The Nursing Shortage
Melisa A. Smith Dr. Kathryn Skulley Eng 122-500 22 November 2011 Crisis in America Back in the late 1930’s, American men were drafted to go off and fight in World War II while women at home had to learn a new way of life to support their families and support the soldiers. A woman named Florence Nightingale who was recognized as one of the first nurses to care for the wounded soldiers during the Crimean war helped to influence other women to learn how to become nurses and care for the sick and wounded.
After the war ended in the mid 1940’s, thousands of soldiers returned home to begin the next chapter in their lives by starting a family while women returned to homemaking. In fact, due to the major population shift after the war, thousands and thousands of babies were born in which it would be named the Baby-Boomer generation. Now fast forward to the year 2010, several decades later, the baby-boomer generation is aging and approaching there sixties and beyond at a time when healthcare is beginning to be used more frequently by many others.
Now that America is beginning a new era of healthcare with the creation of healthcare reform that soon will create access for the uninsured and underinsured to gain access to healthcare treatments. On March 23, 2010, “The Affordable Care Act” was signed into law by President Obama that would create healthcare access for millions of Americans. This is turn would create a huge strain on the American healthcare system at a time when concerns are rising due to the increased need of services for the baby-boomer generation and the current nursing population to care for them.
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If Americans already planned on facing a nursing shortage with the baby-boomer generation, then how would the shortage affect everyone else when healthcare reform becomes active in the year two-thousand-fourteen? This paper will discuss some individual points more in detail and evaluate the nursing shortage situation from the beginning of nursing history to present day that could affect all healthcare workers now and in the future. The nursing shortage topic in America has always been a debatable question where it will be analyzed further in detail starting with some statistical data.
Looking at the national level for current nursing employment, the U. S. Bureau of Labor and Statistics stated that, “2,655,020 registered nurses were currently employed as of May two-thousand and ten” (U. S. Bureau of Labor and Statistics: Occupation section). The information presented here did not account for self-employed nurses or one’s that currently work multiple jobs. Now on a smaller scale looking at the State of Colorado’s population and registered “nurses per 1000 rate is 7. 98 as compared with a national average of 8. 6 with an additional need of 1,780 nurses to meet the national average” (The Demographic Challenges Facing Colorado’s Health Care Workforce 15). The information noted here did not account for rural areas and small towns where the population is considerably lower. Next, the discussion will continue on about nursing school factors affecting the nursing shortage. Additionally when someone is attracted by the potential for a nursing career and advancement, they must look at all avenues first before deciding and making a commitment to nursing school.
However, when someone has made the decision to enroll they must take several prerequisite classes and take a nursing entrance exam before being accepted into a nursing program. Furthermore, after students have taken the required prerequisites, they may not easily be accepted into a nursing program because of limited number of slots available and teaching constraints. In fact, it has been well observed by many schools that the major factor in the nursing shortage is due to the lack of qualified nursing instructors.
In the United States, “nursing schools turned away 67,583 qualified applicants from baccalaureate and graduate programs in 2010 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints” (2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing 2). Another factor that contributes to the nursing shortage is that nursing faculty members and educators are being lured away from colleges by higher compensation, which in turn reduces the number of potential educators to meet the demands needed.
Consequently, most educators are generally older with a limited number of years of teaching left before retirement which in turn could also leave more potential nurses waiting on a list that could reduce the national shortage. Furthermore, the United States started facing some major healthcare challenges with the baby-boomer generation beginning to impact the healthcare system in two-thousand ten. Now that this generation is in their sixties many of them will be facing increased health problems due to aging thus putting a greater demand on the healthcare system for treatment and prevention.
Consequently, this generation will begin turning sixty-five at a rate of approximately ten thousand baby-boomers per day for the next nineteen years starting in the year two-thousand eleven. This in turn will create a huge stressor to the already problematic nursing shortage. In addition to the baby-boomer generation, America will soon be forced to provide healthcare to millions of individuals who previously did not have insurance starting in two-thousand fourteen when the Affordable Care Act goes into full force.
Furthermore, “healthcare reform will soon provide subsidies for thirty-two million citizens to more fully utilize the healthcare system” (Joint Statement from the Tri-Council for Nursing on Recent Registered Nurse Supply and Demand Projections 2). This in turn will create a huge stress on the medical profession especially the nursing sector, as the healthcare system is grappling in the shortage of nurses to care for the baby-boomers. Emergency rooms and physicians’ offices will soon be faced with a massive influx of patients to provide care for, which would cause an increased demand for more medical staff including nurses and physicians.
Patients then would be going to local hospitals for elective surgeries and diagnostic testing which would cause a surge and a need for more hospital beds to accommodate the needs of patients. When the demand exceeds the amount of resources available people could be facing other challenges such as emergencies or disasters of magnitude. With the introduction of the healthcare reform and the baby-boomer generation, the healthcare system could also be facing emergency preparedness scenarios that have not been attempted before with the combination of emergency disaster plans currently available.
