miss his ride home and mentions his concern repeatedly. Finally, Matt stands and announces, “I’ve got to catch a train going north.” Scollins is quickly at the man’s side, rubbing his back, encouraging him to stay, assuring him his ride will be here after lunch.

And Matt does settle back into the game, timidly offering scraps of memory from his life in northern California as he searches for words.

A city beginning with S.

“Is San Francisco too far away?”

A city beginning with E.

“Have you heard of Eureka? My uncle built the hotel there… this is wonderful… it makes me remember all of the things…”

It would be a shame having Anne Scollins serve people in need of little more than a tall latte. But working in a Philadelphia coffee shop paid the bills after Scollins graduated from Haverford College with a degree in social work she wasn’t sure how best to use. When her father, Dr. Michael Scollins, a UVM professor of pharmacology, underwent quadruple bypass surgery in 1997, Anne got a glimpse of the power of nursing.

“When my dad was sick, I saw just how incredible the nurses working with him were,” she says. “They were the faces we recognized. The nurses would breeze in and they were just so comfortable and comforting. I really think that affected me, though I didn’t realize it at the time.”

Scollins’ parents are both physicians (her mother, Dr. Mary Scollins, is a clinical assistant professor in neurology at UVM) and she initially thought they might urge her to try medical school instead. “My parents really supported my decision to go back to school for nursing. They realized my tendency is to want to be with people. I want to be right in there.”

Handling Lives in Crises
Stuart Whitney, clinical assistant professor of nursing, acknowledges that teaching Anne Scollins about compassion was a bit like teaching a fish to swim. Typically, nursing is going to attract students of a similar mindset, says Whitney, but there are occasionally those who range toward the other end of the spectrum. He recalls one student who was trained as an EMT and was adept at the technical aspects of nursing but said, “All I want to do is stick tubes in people.”

The challenge for nursing faculty is to develop students’ ability to maintain the spirit of compassion in the face of stressful situations and an ever-evolving array of machinery and procedures.

“I tell the students that, yes, you need to be able to control the machinery so it can do what you want it to do,” Whitney says. “But let’s look at the patient, see what response the patient is having, and never lose sight of the fact that these are human beings whose lives are in crisis.”

Associate Professor Jeanine Carr worked as a hospital nurse through the nursing shortage of the late 1980s and knows the difficulties. “It’s frustrating when you just can’t give the level of care that you want to give,” she says. “You come home at night thinking about all of the things you weren’t able to do because you were just too busy.”

Carr says that before stepping into the demands of such a setting the most important skill a new nurse must acquire is “to have a questioning, inquisitive way about you — not just going with the flow, but always questioning what is going on with the patient.”

Even a stressed nurse is going to have significant time working closely with patients. “Bathing, helping someone go to the bathroom, nurses are involved in very intimate ways with patients that can open up space for a conversation about a concern a patient might not otherwise talk about,” Carr says.

Real Worlds Collide
Perhaps more than any other undergraduate major, nursing presents challenges that run counter to the suggestion that college is not “the real world.” Often, these students juggle trials of both the real and the college kind — for instance, the death of a patient in the morning and a biochemistry mid-term in the afternoon.

In light of that, it’s significant to note that a growing number of UVM nursing undergraduates (about one-quarter of last year’s sophomore class) are non-traditional-age students, card-carrying members of the real world. They bring the advantages of diverse life experience and maturity to their UVM study. They also often carry the responsibilities of families, jobs, and mortgages, along with the weight of those textbooks in their backpacks.

Christina Remillard, UVM junior, is among the “non-trads.” She’s taken the long way through college with years off for her three children, ages 7, 5, and 2. In her mid-twenties, Remillard is focused on graduation in another year and the seller’s market that is the bright side of any professional shortage. A good job, often a solid salary, and the attraction of a helping profession is what draws many non-traditional students to nursing these days.

As she takes a break from her clinical rotation in Fletcher Allen’s post-operative ward, Remillard exudes a calm energy, a fast engine idling. When she wraps up her hospital shift and coursework in Burlington for the afternoon, she’ll go home to a husband and three kids in St. Albans, a Brownie-Girl Scout meeting (she’s the troop leader), and three papers due the next day. What’s more, she and her husband are about to take on a co-parenting role with a terminally ill three-year-old.

As Remillard spins out the story of her life and her day, it’s clear that she’s been through a lot and is unafraid to take on more, an attribute that should serve her well professionally. She sees parallels between the challenges of parenting and nursing, including the need to think fast and be adaptable to new situations.

“When you have kids you just learn as you go,” she says. Asked what area of nursing she hopes to pursue, Remillard doesn’t pause. “I want pediatrics.”

Burnout Proofing
But will Christina Remillard still want pediatrics or even nursing in twenty years? In solving the nursing shortage, retention poses as considerable a challenge as recruitment. For faculty, helping students develop skills to cope with a personal/professional crisis that may be decades down the road requires digging deep into lessons from their own experience in the field.

Jeanine Carr suggests self-advocacy is essential to a nurse’s well-being and fending off the occupational hazard of burnout. “Traditionally, nurses have not spoken up much,” she says. “We try to help students learn assertiveness skills, so they can effect positive change for themselves, for their patients, and for the work environment.” Self-care — mental, emotional, and physical — are essential, Carr adds. To take care of sick people, a nurse must be well.

Stuart Whitney agrees, and he knows the stresses both as faculty member and as a practicing nurse working per diem in the post-operative ward at Fletcher Allen. He sees realities and rewards and aims to give students an accurate picture of their future careers.

“When people concentrate too much on the negative side of nursing, they do get burned out because they’re not recharging themselves,” Whitney says. “If I deal with a combative patient all day long, I can go, ‘God, what am I doing?’ But if one patient comes up and says, ‘Thank you,’ all that bad stuff that I just dealt with is erased. I realize this is why I’m here. I did make a difference.”

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