Abstract
Compelling evidence suggests that regions of the United States face a nursing and physician shortage that our legislators, health officials, and medical professionals must address. To ensure that quality medical care is not harshly impacted, the hospitals and public health leadership, in general, will need to tackle the nursing shortage with solid long-term solutions.
It is no secret that the United States faces a critical nursing shortage, a trend that potentially threatens to undermine quality medical care. One single area of concern does not affect the shortage.
In fact, the hospitals, and nursing in particular, are witnessing a combination of problems that range in salary structure, medical economics/cost containment, post-graduate education, and an aging workforce (pending retirements of baby-boomers). The public health industry is not sitting idly by to address the shortage. It is critically reviewing the needs for both existing professions.
Definition of Nursing Shortage
Nursing shortage is defined as the inadequate number of qualified nurses to meet the projected demand for nursing care within a healthcare setting, where the demand for nurses is greater than the supply.
History of Nursing Shortage
Historical knowledge is important to analyze the present and prepare for the future. As we can see from the current shortage in America today, we learn that it is not a new problem. However what makes this current nursing shortage situation unique is that the causes are related to a multifaceted range of issues. The current nursing shortage is connected to supply and demand factors, demographic changes, population growth, and fewer students enrolling in nursing schools, RNs who are retiring or leaving the workforce and a growth in the baby boom population who will demand more healthcare services in the near future.
These factors are occurring while many nurses are retiring and more jobs are being created. In addition, the nursing shortage is actually a worldwide phenomenon with areas like Western Europe, Australia, Canada and the Philippines facing shortages as well.
Economic factors have also contributed to the nursing shortage in the United States. Mark Genovese, spokesperson for the New York State Nurses Association explains, “For many decades the shortage was cyclical but as the economy tightened and as the insurance industry moved to a managed care model, there was less money in the system and hospitals had less money to work with and tighter budgets.”
Budgetary limitations affected the nursing workforce as many nurses began leaving the profession altogether. “They were forcing RNs to do more with less, handle more patients and work more hours. RNs started to leave the workforce because of the working conditions and fewer RNs entered the system,” explains Mark.
Americans are also demanding more quality healthcare services while many RNs are retiring, further exacerbating the problem. The HRSA has stated: “to meet the projected growth in demand for RN services, the U.S. must graduate approximately 90% more nurses from U.S. nursing programs.”
Decreased staffing means that there are fewer nurses to work with patients. This impacts job satisfaction and causes work related stress. In some cases it has led to many nurses leaving the profession altogether. A 2010 study published in Health Services Research found that over 75% of RNs feel that the nursing shortage is a huge problem that affects their quality of work as well as patient care and the amount of time that nurses can spend with individual patients.
Another important factor contributing to a lack of nurses is that there is a shortage of nursing school faculty to train a new generation of nurses in colleges and universities. The AACN’s 2008-2009 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing report found that nursing programs in the U.S. did not enroll 49,948 qualified students into their bachelor and graduate degree programs because they did not have an adequate number of faculty, clinical practice sites, teaching space, and were constrained by budgetary limitations. Two thirds of the nursing program respondents reported that a big reason for not accepting students was due to not having enough nurse faculty on hand.
The Southern Regional Board of Education conducted a study which found that the nursing faculty shortage in 16 states was caused by vacant faculty positions, retirements, resignations and a shortage of new candidates applying for faculty positions. Shortages like this pose a threat to the availability of nurse education. Defining the Problem
For those students interested in careers in healthcare, becoming a nurse right now could be the best decision for you. Currently, the United States is facing a severe nursing shortage. For several reasons, the number of nurses graduating and entering the workforce, and those already in the profession, is not enough to fill the growing demand. Currently, RNs are the largest group of healthcare workers in the US at roughly 2.6 million and that still isn’t enough to meet the need. According to experts, by 2012, there could be around 1.1 million unfilled nursing positions in the United States.
In the most basic sense, the current global nursing shortage is simply a widespread and dangerous lack of skilled nurses who are needed to care for individual patients and the population as a whole. The work of the world’s estimated 12 million nurses is not well understood, even by educated members of society. But nursing is a distinct scientific field and autonomous profession whose skilled practitioners save lives and improve patient outcomes every day in a wide variety of settings.
In the Truth’s view, the vast gap between what skilled nurses really do and what the public thinks they do is a fundamental factor underlying most of the more immediate apparent causes of the shortage. These causes include nurse short-staffing (due to inadequate pay and long work hours), poor work conditions, the aging nursing workforce, expanded career options for women, nursing’s predominantly female nature, the increasing complexity of health care and care technology, and the rapidly aging populations in developed nations, to name a few.
Other causes of the nursing shortage episode include: the aging baby boomer population and lack of employee incentives. There were seventy-six million Americans born between 1946 and 1964 and are now classified the Baby Boomer Generation. As this population reaches retirement age and beyond, they are requiring more medical treatments and nursing home and long term care facilities. This country is also seeing an increase in population in general, projected to grow 18% over the next two decades. With more patients flooding the healthcare system, there simply aren’t enough nurses to meet this growing need. However, those currently employed in the nursing field should be rewarded for being encouraged and motivated to stay in such a questionable field of employment.
In light of this nursing shortage, it should be relatively easy to find gainful employment after graduation should you choose to study nursing. According to the Bureau of Labor Statistics (BLS), more than 581,000 new Registered Nurse (RN) positions will be created through 2018, which will increase that workforce by an astounding 22%. The BLS also estimates that even as other sectors of our economy continue to suffer, the healthcare sector will only continue to grow. Since the recession began, more than 600,000 positions have been created in the healthcare industry. With so many Americans out of work in other fields, a career in healthcare, specifically in nursing, might be a viable career choice.
