As early as 1915, leaders in the nursing profession were concerned with the “image problem of nurses,” which they saw as needing improvement. Since then, countless studies, reports, and commissions have attempted to explain and solve perceived shortages of registered nurses, which have occurred regularly after brief periods of quiescence or oversupply. Usually, their recommendations have hinged on nurses changing their image. In fact, few of these studies have dealt with the real issues of nursing work, which are a narrow pay range, little extra pay for working on undesirable shifts, disincentives for full-time work, pay unrelated to education, and education unconnected to job level. The multiple studies and commissions do nothing more than recycle data and in the process obscure fundamental problems. Educational funding has been no more successful. Their ineffectiveness suggests the need for less “image enhancement” and more support from physicians and employers to bring about systemic reform. This includes licensing nurses according to their education, assigning them according to their competencies and education, and paying accordingly. These measures, and only these, will eventually curtail the cycles of nursing “shortages.”

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