It's "dumb policy-making" to recruit foreign nurses or to keep allowing the conditions for the nursing profession to get worse?

Note a tie in your various topics: one thing nurses dislike (and the both increases the number of nurses needed and worsens working condition) is the huge amount of paperwork they must do, which is (drum roll) largely due to insurance requirements.

Ultimately, the solution to the nursing shortage requires federal regulation of working conditions and federal subsidy of nurse training.

There it is.....it wasn't hard to find. Let's nationalize nursing!! That's the ticket!

While every nurse union and professional organization supports legislation to set nurse-patient staffing ratios and eliminate mandatory overtime...

Of course they do....*THEY'RE UNIONS*.

Well, Fred's reflexes work. Does he have anything substantial to add to the conversation, though?

An aquaintance of mine is studying nursing. I remarked that she was smart to pick a job that can't be sent overseas. She answered, "No, they just bring foreign nurses here."

You may think it's all 'dumb policy making,' but if you want to keep nursing wages down, it may be a very elegant solution.

Isn't that interesting?

On one hand you rail against the high cost of healthcare and with your other face, rail against keeping down the high cost of healthcare!

"Ultimately, the solution to the nursing shortage requires federal regulation of working conditions and federal subsidy of nurse training."

Huh? When there aren't enough people doing a job, the answer isn't to have the government subsidize training for that job. Should we subsidize computer tech support jobs when computer tech support quality is poor, and subsidize accounting jobs when there's an accountant shortage? Of course not.

in the normal state of things, "the market" takes care of all of this. When more people are needed in a profession, people are willing to pay more for that job, so more people enter that profession. Supply and demand. There is clearly a demand for nursing schools, and so supply should rise to meet demand. Nursing teacher salaries should rise to attract more teachers if there aren't enough teachers at the current wages. So the question is, what are the market failures here?

There are two possibilities. Perhaps there are regulations limiting entry into the market for new nursing schools, and limiting the expansion of current ones -- this seems fairly probable. How hard is it for a new for-profit institution to get nursing accreditation? If there were no restrictions on entry, new schools could pop up and train those 150,000 applicants, pay teachers well, and still make lots and lots of money. If this is the root of the problem -- whether because of overly cumbersome governmental licensing procedures (unlikely) or the influence of current nurses who want to keep wages high by limiting competition (likely) -- then the solution is deregulation, not regulation.

The second possibility is that the importation of foreign nurses is the cause of, rather than the effect of, the American nursing shortage. Think about migrant labor on farms, for instance. Farmers pay the workers less than minimum wage, and then complain that without illegal immigrants no Americans would take the jobs. Sure, but without illegal immigrants the wages would just go up until Americans would take the jobs. In the case of nursing, perhaps there's no money to be made by training nurses because we import so many cheap foreigners. If this is the case, then we can accept the status quo or we can try to limit the importation of new nurses, but either way subsidizing American nurses and regulating working conditions are totally irrelevant.

No, no, no. David Brooks says we should all move in with our sick parents and take care of them. Problem solved!

It's almost a given that Fred Jones is doing some kneejerk anti-union trolling, but I'll acknowledge anyway that the privatized and lackluster-regulated health training industry is exactly where the crisis is bottlenecking. When I worked for my state Assemblywoman in NJ, this was literally among the most pressing issues for the Assembly Health Care committee... Jersey is facing a spiraling decline in nurses because of for-profit health industries cutting corners and a lack of any government subsidy or assistance in not just getting training for new nurses, but providing training services to begin with. Governmental socializing of nurses obviously isn't a solution, but pretending that the "market will decide" isn't just a stupid statement, the entire point of this news is that the statement has proven to have failed.

Alex especially, you're treating nurses like a consumer product, which is ludicrous... the "demand" for nurses is skyrocketing, and the supply isn't raising because the hospitals have to hire them, and can't, for both cost and job pool reasons. If people were "just willing to pay more" for health care, there wouldn't be a problem, but I'm assuming you're smart enough to realize the slight problem with the health care industry is how everyone isn't buying "supply" because they already can't afford it, right?

It's just really frustrating when people lazily scoff at a crisis saying "the market will solve everything" when the entire point of the article is how the market clearly failed to solve the problem.

