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Release: Oct. 5, 2000

National health policy expert to discuss crisis in nursing

IOWA CITY, Iowa -- The nursing profession is "at a crisis point and a decision crossroad" and needs fundamental reform, according to a national health policy expert who will speak at the University of Iowa Wednesday, Oct. 11. Nancy M. Valentine, Ph.D., is special assistant to the secretary and advisor to the under secretary for health in the U.S. Department of Veterans Affairs. She will deliver the second Geraldene Felton Lecture on Health Policy at 7 p.m. in the Senate Chamber of the UI's Old Capitol.

Valentine's talk is sponsored by the UI College of Nursing's Organizations, Systems and Community Health Nursing area of study. A reception cosponsored by the Iowa City Veterans Affairs Medical Center will precede Valentine's talk beginning at 6 p.m. Both the talk and reception are free and open to the public.

The crisis Valentine sees is a growing shortage of nurses that one study predicted could leave the profession well below the number and types of nurses needed by 2020. This shortage is caused by considerably fewer people entering the profession at the same time that changes in health care -- an aging population, growing technological sophistication and the shift toward community based primary care and care management -- increase the demand for nurses. Valentine said past shortages were caused in part by nurses leaving the profession or temporarily leaving the workforce altogether; when employers raised salaries, nurses "came out of the woodwork" to rejoin the workforce. "Now, there's no woodwork," she said.

According to Valentine, nursing as a profession must decide how to reconcile its own internal contradictions if it hopes to meet the challenges ahead. "We're the only group that calls itself a profession that has so many points of entry," she said, noting that graduates of two-year, three-year and baccalaureate nursing programs all sit for the same licensing exam. "These multiple tracks have given nursing great flexibility and have served to bolster the workforce in earlier shortages," Valentine said, "but they're potentially confusing to both employers and the public." Consequently, consumers may not understand the connection between the greater complexity of health care and the need for more nurses with baccalaureate and graduate education.

Valentine likens the need for change in nursing education to that experienced by the medical profession a century ago, when reformer Abraham Flexner catalyzed public support for higher educational standards for physicians. "We really need our own modern day Flexner of nursing," Valentine said, "someone or some group to focus public attention on the problem and develop potential solutions."

In her talk, Valentine plans to offer several avenues for possible action. To address the need for more nurses with higher levels of education, she points to the Veterans Health Administration's earmarking of $50 million over the next five years to allow nurses with associate degrees and nursing diplomas to earn bachelor's or higher degrees in nursing. In fact, the UI College of Nursing and the VA Medical Center in Iowa City teamed up to offer the first program for VA nurses under the initiative. Now in its second year, the program provides more than 60 nurses at VA facilities in Iowa City, Des Moines and Knoxville with all the courses and materials they need to earn bachelor's degrees at no cost to themselves.

Valentine also believes employers cannot be held solely responsible for addressing the issue and that federal support for nursing education should increase substantially. While nursing is the largest health profession with 2.5 million members, Valentine said, the federal government devotes its resources disproportionately to physician education at a time when there is a predicted oversupply of physicians and a severe shortage of nurses. "There needs to be a redistribution of funding based on actual need," she said.

Ultimately, Valentine said, the public's demand for quality health care will drive reform of every aspect of health care. "People are becoming hyper-aware of quality issues and making all health care professionals more accountable," she said. "The public is going to force us to pay attention to its need for the best possible health professionals."

The Geraldene Felton Lecture on Health Policy was established in 1998 to honor Geraldene Felton, Ph.D., who served as dean of nursing at the UI from 1981 to 1997. The American Academy of Nursing plans to name Felton, who currently serves as director of the National League for Nursing Accrediting Commission, one of its "Living Legends" at its national conference in November. She resides in Iowa City.