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The Nursing Shortage Does It Really Exist? Jamie A. Adesso Empire State College

Author Note This paper was prepared for Planning and Finalizing the Degree taught by Professor Daly

The Nursing Shortage On June 3, 2011, the United States Bureau of Labor Statistics reported that the healthcare industry increased its number of employees by 44,600 from April to May of this year. Among these new healthcare professionals, Registered Nurses made up almost a fifth of the employees hired during this one-month period, leading some to believe that there is no longer a nursing shortage (Bureau of Labor and Statistics [BLS], 2011). However, the fact that there are somewhere between 150,000 to 200,000 available nursing jobs at present that need to be filled strongly supports that there is in fact a nursing shortage (American Association of Colleges of Nursing [AACN], 2011, para. 9; The Spokesman-Review, 2011, para.1). While this appears to be the case, as is believed by medical professionals, students, and patients, Registered Nurses that are unemployed believe that if there really were a nursing shortage, they would have a job. Definition A shortage, by definition, is a condition that exists when demand exceeds supply because of a lack of equilibrium in a market (The American Heritage New Dictionary of Cultural Literacy, 2005). In regards to a nursing shortage, the definition is not much different, as it states that, a nursing shortage is a condition in which the delicate balance of nurse supply and nurse demand are not at equilibrium. [It] is defined as a situation in which the demand for employment of nurses exceeds the available supply of nurses willing to be employed at a given salary. A nursing shortage is not just a matter of understaffing, [which] can occur in conditions of shortage, equilibrium, or surplus (Huber, 2006, p. 587). If the demand for nurses is in fact greater than the actual supply, as suggested by the AACN, then what is the cause behind this shortage? Contributing Factors

The Nursing Shortage Several theories exist as to why there may be a nursing shortage. Some people believe it is because of the lack of educators, while others believe it has to do with funding. It is also possible that there is a shortage due to high employee turnover, lack of job applicants, or strict hiring guidelines. Any or all of these issues could be contributing factors to the nursing shortage, and each deserves a closer look so that a cause may be determined. A lack of nurse educators in colleges is, without a doubt, an issue. A survey done in 2005 by the Michigan Center for nursing determined that almost a fifth of current nurse educators intend to retire over the next few years, and more than a third of the nursing programs surveyed are claiming to have a hard time filling these job openings (Beeke, 2008, para. 3). Another issue facing college nursing programs is the shortage of clinical placements, which allows nursing students to gain the hands-on and work experience they need before starting their career as a nurse. Without the cooperation of a hospital, the students cannot fulfill all of the program requirements, which leads to the programs suspension or elimination. The number of students enrolling in nursing schools or programs has steadily declined over the years, which is another contributing factor to the nursing shortage. If no one wants to be a nurse, there is nothing anyone can do short of offering incentives. Currently, the number of students in nursing programs is significantly smaller than those needed to fill hospital positions (AACN, 2011, para. 16). The nursing profession is either being overlooked or students just cannot obtain the funding to attend these schools. Funding is a problem facing both, schools and hospitals. Teacher funding is an issue that needs a resolution, since additional education is necessary to become a

The Nursing Shortage nursing instructor. This extra and expensive cost is one that does not result in a pay increase and, since nurses make significantly more money working in hospitals, there is no incentive for them to transition to educators (Tieman, 2011, para. 6). So, even if schools could obtain more funding for nursing programs, they still would not be able to hire the necessary number of instructors because the pay would still not be comparable to that of nurses. In regards to medical facilities, some have stopped hiring, made cutbacks, or closed down because of new insurance policies and reduced pay out amounts, despite increased premiums for consumers. This reduces the overall supply of healthcare and increases the demand, which makes the shortage even worse. Medical facilities also have a high turnover rate, especially in the Nursing department. Nurses work long hours, often put in a lot of overtime, and have to process stacks of paper work on top of attending to patients. Some nurses skilled at dealing with patients and families grow frustrated with a system that promotes them into dealing with paperwork and administration and leave the field (Beeke, 2008, para. 14). The most recently reported turnover rate for Registered Nurses working in a hospital setting is 14 percent or 12,700 job openings (AACN, 2011, para. 3). The demands of this job tend to be overwhelming and not everyone can handle the stress, especially those just starting out in this field. Medical facilities are very strict about who they hire, which is another possible reason for this alleged nursing shortage. Despite going to college and obtaining an Associate or Bachelors Degree in Nursing, graduates do not always become nurses. Some candidates receive poor performance reviews, others are not able to pass the background check or the licensing exam, and a small handful never bother to utilize