Alex F: having worked as a nurse since 1999, and from talking to my co-workers who have mostly been in the field 20 to 30 years, I feel free to say that if you think "regulating working conditions [is] totally irrelevant" then you don't know what you're talking about.

In some areas it may be that we're importing foreigners because they're cheap - but in the urban, unionized areas where I've worked, wages are really not the issue. Hospitals are simply refusing to hire an adequate number of people to do the work; they claim that an insanely heavy workload is no problem, and they make nurses responsible for more and more duties... while at the same time, they discharge patients much earlier so that the ones who are still in the hospital are much sicker than in years past.

In those settings, the reason they like to hire foreign nurses - and I've heard this discussed quite candidly - is that immigrants are afraid to complain.

After reading Hob's comment it is no wonder why we have a shortage, even for the good pay who wants to be overworked and not appreciated?

Fred, as usual you fail to see the forest through the trees, we want to cut healthcare costs but not at the expense of the frontline staff, there is plenty of other fat to cut before we start looking at the wages of the people who work directly with the patients.

Posted by: Alex F | Nov 3, 2006 3:28:53 PM Huh? When there aren't enough people doing a job, the answer isn't to have the government subsidize training for that job.

This is why literacy was so much higher in the days before public education, yes?

It is quite elementary economics that when there are net third-party benefits to an activity, then the level of the activity pursued by a profit-maximizing enterprise is below the optimal level. An equally elementary argument in economics is that a subsidy equal to the estimated level of third-party benefits is precisely what is required.

In the normal state of things, "the market" takes care of all of this.

It is also well established that when "the market" includes imperfect and constrained information on the part of clients, service provicers, and employees alike, and unequal bargaining power, the facile Pollyana predictions of perfectly informed perfectly competitive markets do not provide an effective basis for modelling the problem.

There is no "the market". There are lots of markets, and market-like settings, with very few of them offering anything resembling pure competition, and none of them offering anything approaching perfect information.

Posted by: Fred Jones | Nov 3, 2006 3:12:44 PM Isn't that interesting?

On one hand you rail against the high cost of healthcare and with your other face, rail against keeping down the high cost of healthcare!

Ongoing declines in real wage costs through speed up does not "keep down" the high cost of healthcare. Indeed, in general, the only way to achieved a long term sustainable decline in wage costs in general is through productivity gains, when they can be achieved. The gains from short term speed-up are going to come at the cost of less ongoing productivity gains due to higher turnover of staff.

And in this particular case, since the massive medical price inflation blow out suffered by the US has happened concurrently with the present squeeze on the overall real wage offered to nurses, there is no evidence that it is even a short-term, temporary aid.

Hob, August: When I say demand for nurses, I mean demand from hospitals, not demand from patients. It was my understanding that hospitals want to hire a lot of nurses, and are willing to pay nurses relatively well, but there just aren't enough (American) nurses to fill the spots. Hence, a nursing shortage. Ezra and Joan seem to be addressing a supply problem (too few nurses) rather than a demand problem (too few jobs).

Hob's point seems to be that hospitals are refusing to hire enough nurses, which is more or less the exact opposite of what Ezra and Joan write about. This would be a market failure with respect to health care delivery, and could potentially be solved by mandating minimum numbers of nurses on the floor. But the problem that Ezra and Joan write about -- a lack of trained and willing nurses relative to the demand for hiring them -- is totally the opposite of this. I'm not saying that Hob is wrong -- there are a million problems with health care delivery in America, and I have seen it convincingly argued elsewhere that healthcare outcomes could be improved substantially at a low cost by hiring more nurses and, for instance, giving them responsibility for making sure that small groups of patients received all proper and routine care. Again, however, the point at issue is that *there are not enough nurses to be hired*. How to best provide care is a different issue.

August, I hope that clarifies what I mean by supply and demand. I agree that there is what you call a "job pool problem" and my post was an attempt to figure out why there should be such a job pool problem. In most fields, job pool problems resolve themselves via market mechanisms, and so I was trying to figure out why that would not be the case here.

