chapter 15 | Nursing Yesterday and Today 253worse, two-thirds of the working-age population
have a health-care–related financial problem such
as unpaid medical bills, being uninsured, or being
underinsured. A survey of over 26,000 Americans,
half of whom belonged to a union, found that 1 in
3 had decided to do without care because of the
cost. Half had stayed in a job just to keep their
health-care benefits. More than half reported that
their health-care insurance did not cover the care
they needed at a price they could afford (Currie,
2008b). More detail about the survey can be found
at http://www.healthcaresurvey.aflcio.org
The quality of the care provided is a second major
concern. A 1999 report issued by the Institute of
Medicine estimated that 100,000 deaths in hospitals
every year were due to errors that could have been
prevented (ANA, 2008a). Hospital-acquired drug-
resistant infections have become a major problem,
having increased a hundredfold over the last 10 years
or so. In 1993 there were 3000 hospital discharges
that included a diagnosis of drug-resistant microor-
ganism. In 2005 there were 394,000 of these
discharges (Currie, 2008a).
Additional concerns include fragmented,
impersonal care; failure to consider the whole per-
son when treating a problem; and continuation of
disease focus rather than prevention focus.
Furthermore, the United States face what Buchan
called a “demographic double whammy” of an
aging population that will need more health care
and, at the same time, an aging workforce
(Hewison & Wildman, 2008).
In Canada, a debate over privatization versus
public funding of health care continues (Villeneuve
& MacDonald, 2006). Health care is still illness-
and disease-focused as in the United States.
Although there is interest in complementary and
alternative treatments, they have not been integrat-
ed into general care. Disparities in care of members
of minority groups threaten to increase if not
addressed more effectively.
Global interconnectedness has brought new con-
cerns about how quickly and easily infectious diseases
can cross national borders. HIV, severe acute respira-
tory syndrome, and the annual waves of influenza
that cross the globe are just a few reminders.
Nursing Today
Issues specific to nursing reflect the problems and
concerns of the system as a whole. The average
bedside RN is in her middle to late 40s (Lillis &
O’Brien, 2007). Ninety-percent of nurses are still
female, although the number of men is gradually
increasing (Dougherty, 2008). Concerns about the
supply of RNs and staffing shortages persist in
both the United States and Canada.
The related issues of excessive workload, manda-
tory overtime, scheduling, abuse, workplace vio-
lence, and lack of professional autonomy contribute
to these concerns (Villeneuve & MacDonald,
2006). On the bright side, there are also some indi-
cations of increasing interest in a nursing career as
salaries improve and job opportunities expand.
Safe staff ing,defined as the appropriate number
and mix of nursing staff, is a critical issue for nurs-
es and the people who need their care. A series of
research studies has demonstrated the importance
of adequate nurse staffing. There is powerful evi-
dence that nurses save lives: there is a 7% increase
in the likelihood of a patient dying within 30 days
of admission for each additional patient assigned to
a nurse (Aiken et al., 2002; Potter & Mueller,
2007). Nurses cannot gain in-depth understanding
of their patients, protect their patients, or catch
early warning signs of trouble if they are over-
whelmed by the number of patients for whom they
are responsible. Adequate numbers of nurses affect
patient mortality, length of stay, urinary tract infec-
tions, fall rates, incidence of hospital-acquired
pneumonia, and more. For further information, see
http://www.safestaffingsaveslives.orgHealth Care in the Future
Ideally, a new model of health care is needed that
offers the following:
■Holistic, person-centered care
■Seamless connections across community, acute-
care, and long-term care settings (Pogue, 2007)
■Elimination of health disparities
■Guaranteed accessible, affordable care for
everyone (ANA, 2008b)
■Safe care that heals and does not harm the
patient
■Equal support for prevention, health promotion,
and mental health care
■Healthy environment from green buildings
(Trossman, 2007) to the elimination of air,
water, soil, and other forms of pollution
■Acknowledgement and addressing of global
health concerns: global warming, hunger, poverty,
and disease at home and in developing countries