Thank you. Good afternoon. I mean, I know we have that post-perennial letdown and everything, but I like to speak before a live and awake audience. So thank you to SSCCM for the invitation to provide the lecture this afternoon, a topic that's near and dear to my heart, and I think with what I will be pointing out, you'll see that there's some interesting similarities, I guess you could say, with the nursing shortages that has occurred in the past. So without further ado, we'll go ahead and get started. I do have no disclaimers other than the fact that I am the, as was stated, I am the immediate past president of the ANA, but I have no financial support from the ANA. But I will be using a series of slides from our Pulse of the Nation's Nurses Surveys. These slides, I felt, were extremely important for this particular presentation because I think it will add to the changing demographic, if you will, that we saw going forward as the pandemic continued and does continue. So that would be the only disclaimer there. The objectives, they told me I had to have some, so here are the objectives, was to explore the longstanding historical causes of nursing shortage, and I think you'll find that there's a lot of similarities as we talk about that. Hopefully you have a greater understanding and comprehension of what ANA's response was during the pandemic and, well, as it is beginning to wane, to try to address the nursing workforce issue as well. Explore some of the causes of nurse burnout and strategies to combat those, the burnout that is occurring. And then also explore some potential solutions to address the nursing workforce shortage. Newsflash though, the nursing shortage is not new. I'm sure for the nurses out there in the audience, you are very much aware of that. Having been a nurse myself for 44 years now, when I first started in nursing in 1976, there was a nursing shortage. They imported a bunch of nurses from Canada to help alleviate that. So that has continued to go on. But I think it is important that we realize what we're facing today, even though it's nothing new, it is much more severe than what we've seen in the past. So I think, however, as we begin to explore the historical perspective of the nursing shortage, we're going to see that there's some similarities also that has occurred. So a quick look at some of the history of the nursing shortage in the U.S. would seem to first have been reported in the early 1930s. During this time, the country was recovering from the Great Depression. And according to an article from the University of Pennsylvania Penn School of Nursing at that time, the 30s shortage was mostly documented as being a demand-driven nursing shortage, meaning that the shortage was due to an increased use of health care at that particular time. And that put forth a reduction in the amount of nursing supplies and also the hours that nurses worked were shortened in order to try to accommodate that. And also the technology that was in place made it very complex patient care demands also that was causing for an increased number of nurses at the bedside. The report also pointed out that hospital administrators failed to find constructive solutions to the problem. In fact, some hospital administrators even blamed nurses themselves for creating the shortage for failing to live up to the ideas of their profession and refusing to work, if you will. But another thing that occurred during this time also, during the mid-40s, was that about 77,000 registered nurses, which accounted for about a quarter of the nursing workforce at the time, was drawn from the civilian sector to supply the ward needs. So with the 1943 Bolton Act and the creation of U.S. Nurse Cadet Corps, that, too, continued to create a shortage in the civilian world, if you will. And at the same time, there were efforts that were done to address the supply side of nursing challenges by creating a new category of nursing. This is where the LPNs and the nursing assistants came in, which would allow the RN to provide supervisory care for that group of nurses at that time. So post-World War II, though, the nurses who served in the military did not return to civilian jobs, and at the same time, the supply of nurses was reduced. As this happened, the demand, again, began to increase. That same report that I mentioned earlier began now to note that the period from 1946 to 1952, hospital admission rates rose by 26 percent. Some of the factors that drove that shortage during this time was insufficient economic incentives to attract or retain nurses, translated into low wages. Does this sound familiar? Nurses identified a lack of retirement pension based on their low rate of pay. Now, keep in mind, we're not too far removed from the old nursing school thought that a nurse should set aside a certain percentage of her salary so that during her old age, she would not become a burden on society. One nurse even stated during this time that, as it stands today, nurses offers only just the bare basics to cover the essentials of living with no chance of having a future retirement fund. So, again, this is all beginning to sound a little bit familiar, but also since most nursing students at the time were required to live on the hospital grounds, because keep in mind, at