Knowing and respecting several nurses, male and female, I can honestly say that they feel undervalued even when they are well paid. Working conditions are often horrendous, the paperwork is overwhelming especially in concert with patient demands, many nurses are hired part-time to reduce their benefits even when full-time staff positions are available and the list is endless of petty daily tasks that take a toll on will power. Nurses have the highest rate of sick leave due to stress of just about any profession.
The 'job pool problem' will not be solved by market mechanisms this time as themath and science literate candidates are going into other fields. With the candidate pool diminished by competition from other fields, the recourse is to look for candidates elsewhere. Teachers in the nursing field are also having problems filling the spots that are opening. The training period is hard, the support is negligible and other fields in the sciences can result in high paying jobs with equivalent benefits, better working conditions and less likelihood of being vomited on.
Serious work is needs to be done before the aging baby boomers find how just how few people are out there to take care of them.

Here's what I remember: HMOs doing their damndest from the '80s through the '90s not only to lard higher workloads onto nurses, but to break their unions and as much as humanly and legally possible replace better-paid and -trained RNs with lesser-paid, non- or lower-credentialed replacements. At the time, my roommate (an ex-Navy medic, yo) was a nurse, mostly psychiatric. I heard a good deal from him. He was lucky: psychiatric nursing is among the toughest gigs out there, so he never had any trouble, but his friends were doing things like going to Stanford for two years so they could make just a little more money and not get fired.

After that, when I found out there was a nursing shortage, I laughed. As with government and democracy, in industry and advanced capitalism, you get what you deserve. Responding to a broken healthcare system with HMOs, the profit motive, fungible and greedy management talent and inept regulation means that a nursing shortage is just what we deserve.

On the bright side, my old buddy can now write his own ticket: he moves wherever he pleases, works decent hours, gets paid well, and if any idiot tries to fuck with him, he just quits, knowing that (since he is very good at what he does) that alone is revenge.

Funny, if healthcare had been nationalized, a rational administrator could have foreseen where demand went and not maltreated an entire industry of workers for a decade. Granted, asking the US government to employ rational administrators is asking a bit much. Look who's running it now.

Maybe Fred is right.

Or maybe we just get what we deserve after voting for idiots.

wcw-Funny, if healthcare had been nationalized, a rational administrator could have foreseen where demand went and not maltreated an entire industry of workers for a decade.

Don't count on it. Here in Quebec the gouvernment managed two cost cutting moves to set nursing back for 20 years. First they decided to cut the bureaucracy. Good thing by all accounts, saves boodles of money. They did it by offering a generous early retirement plan for over 55 year olds. The overwhelming majority of over 55 year civil servants took the deal- the vast majority of whom were nurses and teachers. A part of the deal made it impossible to hire those individuals back for two years, even on a part-time basis. Many of these professionals as second wage earners, simply stayed home, the rest went south.
The second move also made sense on a cost-saving level. The medical field is the most expensive to educate, all those machines, specialties and lab requirements. With a heavily subsidized education many of the people trained were heading south to cash in, so the gouvernment slashed enrollment for the medical fields, across the board. The result was a more than 25% cut in the number of new doctors, nurses and specialists trained. As these individuals work in the hospitals during training, there was an added loss to staffing.
Of course the rational administrators just banged their heads on their desks, this was a political decision.

My sister studied to be a nurse in the early 90s. She was on a long waiting list before she got in. It's the lack of schools and space for all the people who do want to be nurses. You have to wait so long before you can get in. This ultimately discourages many.

So there's a Nursing shortage, and to fill the gap their permitting dirty foreigners to come into the country and practice on good upstanding Americans? Where's the Democratic Party when you need it?

Seriously, not dumb policy-making, dumb writing.

If nursing programs are money-losers, but people are still clamoring to get into them, there's a pretty simple goddamn solution:

Raise tuition on nursing programs.

This has been your Completely Fucking Obvious Answers to Completely Fucking Obvious Problems segment for the day.

I look forward to the day when the average nurse makes more than the average physician.

Posted by: Kimmitt | Nov 3, 2006 8:45:51 PM If nursing programs are money-losers, but people are still clamoring to get into them, there's a pretty simple goddamn solution:

Raise tuition on nursing programs.

