Nursing Shortage: As Serious As It Is Publicized?

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Table of Contents

Abstract
Is the nursing shortage as serious as it is publicized?
References

Abstract

This paper discusses the gravity of the issue of nursing shortage. The nursing shortage is a problem under a high level of media focus in recent times. By definition, a registered nurse is a graduate trained nurse who has passed a state registration examination and has been licensed to practice nursing. The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program.

Nurses face problems such as getting into a nursing education program, lack of scholarships to do advanced programs, understaffing in the workplace, increased workload, lack of recognition, competition from female doctors, etc. Recruitment and retention measures are seen as possible solutions to the problem of nursing shortage in the long term. However, it is also possible to make use of innovative strategies such as floating and resource teams to meet the challenge for the short term. Recognizing the nursing shortage as a problem needing immediate attention is the first step in overcoming it. Media focus helps in reminding the authorities and the public that the nursing shortage is an issue to be attended to urgently.

Is the nursing shortage as serious as it is publicized?

The nursing shortage has been a problem under media focus at the national level for the past six years as it is one of the major issues facing the healthcare sector of the United States. This is attributed mainly due to the lack of enthusiasm amongst the youngsters today for pursuing nursing as a career option and secondly due to the rising population. A study by Joanne Spetz and Ruth Given explains that in recent years, there has been a high level of U.S. media focus on the shortage of registered nurses (RNs).

The authors hold that wage increases can alleviate the problem by bringing labor markets into equilibrium. According to Spetz and Given, inflation-adjusted wages must increase 3.2-3-8 percent per year between 2002 and 1016, with wages cumulatively rising to 69% to end the nursing shortage. Statistics show that the nursing shortage is truly a serious problem as shown in the media. Hospitals in western and southwestern states and New England suffer most from a lack of specialized advanced practice nurses.

Average nurse vacancy rates at hospitals have been found to range from 10.2& to 13 percent, with one in seven hospitals reporting more than 20%. The Bureau of Health Professions predicts that the shortage will increase over the next two decades with a shortage of 800,000 nurses projected by 2020. The issue of nursing shortage is accentuated by the fact that many other countries are also experiencing similar shortages (Spetz and Given, 2003).

For example, in Australia, based on a Senate inquiry into nursing conducted in 2000, it was predicted that there will be a nursing vacancy rate of 30,000 between 2001 and 2006. This announcement shocked governments into acting to investigate what was affecting the nursing workforce across the country (Armstrong, 2004). The nursing shortage had been widely publicized for the last few years. Based on current research and literature, facts show that issue of nursing shortage is currently serious and should not get ignored. The causes and effects need to be presented as well as solutions for future well designed and planned.

By definition, a registered nurse is a graduate trained nurse who has passed a state registration examination and has been licensed to practice nursing. Registered nurses constitute the largest health care occupation, with 2.5 million jobs. About 59 percent of jobs are in hospitals. The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program.

Registered nurses are projected to generate about 587,000 new jobs over the 2006-16 period, one of the largest numbers among all occupations. The duties of registered nurses (RNs), are to treat patients, educate patients and the public about various medical conditions, and provide advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms help perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor’s degree program. Individuals then must complete a national licensing examination to obtain a nursing license. Further training or education can qualify nurses to work in specialty areas and may help improve advancement opportunities.

In the 1960s, the traditional female ideal was attacked and sex-neutral professionalism was promoted. This change was accompanied by a coarsening of doctors’ attitudes. Too many male doctors, nurses became the only women to have fun with. The idealized image of the nurse lost its virtue component but retained its sexual component. The nursing profession’s response to this abusive behavior was to rid itself of even the trappings of womanliness.

Younger nurses switched to unisex pantsuits and both doctors and nurses began wearing the same scrubs. Young male doctors eventually learned to treat nurses as co-professionals rather than as sex objects. The more the nurses lost their feminine markings, the more the profession lost its allure. By expunging the nursing ideal of both its virtue and its sexual components, the nursing leadership erected a barrier in the minds of the doctors regarding the nurses. The increasing number of women doctors also contributed to taking away the attraction of the nursing job. Almost half the medical students in the United States are now women.

