This paper explores such a phenomenon as a nursing shortage in the healthcare system of the USA. The research on that subject describes, in particular, the risks that the shortage of nurses may create. Moreover, it depicts the reasons the deficiency occurs. In addition, this essay pays considerable attention to the steps of resolving the problem. The study provides the results of American researches, which inform that the demand in nursing force will exceed the supply significantly by 2020. The governing bodies, hospitals, and society should take notice of this prognosis and implement actions directed to overcome negative perspectives. The recommendations highlighted in this paper include inviting foreign nurses to work in the USA, making a more attractive image for this profession through media, increasing nursing wages, providing a manageable workload, and building the favorable working environment. The emphasis should also be put on the educational and cultural development in the nursing workforce and additional funding for nursing education. Finally, one of the key ideas of the essay is to bring into focus the influence of healthcare policy on nurses’ motivation. Profound investments in the nursing workforce can provide better care and positive outcomes in patients.
Nowadays, nursing is one of the most popular and exciting jobs. Across the globe, the contribution nurses make to the health of society is immense and beyond compute. The task of every usual nurse is to prevent disease, promote health, and help patients. Undoubtedly, through the usage of their considerable knowledge, nurses provide protection to patients from the risks and consequences of disability, illness, or affliction. The importance of positive outcomes for the social and economic attributes of any nation is obvious and naturally determined. Society requires healthy and free-of-illnesses citizens for the country’s prosperity and well-being. Nursing, as one of the largest health professions, remains integral to achieving those goals. Therefore, nursing health care workforce requires strengthening through increasing the nurse recruitment ratio (Institute of Medicine, 2010). Otherwise, the public will face the problem of a nursing shortage. The nursing shortage is the situation, which indicates the exceeding of the demand for care professionals over their supply. Nowadays, it is a problem of a global scale. The USA, with its growing population, must also take steps for patching up the shortage. The accentuated reasons for the nursing shortage give the society an opportunity to make an efficient policy for managing this problem.
Experts expect that the shortage will worsen over time as a result of low expected growth in the supply of nurses in combination with rising demand for nursing care for the population over 65 (Keenan & Kennedy, 2003, p. 2). The Federal Government exploration supposes that the nurses’ number is expected to grow by only 6 percent by 2020, while a demand for nursing care is expected to grow by 40 percent (Stanton & Rutherford, 2004, p. 1). In addition, the U.S. Department of Health states that by 2015 about 400,000 new nurses will be needed only to fill vacancies left by retirees. Many other researches confirm this dismaying statistics. The lack of nurses is reaching a critical point. Through the facts outlined above, one can understand how dangerous this crisis may appear.
It is taken for granted that the nurses demonstrate greater job satisfaction, and patients get better care with many nurses available. Thus, many studies indicate a close relationship between the nursing workforce and patient outcomes. In other words, the more nurses are engaged, the fewer deaths occur (Aiken & Clarke, 2006). The shortage of nurses may affect two important entities in caregiving: a) nurse-to-patient ratio b) nursing hours per patient per day. In other words, an adequate number of nurses and a manageable workload are required for providing the efficient medical care. The surveys conducted in many hospitals show that clinics with the lowest nurse to patient proportion have higher mortality cases. The nurses in those healthcare units show dissatisfaction with their job, provide care of lower quality, and demonstrate high burnout episodes.
The inappropriate nurse-to-patient ratio has also an impact on the patient outcomes. Thus, one study states that medical patients in hospitals with high levels of nurse staffing were 5-25 percent less at risks to develop urinary tract infections (UTIs) than patients in the comparison group (Stanton & Rutherford, 2004, p. 4). Through different studies, it is proved that besides UTI, the other nonfatal adverse outcomes, such as gastrointestinal bleeding, cardiac arrest, and pressure sores, are potentially sensitive to nursing care.
As mentioned earlier in this paper, nursing workload has an impact on the time that nurses can devote to fulfilling different tasks in a hospital. The deficiency in an amount of nurses may lead to their work overload. Nurses working over the set time are three times at greater risk of making an error in their job. The American Medical Association (AMA) even indicates that each additional patient per nurse increases mortality by 7%. The other research, conducted by Stanton and Rutherford (2004), reports that adding thirty minutes of nurse staffing per patient can lower the risk of pneumonia in surgical patients by over 4 percent (p. 4). Thus, it bears repeating that increasing of care hours spent with a patient is possible only at available number of nurses.