Aha. Solve the supply capacity bottleneck by eliminating the competition for spaces. Clearly, that solves the vicious circle of speed up driving nurses out of the profession leading to a shortage leading to speed up driving nurses out of the profession. Because clearly the people who have been prepared to pay more to study nursing will ...

Hang on, now I've lost it. I don't see how it reverses the positive feedback loop. It might even lapse back into the simple, first year undergraduate economic model of an applicant to a nursing program willing to pay for the improvement in his or her earning power, the commercial medical care provider willing to pay for the improvement in their earning power, and neither willing to pay for the third-party benefits, or "positive externalities", and therefore the quantity of nurses being trained falling short of the overall optimum.

Oh! If only there was some organization or institution that had the capacity to pay more to the training providers without increasing the price charged to the students! Then the third party benefit, or "positive externality", could be paid for, and the failure intrinsic in all markets with substantial positive and negative externalities could be corrected!

In first year Microeconomics, for lack of a better word, we call that organization or institution "government".

Tsk.

http://www.presidency.ucsb.edu/ws/index.php?pid=26484

'The Nurse Training Act of 1964, which we have met this morning to finally sign and complete, represents the response of an enlightened Congress to the urgent need. The act contains four principal elements. It authorizes a program of grants to build and renovate nursing schools; it establishes a program to help schools of nursing strengthen and improve their training programs and to help diploma schools of nursing meet the costs which will come with increased enrollment; it expands the existing program of advanced training of professional nurses; it establishes a loan program which will enable many talented but needy students to undertake the professional training for a nursing career.'

Something of a tough call here. As the Federal bureaucracy has been 'helping' the nurse training system for the past 42 years, might we not blame some of the impending lack of nurses on the fact that the Federal bureaucracy has been 'helping' train nurses for the past 42 years?

Not even a little bit?

The main reason so many nurses have left the profession is deteriorating working conditions.

That, and doctors.

Teenage girl with career on her mind goes through the booklets available. She has worked hard at her math and science grades. She sees nursing program- long program, hard work, reasonable pay at the end working with human waste products. She sees 3D art program- shorter program, cool work, reasonable pay at the end with the possibility of an Oscar. Trick question- which does she choose?

Posted by: Tim Worstall | Nov 4, 2006 4:57:23 AM Something of a tough call here. As the Federal bureaucracy has been 'helping' the nurse training system for the past 42 years, might we not blame some of the impending lack of nurses on the fact that the Federal bureaucracy has been 'helping' train nurses for the past 42 years?

Not even a little bit?

Let me sort out the logic in blaming a program that has been in place for 42 years for an impending lack of nurses. There is a sense of responsibility somewhere here, so lets see if we can chase down where the responsibility lie.

Now, is it the fault of that "Federal bureaucracy" that the medical system has changed tremendously over the past decade and the system need updating? No, that's not even remotely plausible. "Long and variable lags", Friedman's famous cop-out from the gross empirical failures of Monetarist theory, simply do not work for a lag of thirty years plus.

Is is rather the fault of that "Federal bureaucracy" that the program needs to be updated and hasn't been updated? Well, no, that is not their responsibility. The bureaucracy is not responsible for the terms of its enabling legislation, nor is it responsible for the budget that it has to work with. And that is a good thing ... at least for those of us who believe that Democracy should have superior authority to Technocracy.

Well, then, if not the "Federal Bureaucracy", where would that responsibility lie? According to the Constitution, it would seem to be the joint responsibility of the Executive and of the Legislature (in their neglected role of providing oversight over the Executive) to determine that a program like that needs updating; the responsibility of the Executive to propose legislation to serve the common good; and the responsibility of the Legislature to develop legislation to serve the common good and enact it.

So, no, a Federal Bureaucracy that has served reasonably well until there are massive changes in the system it is serving, is not responsible for designing and funding a complete overhaul of the program to serve the needs of the present day.

Rather, it is the responsible Cabinet officer, President, Congressmen and Senators who have that duty in our system. However, it appears that they were too busy, with trivial politicizing like Flag Burning amendments and Gay Marriage bans, with the difficult work of the destruction of institutional guarantees of our freedoms, such as Habeas Corpus and the Posse Comitatus Act, with the pursuit of a counter-productive occupation of a foreign country because the President has determined that recruiting more terrorists (and, as it recently turns out, providing them with information to help produce weapons of mass destruction), is serving the national interest.

