Nursing Care in Crisis

Linda Agustin Simunek Ph.D.

Few professional fields in the United States have experienced a more dramatic and debilitating change than nursing. The profession has been transformed from a hands-on, patient-centered environment – where personal relationships play a key role in healing – to a workplace dominated by technology, regulatory requirements, and exacting record keeping.

Myriad factors are hemorrhaging the profession and creating a critical nursing shortage. How to repopulate the field?

The answer might be found in “in-sourcing,” according to Linda Agustin Simunek.

This Philippines-born nursing professional has become a tireless role model and mentor to a talent pool of newcomers coming to the U.S. from other nations who would follow in her footsteps. Simunek – who is distinguished by a formidable education that includes a Ph.D. in Educational Administration, a Master of Science in Nursing, a Juris Doctor law degree, in addition to her Bachelor of Science in Nursing and Registered Nurse designation – is the first Asian to become a dean of nursing in the United States, and the founder of nursing education programs in several universities.

Joining Nova Southeastern University in 2002, Simunek splits responsibilities between teaching in The Fischler School’s doctoral minor in health education – particularly with clusters of students in South Asia – and NSU’s College of Allied Health and Nursing, where she developed and teaches two core courses for a full Ph.D. in nursing education. All the while, she has been an incisive observer of the growing shortage of qualified nurses in the U.S., and has actively looked for ways to overcome it. In-sourcing – providing educational and employment opportunities for foreign-born potential candidates – is one of those solutions.

Throughout her leadership career, Simunek has repeatedly traveled throughout Asia, particularly returning to the Philippines, seeking ways to overcome the critical shortage in U.S. nursing care, while helping promising individuals to find new and better careers. As Legal Advisor of the Philippines Nurses Association of America (PNAA), the Filipino organization in the U.S. with chapters in 35 states, she has over the years facilitated the acculturation of thousands of promising nurses and nursing candidates into U.S. domestic programs, while advocating at every turn for more and better nursing education opportunities.

“The nursing profession demands a lot of an individual – a caring personality, critical thinking skills, the ability to make decisions, and hard knowledge in the sciences of anatomy, chemistry, biology, and pharmacology,” Simunek said. “Nurses practicing today are expected to manage recurring medical conditions, prescribe medications, and make nursing diagnoses and physical assessments of signs and symptoms.

“Yet the greatest challenge to becoming a nurse is not the multifaceted skills or scientific knowledge – it’s the lack of educational facilities, of nursing programs and teachers. Almost in inverse proportion, employment opportunities continue to increase, while educational avenues continue to decrease. It doesn’t make sense.”

As early as the 1990s, a New York State Education Department report described the critical nursing shortage as global in nature, and pointed to “an aging work force… image of the nursing profession… impact of managed care… and other cost containment measures. . . .”

The report traces the shortage to “a reduction in the number of hospital beds… predicted due to the emerging influence of managed care. In turn, nursing education programs and potential nursing school applicants anticipated that fewer nurses would be needed in the future. Fewer people applied to nursing programs and fewer faculty were hired.”

Ask anyone who’s had a hospital stay recently – nursing attention is not what it used to be. It’s not that nurses are less skilled, less experienced, or less caring; there are just fewer of them. A generation of American-born nurses has been leaving the profession in droves. The fact is there are not enough nurses to replace them. While the public perceives nurses as highly ethical and compassionate, nurses report a lack of appreciation from institutions and physicians, which they believe is reflected in poor recognition and relatively low pay.

Additional factors for the nursing shortage include rapid technological advances in diagnostic and monitoring equipment as well as managed care cost-reduction initiatives, which result in staff downsizing. Increased training requirements, expectations for error-free work, ever-longer and less-friendly work schedules are other factors driving seasoned nurses away and discouraging new American recruits.

As for hospital patients, they are increasingly at risk for life-threatening complications – from neonatal units to ICUs, from avoidable post-operation infections to long-delayed triage in emergency rooms.

A 2007 report from The Center for Nursing Advocacy “encourages the health care system to improve nurses’ poor working environment. . . [citing] studies linking fewer registered nurses to poor patient outcomes and danger to patient safety.” The report encourages increasing the status of nurses, promoting nursing as a more desirable profession, and urges “adequate staffing ratios to improve patient safety.”