this time, most nursing programs were hospital-based, any woman who became pregnant or had children was encouraged to leave the profession as well. So some other factors, as we talked about, the insufficient economic incentives, nurses identifying the lack of retirement and the limited opportunities for promotion and, again, the long hours that they were forced to work as well. During the 1960s, another prominent shortage poked its head as well, and in an attempt to address this particular shortage, the federal government passed the Nurse Training Act, which authorized $283 million into building new nursing schools in an effort to expand nurse training and provide loans for nursing students. There was a noticeable rise in nursing schools, but it is argued, though, that it probably – the increase in wages that the hospitals began to reap from the advancement of – the passage of Medicare and Medicaid, which allowed them to offer better salaries for nurses was what helped to drive that. There was also an improvement in the economy that made nursing an attractive profession. Again, we weren't too far removed from when the choice for a woman working outside of the home was either to be a secretary, a teacher, or a nurse. So this, too, made a huge impact. And of course, nursing hours were cut to eight hours or eight-hour days to make the profession a little bit more attractive as well. And then we began to see more men coming into the profession, and this had a profound change, if you will, because of – with men coming in, we saw an increase in salary because of – you know, just historically, men were always thought of as the primary breadwinner, so they would get a higher salary. And also, men tended to easily transition into leadership positions within the profession, and they also tended to concentrate more in the ICUs and critical care and OR sections of hospitals. So how is today's shortage different from what we have seen? You know, we must ask ourselves that, and from the other prior shortages. So in the 20th and 21st century, we see now that we have an estimated nursing workforce of about 4.3 million registered nurses, yet there's still this documented shortage. So you could say that the supply and demand continues to play a major role in the many decade-long nursing shortage that has happened, with an occasional brief, you know, a little bit of period of relief. But a couple of factors also contributed to the nursing shortage from the 60s onward, such as the demographic changes, and by that I mean we have a society where people are living longer and utilizing healthcare more. And so as a result of that, there's an ever-increasing need for nursing in general. Number two is they're also wealthier, which means that they can demand a higher level of care and also have the ability to pay for that. And again, there's always the ever-increasing demand for more people to enter the nursing profession. And one of the ways to try to speed up or shorten the nursing education programs, again, was a reinvestment in having the LPN's nursing assistant be able to do most of the manual work and have that be supervised by an RN. But as we move into the 2000s, working conditions are still considered to be very challenging. Nurses are feeling undervalued. Nursing schools failed to plan for the predicted nursing shortage due to the Baby Boomers retirement that was first began to be published in the mid-80s as well. Today, even before COVID, there was a gap that existed between supply and demand, if you will. Papers, reports, surveys, et cetera, all began to being published in the early 2000s onward, predicted and revealed that there was going to be a huge workforce shortage or a tidal wave. But market forces, again, such as hospital administrators, nursing schools, Government Bureau of Labor, failed to take into consideration and to act on the part of a system that would put in place or to put a system in place that would begin to combat this huge workforce shortage as well. So now you must ask ourselves then, how is today's shortage different? So another factor that may have contributed to the ongoing shortage perhaps was the Future of Nursing 2010 report. This report called for an increase in the number of BSN prepared nurses in the workforce to 80% and doubling the population of graduate degree nurses. So you have a lot of nurses who would normally be at the bedside now seeking graduate degrees and believe me, I am not against that, I'm just pointing out a fact that the fact that more are wanting to get a graduate degree, that means that they left the bedside. And currently, the workforce still falls short of these recommendations. Additionally, according to the U.S. Registered Nurse Workforce Report Card, the nursing shortage is predicted to persist across the country until 2030 and is expected to be worse in the south and in the west. And again, think of these as very heavily populated areas as well where there's going to be that increased need for nurses to be there. And there's an estimated need of an additional 3.6 million registered nurses by 2030. That's concerning and it's not even taking into consideration also the retirement of the baby boomers that will continue to go forth. And in the United States alone, we only graduate on