Having taken into consideration different risks that follow nursing shortage, it is worth exploring the causes of it. The reasons for the problem currently discussed are multifaceted. The lack of supply of trained nurses is not the single reason determining the issue. The lack of occupational programs for newcomers, the shortage of adequate staffing ratios in different healthcare facilities, inefficient worker retention incentives, and other contributing factors may be taken as potential factors, as well.
One of the reasons for an increased demand for nurses may be the population growing. Statistical studies notify that the population will rise by 18 percent between 2000 and 2020 and the number of people over-65 will grow by 54 percent (Keenan & Kennedy, 2003, p. 2). The population growth, as well as its aging has an impact on the nursing shortage phenomenon. Over 70 million children were born in the years after the World War II. These people, known in the society as baby boomers, are retiring in large quantities nowadays. The number of patients, herewith, increases, while the number of qualified health professionals shortens through aging.
Another sad fact is that there will be not enough new nurses able to replace the qualified specialists after retirement of the latter ones, since fewer young people enter the nursing profession today. It happens, because the nursing career has lost its appeal among the youth. Nursing is often associated with dealing with demanding patients, overburdened doctors, being underpaid, and working over the norm. Nurses indeed face the poor working conditions: they often work long shifts, handle more patients, experience lack of proper facilities, benefits, and amenities. There is no wonder that young people choose future careers based on a good work-life balance and potential earnings. In addition, the wide range of career options available in a modern community gives the opportunity for women to find more attractive jobs than nursing.
Another reason leading to a nurse shortage is hiring medical assistants instead of nurses. Hospitals can spare money while hiring such nursing substitutes as nursing assistants or medical professionals, since they usually are paid less than registered nurses are. However, the skill sets of the two mentioned care groups differ. The registered nurses have a wider range of activities than medical assistants do. Thus, the hospitals that practice such a substitution, subject the nurses who do remain on the staff to overburdening and overworking. It may cause quitting of the professionals, and, thereby, contribute shortage.
The educational aspect of the problem is equally affecting the shortage. Enrollment in the nursing schools is not growing sufficiently enough in order to meet the challenging demands for nurses over the next decade. The limited number of available places in the academic programs often makes exclusively qualified students to be set in the waiting lists of the nursing schools. Hereof, the students pursue other career paths. Another point that concerns educational side of the discussed challenge is the lack of experienced and qualified nursing trainers. Until late in the 20th century, physicians and nurses with hospital diplomas or bachelor’s degrees taught nurses according to the hospital-based programs. Today, there are very few hospital programs; most nurses are college educated. The minimum educational requirement for a nursing educator is MSN (Master of Science in Nursing). However, even if many young people apply for nursing courses, the educational institutions can only enroll the number of students that they can manage to train. According to the report of the American Association of Colleges of Nursing (AACN), U.S. nursing schools weeded out 78,089 qualified applicants from baccalaureate and graduate nursing programs in 2013 because of an insufficient number of faculty, classroom space, clinical sites, clinical preceptors, and budget constraints (AACN, 2014). Thus, there is a critical shortage of nursing educators, and this state of things is the greatest barrier to relieving the today’s nursing shortage.
The salary component is not less influencing the lack of nurses. The quantity of registered nurse (RN) services employed and the wage rate are below the competitive-market level, resulting in an inefficient RN resource allocation (Miles, 2007, p. 306). If to compare the average RN salary to the one of the other community providers (landscapers, garbage men, plumbers, electricians, city workers), the salary discrepancy can be easily noticed. A portion of guilt for the growing reluctance to mastering this profession may be also imposed on image-makers. Thus, media attention is focused predominantly on the challenges nurses face, rather the rewarding aspects of the career (Keenan & Kennedy, 2003, p. 3).
