Nursing Shortage and Strategies to Minimize its Effects

The current nursing shortage affects the healthcare system in many ways. The shortage puts a lot of stress on staff nurses to keep up with their patient load. The understaffing creates potential safety and delivery of care issues. Because high patient to nurse ratios diminishes the quality of care nurses are able to provide, putting patients at greater risk, nurses should implement strategies to alleviate and remedy the shortage. Staff nurses should mentor new graduate nurses and join hospital committees to develop programs that help new graduate nurses transition into staff nurses. Hospitals should employ a staff nurse to coach other nurses when job dissatisfaction becomes an issue. These strategies promote job retention and a positive work image.
The current nursing shortage and the demand for healthcare are expected to continue because of the aging population and medicine’s success in keeping ill patients alive longer (Upenieks, 2005). The U.S. Department of Health and Human Services projects the current nursing shortage of registered nurses could hit 750,000 by 2020 (Johnson, 2004). In many nursing units across the United States short staffing and high patient to nurse ratios are increasing patient risk. According to the Joint Commission on Accreditation of Healthcare Organizations’ 2002 report, a shortage of nurses is a factor in about one-fourth of patient injuries or deaths in hospitals (Johnson, 2004). There are several strategies to reduce patient risk by alleviating the local nursing shortage.
Experienced nurses should be teachers and role models for new novice nurses. When novice nurses are not supported in their learning they become discouraged and may develop a negative outlook on their nursing career, possibly leaving the profession and adding to the nursing shortage. The concept of mentoring is a strategy that many nurse managers use on their units to foster socialization and retention of new nurses. However, there have been instances where a formal mentorship program was seen to be detrimental within the nursing unit (Thomka, 2007). Nurses feared that accusations of favoritism would surface and damage the atmosphere of the working environment. Nurse managers of these units did very little to support the idea of mentorship in a positive way. As a result, many mentoring relationships have developed informally with the mentoring nurse unaware of the relationship. Nurses who were identified as mentors were thought to simply be doing their jobs during the normal course of their day, acting like leaders, teachers, and role models who did this for everyone in their work environment (Thomka, 2007). The mentees aspired to grow professionally and acquire the skills their chosen mentors exhibited. As a result of the mentoring, many mentees become mentors for new nurses as a way to give back to the profession. Nurse managers can facilitate the mentorship relationship by encouraging nurses to share their knowledge and experiences with novice nurses. By acknowledging individual nurses for situations in which they supported a novice nurse’s professional growth, nurse managers may also encourage mentoring relationships.
The turnover of new nursing graduates is relatively high when their first year of employment is viewed negatively. This is the reason many nursing managers and hospital administrators seek staff nurses to join committees in helping design orientation programs and residencies for new novice nurses. New hires are more likely to work for an employer that supports the development of the nurse. Experienced staff nurses are able to use their past experiences to develop and implement an internship program that will encourage the professional growth of new nurse graduates. At Children’s Memorial Hospital in Chicago, a Magnet designated hospital, the turnover among new nurse graduates was 29.5% before an improved RN internship program was implemented (Halfer, 2007). The internship program included a greater amount of hours spent in a classroom learning environment, clinical mentors, professional transition group discussions, and working with a preceptor for 4 to 9 months, depending on the nursing unit. As a result of the internship program the turnover rate dropped to 12.3%. Staff nurses are able to make a difference in a new nurse’s career by providing strategies to committees, nurse recruiters, and retention managers on how to increase job satisfaction for new nurse graduates.
Coaching is a short term strategy used to address concerns of job dissatisfaction. When a conflict arises, job dissatisfaction may occur and the end result may be the nurse quitting the position. The nurse might look for employment at another facility or change career, both of which could potentially increase the nursing shortage at that particular healthcare facility. A coach is a nurse that works in the human resources department and coaches employees with job satisfaction issues. Regardless of the cause of the problem, the coaching process shows the employees the seriousness of the hospital’s intent to learn about their dissatisfaction and do something about it (Stedman & Nolan, 2007). Coaching is an approach to conflict resolution and finding strategies to better the work environment with the conflicted nurse. The coach helps the employee and the facility at the same time. By successfully resolving the conflict, the coach relieves the conflicted nurse’s dissatisfaction and job retention is achieved by the employer. Due to the current nursing shortage, keeping qualified nurses as employees is a great strategy in reducing the strain the shortage has created on the healthcare facility.
The current nurse shortage in the United States will persist. Due to high patient to nurse ratios and an increasing amount of paperwork to fill out, many nurses find it hard to provide adequate nursing care leading to job dissatisfaction. By reducing the patient to nurse ratio patient safety, job satisfaction, and job retention increase. Hospitals and individual nursing units can minimize the effects of the shortage by employing mentoring, coaching, and implementing well designed new hire programs.