Blaming the Federal Bureaucracy set in place 42 years ago for not independently restucturing itself and not autonomously increasing its funding to cope with the substantial increase in demand for new nurses is like ...

... well, it would be like blaming Johnson's War on Poverty for the increase in poverty under Bush, after Clinton and the Republican Congress effectively dismantled most elements of the 1960's system, replacing it with a reliance on the private creation of new jobs, and then Bush decided to channel his massive deficit spending overseas and helped engineer the recovery with the weakest job growth in the post WWII era.

Thanks, Bruce. As for what sort of 'logic' - it's not, it's boilerplate and reflexes.

Blaming the Federal Bureaucracy set in place 42 years ago for not independently restucturing itself and not autonomously increasing its funding to cope with the substantial increase in demand for new nurses is like ...

That is how a market functions and why we use them.

Fred- market forces cannot repair a crisis caused by market forces. Decline in available workforce and a move to work in other fields is creating a decline in the pool of nurses. Competition from other countries that offer better pay and working conditions only makes it worse. Add to that an increased need for the services in the Western World due to an aging population and you have a crisis that is not solved by throwing money at it (which is a market's best ressource). We need to rethink what we need, want and expect from medical services before we can even begin to train a new generation.

Hawise:
Teenage girl likes math and science. She looks through the booklets. She sees a program that requires an extra six or seven years of training, but which is easier to get into and pays 50% more, so she chooses medicine. Or, if she doesn't want to do the extra years of training (and avoid the body fluids!) she chooses engineering. Medical school classes are now more than 50% female although engineering is still weighted toward men. In my mother's era, it was hard for women to go into a profession other than teaching or nursing. Now it isn't.

Market forces did not cause this crisis. If not fettered, the market would have increased the number of schools and nurses as the demand rose. The crisis was caused by not allowing the market forces to react to the demand because of the unreasonable government restrictions lobbied for by the health industry's representatives. The difficulty in building schools, in particular.

There was no bureaucracy for the tech sector and when the whole world needed to be connected and the market reacted quickly. Demand made salaries skyrocket and ponly tailed hipsters in their twenties were changing jobs every six months to double their salaries. This attracted lots of people into the field when they were critically needed.

I would also like to add that these were motivated people and were attracted by the capitalsim of the market and not by a wealth distribution bureaucracy.

Thought you were talking about the good version of TAP. My bad.

Then again, it sure sounds like the same perspective.

Solution: Contract nursing services out to Halliburton! It's guaranteed to pass in the next couple years if you do it that way.

Solve the supply capacity bottleneck by eliminating the competition for spaces.

No, it solves the supply capacity bottleneck.

If colleges are loathe to expand nursing programs because they are money losers, but there are still people more than willing to get in, then raise tuition (or fees or whatever) on the program so that the college loses less money per student and therefore can afford to expand the program.

There's no nursing shortage. There's a training shortage, because those doing the training can't afford to expand their programs. Tuition increases, problem addressed, nursing shortage fixed.

Posted by: Fred Jones | Nov 4, 2006 8:01:10 AM

Blaming the Federal Bureaucracy set in place 42 years ago for not independently restucturing itself and not autonomously increasing its funding to cope with the substantial increase in demand for new nurses is like ...[quoting myself]

That is how a market functions and why we use them.

Only for the demand that shows up in market transactions. Third party demands are ignored by markets unless there is some organization or institution to represent those third part demands in the marketplace, which for the sake of a better term we micro-economists refer to as "government" in our modelling and empirical research.

Indeed, that is why the Federal program subsidizes training rather than providing it directly ... that allows the market to do what it can do, while providing for what the market cannot.