Some may remember the hundreds killed and injured from the two-thousand eleven tornado outbreak or the terrorist attacks on the twin towers that caused mass casualties and injured numerous people on September 11, 2001. This is just to name a few disasters that America was impacted by with the need for emergent healthcare services. Additionally in the United States, “there is little flexibility for unanticipated fluctuations in patient acuity and demand on a daily basis, and an absence of standby capacity for large-scale emergencies” (McHugh 442).
Consequently, if the United States doesn’t come up with a large scale disaster plan that has been attempted before, then many will be faced with total destruction and demise. Nurses have gone through the grueling process to begin and succeed in their careers from the dedication of going to school to meet entry level standards, as well as taking the national licensure examination prior to practicing. Some nurses graduate with the expectation that the wages and demands of the job will be satisfying to keep them in their current role.
But some people may know very little about the profession until they are faced with the reality of the job demands versus the salary. A new graduate nurse just beginning his/her career maybe making less than the more experienced nurses, but still held to the standard of providing the same type of care to all patients. According to the U. S. Bureau of Labor and Statistics, the national median wage for registered nurses as of May two-thousand ten was “$67,720 annually” (U. S. Bureau of Labor and Statistics, Occupational Employment and Wages).
However this statistic did not report the level of education held other than the title of registered nurse. Furthermore, nurses are held to a high standard to uphold to their duties and continue to give accurate, compassionate and safe care to all patients. Nevertheless, nurses play many roles other than a care-taker or pill pusher, they are expected to know about possible medication interactions that could harm a patient since they are the last line of protection for patient. Nurses have also been trained to think critically in times of crisis and to intervene with life-saving interventions without the supervision of a physician.
Many of the “hazards on the job, include blood and body fluid exposure as well as musculoskeletal injuries related to ergonomic hazard from lifting and repetitive tasks” (Stone et al. 1984). During times of busy patient demands, nurses may also run the risk of harm to themselves, especially during the administration of an injection that could cause a needle puncture that may potentially be from an infected needle, or come in contact with the splashing of body fluids on exposed skin.
However, many hospitals have currently up-graded equipment to help prevent unwanted needle stick exposures through the use of needle free systems, but there is still work to be done to keep nurses and patients safe. Furthermore, nurses may also be exposed to occupational injuries while lifting a patient in bed, or when a patient falls on a staff member and injures them in the same turn as well. Obviously some hospitals have improved the safety for staff, and patients with the use of lifts or ssistive devices, but time maybe of essence. With this in mind, the physical and mental demands of the nursing profession may take a toll on a person’s body, or it may potentially provoke thoughts of a career change from the risks involved. However, since nurses are also held accountable for mistakes made even when times are proven difficult, in hind sight turn this could potentially create a stressful environment full of expectations without satisfaction.
Furthermore, “nurses’ working conditions have been associated with medication errors and falls, increased deaths, and spread of infection, but nurses report making more errors when working shifts greater than twelve hours, working overtime, or working more than forty hours per week” (Stone et al. 1984). In some hospitals nurses are given an assigned number of patients to care for, but patients are coming into the hospitals’ sicker than in previous years which can create a dilemma when assigning patient care.
Some hospitals’ have been designated as a Magnet hospital where the maximum ratio is one nurse to five patients which could help ease some demands to be able to provide better care to patients, but this trend is still new to some healthcare systems. On a typical working shift nurses are responsible for medication administration, physical assessments and general care of the patient, but during times of staffing shortage nurses may have to provide all the care for all assigned patients.
Generally speaking, nurses care for four to eight patients per shift while “an additional patient within this range was associated with a seven percent increase in the odds of dying within thirty days of admission and a seven percent increase in the odds of death following complications such as shock or pneumonia” (Keenen 1). In addition patients have a greater risk of infection due to lack of adequate infection control from proper hand washing by healthcare staff when staffing shortages occur.
When nurses are held accountable for a certain number of patients, and one person falls out of bed down the hall while they were getting another patient up to the bathroom can create an unsafe and unsatisfactory environment for all involved parties that in turn can cause higher morbidity in patients. With a stressful environment and combined fear of making a mistake which would result in punitive action against them, “the U. S. healthcare system contains a safety climate which blames individuals for errors instead of the system or organizational failures that may really be at fault” (Fox and Abrahamson 235).
With that said, more nurses feel pressured to not make any mistakes instead of being human. However, when hospitals’ are dealing with staffing issues and nurses are not able to give proper attention to their patients this in turn could create a dangerous situation for patients that have an increased mortality risk due to complications or co morbidities. Studies have shown that staffing insufficiencies increase the mortality risk in patients due to the inability to adequately care and educate patients on complications such as pneumonia or bloods clots which can be proven fatal.
Nurses are also expected to perform many tasks that include life saving techniques in critical situations, but in order to keep these individuals with these skills employed by a specific facility it takes a clever approach to nursing retention. However, “research shows that nurses contribute heavily to the quality of patient care, reimbursement based upon performance outcomes would likely increase the economic value of nurses, thus improving wages, work environment and recruitment and retention” (Fox and Abrahamson 235).