Many women once looked upon nursing as the perfect part-time job. Nursing is still a convenient part-time job. But the economic status of women has dramatically changed over the last 50 years, such that what was once a great advantage is now less so. Many women either live by themselves or raise children alone. Today’s nurses often must extract an entire family’s income from their jobs. And they can, but only by working the worst shifts–nights, holidays, and weekends.

This can be physically painful and psychologically grueling. Women need to work these shifts to provide for their families, but, as a consequence, they find they have little time to spend with their children. Nursing itself is becoming divided as a profession because of this desperate situation. Hospitals are not able to pay nurses more due to tight healthcare budgets. Young women see unhappy nurses leading difficult lives and choose to pursue other careers.

Moreover, nurses, although they are caring professionals, lack the time to forge real relationships with their patients, especially in critical care. They lack the scientific background of doctors which might allow them to interact with patients more extensively. According to one nursing journal, “The prime candidate for burnout is the nurse who strives for excellence in a toxic environment.” Nurses have little control over their professional lives since they are usually under the authority of doctors or hospital administrators. Today’s nurses are understandably weary, discouraged, and demoralized, and their leadership is looking for solutions.

There are three major educational paths to registered nursing—a bachelor’s of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2006, 709 nursing programs offered degrees at the bachelor’s level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete.

About 850 RN programs granted associate degrees. Diploma programs, administered in hospitals, last about 3 years (BLS, 2008). Only about 70 programs offered diplomas. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions. Many RNs with an ADN or diploma later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. In 2006, there were 629 RN-to-BSN programs in the United States.

Accelerated master’s degree in nursing (MSN) programs also is available by combining 1 year of an accelerated BSN program with 2 years of graduate study. In 2006, there were 149 RN-to-MSN programs. Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving into nursing. In 2006, 197 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor’s or higher degree in another field (BLS, 2008).

Nursing shortages are not a new phenomenon. There are some factors, however, that make the current shortage much more problematic than in the past. One of the key factors is the ‘aging’ of the nursing profession. The aging of the nursing workforce is has been a predictable factor (Tierney, 2006). While workforce analysts did consider the aging factor, they tended to be somewhat complacent towards the imminent exodus of nurses retiring from the profession.

Along with this factor, the nursing shortage has been shaken by the escalating difficulties over recruitment and retention (Tierney, 2006). While the cause of the nursing shortage has been linked to an aging and disaffected population and aging nurses leaving the practice, a more fundamental cause may be the lack of nurse educators, according to David Hopkins, Ph.D., chief learning officer of distance learning provider Rue Education. These educators are unable to serve the growing waitlists of qualified nursing student applicants. In 2005, schools of nursing, colleges, and universities turned away nearly 180,000 qualified applicants, due largely to the educator shortage (BusinessWire, 2008).

Researchers Spetz and Given (2003) cite the fact that the delay between people’s choice of the nursing profession and the time they are licensed as nurses is the main reason for these shortages. RN licensure comes at the end of three to five years of study in a college, university, or hospital-based diploma program. Moreover, it has also been found that there is a link between wages and the number of students opting for nursing programs.

Grown in wages has historically led to growth in graduations two to four years after wage increases. Some studies show that poor working conditions in the hospital are primarily to be blamed for the shortage. Towards this end, one can find hospitals making efforts to improve their working environments to attract nurses. These strategies however cannot mitigate the problem say Spetz and Given (2003). Moreover, due to limited seats in nursing, there are long waiting lists.

To handle these applicants, a lottery system is used instead of an interview. There is a high dropout rate in nursing programs due to stress and because students find the academic curriculum challenging. The faculty is also mostly aging people as nursing professors are not well paid and not many enroll in Master’s degree programs. Finally, the nursing education scenario suffers from inadequate faculty and inadequate slots in programs.