average of about 250,000 new nursing students every year. So it's going to be difficult to try to fill that or back hold that huge deficit that has already began to occur. So when you factor in all those, the shortage had already created a deficit, and more and more nurses are choosing to remain at home. And notice I'm saying that they're not leaving the profession, but they're choosing not to work in the environment or the acute care environment. It would be difficult to meet those estimated deficits that we had talked about. And then came along our friend COVID-19. When I was first started my presidency with ANA, I had six goals that I was going to work on. And one of those was to increase the diversity of nursing and increase nursing in general, but increase the diversity of nursing because I'm a strong believer that our profession should be representative of the people that we care for and also have more men to go into nursing as well. But then that got sideswiped a little bit when our friend called SARS-CoV-2 came in. It officially arrived in the United States in January of 2020, but didn't spread enough to shut down the country until March 13th of 2020. If you remember back then, there was a lot of unknown factors about this virus as well. It was definitely something that we in the healthcare science industry and globally had never experienced before. People were being affected by this virus regardless of their ethnicity, their sex, their age, although there did seem to be, that it seemed to have struck older adults first and people with other comorbidities as well. COVID-19, as we all have heard say in so many different ways, that it not only exacerbated and accelerated the nursing shortage, but that was already occurring, but it did make it that much more significant. Let's take a look at the ways the pandemic may have accelerated this shortage. First of all, back up for just a second. First of all, once COVID hit the U.S., healthcare positions were not isolated from the sudden job losses that happened and a wide gap began to be projected, if you will. What we saw was that on March 20th, there was a sudden job loss. Then in April, older nurses were, as we began to pull nurses back in, older nurses were told to remain at home due to the fact that patterns of the COVID affiliation with this particular population and a lot of older nurses, once they were asked to come back to work, decided that, I don't want to take a chance. We still were not that well versed on how this virus was transmitted, and so there was a lot of things that would go into the mind of the older nurses, plus they didn't want to perhaps take the risk of bringing it home to family members as well. Some of the other things that we saw was the hospitals began to furlough staff, which were not involved in the care of the COVID patients, and nurses who worked in areas such as outpatient surgery centers and clinics and et cetera, they were suspended. This obviously saved a lot of money for hospitals, and staff were leery, again, about coming back into work once they were called back into work, and in fact, let's not forget that in some cases, some people qualified for the funds that the government was given, and in some cases, they were making more money from those funds than what they were making in their weekly or biweekly checks, so they were opting to stay at home as well. But as the virus continued to spread, and we began to get more and more information about it, then we began to do a pulse of the nation's nurses survey. The American Nurses Foundation began to do those surveys, and we began to see that nurses were already becoming or experienced extreme exhaustion, fatigue, both mentally and physically. There was mandatory overtime that was put in place because a disaster had been declared by the federal government, which it wasn't unusual for nurses to point out that they were working anywhere close to about 60 hours a week in mandatory overtime as that was beginning to happen. One of the other ways that, you know, that began to affect the need for more nurses to come back into the setting was that hospitals began to invest in travel nurses, and they could, nurses realized they could begin to make anywhere on average of $12,000 to $15,000 a week, you know, by being a travel nurse. Now this created obviously a huge brain drain and a shortage at facilities where nurses were working before, and also it created tension for nurses who chose, those who chose to undertake travel, but for those who remained, feeling that they were not being compensated as well when they were making on an average of about $35 an hour, and the travel nurses were making four to five times that amount, that did not create such a good scenario. So what a lot of nurses perhaps would do was leave their current employer, come back two weeks later in that same position as a travel nurse, but still making a significant amount of money. Nurses also were beginning to report physical assaults on them by either a patient, a family member, or even their colleagues as well from the frustration that was beginning to happen. And of course now we use the term the quiet quitting that is beginning to pop his head at this time as well, meaning that they were just doing enough just to get by, you