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Infection control professionals come into this time of economic uncertainty as an entrenched but aging work force, cutting a broad band across the mid-five figure income bracket, according to the 2001 salary survey by Hospital Infection Control. How broad is the band? Fifty-seven percent of survey respondents reported incomes in the range of $40,000 to $60,000. That breaks down to 30% in the range of $40,000 to $49,999, and 28% in the $50,000-$59,999 bracket. Another 17% reported incomes between $60,000 and $69,999.
Raises were steady but unremarkable over the last year, with 52% reporting wage hikes in the 1% to 3% range. Another 21% reported raises of 4% to 6%, and 6% reported raises of 7% to 10%.
The 2001 HIC survey showed an easing in past trends of department downsizing, as 83% of respondents reported their staffing was holding steady (66%) or had actually been increased (17%). That left 14% of departments reporting staff cuts, as opposed to 25% in the 2000 HIC salary survey. But the future, to say the least, is marked by uncertainty and challenge for the profession. All surveys were completed prior to September 11th and subsequent events.
A key question — at a time when there are no easy answers — is whether ICPs can leverage the nation’s expected investment in bioterrorism readiness into professional recognition, job security, and wage growth.
"It could be a real important role, but there are a lot of players right now," says Elaine Larson, PhD, professor of pharmaceutical and therapeutic research at the University of Columbia School of Nursing in New York City. "If ICPs want a role, then they have to actively seek a role. [Other] people want it and are ready to jump in. My question is, is the infection control community ready to jump in?"
The theme of "go forward or risk being left behind" is somewhat similar to the patient safety movement, but — depending on unfolding events — the bioterrorism issue could dwarf patient safety in terms of health care investment.
ICPs are in a fairly strong position at the outset, as they are one of the few professional groups that have been actively discussing and planning for bioterrorism over the last several years. "We’re an integral part in preparing for bioterrorism," says Pamela Niemiec, RN, infection control coordinator at Alexian Brothers Medical Center in Chicago. "But we’re not the only part. We need to work as a multidisciplinary team with pharmacy, the EMS coordinator for safety and environmental services in disaster planning."
ICPs must raise their program profiles if they expect to emerge as key benefactors in national spending on health care bioterrorism preparedness, she says. "As with the big patient safety initiative within the last few years, we have a niche to carve," Niemiec says. "Unless we are very active — and a lot of us are — I could see us being edged off to the side. But bioterrorism puts us right back in the bulls-eye."
A veteran of both the nursing field and infection control, Larson points to the emerging nursing labor shortage as another huge challenge. "There are predictions that we are going to be way, way under needs within the next five years," she says. "Already, hospitals are offering incentives to get nurses. The shortage is like a roller coaster; we go up and down. But the average age of nurses now is about 45 — a lot older than it has been previously."
According to the American Hospital Association in Chicago, there currently are about 126,000 vacant nursing positions in U.S. hospitals, a figure that could grow to 400,000 by 2020. Some of the commonly cited factors in the exodus from nursing are high job dissatisfaction due to managed care staffing cuts and rising in-patient acuity. That situation, coupled with fewer students entering the field, is contributing to a trend that could leave hospitals severely understaffed to treat an aging population.
By the same token, as the industry tries to respond to the labor crunch, there will be jobs galore for nurses. According to the Bureau of Labor Statistics, employment of RNs is expected to grow faster than the average for all occupations through 2008. There will be a need for traditional hospital nurses, but a large number of new jobs will be in home health, long-term care, and ambulatory care. That spells fierce competition between nursing professions looking to replenish their ranks. "The options for nurses are much greater," says Larson. "And that may have an impact on infection control."
New recruits will be needed. More than half of the ICPs responding to the HIC survey had been working in health care 25 years or more, and roughly two-thirds of respondents were between 41 and 55 years old. "The profession has been around for 30 years now, and people who started out in it in their mid-30s are now retiring," says Niemiec.
If the infection control profession is to preserve its vitality, it must attract new recruits and move beyond the perception that it is a transition job for those weary of patient care, she adds. "We have been the retirement home for staff nurses," she says. "I see us having problems with the nursing shortage as well, even though that is not the only pool we get people from. It certainty is the majority, but we also draw people who work in microbiology and laboratories."
If ICPs can hold key positions in patient safety and bioterrorism, the field could be attractive to clinicians considering careers in epidemiology and public health, she says.
"People who are thinking about public health are not necessarily thinking about the hospital infection control position as kind of integral," she says. "We have to market ourselves and show the role as being interesting. Anytime there are interns from MPH (master’s in public health) programs or nursing staff who are interested, we need to take the time and offer internships or at least talk it up."