In Part Two, we examined the rapidly changing nature of post-secondary teaching, one of the two reasonably skilled jobs among the top ten jobs estimated by the U.S. Bureau of Labor Statistics to show the highest job growth between 2002 and 2012. The other job is nursing. Job experts claim that there is a severe nursing shortage in the United States, and all sorts of programs have been initiated to get more students into nursing schools and to make it easier for hospitals to recruit nurses from foreign countries such as India and the Philippines. The student recruiting includes advertisements ballyhooing the fulfilling nature of the nursing profession: nursing requires a lot of skill and at the same time allows a person not only to satisfy the need for meaningful work but to alleviate human suffering.
In preparing to write this article, I interviewed a Canadian nurse, an activist in her union, with more than thirty years experience. I also read an informative article by Gordon Lafer (“Hospital Speedups and the Fiction of a Nursing Shortage,” Labor Studies Journal 30.1, Spring 2005: 27-46). Lafer tells us that
Nurses may constitute the single most dissatisfied profession in the U.S. . . . When one recent survey asked nurses to describe how they felt at the end of the day, nearly 50 percent reported feeling “exhausted and discouraged.” Forty percent felt “powerless to affect change necessary for safe, quality patient care”; 26 percent felt “frightened for [their] patients,” and 24 percent felt frightened for themselves. Perhaps most disturbingly, 55 percent of nurses reported that they would not recommend a nursing career to a child or friend. (p. 32)
Things are so bad in nursing that nurses are quitting their profession in droves. Hospitals everywhere in the country are suffering severe shortages, many forced to close beds and delay or cancel surgeries, much to the chagrin of patients who regularly complain of poor care. The number of unfilled nursing positions is perhaps as high as 150,000. However, what is remarkable is that there are tens of thousands of nurses working in jobs other than nursing, having left for better salaries, more convenient hours, and safer workplaces, disgusted with their inability to “practice nursing on a professional level” (Lafer, p. 31). A conservative estimate is that if the nurses who have left the profession and still have up-to-date skills returned to nursing, two-thirds of the shortage would disappear overnight. Lafer contends that the shortage will only get worse if the conditions that drive nurses out of the hospitals do not change dramatically. The new nurse pipeline may contain larger numbers of first-time job seekers, but these will soon leave, too, disgusted with degraded working conditions.
The increasingly money-driven nature of health care, marked in the United States by the rapid spread of managed health care, which, by greatly reducing the length of patient stays, reduced hospital revenues. Hospitals responded by cutting nursing staff and instituting radical changes in nursing procedures, such as sharply increasing patient loads, implementing mandatory overtime, and forcing nurses to abandon many patient-centered aspects of their jobs, using less-skilled and lower-paid nursing assistants and electronic technology to perform these tasks.
My Canadian nurse informant gave me chapter-and-verse verification of what Gordon Lafer reports in his article. She reported to me that patient loads (patients are now called “clients”) have risen to unconscionable levels. She now works in a long-term patient care facility, where most patients require acute care. Last year there were four Registered Nurses plus some nurses’ aides for 32 patients. Today there is one RN for 107 patients. Much of an RN’s time is spent filling out forms for funding purposes, and most of the nurses’ patient-centered activities are done by less-skilled aides and machines. This means that the nurses’ knowledge of their patients, knowledge which can save lives, has been lost. Senior nurses have been laid off or encouraged to take early retirement, and they are either not replaced or replaced with student nurses. This has led to occasional disasters. In the past, student nurses had senior mentors and learned how not to make mistakes. Now they are on their own, and their failure to see warning signs obvious to an experienced nurse costs lives.
Like the colleges, hospitals are top-heavy with highly-paid administrators; when hospitals merge, the number of workers decreases relatively much more than the number of administrators. And as in colleges, administrators are primarily money managers, concerned with the bottom line and not with the health of their “clients.”
One final point the Canadian nurse made is that nursing students are now being trained in a system far different than the one in which she was trained. Their expectations are not to become care givers but to become middle managers. So the system creates the people best suited to it. What was will soon be lost forever, unless the nurses’ unions and the larger labor movements struggle for change.
Well, so much for the best jobs among the ten fastest-growing occupations in the United States. New entrants into post-secondary education and nursing will not be likely to find rewarding, fully human work in their hospitals and colleges. Nor in any other jobs. In the next part of this series, I will begin to explain why most jobs entrap us in meaningless and inhuman labor. I invite readers to submit essays on their own work. Send them to me at .
Michael D. Yates is associate editor of Monthly Review. He was for many years professor of economics at the University of Pittsburgh at Johnstown. He is author of Longer Hours, Fewer Jobs: Employment and Unemployment in the United States (1994), Why Unions Matter (1998), and Naming the System: Inequality and Work in the Global System (2004), all published by Monthly Review Press.