The Nursing Shortage their education. The stronger emphasis on education is also causing medical facilities to seek out candidates with Bachelors or Masters degrees, overlooking those with Associates degrees. The problem with this is that 34% of Registered Nurses have no education beyond their Associates degree yet 60% of all nursing students obtai n an Associates, not a Bachelors degree (Mahaffey, 2002, para. 5). If students are seeking a two-year degree but employers want them to have a four-year degree, the majority of nurse applicants will not be employable. The majority of Registered Nurses that currently hold employment are over the age of 40 and those in their 50s account for 25 percent of all nurses (AACN, 2011, para. 19-20). The problem with this is that these nurses are expected to retire soon and when they do, there wont be anyone to take their place. This is especially problematic because when these nurses retire, so will the rest of the Baby Boomer population and the need for health care will sky rocket, increasing the gap between the supply and the demand. The Other Side While most believe there is a nursing shortage, there are people who believe that the supply meets or even exceeds the demand. Unemployed nurses feel that if there really were a nursing shortage, they would not be without jobs. Others believe that if a shortage did exist, hospitals would not be making cutbacks and laying off staff. Some people wonder how a shortage could exist when nurses are trained overseas and hired before they even come to the United States. By training nurses overseas, it eliminates the funding and educational problems that nursing students are experiencing here and

The Nursing Shortage allows the hospitals the opportunity to hire qualified applicants but it increases unemployment numbers of nurses in this country. The number of unemployed and qualified nurses is evident by visiting, a website where nurses can talk all about nursing and those that are unemployed veterans or new graduates, talk a lot. At first glance, it seems that they have legitimate concerns about local jobs going to foreigners but by the third page, you start to realize that these people are complaining more than anything else. No one is offering any facts, nurses on the site debate as to how many jobs really are going to foreign workers, while others just appear lazy. If they put half as much effort into getting a job as they do complaining, they might obtain employment (, 2011, p. 13). Other than their words, no statistical data is claiming anything other than a nursing shortage. Resolutions To resolve the educational issues at hand, medical and educational facilities should form partnerships so that intern, extern, and residency programs are ongoing. Employers should not only promote continuing education, but also require its employees to participate in learning field advancements and procedural changes. Universities and hospitals should work together to encourage educational advancement by creating programs that allow nurses with Associates degrees to work and go to school to obtain their Bachelors or Masters degree (Mahaffey, 2002, para. 46-47). Nurse educators should be more active in the college recruitment process because they know what it takes to be a good and successful nurse. Attempting to turn these solutions into realities, the Robert Wood Johnson Foundation (RWJF) came up with a policy full of innovations that address the nursing

The Nursing Shortage shortage. One suggestion contained in the policy is that all new nurses must obtain their BSN within ten years of obtaining their nursing license (AACN, 2011, para. 41). In an effort to identify the reasons for the nursing shortage and come up with a solution, academic and medical professionals from 47 states met at the Nursing Education Capacity Summit. They shared strategies, talked about increasing faculty, and restructuring the curriculum, along with policies and regulations (AACN, 2011, para. 43). In 2010, the AACN took steps to expand NursingCAS, the nations centralized application service for RN programs, to include graduate nursing programs (para 40). The intent of this expansion is to omit empty seats in nursing schools at the baccalaureate and graduate levels. In regards to funding, during World War II, the government gave out grants to nursing students as an incentive to help meet the high demand. These grants covered the cost of nursing school and provided a living stipend. The incentive worked and the country went from a nursing shortage to a state of equilibrium. Unfortunately, the government funding only lasted for five years, after which time, nursing students had to find other means of obtaining money for their education or they were on their own. Some organizations, consumer groups, and foundations did help out, but they also seem to have vanished over the years (Mahaffey, 2002, para. 7-10). Today, there are student loans, grants, scholarships, and donations that allow students to attend school but apparently, this is not enough to sustain a nursing program at some universities. The government needs to implement a new grant that helps students to become nurses so that the shortage ends and employment increases, a task that Illinois Senator Richard Durbin fully plans to take on. The Senator wants his Nurse Education,

The Nursing Shortage Expansion, and Development Act, or NEED Act, to pass so that the number of grants given to nursing schools increases, allowing for more teachers and students. Additionally, the Governor of Pennsylvania, Edward G. Rendell got the state to invest $750,000 to resolving the nursing shortage and obtained another $870,000 from private sectors. The money from this partnership has already allowed nursing programs to hire more educators and accept more students (AACN, 2011, para 42, 44). Despite these efforts, more solutions need to be implemented and at an accelerated rate. Conclusion The BLS projects that, between 2008 and 2018, the healthcare sector will add 582,000 nursing jobs to meet the growing demand of patients (BLS, 2009, para. 11). This number could easily snowball into a nursing shortage of one million by 2020 (PBS, 2009). As things are right now, many expect these jobs to remain vacant. If this holds true, than the country will experience a nursing shortage, though many believe a nursing shortage already exists, including William C. Goodman. Mr. Goodman works for the Office of Employment and Unemployment Statistics at the BLS as a social science research analyst and his research says there is a nursing shortage. His studies show that the number one reason for the shortage is that women now have options, whereas 30 years ago, they did not. More women are choosing business careers where the demands are sometimes less and the pay is sometimes higher than in the nursing profession. The other top reason for a lack of nurses is job dissatisfaction, leading to a high turnover rate (Goodman, 2006, p. 7). These are the true causes of the nursing shortage, which will continue if these issues, which are very personal, remain without a resolve.

