Shortage of Nurses in the US Healthcare System

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Table of Contents

Research Article
Limitations noted
Valuable suggestions
References

Research Article

Rambur, Betty; McIntosh Barbara; Palumbo, Mary Val; Reinier, Kyndaron; (2005), “Education as a Determinant of Career Retention and Job Satisfaction Among Registered Nurses”, Journal of Nursing Scholarship, Vol. 37, Issue 2, Pgs. 185-192, Published by Sigma Theta Tau International.

The literature highlights the shortage of nurses which is a major problem in the US healthcare system and must be countered with feasible long term plans. This research is timely and addresses an acute global problem. Graduates of hospital-based diploma programs, 2-year associate degree programs, and 4-year baccalaureate degree programs all appear for the same licentiate exam surprisingly and they become registered nurses who are equally accepted with the same remuneration, kind of job and responsibility. They are not being differentiated for any posting based on their qualification as is done for any other profession.

There is no official regulatory difference. This probably has discouraged nurses from delaying their graduation and intelligently opting for shorter courses. However the baccalaureate degree has been preferred by the American Nurses Association since 40 years ago. The issue still smolders without resolution.

A study conducted by Aiken et al (2003) is about the only evidence which indicates a link between nursing education and patient safety. This study suggested the careful consideration of policies concerning the quality of patient care that could be provided by the various nurses. Other studies have also spoken about the outcomes of having the different educational qualifications but none really touch upon the education and how it could provide a return of investment in terms of social returns or years contributed to the profession.

This study analysed individual and social return on investment, job satisfaction, and career patterns in individuals of a group AD, whose highest degree was an associate degree in nursing (AD) and a second group termed BS for this analysis. BS comprised of those whose highest degree was a bachelor of science with a major in nursing or a bachelors of science in nursing. The professional acumen of a nurse with a baccalaureate degree should be recognized..

The investment for her studies implies that she needs a longer time in her profession to get a return. The approach that she makes and her wider knowledge would ensure higher levels of job satisfaction. This would account for social dividends. Additional years of expertise derived from long years of experience would be another form of societal gain. Quantity and quality are added to the workforce.

The authors comment that career development is related to job mobility. Professionally committed people in their early careers have a tendency to move from job to job in different organizations in search of a satisfying job or one that offers developmental opportunities. “Career migration within the profession enhances breadth of experience as well as personal and professional competency”. Job retention is less important than career retention. Older workers are more likely to remain in one organization and this provides stability to the health care system. Fewer patients to a registered nurse are an important element in patient safety.

Only 26% of hospitals had salary based on educational status (Office of Nursing Workforce Research and Development, 2003). Employers are seen to look out for new nurses from US or abroad. The States are making attempts to keep students within their courses. Students are excused from repayment of loans so that they remain to complete their courses. Attempts are being made at workplaces to differentiate nurses on the basis of education (Aiken et al, 2003).

What should be done is have a regulation at the national Level. Efforts must be made to have better qualified nurses to attend to the increasing demands for quality nursing in the global context. The shortage must be handled by sufficient funding in education.

Creation of environments in hospitals which ensure nurse retention has proved successful in studies of Magnet Hospitals. Working with colleagues who are clinically competent, getting support for education and acquiring a specialty certificate seem to work positively in Magnet Hospitals. The present nurse population is mostly over forty. Government fiscal policies have not yet recognized the need to retain mature nurses.

Many researchers have tried to understand the factors that affect nurse satisfaction. It has been noted by some researchers that higher education was a point for satisfaction and did not cause a tendency to move on. Job satisfaction has been found negatively related to the variables ‘thinking of quitting, intention to search, intention to quit, actual turnover’ in decreasing magnitude.

The hypotheses that were selected suited the doubts created from the available literature and the requirements of the present and future health care global concerns: (I)The careers of Baccalaureate Graduate nurses (BS) have a better social return on investment with a career pattern showing early exploration and a longevity in one place when compared to AD. (II) BS nurses have higher job satisfaction in more dimensions and are considered to have a better private return on investment.

A mail survey which was part of the JARS (Job analysis and retention study) study provided the information for analysis here. This probably provided a larger sample than would have been obtained by other methods of interviewing. The satisfaction factor with many job dimensions was graded from extremely dissatisfied to extremely satisfied on a 7-point Likert scale. 21 questions, 13 from the Job Diagnostic Survey and 8 newly chalked up by a management expert were used.

These related to six factors including quality of supervision, opportunity for autonomy and growth, career and advancement opportunities, pay and benefits, physical and job stress and job security. Pilot testing was appropriately done in 3 settings: education, a tertiary hospital and a home health agency. 3000 nurses active in the Vermont Board of Nursing in September 2002 were the sample taken. The response rate was 56% from 2778 nurses in the survey.

The design can be considered appropriate for various reasons. The findings showed that of the 1574 respondents, 1440 were current nurses. Systematically excluding nurses who would not reveal their qualifications, 303 with diplomas, 89 with masters and 2 with doctorates, another 111 as their qualifications were not relevant to the study due to their baccalaureate and masters being in other fields, the sample had remaining 379 AD RNs and 499BS RNs.

It was found that BS RNs had more nursing jobs and with increasing age, the BS RNs held more jobs. The findings indicated that the satisfaction with supervision, pay and benefits were lower than the national norms in the Job Diagnostic survey for both groups. The satisfaction for autonomy, growth and job security was higher than in the national norms. The results show the BS RNs significantly more satisfied than the AD RNs in the job satisfaction factors of opportunity for autonomy and growth, job stress, physical demands and job and organizational security. Supervision, career, continuing education, promotion, pay or benefits showed no difference of satisfaction in both groups.

Early careers showed skill building and position changes while job stability and relative contentedness were seen in later life. Career retention in the face of a shortage happened to be a positive social return. Hypothesis I was proved. The second hypothesis was also explained in the findings to show that no differences were noted between the 2 groups.

Limitations noted

The cross-sectional design adopted here precluded the analysis of lifetime patterns of cohorts. The number of RNs was taken into consideration rather than the nurse years which could have given a better picture. Follow-up could have been done had longitudinal data been gathered to assess career dropouts and retirement. The retention aspect of societal return on educational investments could have been analyzed accordingly. The focus here is on the RNs with a nursing qualification of AD or BS. Other degrees of nurses were not included. Including all the various educational qualifications would have given a more definitive picture. The study was limited to one state, preventing generalization. Investments should have been concentrating on long term outcomes rather than immediate effects.

Valuable suggestions

Private individual and societal returns on investments need to be considered. Policy makers should take caution to consider the global shortage of qualified nurses seriously and aim for long term efforts to solve the problem rather than hasty remedies.

More researches are needed to modify the educational policy. No single research can rectify situations.

References

Aiken, L., Clarke, S., Cheung, R., Sloan, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623.

Office of Nursing Workforce Research and Development. (2003). Vermont HealthWorkforce Pilot Study. Burlington, VT: University of Vermont.

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Shortage of Nurses in the US Healthcare System

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