An essay by the University’s new nursing dean, Joanne Rains Warner. Warner, associate dean to the late testy and brilliant nursing dean Terry Misener, was a nursing dean at Indiana University before coming to The Bluff.

How unflattering to discuss my chosen profession with phrases like embattled workforce, poor image, deficit of crisis proportions. It’s easier and sweeter to keep those damning indictments distant — to drown words like that in the sacred joy of being a nurse educator, in the miraculous intimacy of giving care and comfort to others.

But those words are true, and they cannot be evaded, and they are symptoms of an intractably broken health care system, set adrift in a perfect storm of demographic and technological change. Here are the uncomfortable facts:

• The national registered nurse workforce is dwindling. The Health Resources and Services Adminis­tra­tion projects a shortage of one million nurses by the year 2020 — twenty percent below the need.
• The average nurse in 2004 was 50 years old, and the average age rises each year, in a profession of incredible physical, emotional, technological, and intellectual challenges. Nearly half of Oregon’s nurses are fifty or older; the proportion of Oregon nurses over 50 has more than doubled in 20 years. By 2025, 41 percent of American nurses are expected to retire. Nation­ally, nurses younger than 40 are more likely to leave than their older colleagues. At the same time, demand for nurses continues to grow steadily. Nearly 16,000 new jobs are expected in Oregon alone over the next 15 years.
• In 2006, U.S. nursing schools turned away more than 42,000 qualified applicants because the schools didn’t have enough faculty, preceptors, or clinical sites to educate them. In 2006, nursing schools in Oregon reported an average of six applicants for every position.
• Yet nurse educators are working hard: the Oregon State Board of Nursing reports a 76 percent increase in the number of nursing graduates since 2001. On The Bluff, nursing enrollment has increased 300% in the last 10 years.
• But faculty are also aging; the national (and University) average age of nursing professors is 58 years. In the next two years some 65 nursing faculty positions in Oregon will open because of retirements, but the pipeline of fresh faculty candidates is thin.
• Demographic changes deepen the mismatch of need and resources. Projections of Oregon’s shifting age distribution include swelling numbers of retirees. The Census Bureau projects that by 2025, 24 percent of our population will be 65 or older, earning us a ranking of the 4th highest proportion of elderly in the nation. Chronic, degenerative, and unexpected health conditions in elderly folks require more resources and nursing care. When you pair the growing numbers and needs of an elderly population with the flat growth of women aged 25 to 54 — the women who have provided the traditional core of the nursing workforce — you get words like deficit of crisis proportions.
• There’s more: expanded career options for women and the challenging work climate and the poor image of nursing, for example. Nurses are not shy about discussing the stress of their jobs, the excessive workloads, the days and nights of little control but high accountability for safe, compassionate care.
     Yet none of this can quench the river of hope that has carried me through more than three decades as a nurse and educator. And now, as the ominous shortage projections inten­sify, I am acutely aware of my personal sources of optimism. Among them:
• The values, deep and genuine personal connections, and complex scientific knowledge that nursing provides are sorely needed in our antiquated health system — which, in fact, is rarely about health and hardly a system. Nurses provide the human presence and touch that says No matter how vulnerable, scared, or pained you feel, you share it with another: me. Nurses give immeasurable relief and balm by their knowledgeable presence, attentiveness, and skill. Society needs our authentic presence — as much, or more perhaps, than any other craft in this nation.
• There are great, and I mean great, nursing schools in this country — ours among them, I am convinced — that are preparing graduates to not only work adroitly in our system but to improve and refine it. Every Uni­versity of Portland nursing graduate is armed with the skills and knowledge to be a proactive creator of a better system, but my heart leaps when I spot those few radically restless souls who are called to name and tame injustice or inadequacies in our system and society. The fixes we need are on this macro level, not in enrolling and retaining more sheer numbers of bright students. Real change will come in the transformation of a system that is less hierarchical and bureaucratic and one where nurses are rewarded as change agents, visionaries, and valued partners in the business of health.
• The stunning rise in numbers of partnerships between schools and hospitals also gives me great hope. An educational brain trust isolated from the critical realities of care-giving is disrespectful and foolish, but the synergy of partnership among schools and hospitals, for example, produces real innovation. Our clinical partners are quick to tell us where we are wrong or silent, and we bring creative and analytical energy they need to survive.
• I know for a fact that nursing schools can be communities of remarkable cohesion and verve, and this in a profession that for all its reputation of being caring can be notoriously petty and cruel. Not so at the University, where the culture of eager inquiry and communal zest is patent. We attracted and hired five new talented professors last year, in this era of critical national faculty shortages. Evidence enough.

My most persistent hope is based on the fact that nursing is a sacred act. I do not mean religious, though religious traditions like Catholicism have funneled many glorious nurses into the craft. I mean the deep and powerful spirituality of bringing your open heart and healing hands to bear on the pain and fear of another human being. To do that with your whole heart and mind is to know God. And I believe that the sheer spiritual power of my profession, the astounding gift and honor it is to be a nurse, is what will see us through dire years. I believe that with all my heart.