know, nothing extra along those lines. As I mentioned, the American Nurses Foundation began to do its Pulse of the Nation's Nurses Survey Series, and one of the first ones that we did was in, was done in March, excuse me, April of 2020, and by that time we had 10,000 nurses who took the survey, half said that they continued to feel overwhelmed by, you know, what they were experiencing. Nearly 30% said that they were experiencing feelings of depression. Three of the four nurses who responded also said that they were suffering from challenges with sleep, either excessive sleep or sleeplessness, again showing that this is beginning to have a significant mental effect as well. And a few weeks after that we released another report that showed the financial impact that COVID-19 was having on nurses as well. While more than a third reported, of the respondents of this particular survey, reported that they had delayed making major purchases, findings in the survey also showed that black and Hispanic nurses and Latino nurses were more likely to have offset financial challenges. In other words, they either had to, about 44% had to access their savings, some had to stop paying their student loans, some were reported borrowing from friends or families, and others reported receiving assistance from charities, even going to food banks because they were not able to make ends meet on the monies that they were getting when they had been furloughed. Also during this time, we began to see, too, that nurses were concerned about the mask shortage that was beginning to happen. Again, this is a comprehensive survey, and throughout this we learned that, you know, the shortage of PPEs, which allowed me to go to Congress and talk to them about the supply chain or the inefficiencies of the supply chain that was beginning to happen. Since the initial one we've done, we did a total of three Pulse of the Nation surveys that specifically addressed the mask issue, and again, six months into COVID, one of the big concerns that nurses was having was that, you know, the fact that the way masks were being re-sterilized and et cetera, you know, was not, was going against the CDC guidelines. And again, a survey, 42% of the nurses said that they were still experiencing intermittent PPE shortages. Over half or 15% in the May survey that we did reported that they were having to reuse the same mask and 68% said their facility policy was that they would continue to use those masks as well. So based on those findings, what we were able to do at the American Nurses Association was to set up, you know, programs that would provide the education that patients needed, or excuse me, that nurses needed regarding PPEs, ventilator training because a lot of nurses were being pulled from maybe a med search floor to try to work in the ICU because of the shortage that was happening as well. The ethical challenges of COVID-19 as well, the, and also addressing their mental health needs and mental health resources. We talked about the racial disparities that was brought on as a result of COVID as well. And all these were available on the ANA website. Also during this time, the foundation, as you said, launched the COVID response fund for nurses. And one of the things we were able to do with this particular fund was, thanks to a generous donation, started out with J&J and then we had a golf tournament and several other donations to get a total of, I believe, $10 million that went to, part of that went to Nurses House, which allowed for nurses to apply for a one-time $5,000 grant, if you will, to help defray the cost of bills and things that were beginning to pile up. Some of you may have even taken part of the Hilton Honors Program where they allowed nurses to stay at the hotel as opposed to going at home and, you know, taking the risk of bringing the virus to their family members as well. Additionally, based on, we were concerned about the mental health and well-being of nurses as well. So as part of the mental health efforts, the American Nurses Foundation, ANA, and our partners, the American Association of Critical Care Nurses, the Association of Perioperative Registered Nurses, the American Psychiatric Nurses Association, and the Emergency Nurses Association launched the Well-Being Initiative in May of 2021. And this was designed for nurses by nurses to specifically address those mental health needs. This is a comprehensive mental health assessment program that offered vital support for nurses. It starts out that nurses would take a self-assessment test, answer 10 questions, and then it would steer them or offer them various tailored suggestions of techniques and things that they may want to use. Some of the things that were offered, nurses together connecting through conversation. This allowed you to talk to other nurses across the country who were experiencing the same thing that you were. There was a ModFit app that, again, promoted wellness. There's the Happy App as well. There was also the expressive narrative writing that was encouraged as well. And last but not least, there was a lot of mental health support services as well. One of the big things that we were hearing from nurses at the time was that one, they're trying to be stoic about the mental health needs, even