Nursing is not as competitive today as other majors. Many students do not opt for nursing programs. This is because many college students perceive nursing as a boring and hard major. This is compounded by the poor nursing image in our society. According to a recent study by Seago et al (2006), though students generally had favorable perceptions of nursing, with two-thirds agreeing that nursing has good income potential, job security, and interesting work, they felt that nursing lagged behind the other occupations in terms of independence at work and was more likely to be perceived as a “women’s” occupation (Seago et al, 2006).

Across the decades, the nursing job has evolved. Earlier, nurses played a minor role in healthcare. But now nurses are expected to handle greater responsibilities. They assist the physician in assessing, advocating for patient/family, educating, documenting, etc. They do not get recognized for the tasks they have completed rather the focus is often on what they have not yet done. Nurses can perform to their best only when the patient-nurse ratio is reasonable.

But then, there are no standardized patient-nurse ratios across the country. Due to high vacancy levels at hospitals, nurses are forced to work long hours, work during weekends, and have to work in challenging schedules that often drive nurses out of practice. Nurses face a very stressful environment at work. While nurses’ productivity has escalated over the last decade as they care for a far greater number of people than they did 10 years ago, the people they care for are also much sicker and require more intensive support (Armstrong, 2004). Consequently, the burden on individual working nurses is increasing.

Many are responding by leaving the profession, distressed by being unable to provide quality nursing care, disgruntled with their conditions, lack of recognition, and the stress of juggling work around their community and family responsibilities (Armstrong, 2004).

Most often, nurses have to be caregivers and look after aged people with mental and cognitive disorders. This is mentally draining for nurses. They often face problems with patients. Frustrated families and patients related to the long wait for medical services often get it out on nurses. These factors combined lead to nursing burnout. But still, they face a lot of criticism. A Canadian health policy analyst (Lewis 2002) has commented thus on the issue of nursing shortage (Finlayson et al. 2002): “the extent of the nursing shortage will be known only when nurses spend all their time nursing”.

This comment implies that while there may be a shortage of nursing, there may not necessarily be a shortage of nurses. ‘Nurses spend much of their time doing things that should be delegated to others, he wrote, ‘and not enough of their time doing what they are educated to do” (Tierney, 2006).

The nursing shortage has had a dramatic impact on society. More deaths have been reported due to understaffing. These deaths are mainly due to complications and lack of secondary care. It has been found nursing shortage has lead to increased mortality rates among high-risk patients. It has also meant longer waits for beds in Emergency Rooms. Because of inadequate nursing care, more and more people are reluctant to seek medical attention.

One of the main dangers of nursing shortage is that poorly fitted for profession and less trained individuals will become nurses. Hereafter, people will be got into nursing more for the money involved and not because of a passion. This is a high-demand profession that is likely to pay better during a shortage.

Many steps are already being taken to prevent the nursing shortage from happening. According to Tierney, there are only two simple problems to the problem of nursing shortage: adequate recruitment and effective retention (Tierney, 2006). This concept is affirmed by Joanne Spetz and Sara Adams (2006). Spetz and Adams (2006) have found that during a labor shortage, employment-based benefits can be particularly important as a device to recruit and retain workers.

They are known to improve employee satisfaction and recruitment and retention of staff. In the context of recruitment, Spetz and Adams hold that recruitment-targeted benefits focus on attracting newly graduating nurses to the employer. Some such benefits include student loan repayment for new employees, which is attractive to graduates with debt, and scholarships to nursing students in exchange for a guarantee that the student will work at the hospital for a few years after graduation (Spetz and Adams, 2006).

In the field of education too, steps have been taken to counter the problem of nursing shortage. There are many bridge programs such as LPN to RN transition.. The enrollment processes for Master in nursing education programs had been revised and made easy. There is growing popularity of distance education making it easier for working adults to get certified (BusinessWire, 2008). With an eye toward retention, new technology and student-centric approaches to distance learning are being developed.

