Monday, November 19, 2007

The Ubiquitous Nursing Shortage

The national health care system is facing another significant nursing shortage. According to Mikhail (2005), by the year 2020, the average registered nurse vacancy rate in the United States will be 20%.

Results illustrate that the shortage negatively affects the quality and safety of patient care in hospitals, as well as the time spent with patients, according to Buerhaus, Donelan, Ulrich & Norman (2005).
The nursing shortage poses a major concern for patient safety and threat to the nursing profession; therefore, nurses must use immediate and enduring strategies to reduce and alleviate the nursing shortage through improved working conditions, recruitment and retention strategies, and professional respect and appreciation.
The current nursing shortage is real, serious, and likely to worsen. A study conducted by Beurhaus (2005) demonstrates that 93% percent of RNs reported major problems with insufficient time for patients with the majority also noting additional problems maintaining patient safety, detecting complications early, and collaborating with team members. There are numerous contributing factors associated with the shortage. The aging workforce cannot meet the physical demands and are burnt out due to poor working conditions that the job requires. This leads to a difficulty in retaining experienced nurses. Nursing schools and programs lack the space for prospective nursing students due to a major shortage of nursing faculty. Lastly, low job satisfaction and lack of respect and appreciation in the clinical setting has led to difficulty in retaining qualified nurses.
A difficulty in retaining the older workforce due to poor working conditions, poor supervisory relations, and increased physical demands has a negative affect on patient care. Cohen (2006) states, “The issues that most often lead to the low job satisfaction result from low morale (68%), mandatory overtime (64%), stress (56%), physically demanding workloads, irregular hours, and unrealistic workloads” (para. 11). The intervention most likely to improve retention of RNs is superior manager behavior (Cohen 2006). It is essential that nurses join committees, organizations or coalitions and collaborate with nurse managers/administrators to address these issues, thereby, creating a more desirable working environment. Perhaps, it would be worthwhile to redesign patient care to support the practice of an older workforce. For instance, decreasing patient-care load will reduce stress levels as well as increase the quality of patient care (Cohen 2006). In addition, an increase in job satisfaction could be achieved by offering greater flexibility in scheduling, less overtime, increased time off, and increased benefits and salary (Cohen 2006). Hospitals should consider reconfiguring work processes and environments to be more ergonomically sound in order to assure nurses' health such as operational changes and redesigned work processes such as comfortable chairs, good lighting, adjusting the height of charting tables, and a no lift policy for older nurses is essential to help older nurses deal with the emotional and physical demands of the job. It is crucial that nurses voice their opinion and it is equally important that nurse managers listen and provide the necessary physical and emotional support.
It is imperative to recruit nursing faculty and nursing students in order to alleviate the nursing shortage. According to Falk (2007), the aging faculty and a shortage of nurse educators combine to serve as powerful drivers that have the potential to leave nursing programs without faculty to educate the next generation of nurses. The nursing profession needs to develop and evaluate new and creative recruitment strategies to attract nursing students and faculty thus countering the shortage of nursing faculty. Nursing administrators must target and encourage the older workforce, who display low job satisfaction, to be nursing educators, while earning equivalent salaries (Falk 2007). In addition, new nursing graduates should be encouraged to select an academic nursing career. Establishing new educational and research training in order to motivate nurses to enter master and doctoral programs earlier while providing them with monetary support is also an important strategy. Moreover, nurses need to join committees and should raise awareness of the effect of faculty shortage and fewer nurses trained and how it negatively affects the quality of patient care. Collaborative efforts of hospitals and nursing representatives can present grant proposals to directors that will provide salary stipends for faculty. As a result, nursing programs will be able to produce more nursing graduates, ultimately allaying the nursing shortage.
Dire efforts are necessary to increase job satisfaction, respect, and appreciation. Reorganizing the work setting by making hospital work more appealing to nurses plays a crucial role in reducing the shortage. Nurses must collaborate with nurse executives and hospital administrators to find ways to make nurses feel more valued by enabling professional nurses to be autonomous, recognized, and empowered. This can be accomplished through exploiting Magnet status hospitals. Magnet hospitals are three-fold: they emphasize the value of nursing, they exhibit exceptional characteristics that support professional nursing and most importantly, they enable nurses to be autonomous, recognized, and empowered (Upenieks 2005). According to Upenieks (2005), magnet hospitals have been associated with lower turnover rates, flexible schedules, higher levels of job satisfaction, and a decentralized administrative structure. It is imperative that nurse managers listen to their nurse employees and address their concerns through exploiting magnet hospitals.
The nursing shortage continues to remain a problem and this poses a threat for patient safety. Nurses must use immediate and enduring strategies to alleviate the shortage through improved working conditions, recruitment and retention strategies, and professional respect and appreciation. Nursing must be structured to reward and accommodate the physical capabilities of older nurses. RNs need to collaborate and join committees to raise an awareness of the faculty shortage. In order for nurses to provide quality patient care, they must first be appreciated, respected, and valued and the magnet hospital model has empirically confirmed job satisfaction outcomes on numerous occasions. Together, these immediate and enduring solutions will help alleviate the nursing shortage.

