Upstream Thinking about the Nursing Workforce

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

One of the big challenges in organizational and governmental planning is convincing policymakers about the value of preventative measures. Paying to solve problems before they happen is not top of mind in a world that has been more focused on short term gains. Yet in the COVID-19 pandemic, we are seeing the outcomes of not being more proactive. When you fail to work at prevention and/or proactive planning, you are forced into a reactionary mode to deal with the fallout of a crisis.

Many nurse leaders have talked with me over the years about their frustrations in trying to present a business case to stop often foreseeable problems from happening. Some Chief Financial Officers are often quick to point out that they are not in the business of spending money on something that “could happen but might not.”

If there is one lesson learned from our experiences with COVID-19, it should be that we do need to become better upstream thinkers. Most leading infection control experts will tell you that it was only a matter of time before we had a pandemic of this magnitude. Yet getting someone to own the problem and the planning has proved very challenging. It is easier to wait and then respond.

In his new book, Upstream; How to Solve Problems Before They Happen, Dan Heath points out that we all have a tendency to work around problems. We are resourceful. We are great at improvising at the moment. We have become so accustomed to dealing with emergencies that we don’t reflect on how we could have prevented them in the first place. It is our inattentional blindness that can lead to a lack of peripheral vision.

I thought about this as I read this morning that all of the school nurses in the Florida county where I live have been furloughed because public classes are being moved online for the fall semester. The most experienced nurses are being offered a retirement buyout. It seems like an incredibly shortsighted decision. For years, these nurses have received accolades for the care they are providing to many indigent and chronically ill children with little access to healthcare. One school nurse that was interviewed reported that she was shocked. She noted that we are in the middle of one of the nation’s COVID hotspots with almost no contact tracing. It seems shocking that our county health department cannot find a way to employ these nurses to fight what has become a community crisis. She referred to the work that she and her colleagues are doing as “dispensable”.

Now here is the sad part that Dan Heath talks about – the fallout from all of this is predictable. Many of these nurses will likely not return to work in these settings again. With them, they will take decades of vast experience in managing children with complex medical needs. Absenteeism which has been a key metric of their success will increase. At some point in the future, resources will be reinvested to rebuild what has been lost. It will be costly and take years. It is a tremendous loss for the community and the children. These decisions which focus exclusively on short-term budget gains have long term consequences and costs. No one will be held accountable for the price of failing to acknowledge the upstream problems likely to occur from this nursing workforce decision.

Lead to Read

Heath, D. (2020). Upstream: How to solve problems before they happen. London: Bantam Press.

Read Rose Sherman’s book – The Nurse Leader Coach: Become the Boss No One Wants to Leave