Because of the belief that the poor image of nursing could be an organizational recruitment problem, a lot of money has been spent to enhance the image of the nurse through media campaigns, job satisfaction surveys, and other recruitment strategies. For example, Johnson and Johnson (2005) has sponsored “The Campaign for Nursing’s Future,” a high-profile marketing effort to promote nursing as a career.

To face the nursing shortage problem, many hospitals have specially designed recruitment departments. Better benefit packages and increases in salaries, as well as hiring and retention bonuses, are being offered. Nurses are becoming more organized and have begun to address the legislature about their issues (organizing conventions, conferences, shared governance, etc). Australian National Federation, General Secretary Jill Iliffe says: ‘For the last four years, there has been an insufficient place in undergraduate nursing courses for the number of eligible applicants. Creating another 1,100 places each year is the minimum required to ensure there will be a sufficient number of nurses to care for the community into the future.

To address shortages in specialist areas, the ANF suggests an increase in the number of postgraduate scholarships in specialty areas (Armstrong, 2004). ‘Nurses are choosing not to undertake postgraduate education because it places a huge financial burden on them. We need to ensure that nurses are able — and can afford — to undertake the specialist training they require,’ Ms. Iliffe said (Armstrong, 2004).

A growing number of employers believe that their employees can help address shortages in nursing, pharmacy, and other professions. Employers can offer forgivable education loans, scholarships, tuition reimbursement, salary support for educational time, and other incentives to pursue RN education. In the long term, these programs help employees move up a “career ladder,” which provides professional and financial advantages.

More employers also are developing extended RN orientation, mentoring, and preceptor programs. Senior staff is particularly encouraged to take up these programs as it also reduces attrition of newly hired nurses. Preceptor programs facilitate the transition of a nurse to a new department, such as oncology or pediatrics. Some employers have developed explicit clinical ladders for employees, with greater pay at each rung (Spetz and Adams, 2006).

Another common way in which nursing shortage is being countered is by importing workforce from developing countries. But according to Armstrong (2004), nursing services can be staffed only by people who live locally. He says that nurses who are trained in a hospital would be more loyal while working there.

Floating is a very recent phenomenon in nursing introduced mainly due to problems such as staffing shortages and fluctuating census (Dziuba-Ellis, 2006). Nurses are in general trained to work in particular specialties. But, in the floating concept, they are allowed to work in different specialized units requiring them to undergo cross-training. This causes stress to the nurses and they lose their efficiency and confidence in attending to critically ill patients in specialized departments.

When nurses are floated to different specialized units, both the nurses and the patients suffer. While the nurses find themselves inadequately trained to work in certain specialized units, patients face the danger of negligent or faulty treatment. Earlier, float pools or resource teams were used across Canada and the US to save expenditure, counter the shortage of nurses, fluctuations in inpatient census, acuity, volume, and care demands. Baumann et al point out that the use of float pools/resource teams is often viewed as a staffing strategy – one that facilitates flexible manipulation of staff. Today, float pools are more of a recruitment and retention strategy and this is proved by a study conducted by Crimlisk (Crimlisk et al, 2002).

In their research report titled “Nursing Resource Team: An Innovative Approach to Staffing” by Baumann et al (June 2005), after a detailed analysis of the case study of the Nursing Resource Team at Hamilton Health Sciences from September 2002 until June 2004, conclude that resource teams are an innovative staffing strategy which can create opportunities for full-time work and provide nurses with opportunities for professional development. This is also known as the NRT approach. The NRT approach is different from the float pool in that it recognizes nursing expertise. In the case of float pools, a nurse is regarded as a generic worker who can work with different patient groups and utilize many skill sets.

Traditionally, nurses provided bedside care for patients whereas physicians assessed diagnosed, and prescribed treatment. However, with time, due to the increasing demand for nurses, there has been overlapping of responsibilities and duties. Nurses today are required to provide a wide range of services independently and several other services in collaboration with other healthcare providers (CUSN, 2006).