Indeed, what is startling about the record of achievement of the Federal Government in Enhancing the Nation's Health Care Infrastructure is about how so much of it is getting long in the tooth and likely due for an overhaul. From the Brooking's Institute site, 50 Greatest Government Endeavors, Enhance the Nation's Health Care Infrastructure:

Action to build medical treatment and research facilities ... Major Statutes:
* 1946 PL 79-725 Hospital Survey and Construction Act (Hill-Burton Act)
* 1949 PL 81-380 Hospital Construction Act
* 1961 PL 87-395 Community Health Services and Facilities Act
* 1963 PL 88-164 Mental Retardation Facilities Construction Act/Community Mental Health Centers Act
* 1964 PL 88-581 Nurse Training Act
* 1965 PL 89-109 Community Health Services and Facilities Act
* 1965 PL 89-105 Mental Health Centers Act Amendments
* 1965 PL 89-239 Heart Disease, Cancer, and Stroke Amendments
* 1966 PL 89-749 Comprehensive Health Planning and Service Act
* 1970 PL 91-211 Community Mental Health Service Act
* 1974 PL 93-641 National Health Planning and Resources Development Act

Posted by: Kimmitt | Nov 4, 2006 11:07:52 AM There's no nursing shortage. There's a training shortage, because those doing the training can't afford to expand their programs. Tuition increases, problem addressed, nursing shortage fixed.

So, Kimmitt, you are arguing that there is no net positive externality from the training of additional nurses. No matter how many problems of incomplete information, risk exposure in the development of additional capacity, and liquidity constraints on potential students we assume away, the market will still deliver based on the net benefit of the training to the trainee, not the net benefit of the training to the economy as a whole.

the unreasonable government restrictions lobbied for by the health industry's representatives. The difficulty in building schools, in particular.

What restrictions? Accreditation by non-government associations?

Just a comment: The community college I went to, BCC, is adding its very first 4-year degree, and it's for nursing.

The community college I went to, BCC, is adding its very first 4-year degree, and it's for nursing.

Yep, same in my area and it makes sense. The problem was that although this was an ongoing institution and they had the infrastrucure availale, it took years and years to get the government nod.

So, Kimmitt, you are arguing that there is no net positive externality from the training of additional nurses.

No, I'm really not. Since all of these students are eligible for Federal school loans, I am implicitly in favor of significant Federal subsidies.

What I am saying is that in this case, we have a fruit so low-hanging as to be essentially touching the ground. Why force schools to wait around for their states or the Fed to start subsidizing a particular program, when there actually is a quick and reasonable market-based solution available?

it took years and years to get the government nod.

Why?

Alex: Unfortunately, Ezra and Joan are also correct. It's confusing, and the press almost never gets this right, but bear with me.

HMO-ization and hospital mergers in the '80s brought massive cutbacks, and nursing staff was the first to go. At the same time, the work became more hectic due to the trend toward discharging patients earlier, so that the ones still hospitalized were more acutely ill.

The cutbacks were not practically or fiscally sustainable, so eventually they began to replenish nursing staff (assisted by some very effective union campaigns over concerns of patient safety). But there still hasn't been any effort to restore staffing to anything over the bare minimum. When California passed a regulation establishing a minimum nurse-to-patient ratio that was just barely adequate, hospital administrators howled that it couldn't possibly be implemented without destroying health care; it has been, and it didn't, but they continue to push back. Basically they do not want to spend money on skilled staff, and you save more by having fewer skilled employees than by holding down wages on the ones you have.

The industry is still in transition, and the roles of RNs, advanced practice nurses, and unlicensed staff will probably be in flux for some time. Unfortunately the current situation is still unfavorable to nurses in every way except pay. They're responsible for a volume of work that would have been unthinkable 20 years ago; they support a medical staff that has less and less time to spend with patients; mandatory overtime is still legal and common in many areas; and besides the increased acuity of sick patients due to hospital policy changes, patients are becoming heavier (figuratively and literally) as chronic diseases continue to increase (it wasn't unusual for 50% of my patients at my last hospital job to require blood sugar testing and insulin three times in a shift). That makes it a less attractive job. Medical-surgical nursing - i.e. the typical hospital floor job - is now considered a grind that new nurses should escape as soon as possible; turnover is high, so there's less experienced staff around, which makes the job even more stressful. The more dedicated you are to the job, the more frustrating it is to realize that you only have time to do 2/3 or 1/2 of the necessary tasks for proper patient care.

I just don't see how the problem can be solved simply by expanding nursing schools or importing workers. Too often, new nurses are taking a look around and deciding that even if the money is good, it's not worth the abuse. The attrition rate when I went to school in the late '90s was horrible - students kept fleeing to any other health-related job they could find.