In the past, when hospitals were dealing with nursing shortages some would offer a sign-on bonus or a contract to pay for a portion of education expenses as an incentive to attract employees for difficult to recruit positions such as night shifts. Due to cost constraints some facilities were beginning to do away with sign-on bonuses and offer other assistance after a specific time period of employment. On the contrary, most facilities do not recognize nurses with compensation based on performance other than an increase in cost of living wages, but could benefit further through increased recognition programs.
Since World War II the nursing profession had always been a female dominant profession until now, with the addition and encouragement of male nurses in the profession. Most patients saw nursing as a female dominant profession due the delicate nature of caring for sick patients and the need for gentle interactions and nurturing. Furthermore, working conditions were often poorer in nursing with a predominately female occupation.
During times of economic recession more nurses were choosing to work, or continue employment to help meet the financial expectations of their households especially in times when other family members are facing a layoff or furlough. Although when the economy improves the shift of nurses actively working may change and create an even bigger nursing shortage while some may change careers or retire all together. Furthermore, with the introduction of men in nursing things have begun to change and more and more men were joining the nursing profession for career stability and advancement opportunities in an already female dominant profession.
A man named James Derham “in 1783 who was a slave earned money to buy his freedom by working as a nurse” making him the first male nurse (Bonair and Philipsen 19). Nursing schools began offering scholarships to male nursing students as a way to attract more people to the nursing profession. With men in a female dominant profession they were making up “five to ten percent of the workforce in the UK, USA and Canada” while in the nursing profession they were more likely to be promoted into leadership roles (Brown 120).
Male nurses generally started a nursing career at a younger age compared to their female counter parts. As working nurses were getting older many of them were planning for retirement at a time when a majority of people were retiring with the baby-boomer generation. More and more people began to choose a nursing career later in life, so consequently most nurses ended up retiring earlier due to the strains of the job or age factors. Consequently, the average age of nursing students graduating was thirty-one, while the average age of the working nurse is forty-six years old.
Due to the popularity of nursing for some it is becoming a second career for individuals after many years of employment in other fields such as business, or computer industries that have had many changes and layoffs that contributed to the employment shift. With this new employment shift new nurses that began a nursing career as older adults are not working in the field as long and retiring sooner. Furthermore with the short periods of nursing employment, this again creates problems with fixing the nursing shortage across the country.
Now that the factors of the nursing shortage have been described in detail, the next discussion will be about ways to fix the nursing shortage problem in America from the faculty shortage to loan forgiveness programs. If America is going to get out of the nursing shortage crisis the first step is to address the shortage of educators, and nursing faculty that teach and train the future nursing students. In order to create an interest in teaching there needs to be some changes with regards to income levels, and more education assistance to give nurses the ability to increase their knowledge. Some hospitals ffer opportunities to take a leave of absence from their jobs to pursue further education options without the fear of job loss. However, this in turn would not only be an asset to the individual but the facility as well that encouraged their employees to seek more education. Another factor in the nursing shortage is the number of clinical sites needed to give adequate clinical experiences for nurses to learn in. In hospitals today nursing schools generally have clinical experiences five days a week instead of an additional two days on the weekend to meet more needs of clinical experience time.
By offering the additional two days per week, nursing students would meet their clinical expectations ahead of schedule therefore they could graduate earlier and begin nursing practice sooner. This in turn would help to ease the shortage of trained nurses sooner and decrease the waitlist time for entrance into nursing school. In order to attract more nurses to continue advancing their education there needs to be more monetary compensation to pay for the cost of education in order to encourage more nurses to advance into teaching.
Furthermore in order for the healthcare system and colleges to meet the recruitment demands and the shortage requirements there needs to be some collaboration between facilities for education and tuition assistance. Consequently to address the aging of the nursing faculty, more people need to be encouraged to continue their education without any lapse of time after graduation. Nevertheless, since most nurses cannot afford to pay for the higher expenses of college and continue to work then only a selected few would advance their education.
However, some nurses may choose not to continue their education due to conflicts with work schedules and family, unless there was some loan assistance or forgiveness program widely used. The United States currently has loan forgiveness programs that pay the entire amount of the loan after requirements are met. Furthermore, after a nurse has completed two years of service in a hospital then they can apply for the loan forgiveness program that may take up to six months before a decision is made, and only a limited number of individuals are selected.
In addition, if the United States invested in more healthcare facilities and offered more loan assistance and scholarships then people would be more attracted to the nursing profession and possibly reduce the nursing shortage. In conclusion, after discussing the many challenges that the nursing profession faces, it is still considered a highly respected field by many but may not be the choice for everyone. However, until the United States aggressively pursues a solution to the nursing shortage, better wages, and working conditions, then healthcare reform will define the critical needs of nurses that may end up costing more lives than money.
In the end, if the nursing shortage continues, it could be catastrophic to American society at a time when healthcare has made so many advances to increase the life expectancy rate. Works Cited “2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. ” Fact Sheet-Nursing Shortage (2011). <http://www. aacn. nche. edu/Media/Factsheets/NursingShortage. htm>. Bonair, Jennifer, and Nayna Philipsen. “Men in Nursing: Addressing the Nursing Workforce Shortage and Our History. ” Maryland Nurse.
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