The following dispatch from the Associated Press caught my attention this afternoon:

Facing a nursing shortage, hospitals seek to retain new nurses by easing transition

Associated Press Writer

5:48 PM PST, February 15, 2009

MIAMI (AP) — Newly minted nurse Katie O’Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

She lasted nine months. The stress of trying to keep her patients from getting much worse as they waited, sometimes for 12 hours, in an overwhelmed Dallas emergency room was just too much. The breaking point came after paramedics brought in a child who’d had seizures. She was told he was stable and to check him in a few minutes, but O’Bryan decided not to wait. She found he had stopped breathing and was turning blue.

“If I hadn’t gone right away, he probably would have died,” O’Bryan said. “I couldn’t do it anymore.”

Many novice nurses like O’Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

The critical shortage of nurses in the general acute care hospital setting is an issue that continues to draw much public attention and debate within the healthcare industry.

One factor in the stress turnover equation is that BSN programs do not provide their students with sufficient clinical training.


In the mid-1970s, Hermann Hospital in Houston launched a nursing residency program because the clinical skills of graduates from the four-year nursing schools were, in a word, WEAK. The BSN students knew more about management theory than patient care.

Once upon a time Hermann Hospital, like many other hospitals in the U.S., operated one of the most successful diploma schools in Texas. The clinical skills of the graduates consistently topped those from the BSN programs. I appreciate why the diploma schools faded from Americana… their demise ranks right up there with the demise of the kid on a bicycle who delivered our afternoon newspaper.

The diploma school phenomenon apparently was a strategy for training and developing clinical nurses that is no longer practical, especially when you consider the federal government consistently tries to cut reimbursement funding for graduate medical education. Hospitals saw the financial writing on the wall: diploma schools were going to be too costly to operate.

Today, Associate Degree RN and BSN programs struggle to find qualified educators and to get more funding to expand the size of their graduating classes. Huge numbers of potential nurses reportedly are rejected in many states because the nursing schools cannot absorb the numbers of people who want to enter the nursing profession.

For years we relied on overseas recruiting – from Canada to the Republic of the Philippines to South Africa – to solve our staffing problems. But with tougher immigration rules, this is no longer feasible – at least not for a quick fix.

I am not going to ask for a clean neat solution, because I know one does not exist. But I would like to hear your thoughts.