though it was definitely being reflected in their work and what they were doing. But there's the stigma associated with seeking mental health. So this was designed to reduce that particular stigma that they would be able to connect with mental health support services and not have it, you know, appear either on their personnel records or even on their licensure if it was, if their license were up for renewal or insurance as well. And that was one of the hugest concern that we were experiencing. We also wanted to remember our fallen nurse heroes as well. You may remember that 2020 was officially declared as the year of the nurse and midwife. And however, we got sod lined by the coronavirus. But we were doing everything that we can to ensure that those who paid the ultimate price that we remembered them and the work that they did as well in this particular effort. So as we continue to do more and more surveys, you know, with nurses and particularly concentrating on the mental health and well-being of nurses, it still remained a pressing issue with the ongoing stressors of the pandemic taking a significant toll on the younger nurses. And as you can see from the findings from this two years of impact survey, which was just done in last March, many nurses still report that they began to experience trauma. Younger nurses were suffering more than their older nurse colleagues. And it's clear from this survey too that just close to, we just did one actually that just will close in, closed in January of this year. But nearly half of the nurses age 35 and older said that they have sought professional mental health support since March of 2020. And of the survey, under 25, 69% said that they were still suffering burnout. And as a result of that, that is also causing them to want to either consider leaving the profession or at least take some time out from the job that they were doing. So we also began to experience that part of the survey was, you know, what were some of your reasons for leaving? Part is insufficient staffing. As you can see there, greater than 55%. Work has negatively affected my health and well-being. There was a lack of support from my employer during the pandemic. The inability to deliver quality care and a need for higher income. And you would note, I want you to note where that particular one has fallen. Because a lot of times what you're hearing is that nurses want more money. And we'll see this in a little bit later on in a couple more slides. But here is a framework I think that we can use to navigate the current challenges and also co-creating a different, better future for the profession. So in other words, if you take these expressed reasons for leaving as a starting point to begin to address the problem, well, maybe, and I say maybe because there's, this may not be reflective of everywhere where nurses are employed. As we know, nurses are everywhere. So we need to take a look at, well, where are nurses employed? And how does, how might that affect things? Well, we still see the majority of nurses are in the acute care setting. But this is changing. You know, they're in schools. They're in law practices. They're in ambulatory care clinics. They're in the homes. They're, you know, they're doing work in the streets as well. So all of these are a little bit different than what we normally see. We also wanted to provide a snapshot of the nursing workforce and the demographics of where nurses work. And this is from the federal government's National Sample Survey of Nurses. And this has been around since it started in 1977. And this is the most recent one that they put out, which is in 2018. But again, it still provides data of, you know, where nurses may work. So as the pandemic began to happen, and we noticed that, you know, predominantly one of the biggest drivers of the nursing workforce shortage was, one, the mandatory overtime, two, the insufficient staff that was beginning to occur, and of course, the mental health and well-being as well. Once these factors all combined, they began to contribute to the worst nursing shortage ever seen in the United States. The shortage is so significant that on September 1st of 2021, I personally, when I was president of ANA, wrote a letter to HHS Secretary Beaucer asking him to declare the shortage a crisis and to bring all the stakeholders to the table so that we could begin to address both short-term and long-term solutions to this problem. And although these many issues still continue to contribute to the current shortage, I'd like to address, you know, perhaps a few proposed solutions that I think may be worthwhile here. First of all, I think from a legislative perspective, you know, ANA, we have long been vocal on advocates up on Capitol Hill, ensuring that any change to healthcare needs to have these four elements. Ensure universal access to a standard package, optimize primary community-based and preventive services, also encourage that it is quality care that we're getting, and most importantly, that there is a sufficient supply of skilled workforce that may be dedicated to providing the high-quality care that's going to be needed as well. And also from a legislative perspective, the American Nurses Association, along with several other major nursing organizations, have