a. Intervention 1 (Retain qualified nurses through exploiting Magnet status hospitals)
i. Disadvantage 1: (Obtaining Magnet status is no easy feat)
One major disadvantage in achieving Magnet status is that it is a lengthy, rigorous, and laborious process, which does not occur overnight. Instead, it is a long term solution to the enduring nursing shortage (McClure 2005). The bar for Magnet status is raised fairly high, and the application process is quite painstaking. In order for a facility to become Magnet status, a hospital must meet a stringent set of 14 standards of care, known as the “Forces of Magnetism,” in addition to practicing with 95 different criteria (Westendorf 2007). Hospitals must demonstrate they are committed to sustaining nursing excellence, improving professional practice, and transforming the culture of a work environment. A facility will undergo a six-part process that will thoroughly examine the organizations structure, process, and outcome delivery methods. The first 4 phases include application, evaluation, site visit, and award decision and the last 2 phases are for maintaining the status (Westendorf 2007). Gathering and compiling the necessary information is a very large task that becomes a team effort involving the entire hospital (Moore 2001). Therefore, as one can imagine, obtaining Magnet status can take years and even then, a facility may be rejected. Furthermore, if Magnet status is awarded, it is only granted for a 4 year period, in which a facility must reapply (Moore 2001). As a result, the nursing shortage is not being immediately resolved due the lengthy and rigorous process of achieving Magnet status.
ii. Disadvantage 2: (Achieving Magnet status is not cost effective)
Achieving Magnet status is difficult to implement due to today’s cost-conscious health care environment (Upenieks 2005). The American Nurses Credentialing Center (AANC) collects several different fees from hospitals for its Magnet recognition process. The fees include: an appraisal fee that can cost up to $50,000 (plus $50 per beds over 950), honorarium fees, site visit fees, travel and lodging fees, and other related expenses that are paid by the hospital applicant. The total estimated initial cost of Magnet designation can be hundreds of thousands of dollars (Crotty 2004). Many facilities lack the resources to support their Magnet pursuit. Many administrators, specifically those working in medically underserved and under-funded communities, report that the application fee alone can be a discouragement (Kidd). Magnet hospitals are also associated with significantly higher registered nurse staffing numbers and the operating costs associated with Magnets are just too difficult to justify with scare resources. In conclusion, the Magnet program requires a considerable amount of money and resources to transform its culture and improve conditions.

b. Intervention 2 (It is essential that nurses join committees or groups and collaborate with nurse managers to address issues regarding poor working conditions and poor supervisory relations)
i. Disadvantage 1: (Nursing managers themselves are in poor working conditions)
Unfortunately, many nurse managers have been unable to provide their nurses with the leadership and support they need due to nurse manager turnover rates (Cohen 2006). Turnover rates of nurse manages are comparable with those experienced among staff nurses (Cohen 2006). This may suggest that nurse managers themselves are in poor working environments. Often, nurse managers are not provided the necessary support by top management and are neither recognized nor held accountable for nurse turnover (Cohen 2006). Thus, it will be difficult for nurse managers to address nurses concerns of poor working conditions when they themselves are experiencing similar problems. Not enough consideration is given by first addressing the work environment of the nurse manager.
ii. Disadvantage 2: (Nurse Managers are not actively involved with their staff due to lack time)
In order for nurse supervisors/managers to provide the moral support necessary to assist their nurses, they must be actively involved with their staff (Cohen 2006). However, nurse managers/supervisors are forced to balance multiple job responsibilities, thus employee concerns regarding job satisfaction and poor supervisory relations may not constitute a high priority (Cohen 2006). In addition, many nurse managers feel they do not have time to adequately support their employees and improve job satisfaction, due to high supervision ratios and clinical workloads (Andrews & Dziegielewski 2005). The first-line nurse manager is responsible for an average of 32 staff members and as the size of the hospital increases, so does the workload of the nurse manager. Essentially, nurse managers can be managing over 100 employees and a clinical component that may occupy up to 50% of the manager’s time (Andrews & Dziegielewski 2005). Thus, it remains a difficult task to address staff concerns when manager’s hands are tied up.

References
Andrews, D. R., and Dziegielewski, S. (2005). The nurse manager: Job satisfaction, the nursing shortage and retention. Journal of Nursing Management, 13(4) 286-295. Retrieved October 25, 2007, from Cinahl database (2005120894).
Buerhaus, P., Donelan, K., Ulrich, B. T., Norman, L., et al. (2005). Hospital rn’s and cnos’ perceptions of the impact of the nursing shortage on the quality of care. Nursing Economics, 23(5) 214-222. Retrieved April 14, 2007, from Proquest database (914357041).
Cohen, J. D. (2006). The aging nursing workforce: How to retain experienced nurses. Journal of Healthcare Management, 51(4) 233-246. Retrieved January 5, 2007, from Proquest database (1092901971).
Crotty, M. (2004). As nursing crisis continues, hospitals turn to Magnet program. Massachusetts Nurse, 75(8) 1-12. Retrieved October 24, 2007, from Cinahl database (2005022153).
Falk, N. L. (2007). Strategies to enhance retention and effective utilization of aging nurse faculty. Journal of Nursing Education, 46(4) 165-170. Retrieved May 2, 2007, from Proquest database (1245472781).
Kidd, J. Magnet hospital development in the pittsburgh region: A status update. (n.d.). Retrieved October 25, 2007 from http://www.hcfutures.org/Pdfs/News/finalmagnetreport.pdf
McClure, M. L. (2005). Magnet hospitals insights and issues. Nursing Administration Quarterly, 29(3) 198-201. Retrieved October 24, 2007, from Cinahl database (2009016504).
Mikhail, J. (2005). The nursing shortage: Clear and present danger. Journal of Trauma Nursing, 12(2) 38-40. Retrieved April 14, 2007, from Expanded Academic ASAP database (A135339851).
Upenieks, V. (2005). Recruitment and retention strategies: A magnet hospital prevention mode. MedSurg Nursing, 14(2) 21-28. Retrieved January 23, 2007, from Expanded Academic ASAP database (291208641).

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