Literature Review
Today, the average age of nursing faculty in baccalaureate and graduate degree programs is 51.5 years and the rate of projected retirements will exceed the rate of re placements. Nurses enter the faculty role later in their careers and typically retire at an earlier age, around 62.5 years. More efforts need to be put into place to encourage those already teaching to remain in their positions even if it is in a limited capacity while future faculty are educated.
What factors are present that facilitate the desire for nursing faculty to retire? Kowalski, Dalley, and Weigand (2006) conducted a cross-sectional, randomized study of 129 nurse educators teaching in 61 schools of nursing to find out what personal decisions influenced their retirement plans. With a 37.6% response rate, results reflected that the mean age of planned retirement was 64.4 years. However, the mean age respondents would like to retire was 62.4. Factors influencing retirement included workplace issues, personal and family health, attitudes about retirement, and financial security.
One of the most important factors influencing retirement plans was financial security. Faculty members who were financially secure retired earlier. Job satisfaction was another important influencing factor resulting in early retirement. In lieu of the faculty shortage, the authors contend that studies such as this will offer insight into future retirement trends which may help bridge the gap between supply and the demand of nurse educators (Kowalski et al., 2006). From the results of this one study it may be important to consider the needs of the aging faculty by providing healthy, satisfying, and stimulating work environments, appropriate benefits packages, and relaxing mandatory retirement ages.
One serious factor contributing to the faculty shortage is financial. Not only are academic salaries much lower than they are for clinical practice and administrative positions of advanced practice nurses, but the cost of securing advanced academic degrees is costly. In 2004, the average salary of a master’s-prepared nurse practitioner in a clinical setting was $80,697 compared to $60,831 for that of a master’s-prepared nursing faculty member (Nevada Nurses Association, 2004). By increasing academic salaries and providing tuition allowances in return for teaching will indeed make teaching a more attractive career choice (Yordy, 2006).
Another important factor affecting the faculty shortage is that of job satisfaction, stress, and burnout. To maintain current faculty on the job, more research should be conducted on factors affecting job satisfaction and what works to provide a better environment. Gormley (2003) performed a meta-analysis study on nursing faculty job satisfaction and which factors had the greatest influence using a sample of six studies from 1976 and 1996. Nursing faculty are pressured not only to educate future nurses to provide safe and competent care, but also have many other professional responsibilities, such as publishing, conducting research, writing grants, performing community service, and maintaining their own competencies (Gormley, 2003). These responsibilities combined can become overwhelming and lead to job dissatisfaction especially as the faculty is aging.
In Gormley’s study (2003), factors that affected job satisfaction were perception/expectation of the leader’s role in curriculum and instruction, suggesting that the dean’s role has significant effects on faculty’s job satisfaction and role conflict/ambiguity. Shirey (2006) argues that prolonged stress can lead to burn-out in many faculty who then become “deadwood,” jeopardizing the quality and spirit of the institution. These faculty members can ward off potential new faculty who are even more vulnerable to the stresses of the teaching role.
It is imperative that academic institutions pay close attention to the needs of their faculty. Mentoring programs, self-renewal, and organizational engagement are key strategies to prevent burnout (Shirey, 2006). “A carefully structured and deliberate mentoring program can be an invaluable orientation as schools of nursing seek to provide an academic environment that is conducive to the professional and scholarly development of adjunct faculty members” (Peters & Boylston, 2006, p. 64).
One serious factor contributing to the faculty shortage is financial. Not only are academic salaries much lower than they are for clinical practice and administrative positions of advanced practice nurses, but the cost of securing advanced academic degrees is costly. In 2004, the average salary of a master’s-prepared nurse practitioner in a clinical setting was $80,697 compared to $60,831 for that of a master’s-prepared nursing faculty member (Nevada Nurses Association, 2004). By increasing academic salaries and providing tuition allowances in return for teaching will indeed make teaching a more attractive career choice (Yordy, 2006).
Program Analysis
Possible Solutions
For sustained change and assurance of evading the forthcoming shortage, solutions must be developed in several areas: education, health care systems, policy and regulations, and image. This shortage is not exclusively a nursing issue, but will require a collaborative effort among nursing leaders, practitioners, health care executives, government, and the media.
Creating Cultures of Retention
The American Nurses Association Magnet hospital program has had a proven success in raising the standards of nursing practice and improving patient outcomes. Currently there are 85 organizations that are designated Magnet hospitals. Magnet facilities are characterized by strong administrative support, adequate nurse staffing, strong communication, nurse autonomy, better control, and a vital focus on the patient and their family.
A growing body of research indicates that this program is making a positive difference for nurses, patients, and the hospitals as a whole. Research is proving that through this program, nurses are having increased satisfaction as well as increased perceptions of productivity and the quality of care given. Studies also indicate that these facilities have lower incidence of needle stick injuries, lower burn out rates, and double the retention of non-Magnet facilities. By adopting the characteristics of Magnet hospitals, facilities will be able to create a culture of retention that empowers and is respectful of nursing staff.
Strengthening the Infrastructure
In 2002 the Nursing Reinvestment Act was signed by President Bush to address the problem of our nation’s nursing shortage. This initiative was intended to promote people to enter and remain in nursing careers, thus reducing the growing shortage. The law establishes scholarships, loan repayments, public service announcements, retention grants, career ladders, and grants for nursing faculty. Many statewide initiatives are underway to address this issue as well.
In Pennsylvania, six new nursing education initiatives have been announced to address faculty shortage by encouraging current nurses to return to school, earn graduate degrees, and teach the next generation of nurses. Illinois is unveiling a plan to provide faculty scholarships and grants to nursing schools in order to expand student enrollment. California, whose nursing programs currently have wait lists over three years, is trying to expand nursing education through a $90 million initiative.
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