set forth a priority for the 100, well now it's the 118th Congress, to begin to address these specific legislative issues that will address the nursing workforce and or access to care. One is the Workplace Violence Prevention and Healthcare and Social Services Workers Act. This will, again, will address the issue of nurse violence that may occur. The ICANN Act or the Improving Care to, Access to Care to Nurses is, again, would be beneficial for the advanced practice nurse and have improved access to them. The future advancements of academic nursing. Again, this was a funds that will be set aside to, again, provide more dollars for nursing education, faculty training, more classrooms, and et cetera as well. Improving access to workers' compensation, again, so that nurses who are injured on the job will be able to be fairly compensated, and restoring hope for mental health and well-being act, again, continue to address the mental health issues that were brought forth as well. Another solution approach is to hear from nurses themselves and what they want or what their thoughts are when it comes to solving the workforce issues as well. So, in the first quarter of 2022, ANA, the AACN, AONL, HMFA, and IHI, and several other major players in the whole hosted Nurse Staffing Think Tank. The purpose of this event was to evaluate and to hear directly from nurses themselves as to what they needed that, you know, would help keep them in the workforce and at the bedside. And once all that information was gathered, then it was synthesized into six particular areas here. But the information was gathered with the promotion that we would have better patient outcomes, better patient experiences, a thriving nurse workforce, and, obviously, optimized the value of care that was there as well. So, there were six imperatives, if you will, or six recommendations that came out of that. The first one is a healthy work environment. With the healthy work environment, what do we mean when we say healthy work environment? Well, nurses and other members of the healthcare team want to report to work and know that they're safe. They're safe and free from hurt, harm, and danger. And they also want to know that there's enough staff there to provide the care that's going to be needed, you know, so that they can do the work that needs to be done and also be attentive to the patient's need and not necessarily being required to check boxes in the electronic medical records to indicate that you did or did not do something but actually be more relevant at the bedside. The second recommendation dealt with diversity, equity, and inclusion. And here, nurses voiced a concern where there's a need for deliberate integration of DEI ideas into leadership, practice, daily operations, strategic planning, and, of course, decision-making as a priority as well. More flexible work schedule was the third recommendation. And what we mean by that is, obviously, flexible shifts. And what we're seeing is that some institutions are beginning to address this. They're looking at or trying going back to the eight hours so that, again, we all know that 12 hours quickly turns into 13 hours or 14 hours or 16 hours. And if you're working three and four days in a row, it's going to tell on your body. And if you don't have the downtime or, as I would frequently hear from nurses when I would be traveling the country, that they literally have to turn their phones off on their day off because they know that their employer is going to be calling asking them to come in and, yet again, work more overtime or make them feel guilty because they have a day off and their colleagues are still, you know, sitting back here at work facing the same thing. So perhaps looking at a more flexible work schedule may be something that would invite more nurses back knowing that I can work eight hours and still have a life after that eight-hour period is up. Also, speaking of flexible work schedule as well, another initiative is to bring those retired nurses back and perhaps have them come in and do four-hour shifts, you know, split an eight-hour shift, you know, two people do four and four or at least just come in and work four or six hours just enough to get them over the hump and then go back home as well is another thought of consideration. The other is a stress injury continuum. This is something to address burnout, moral distress, and incorporate the well-being of nurses, initiatives such as the Well-Being Program that we talked about earlier is a good example of such programs for this particular imperative here. The fifth one is the call for implementation of what would improve access to care, increase patient and staff experiences, and provide resource management that would stress continual improvement as well. And finally, the sixth one of the would be total compensation. And I think it speaks volumes that this is the sixth recommendation. If you remember previously, you know, compensation was the last one before. But it doesn't mean that we're minimizing this or it's not important because it is extremely important. Nurses should be paid for what they're worth and what they bring to the table. And as the largest member of the healthcare workforce, it still baffles me that, you know, nurses are treated as a