The Nursing Shortage If the cause of the nursing shortage was funding, money would fix the problem but how do you resolve a problem that is occurring based on personal choice? The only option is incentives and, since Registered Nurses already receive generous salaries, what more can an employer offer them? A lack of employees means no one to cover a shift, minimal time off, many extra hours, and too many patients that all demand care. This leaves employers option less, therefore maintaining the high levels of turnover, and continuing the nursing shortage.

The Nursing Shortage Bibliography 1.) Beeke, Candace. Nursing Schools Struggle to Find Teachers. Spring 2008. Retrieved from: Candace Beeke, a journalist for over a decade, explains how the lack of educators in college programs is affecting the nursing shortage. She uses interviews as her main source of insight into this topic and as supporting evidence. Beeke does not refer to any previous works on this topic and her article is easily comprehensible for most readers. 2.) PBS Video. Nurses Needed. Fall 2009. Retrieved from: PBS, the Public Broadcasting Station, which has been providing educational television programs since 1969, aired a documentary on the importance of nurses and their vitality to medical facilities. The information gathered in this video was collected through multiple interviews and real life situations in a hospital setting. This video does not acknowledge any previous works and has no rating, making it appropriate for everyone. 3.) Tieman, Linda. Is There Really A Nursing Shortage in Washington State? Washington Healthcare News 5 (6) Summer 2010. Retrieved from: By: Linda Tieman RN MN Fache Linda Tieman RN MN Fache, Board President for The Forum of State Nursing Workforce Centers, a previous Director of Nursing and VP of Patient Care, and currently the Executive Director at Washington Center for Nursing, wrote this article to determine if there really is a nursing shortage. She based her information on statistics from credible sources, all of which she cites at the end of the article. She does not mention previous works though she does talk about some solutions to curb the nursing shortage. Her thoughts are unbiased, as she offers mostly facts and not much opinion, and the style and vocabulary of her article makes it an easy to read piece for the average reader. 4.) Mahaffey, Elizabeth H. The Relevance of Associate Degree Nursing Education: Past, Present, Future. The Online Journal of Issues in Nursing 7 Spring 2002. Retrieved from: als/OJIN/TableofContents/Volume72002/No2May2002/RelevanceofAssociateDe gree.aspx Dr. Elizabeth H. Mahaffey is the Dean of Nursing and Allied Health at Hinds Community College, where she previously taught nursing for 22 years and has


The Nursing Shortage 25 years of clinical experience prior to teaching. She talks about the associate degree nursing program and the changes it has seen over the years, both in curriculum and status in the nursing community. Towards the end of her article, she mentions the relationship between the nursing shortage and those with an associates degree, using numerous sources, including herself, and organizations to support her information. She makes no mention of previous works and the article reading level is for someone with a college education or educated professional. 5.) Huber, Diane. Leadership and Nursing Care Management. Third Edition. 2006. Professor Huber, Ph.D., RN, FAAN, NEA-BC, currently works at the University of Iowa in the Nursing Department. She has worked on over 20 research projects, has written over 50 articles, books, and chapters combined. This book, with more than 900 pages, covers all aspects of leadership and care management, from health policies, to trends, to human resource and monetary guidelines. She dedicates an entire chapter to discussing the nursing shortage, which includes a definition, a history of nursing shortages and surplus, and factors that contribute to or cause the nursing shortage. 6.) American Association of Colleges of Nursing. Nursing Shortage Fact Sheet. Spring 2011. Retrieved from: The American Association of Colleges of Nursing, or AACN, establishes the standards for nursing degree programs at bachelor and graduate levels. This article is full of statistical information, problems, and possible solutions. It does not mention previous works and is easy for the average reader to comprehend. 7.) United Stated Bureau of Labor Statistics This website provides a variety of information in regards to the current employment and unemployment rate of nurses, as well as projections for demand and growth. It uses data from multiple sources, such as the United States Census, tax information, and company records. The information is usually one to two years behind, so it is not the most accurate source, but it is as close as possible. A history of previous information is stored on this website, which is probably best utilized by an upper level high school student, college student, or above. 8.), 2011. Retrieved from: This website is a place where nurses can network, discuss, or learn about the ongoing events in their profession. The site has a mixture of opinions and facts, so there is some bias. Opposing viewpoints do offer some neutrality because it


The Nursing Shortage allows the reader to see both sides and come to the conclusion that more research needs to be done to make an informed decision or opinion. 9.) Shortage. (n.d.). The American Heritage New Dictionary of Cultural Literacy, Third Edition. Retrieved July 11, 2011, from website: