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The Nursing Shortage

And what is being done to stop it


Emily Urbanowski

Urbanowski 2 Introduction The United States is in the midst of a crisis unlike any other it has experienced before. Underneath all the political policy discussion healthcare is facing a fundamental issue that poses a direct threat to hospital and healthcare patients across the nation. The hospitals in this country are not staffed with enough qualified, satisfied nurses to meet the demand set by nurse-to-patient ratios and standards of care. Following drastic staffing cuts in the 1990s and early 2000s American healthcare facilities are now stuck in the worst shortage in history. Estimates from the past few years predict that by the year 2020 there could be a deficiency of between 400,000 and 800,000 nurses due to a range of retention and entrance issues. (CITE) Nurses are the backbone of hospitals in todays world. Tasked with some of the most tiresome, unnoticed, and necessary work in the healthcare system hospitals can simply not afford to lose any more. New perspectives combined with old strategies and information gathered from previous events will help analyze why this nursing shortage is happening and what can be done to restore the necessary balance.

Nurses and Patient Mortality The importance of this shortage is huge. Data supporting a correlation between low nurse staffing levels and patient mortality is strong. California was one of the first states to implement legislation regarding nurse-to-patient ratios in an attempt to maintain levels necessary to provide safe and effective care, and the results that were uncovered are revealing of just how much of a difference the right amount of staff can make (Aiken 2002). It is the registered nurses duty to provide care and surveillance 24-hours a day to those who need it. The effectiveness of this care and surveillance goes down when lack of staff and exhaustion levels come into play. Losing

Urbanowski 3 nurses to the shortage forces the remaining nurses to work longer shifts which leads to mistakes in caregiving. The conclusion is simple; the more nurses there are available at one time to provide care in a hospital, the lower the patient mortality rate and failure-to-rescue rate (Aiken, 2002) If these changes could be made across the country and everywhere in the world where there is a shortage of nursing, less unnecessary deaths would occur.

Causes of the Nursing Shortage Although this particular nursing shortage is very unique, this is not the first time in history that the nation has experienced decline in employed registered nurses. The most recent of instances, which is the same shortage currently occurring, started in 2000. This shortage cannot be attributed to one single catalyst and is instead a response to what is being considered the perfect storm for a shortage. Consequently there is no single solution to cure the problem. Several approaches must be taken on several different levels in order to combat this serious risk to the nations healthcare. One of the most cited reasons for the lack in qualified nurses sources back to the where they get their qualifications. There are four available pathways for a person to take to acquire the necessary level of education to work in a hospital as a nurse. The oldest and now outdated method is via a three-year hospital diploma program that does not always yield an academic degree but adequately trains personnel for the field. The most popular method, a three-year associate degree program, offers another way to become a nurse. A Bachelor of Science degree can be obtained by attending a four-year university and continuing on to licensure. Lastly, directentry programs for college graduates whom already have a bachelor degree in another area of study can grant a BSN in as little as one to two years. In recent years there has been a dramatic

Urbanowski 4 shift from the first option to the third and fourth, creating a huge demand for graduate-level faculty members. These candidates are also being demanded by the positions in actual clinical setting, which provide better income options and therefore make it extremely difficult to fill the faculty positions needed to educate the students and future nurses (Aiken, 2009). In short, the record high nursing school enrollment that has come from the nationwide plea for more nurses can be very beneficial in eradicating the nursing shortage, but only if there is adequate faculty to prepare them for clinical practice. In addition to the obstacles presented in getting students through the transition of student to registered nurse in the field, those already in practice are experiencing a work environment that discourages them from staying there. Susan B Hassmiller and Maureen Cozine site that 43% of nurses plan on leaving their current place of employment within three years. They credit this to multiple sources of stress-related burnout. Nurses are asked to work incredibly long and taxing hours and often report that being required to do non-nursing tasks causes dissatisfaction in their career. Because of this many nurses choose to leave the hospital setting for a different experience of nursing, or leave nursing all together for other career opportunities. In response the remaining nurses are expected to work even harder and care for more patients causing a vicious cycle, which has led to the state of shortage currently reeking havoc on hospitals (Hassmiller, 2006).

Solutions to the Nursing Shortage Perhaps the biggest most debated variable in the past and current nursing shortage is wage. There is a basic economic principle that wage increases can bring supply and demand into balance, but the question is how much does wage need to change (in this case, increased) to yield an adequate rise in nurse hiring/retention without causing a reaction to drastic. In order to

Urbanowski 5 understand the effect of wage increase it is imperative to recognize the relationship it has with licensure delays. When nursing shortages occur for any combination of the reasons already discussed, the first response is generally for hospitals to increase their wages. Following the increase, there is a rise in nursing school and hospital-based diploma program applicants, programs that take three to five years to complete. Therefore, the effects of the wage bump do not come to fruition until several years down the line. In order to avoid a nursing surplus the wage increase is based on a projection of growth in graduation that is needed to meet the demand. According to a study by Joanne Spetz and Ruth Given in 2003, between the years of 2005 and 2016, a 3.2-3.8%/year increase in nursing wages will yield a 6.2%/year rise in graduation rate and fuel the supply of nurses to meet the growing demand by the year 2020 (Spetz, 2003). This calculation is based of previous cyclic shortages and is deemed plausible presuming several factors go as planned including a predictable demand, ability to raise wages (but not too much to cause surplus), and accommodation by nursing schools. Other than wage manipulation one tactic being explored to combat the issue of the nursing shortage is improving the lure of employment-based benefits. Making the job more appealing in ways other than increasing wage which isnt always ideal or even possible, is to offer more perks. Some of these benefits include health insurance provided through the employer, paid vacation time, reduced hospital fees, ranges of retirement programs, tuition reimbursement for further education, and childcare support. On average, 29% of the compensation received by workers is in the form of these benefits. (Spetz, 2006) Not only do these benefits make a job look more appealing to prospective applicants, but also it makes the currently employed more likely to stay at that place of work instead of relocating. The latter is

Urbanowski 6 being emphasized more in hospital settings currently in order to provide a more immediate remedy to the shortage. The most common benefits received by nurses nationwide are retirement programs and health insurance. Both of these benefits are utilized by the majority of nurses in the facilities they are offered. Packages for health insurance vary between combinations of health maintenance organizations, preferred provider organizations, dental insurances, family plans, and ranging employee contribution and minimums. In response to previous nursing shortages nursing unions have kept the pressure on their employers to maintain coverage of most of these benefits. Retirement plans are offered in the forms of defined-benefit plans and contribution plans, the difference between the two being in how much is provided by the benefactor and when. In an industry that features and average retention of 28 months in the first clinical position and only 40 months in their fourth, these benefits that focus on the long-term gain are essential in providing job comfort (Spetz, 2006). Nurses rate scheduling flexibility very highly when asked about what factors into job satisfaction. The shifts are notoriously long and assignment is based heavily on seniority. There are various strategies that have been tried and tested to ensure that staffing guidelines are met including higher pay for undesirable hours, floating nurses, per diem employees, and varying shift lengths. This is one aspect that has not been heavily explored as far as changes in order to improve employee satisfaction. It is important to look at all possibilities for bettering the work environment and maintaining nurses in their positions (Spetz, 2006). The National Sample Survey of Registered Nurses in 2008 reports that out of the nurses who graduated with an associates degree between 2001 and 2004, only ten years ago, decided to go back to school and obtain a higher degree. (Reilly, 2011) Employers who provide educational

Urbanowski 7 and career benefits could see an increase in retention and a rise in interest for their available positions. There are two main types of educational benefits. Those targeted at potential employees, most commonly students, include loan-repayment programs and scholarships with the agreement of a certain amount of time dedicated from the student to the establishment after they graduate. The second type, known as a grow-your-own strategy, stresses the importance of developing the skills of ones own employees. Tuition reimbursement, financial aid, and paid leaves encourage those holding an associates degree to achieve a higher level of education and allows hospitals to promote from within. Hospitals have even developed mentoring programs to involve senior staff in the education of RNs and provide support for these education benefits (Spetz, 2006). When it comes to benefits, it is a delicate balance that needs to be reached. The combination of older nurses looking to retire and young prospective entrants makes it impossible to create one single combination of benefits for all the countrys nurses. In addition, employees and employers must work together to ensure that nurses are being offered the benefits they want and need, and are not just being bribed with certain flashy fringe benefits. According to a focus group on the perception of benefits offered to hospital employees most informants agreed that benefits are low on a list of priorities when it comes to a nurse deciding whether or not to stay in a position at a hospital and that it is more important to be respected and recognized for the work you do than to have great benefits (Spetz, 2006). With the opinions of nurses in the field it is possible to create a well-rounded approach the problem, keeping in mind what will be the most effective and what can be supplementary.

Urbanowski 8 Conclusion Although not this is not the first time American hospitals have faced a nursing shortage, the severity of the one occurring now should promote the motivation to make it the last. Hospitals need many well-trained enthusiastic nurses to operate efficiently, the absence of which is life threatening. There is no perfect solution to reverse what has happened to the nursing community because of the wide range of causes. It will take time, patience, and teamwork to restore the balance between supply and demand within the hospital system. Universities and educational programs need to be adequately staffed with qualified faculty. Nurses need to be provided comfortable and supportive work environments in order to provide safe and effective care. Strategies to eliminate burnout must be implemented to ensure retention of nurses after entering the workforce. Proper benefits are a useful tool in encouraging new employees to develop a long career in nursing as well as existing employees to foster healthy relationships with their employers.

Urbanowski 9 Works Cited Aiken, L. H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA: The Journal of the American Medical Association, 288(16), 1987-1993. Aiken, L. H., Cheung, R. B., & Olds, D. M. (2009). Education Policy Initiatives To Address The Nurse Shortage In The United States. Health Affairs, 28(4), w646-w656. Hassmiller, S. B., & Cozine, M. (2006). Addressing The Nurse Shortage To Improve The Quality Of Patient Care. Health Affairs, 25(1), 268-274. Reilly, J. E., Fargen, J., & Walker-Daniels, K. K. (2011). A Public Health Nursing Shortage. AJN, American Journal of Nursing, 111(7), 11. Spetz, J., & Given, R. (2003). The Future Of The Nurse Shortage: Will Wage Increases Close The Gap?. Health Affairs, 22(6), 199-206. Spetz, J., & Adams, S. (2006). How Can Employment-Based Benefits Help The Nurse Shortage?. Health Affairs, 25(1), 212-218.

Urbanowski 10 I felt disorganized in creating this piece even with the guidance of my topic memo. There is such a vast amount of information, and a lot of it differs in time period as well as basic facts. I struggled with the voice/tone and tried to create a professional, un-biased analysis but fear that my passion for the topic got in the way. I thin through the editing process I was able to create a more polished and cohesive essay. I do think that this could fit into a professional portfolio, I used exclusively peer-reviewed journal sources and no popular sources. I think this style of writing could compliment the other pieces I have created so far and show another side to how I create a final draft form a prompt.