From the Editor's Perspective…

Article Outline

• References
• Copyright

• 
  • View Large Image
  • Download to PowerPoint

• Cindy Lewis, MSN, RN, ACNS-BC

Once upon a time, in a land not so very far away, jobs were plentiful along with large-sized cars and mortgages. But then, the economy plummeted, and a recession arrived. As unemployment and inflation have crept up month by month, we are all challenged with managing and coping amid potential threats of unemployment and financial loss.

This is not a fairy tale; it is what we are facing today. Certainly, as long as people continue to get sick, there will be a need for nurses. For those who are insured, the new calendar year has most likely brought higher co-payments, higher deductibles and out-of-pocket expenses, as well as other changes in health insurance coverage. These changes do affect the level of care people seek. Moreover, given a choice between paying the medical bills, buying food, or paying the mortgage, people will be more likely to place medical bills on the bottom of the pile. This will certainly affect providers.

As hospitals, clinics and other providers face financial losses associated with these factors, nurses and other staff will be affected. Some hospitals and other facilities have already instituted hiring and merit holds and benefit changes; a few have eliminated positions. Thankfully, the Bureau of Labor Statistics predicts a nearly 30% growth in nursing jobs through 2014, the second largest increase of any occupation.¹ Although as nurses we may have less reason than many to worry about our jobs, it would be naive to expect that our profession will go untouched by a long and deep recession. The effects of such could be far reaching, affecting jobs, health, wealth and professional boundaries. The immediate impact of the recession is likely to mean some nurses may want to increase their working hours, while others may re-enter the profession. Yet, with decreasing elective procedures, job functions may also be scrutinized.

Many experts have noted that health tends to worsen in a recession. The most obvious way is the effect of unemployment on health. The mere threats of unemployment and homelessness have been associated with damaging health. At the extreme, such negative events are associated with increased risks of suicide and depression. Studies looking at the effects of factory closures on health status found that those who lost their jobs saw their health deteriorate, regardless of how healthy they were to start.²

International evidence on the health effects of a recession is pretty much unanimous: It's a bad thing. Only two studies, both from the United States, seem to contradict this. One suggests that employed people become healthier in a recession, perhaps because they reduce risk-taking behaviors, such as drinking and smoking. The other study shows that death rates go up in times of boom as people overwork, drink, smoke too much, and are more frequently involved in car crashes and industrial accidents. However, the weight of evidence from studies in Japan, the U.S. and Europe shows mortality and morbidity rise in hard times, especially for those who lose their jobs.³ Historically, any financial crisis affects poor people the most; health inequalities become more evident as a recession deepens.

So what does that mean for nursing? Ironically, illness does not consider economic factors. We know that the population today is older, more obese and more prone to chronic diseases. Those who face cancer, heart disease and emergency medical situations will need care whether they can afford it or not. We will be caring for sicker patients with higher comorbidities and with fewer resources available to aide us in our day-to-day practice. We will need to revise and streamline our processes. We will need to rely on each other and demonstrate greater teamwork to ensure the provision of quality, seamless care.

Nursing practice in today's world is both full of opportunities and challenges. Collaborative nursing practice offers the opportunity to improve patient care by efficiently using nursing resources. We need to ensure that we are working together, efficiently and wisely, to support the provision of quality patient care. Our patients deserve and should expect comprehensive care. We need to demonstrate mutual respect and teamwork in the best interest of our patients. Each of us has the responsibility to do our best and contribute to team efforts through effective communication and collaboration with one another. As we continue to be challenged to provide high quality, evidenced based care, our Journal is committed to providing the avenue to disseminate nursing knowledge. Share your patient stories, research and outcomes with our nursing community. Share your successes and practice changes. Share and collaborate. We look forward to hearing from you!

Back to Article Outline

References 

1. Bureau of Labor Statistics.U.S. Washington, DC: Department of Labor. Occupational Outlook Handbook, 2008-09 Ed. Available at http://www.bls.gov/oco/. AccessedMarch 9, 2009
   • View In Article
2. Carlisle D. Public health in a recession. Nurs Times. 2008;104:20–23
   • View In Article
3. Ewing J, Marlack C, Stecker T, et al. What's dragging Europe down?. Business Week. 2009;4122:36–41
   • View In Article