a. Intervention 1 (Experienced nurses should act as mentors for new novice nurses.)
i. Disadvantage 1 (Formal mentorship may be seen as detrimental.) A mentorship program has many positive effects in a nursing unit. It can foster support and facilitate learning of new graduate nurse. However, there have been instances where a formal mentorship program was seen to be detrimental within the nursing unit (Thomka, 2007). Fear of accusations of favoritism and damage to the atmosphere of the working environment were some reasons experienced staff nurses did not support formal mentorship programs. Also, nurses may feel that quality patient care decreases when mentoring a new graduate nurse. Another reason nurses frown upon mentoring novice nurses is that they do not have the time to deliver quality patient care to their patients as well as answer questions and demonstrate interventions for the novice nurse. In addition, research suggests that mentors frequently feel unsupported by their academic colleagues and poorly prepared to undertake the role (Duffy 2000).
ii. Disadvantage 2 (There is a misunderstanding of what mentorship really is.) Mentorship is often times thought of as preceptorship. Mentorship is a relationship between an experienced nurse and a novice nurse with an emphasis of helping the novice nurse become an expert. It is collaborative approach and there is no time limit within which this process must take place (Loads, Brown, McKenzie, & Powell 2006). In contrast to the mutual relationship of mentoring, precepting is an orientation technique involving the formal assignment of staff RNs and holding them “accountable for the transition of new staff…over short, limited periods of time” (Stewart & Krueger 1996). Mentorship lasts for an extended period of time that culminates in a relationship where both mentee and mentor grow professionally. Preceptorship on the other hand lasts for a disclosed amount of time where usually only the mentee grows professionally.
b. Intervention 2 (Experienced staff nurses are able to develop and implement an orientation program that will encourage the professional growth of new nurses.)
i. disadvantage 1 (Difficult to find willing preceptors) Due to the nurse shortage many units are understaffed and nurses overworked. Adding precepting a novice nurse in addition to an already high patient load dissuades many qualified nurses from becoming preceptors. Nurse preceptors should be given lower patient loads as they integrate and evaluate novice nurses. Both new and experienced nurses can find orientation to an acute care area very demanding and extremely overwhelming experience, producing feelings of disillusionment and failure if not implemented correctly (Maiocco 2003). It is the job of the nurse manager to assess the unit’s capability of providing willing preceptors.
ii. Disadvantage 2 (Orientation and internship programs are costly.) When a nursing unit decides to offer a comprehensive orientation and internship program, the unit coordinator must decide the program’s cost effectiveness. Chicago’s Children’s Memorial Hospital provides two classrooms, a computer lab, and a clinical skills lab (Halfer 2007). Along with providing learning tools and equipment, nurse preceptors and mentor are usually paid a differential for their added duties as teachers. In most instances the benefits outweigh the costs.

References:

Halfer, D. (2007). A magnetic strategy for new graduate nurses. Nursing Economic$, 25(1) 6-11. Retrieved April 18, 2007, from Expanded Academic ASAP database.

Johnson, L. (2004, March 29). Shortage of nurses putting patients at risk: Unions push for limits on patient loads in hospitals. Retrieved January 8, 2007, from http://www.msnbc.msn.com/id/4587667/

Maiocco, G. (2003). From classroom to CCU. Nursing Management, 54-57. Retrieved October 31, 2007, from Proquest database.

Loads, D., Brown, M., McKenzie, K., & Powell, H. (2006). Developing mentorship through collaboration. Learning Disability Practice, 9(3) 16-18. Retrieved October 31, 2007, from Proquest database.

Stedman, M. E., & Nolan, T. L. Jr. (2007). Coaching: A different approach to the nursing dilemma. Nursing Administration Quarterly (31.1), 43-47. Retrieved April, 18, 2007, from Expanded Academic ASAP database.

Thomka, L. A. (2007). Mentoring and its impact on intellectual capital: Through the eyes of the mentee. Nursing Administration Quarterly 31(1) 22-27. Retrieved April 18, 2007, from Expanded Academic ASAP database.

Upenieks, V. (2005). Recruitment and retention strategies: a Magnet hospital prevention model. MedSurg Nursing. (14.2), S21-27. Retrieved April, 18, 2007, from Expanded Academic ASAP database.