commodity or included in the room and board of a patient's hospital bill when no other member of the healthcare team is treated that way. So, we definitely need to address the compensation issue as well to ensure that nurses are paid for what they are worth. So, we, the task force has taken those recommendations and have now begun to go to the next phase, which is the putting them into action. And you will note that even though previously there were six, we've narrowed it down to five. And these are the five priorities, if you will. And you will note that each of the priorities start with the imperative, we must. And it's extremely important that we must do this. Otherwise, we're going to be like a dog chasing its tail and, you know, look around and figure out, well, what did we learn? Absolutely nothing. So, there are five imperatives. And the first one is that we must recognize the unique contribution of registered nurses. And this can be done in several ways. Again, compensation being one, flexible work schedule, the work environment, you know, improvement in that, making sure that there's safe staffing, you know, is one of the recommendations there. The second one is, is that we must also have staffing standards that ensure quality care. Obviously, safe staffing standards that would ensure quality care in a less stressful environment for the nurses to work in. Staffing standards should be flexible to meet the needs to be able to flex up and flex down, depending on the acuity, the experience of the RN, and the support staff that's available. We have to take in consideration also the need for critical access facilities, regions of the countries where there may be fewer registered nurses than in other areas. The third one is regulatory efficiency is extremely imperative, or efficacy is extremely imperative as well. And I'm sure that you would agree that this doesn't do anyone any good to have staffing laws or regulations or staffing committees or mandated staffing governance if they're not able to be enforced, or there's no teeth, if you will, to ensure that these needs are met or adhered to. So nurses need to be able to talk to payers, insurers, their local, state, national representatives about how important it is that the decisions that they make at their particular table, how that begins to have that trickle-down effect and will affect the areas in which nurses practice as well. The fourth recommendation is to embrace new models of care delivery. And I think this is imperative as well. If we're ever going to provide improved healthcare access to all, we must look at new models that embrace the social determinants of health, that provide access for all, access to care for all, and is cost effective. And as we have a growing older adult population, and think about it, we're going to have the millennials and the Gen Xers begin to join the baby boomers in a few years as well, we definitely need to embrace some new models of care. Otherwise, again, as I stated before, we're going to be looking around and ask, what did we learn, you know, history is about to repeat itself. So that is the question that we must be prepared to ask ourselves if we don't do that. And finally, the fifth one is that we must reform the work environment. And the, we need a work environment that will incorporate skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership as well. So these are my thoughts as, or, you know, when we talk about how are we going to address the nursing workforce shortage, it's simple, pay nurses what they are worth, safe working environment, make nurses feel valued, listen to nurses, you know, because what one nurse may say is a value for them, for someone much younger or much older may have a different value. But the main thing is that the person or the individual feels that they have been listened to. More funding for nursing education. You know, if the average age of the nurse at the bedside now is, I believe, is 56, you can imagine what the age of the faculty member may be at that particular time. So we need to put more funding towards more younger nurse faculty, more facilities in which, for nurses to be trained, and also more scholarships so that people who would like to become nurses can do so without the added burden of either having to work while going to school or maybe taking, you know, their courses piecemeal at a time instead of being able to start and complete within a, you know, recognized period of time as well. Staffing standards that promote quality care, really can't emphasize that in, you know, much more, and, of course, innovative new models of care as well. And let me just say one last thing, and that is one of my favorite saying is that if you're not at the table, then you're on the menu. So for you nurses that are out there, you need to become more active and to have a voice in how your profession is practiced, because if you don't, someone who's far removed from nursing is going to continue to dictate how and what you do, your resources that you may have, and all that. And as we say in the South, that ain't right. So thank you very much. And enjoy. Thank you.

nursing shortage

historical causes

COVID-19 pandemic

job losses

mental health challenges

solutions

legislative actions

nurses' voice