Nurse shortage witnesses the fundamental changes in society’s demographics, work attitudes, or career expectations. Unfortunately, the prognoses regarding this issue remain unfavorable. However, having detected the reasons, which cause the shortage, the American society may find the ways for resolving the situation. The steps for improving the situation should not be subdued. As follows, the government and the managers of healthcare facilities should carry out the policy of intense nursing support. It should be recognized that some steps in this direction have been already taken. Thus, in 2002, Congress approved the Nurse Reinvestment Act in order to provide funding to advance nursing education, grants, scholarships, diversity programs, nursing faculty and loan repayment programs, and comprehensive geriatric education (Keenan & Kennedy, 2003, p. 5). The executive branch, states, and private organizations should be entirely involved in preparing and implementing supporting programs for nursing, as well. The good news is that such programs have been already applied in many private hospitals. It can be seen at the John Hopkins Hospital in Maryland, which follows the state Nurse Support Program and the own ones. Thus, the INSPIRE (Inform, Nurture, Support, Promote, Instruct, Role Model and Encourage) program allows new graduates to feel themselves comfortable in their units (Shapiro, 2008). Along with INSPIRE, the other projects, such as the SPRING (Social and Professional Reality Integration for Nurse Graduates) and PEDS (Pediatric Education Development and Support) are assisting newcomers in navigating an unfamiliar environment of the hospital. The current approach, if used in other hospitals, could greatly promote nurses’ retaining.
Improving the quality of nursing education can be regarded as one of the most required strategies. The USA needs not only sheer numbers of nurses in general, but medics with higher education and training. The country must graduate approximately 90% more nurses from the US nursing schools in order to meet the projected growth in demand for RN services. In October 2010, the Institute of Medicine released its report on The Future of Nursing, initiated by the Robert Wood Johnson Foundation, which called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% and doubling the population of nurses with doctoral degrees. The current nursing labor resources fall far short of these advices with only 55% of registered nurses prepared at the baccalaureate or graduate degree level. In order to supply highly educated nurses to the market, the government should make greater investment in nursing-education programs, including faculty and facilities. Therewith, hospitals need to work with universities and colleges in order to help educational institutions quickly transform their traditional programs to meet the requirements of new work models.
Another way to improve the situation is to devote resources to increasing wages of nurses. Though many publications usually point out other factors of shortage rather than an income constituent, its motivational potential is significant. The policy recommendations should include calling for higher wages and benefits that are more generous. The hospitals can collect data on nurse turnout, vacancies, and wages and make it public for avoiding a salary discrimination against nurses and providing better public policy development towards nursing. According to the Lovell’s research, “Higher pay would signal that demand was beginning to outstrip supply and would draw new trainees into the nursing profession” (2006, p. 14).
Different government, state or local health care organizations should be involved in creating programs and initiatives designed to withstand the problem of nurse lack. For example, the Society for Healthcare Strategy and Market Development could act as an initiator of meetings (seminars or webinars) intended to demonstrate how to integrate workforce strategies into the hospital’s overall strategic. It would help understand the workforce needs of hospitals.
Since aging of the nursing personnel also affects the workforce count, hospitals need to work with the nurses approaching retirement age in order to find out attractive options regarding schedules, roles, and benefits for continuing to work. In addition, strategies for retention of the employed nurses are needed. Since the stressful working environment remains one of the key factors contributing a shortage, the hospitals need to develop new models of work. These models would increase efficiency and work satisfaction. The high nurse-to-patient ratio, a low turnover among nurses, promotion of nursing leadership and autonomy could be the attributes of the favorable work environment setting. Another aspect of improving the latter supposes reorganization of nursing care through reducing paperwork of RNs, herewith increasing the proportion of time spent on patient care.
Hiring foreign nurses can be another way to address shortages in the USA (Keenan & Kennedy, 2003, p.4). However, this strategy is rather controversial and should be implemented cautiously. Although international recruitment fills the nursing gaps, it also raises the risks of inappropriate wage policy. The presence of foreign RNs may depress the wage growth in the United States and meanwhile aggravate the nursing shortages in the countries supplying nurses. Experts also emphasize the need to improve the nursing image. Positive aspects of the profession should be highlighted in the press or in different advertising campaigns.
In summary, it should be said again that the best way to overcome the problem of nursing shortages is to invest in the nursing workforce through increasing salaries, additional funding for nursing education, creating a favorable working environment, and recruiting foreign specialists. The fulfillment of all these characteristics can ensure that the community has access to quality and safe care. As follows, the government and the managers of healthcare facilities should carry out the policy of intense nursing support.
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