Texas has a deep bureauocracy. Here is a sample and this is candy-coated as it came from the state website. The reality is that these bureaus can keep you in limbo for years. There is no appeals process.

In contrast to Nursing, public accounting regulation is largely delegated to their professional organization (AICPA) who determine the requirements for licensure, test, etc. As a result, the quality is high and there are many, many CPAs available at a reasonable price. There is no shortage, even though the demand has gone up in the last 20 years.

======================================================

Starting a Nursing School

By statute, the board shall prescribe two programs of study to prepare vocational nurses, those conducted by an educational unit in nursing within the structure of a school, including a college, university, or proprietary school, and a program conducted by a hospital.

The board shall prescribe three programs of study to prepare registered nurses: a baccalaureate degree program that is conducted by an education unit in nursing that is a part of a senior college or university and that leads to a baccalaureate degree in nursing; an associate degree program that is conducted by an educational unit in nursing within the structure of a college or university that leads to an associate degree in nursing; and a diploma program conducted by a single purpose school, usually under the control of a hospital and that leads to a diploma in nursing.

All institutions must have approval from the appropriate agency, i.e., SAC, the Texas Higher Education Coordinating Board, or the Texas Workforce Commission. Individuals desiring to start a program, but are not approved as a school, must establish a school identity and be approved by Texas Workforce Commission as a proprietary school prior to contacting the Board for approval to start a vocational nurse education program.

Proposal for Approval to Establish a New Nursing Education Program
15.16 Development of Nursing Education Programs
Total Program Evaluation

Hey, Fred, I hear the unfettered free market in Somalia is just littered with nurses.

Less snarkily, I notice that my grandmother has extremely good nursing care in Austria. If there is one thing Austria does not do in healthcare it is unfetter the free market.

Maybe, just maybe, you're full of it.

Posted by: Fred Jones | Nov 4, 2006 2:52:21 PM Texas has a deep bureauocracy.

Maybe they should elect some Republican Governors and State Legislators to fix that. Republicans talk a great game on fighting bureaucracy.

On the other hand, even Republicans might run into the kind of situation that the AMA describes when they explain the complexity of licensing requirements for physicians:

Increasing public demand for protection, coupled with the growth in the number and sophistication of fraudulent practitioners over the past 2 decades, has resulted in stronger and more complex licensing boards and licensing statutes throughout the country.

However, I reckon this is a bit unlikely ... it is far more likely to be all them Democrats running things and their sheer cussed love for bureaucratic regulation.

"She sees a program that requires an extra six or seven years of training, but which is easier to get into and pays 50% more, so she chooses medicine. Or, if she doesn't want to do the extra years of training (and avoid the body fluids!) she chooses engineering. Medical school classes are now more than 50% female although engineering is still weighted toward men."

Med school accept rate is about 50%. Nursing school is not that hard to get into yet, although if the shortage continues and programs are not expanded it may get that way.

BTW,

nursing is a very good career and pays more than almost any occupation for the same amount of training. Many nurses now make teh same money as engineers. The average RN salary is close to 60k per year.

CRNAs/nurse anesthetists can make up to 150k per year, which is more than most primary care doctors.

The problem with nursing is lack of training programs, not money. Nurses make good money.

"The problem with nursing is lack of training programs, not money. Nurses make good money."

Yep - and ultimately (as we're already seeing, from comments like Sandals') this will result in more people going into nursing, pushing for more training places, both expanding existing courses and creating new ones.

From the comments earlier, people have been talking about this "shortage" for longer than most of us have been alive, each time taking some steps which result in some more nurses and stave off that shortage a bit longer.

I'd like to see more sponsorship (training to be an airline pilot costs a fortune, more than almost anyone could normally find or borrow - so airlines recruit promising would-be pilots and pay their way through, in exchange for getting them as a pilot for a while once they qualify) - long term, putting in the $100k upfront and getting, say, a five year commitment to be a nurse on $40k will work out better than trying to offer $60+k to entice would-be nurses to borrow the $100k themselves. I've seen some things along those lines, but don't recall the details off-hand - anyone?

Posted by: joe blow | Nov 4, 2006 7:30:01 PM The problem with nursing is lack of training programs, not money. Nurses make good money.