This shift towards a collaborative work environment has changed the education of nurses, the nature of nursing tasks in the clinical environment, and the perception of the roles of nurses (ANA, 2006). In the past, there was no regulation in healthcare and there was no definition for the nurse/physician collaborative relationship. This has changed in recent times as state legislatures have widened the authority of nurses to receive direct payment and to write prescriptions (CUSN, 2002). These laws permit nurses to practice independently like primary care physicians and allow them to establish collaborative practices whereby they can share clinical responsibilities with physicians.

In an era when America is failing to meet the health needs of its citizens, collaborative practice is seen as a significant key to ushering in more and better primary care to the public. In collaborative practice, a nurse practitioner and a physician along with other healthcare professionals provide healthcare services to patients. In a collaborative environment while physicians hold responsibility for complex medical problems involving critically ill patients whereas nurse practitioners hold responsibility for prevention, access to community-based resources, health education, and counseling. It has been shown through research that nurse practitioners are equally competent as physicians in the context of primary care decisions. The physician focuses on the illness of the patient whereas the nurse focuses on wellness.

These two approaches are complementary and provide the best possible healthcare solution in collaborative practice. Another valuable benefit of collaborative practice is that it proves to be very cost-effective (CUSN, 2002). Nurses in the collaborative practice need to take on leadership roles by developing fresh approaches to solving problems, acquiring decision-making and strategy formulating skills, acting as a change agent, mentoring other nurses, being professional, and acquiring team-building and team-managing skills (CNA, 2002). Thus we find that nurses need additional skills apart from their traditionally acquired ones. This fact emphasizes the importance of updating and redesigning medical training for nurses.

Currently, things are slowly getting better. There is a slow increase in enrollment in nursing programs. Despite the media focus on the nursing shortage, nursing continues to remain one of the most trusted and respected professionals. However, the above discussion of facts shows that it is true that the nursing shortage can become a bigger issue if it’s not rectified at this stage. Hence, it is only right that the media chooses to focus its attention on as serious an issue as the nursing shortage. This would be the first step in unraveling the causes of the shortage and taking corrective measures.

References

Spetz, J., & Adams, S. (2006). How Can Employment-Based Benefits Help The Nurse Shortage? Health Affairs, 25(1), 212-218.

Spetz, J. and R. Given, “The Future of the Nurse Shortage: WHl Wage Increases Close the Gap?” Health Affairs 22, no. 6 (2003): 199-206.

Finlayson B., Dixon J., Meadow S. & Blair G. (2002) Mind the gap: the extent of the NHS nursing shortage. British Medical Journal. 325, 538–541.

Lewis S.J. (2002) Extent of shortage will be known only when nurses spend all their time nursing. British Medical Journal 325, 1362.

Tierney, A. (2006). What’s the scoop on the nursing shortage?. Journal of Advanced Nursing, pp. 455,456.

Distance Education Offers Solution to Nursing Shortage. (2008). Business Wire, 1-2.

Armstrong, F. (2004). Can you hear us? There’s a nursing shortage! (Cover story). Australian Nursing Journal, 12(2), 21-24.

Seago, J., Spetz, J., Alvarado, A., Keane, D., & Grumbach, K. (2006). The Nursing Shortage: Is It Really About Image?. Journal of Healthcare Management, 51(2), 96-108.

Dziuba-Ellis, Jennifer (2006). Float Pools and Resource Teams: A Review of the Literature. Journal of Nursing Care Quality. 21(4):352-359.

BLS (Bureau of Labor Statistics) (2008). Registered Nurses. U.S. Department of Labor.

Crimlisk et al (2002). New Graduate RNs in a Float Pool: An Inner-city Hospital Experience. Journal of Nursing Administration. 32(4):211-217.

CNA (2002). Advanced Nursing Practice: A National Framework.

CUSN (Columbia University School of Nursing) (2006). The Evolving World of Healthcare. Web.

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Nursing Shortage: As Serious As It Is Publicized?

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