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An interesting conversation took place recently between a 45 year nursing veteran and her family. The topic of the day was the nursing shortage and the veteran nurse surprised all by announcing, There is no nursing shortage, there is a hospital nursing shortage.

She went on to explain that in the home health and non-institutional nursing fields, there is an adequate supply of nurses willing to work for employers who respect and value their services. According to this nurse who had worked in hospitals for much of her career, the problem today is that hospitals and other institutions see nurses and other professionals as replaceable rather than precious.

No nurse my age is going to work for some young supervisor who believes that you manage people by threatening them or their license. There are too many jobs out there to deal with that nonsense.

This veteran nurse struck on the key factor in any employee shortage, the relationship between employer and employee. Two contrasting examples of the value of the employer/employee relationship demonstrate the promise and peril facing healthcare in the future.

Steeley Corporation:

One of the two largest employers in a north Florida community, Steeley Corporation had once been one of the two most reliable employers in the region. Steeley Corporation was the unrivaled market leader in their niche and pay at Steeley Corporation was second only to pay at the paper mill. Steeley Corporation management was exclusively hand picked individuals who had proven their willingness to follow any order given by the company president. Steeley Corporation management believed in an authoritarian management model and the lack of other good paying jobs ensured that employees remained despite the poor employer/employee relationships.

As the economy of the area shifted from manufacturing to tourism, Steeley Corporation began to suffer financial difficulties. Convinced that the company could be profitable again if the employees would stand with the organization, mandatory overtime and shortened breaks were instituted to save jobs. Employees unwilling or unable to work past the end of shift were terminated and management further retaliated by giving poor references. As the company spiraled downward, payroll checks began to bounce and managers began threatening licensed employees with reports to the state. Employee resignations skyrocketed and families began leaving the community. Finally, the company collapsed and disappeared overnight. In the aftermath, hundreds of employees were owed millions of dollars.

Intuit

The early days of the dot-com craze were characterized by a many great ideas that would flounder for years until rediscovered by a bigger company. Small software houses would create a fantastic product, but without the funds to run a start-up business, these products would either disappear or be purchased by larger companies. Microsoft was the biggest buyer of such innovative technology. It was into this environment that a small company with an electronic checkbook was born. Intuit began in a garage and grew quickly on money borrowed by the founders.

The brightest days for Intuit were quickly followed by sudden financial darkness. As larger software developers entered the personal finance market, Intuit found itself in financial trouble. The company founders made the employees an extraordinary offer based on the value they placed on the employees and the relationship with each as a person. The employees were offered an opportunity to work for partial ownership of the company. Those who chose this option would become shareholders with the potential of making millions if the company survived to be a publicly traded company. Employees who could not afford to forego being paid received a guarantee that their job would be available if they chose to return when the company was again solvent.

Intuit management had cultivated caring relationships based on mutual respect with each employee. There was no management by intimidation at Intuit and the company was rewarded when financial disaster loomed large on their horizon. Most key company employees opted to stay, unpaid, in exchange for ownership. A small group of employees were unable to forego an income. Intuit management guaranteed their jobs and honored these guarantees when these employees returned. Over time, Intuit became the dominate personal and business finance software manufactured, even staving off a take over attempt by Microsoft.

Healthcare has become a split marketplace with institutional care (hospitals and nursing homes) separated from non-institutional care. Nurses are gravitating to non-institutional care despite lower pay because of the factors that Intuit and others have come to appreciate. Employees care more about the relationships than the money. Veteran nurses remember being respected and appreciated for long hours and selfless dedication. It was not expected or required, it was given freely and accepted graciously. Even in a materialistic society people want to be loved and cared for, respected and valued.

There is no nursing shortage, there is a relationship shortage.

Dr. Maurice A. Ramirez is co-founder of Disaster Life Support of North America, Inc., a national provider of Disaster Preparation, Planning, Response and Recovery education. Through his consulting firm High Alert, LLC., he serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple medical specialties, Dr. Ramirez is Founding Chairperson of the American Board of Disaster Medicine and a Senior Physician-Federal Medical Officer for the Department of Homeland Security. Cited in 24 textbooks with numerous published articles, he is co-creator of C5RITICAL and author of Mastery Against Adversity. Dr. Ramirez invites comments at: http://www.disaster-blog.com