Posted by: Hob | Nov 4, 2006 2:52:09 PM I just don't see how the problem can be solved simply by expanding nursing schools or importing workers. Too often, new nurses are taking a look around and deciding that even if the money is good, it's not worth the abuse. The attrition rate when I went to school in the late '90s was horrible - students kept fleeing to any other health-related job they could find.

If attrition is a problem, then increasing the number of available place in training programs is only the start of addressing the problem. Not only do there have to be more nurses available, to improve working conditions, but there have to changes that encourage hospitals to improve working conditions.

One of those changes, of course, is universal coverage that includes basic preventative care and the urgent care that hospitals are required to provide, to reduce the amount of cost-shifting required in the system.

Yes, The idea that nurses make as much as engineers ignores (a) that much of that is overtime, frequently mandatory, and (b) that nursing is a more stressful job, frequently performed under worse circumstances.

Dear Fred,
If, God forbid, you should ever become ill and require hospitalization demand to be sent to a unionized facility. The single most important factor for a good outcome is an experienced RN at the bedside. A nurse in a union is better paid and enjoys better benifets and therefore is more likely to stay in that facility and has the incentives to improve his or her level of education and skills. Also, unionized hospitals have higher nurse to patient ratios which result in better outcome and more satified patients.
Don't just take my word for it: Link Between Nurse Numbers and Patient Mortality. http://www.medicalnewstoday.com/medicalnews.php?newsid=55228
Paul RN

I teach the required composition course at a university, and a student came the other day to complain about her B+ grade. (That is a good grade, really. :) She said that she would not be able to get into the nursing school if she got less than an A- in the course. I couldn't believe this (not that I'm going to change a grade because of this) so called someone I knew in the nursing school.

The student was right. To be a nursing student, she would have to get an A- in an English course. Understand, probably only 5 students out of 30 in this class will get A or A-, and they really are terrific writers-- just being good isn't good enough for an A (and shouldn't be).

The question is, why in God's name when we need nurses does the school have this absurd requirement of a top grade in a quite-unrelated course? Now I yield to no one in my belief that everyone should be literate and able to write. But there is nothing wrong with a B. Students who get As are usually English majors who want to write professionally or future professors. Why on earth would a nurse need writing talent and skills at that level? But that's what the nursing school dean insists on.

But please note, once you get into a nursing school and pass all the courses, then you get the RN or BSN and you're in-- you're qualified for a job. That's why foreign nurses, many of whom hardly speak much less write top-level English, can get jobs here-- they have that degree. But our own universities are making it next-to-impossible for our own American students to get the degree that will allow them to practice nursing?

Trust me-- a B in an English course is a good grade and adequate for anyone who isn't majoring in English or journalism. There is no need for science majors to get the top grade. Of course, I suspect the point of this is to force those of us in entry-level classes to inflate our grades and give everyone who "tries" an A, thereby making no distinction between adequate and great.

Anyway, next time you're in a hospital and you're wondering where all the American nurses are, well, they're probably retaking my class for the third time, hoping desperately to get an A this time so they can go to nursing school. This is absurd.

Lister - if it's anything like the place I started school (City U. of NY - a very good program) it's not that they have a specific rule about English grades; more likely they just have X number of slots available in the program, and a larger number of applicants, and the easiest way to winnow them is just to take the X highest grade point averages. They have very little leeway to take extra students if they don't have enough clinical instructors, because each teacher can only be responsible for a limited number of students when they're in a hospital or wherever.

I happen to be a highly trained nurse from the Phillipines and have worked in the US for over 24 years before this so called nursing crisis was a crisis and the spooks came out of thw woodwork to blame anything non-US. Well, I have to say that the state of nursing is no one's fault. The market will take care of it self. Meanwhile many nurses will have many great opportuniites.

Online nursing programs have proven to be very effective. Some highly regarded nursing schools now offer their programs online.

Changing nursing laws is essential to let more qualified nurses into this country.

Training more nurse educators is another thing that needs to be done.

While many industries are cutting back on the number of workers, nurses remain in demand. At http://nursejobslink.com, there are hundreds of nursing jobs available in all subfields of nursing. RN's, we have you covered!