Addressing the Shortage of Nurses: From a Nursing Perspective

A posting by Nathan Ho about the the nursing shortage and what nurses can do to combat it.
Nursing has always had a shortage, but with the upcoming generation of Baby Boomers (those born from 1946 to 1964) reaching the social security age of 65, the need for additional healthcare workers increases.
Whether Baby Boomers find themselves in hospitals or long term care centers, registered nurses will need to be there to ensure proper care.

However, many factors such as a deficit of teaching faculty, a negative work environment, and the fact that women now have broader career options, have placed a severe shortage on the amount of current nurses. The nursing shortage leads to a decreased quality of care in patients which is further perpetuated by an increase of those needing care, the Baby Boomers. This dilemma is best solved through nurses forming committees to find and address concerns they may have, advertising the benefits of nursing through job fairs or school visits, and encouraging retiring nurses to become faculty.
Born right after World War II.and around the Vietnam War, thanks to soldiers returning to their wives, Baby Boomers created a sharp increase in the population. As this large age group matures, requires more care as they grow older, and lives longer due to advanced medicine, a problem arises. By 2020 there will be at least 400,000 less nurses than in 2006, right when Baby Boomers are around their seventies or eighties (Hassmiller, 2006). The Service Employees International Union Nurse Alliance reports that nurses already work eight and a half weeks of overtime a year (as cited in Hassmiler, 2006) and a study done by Curtin and Rogers reports that, “Taking care of too many patients and working overtime…are associated with errors and poorer quality of care” (as cited in Hassmiler, 2006, para.8). As the Baby Boomers age and begin to seek more health care, the ratio between patient and nurse will only increase, further increasing the stress of nurses still in the field and decreasing quality of care.
According to a 2002 and 2004 United States national nursing survey reviewed by Buerhaus, Donelan, Ulrich, Norman, and Dittus (2006), four of the top reasons for the nursing shortage were inadequate benefits and salary, more career options for women, objectionable hours, and a negative work environment. Though the 2004 survey showed an increased satisfaction in these areas compared to the 2002 survey, both surveys stated the change most desired was an improved working environment. The surveys reported that nurses who felt they had a very good or excellent relationship with their fellow nurses had increased from 53% in 2002 to 72% in 2004. However, few Registered Nurses reported having very good or excellent relationships with the physicians or hospital managers. While individual hospitals can survey nurses to determine how they feel about their work environment a more aggressive action would be for nurses to come together and form committees to agree on what needs to be changed at work and how it should be done. It has been suggested by Buerhaus et al (2006) that the government establish an independent board within the Department of the Health and Human Services which would be responsible for essentially “grading” the quality of care hospitals provide. If there is a quantifiable quality of care difference between facilities which incorporate the nursing committee’s ideas and facilities that do not, then in the future the status of nurse’s opinions would increase.
According to Buerhaus et al (2006), 83% of nurses in both the 2002 and 2004 surveys reported being either somewhat, moderately, or very satisfied with their profession and 70% of nurses would recommend nursing to qualified students. If this is the case, nurses should take the time to voice how they feel about their career to the public. Exposing the community to nurses through free blood pressure readings, presentations at local schools, or a booth at job fairs would increase public interest in nursing. In addition, having male nurses present during these exposures could open interest to a whole new group of people to nursing, the males. Though the amount of male nurses has increased from 57,000 in 1983 to 164,000 in 2002, men made up only 5.9% of the nurses in 2003 (Cantrell, 2004). A lot of room for potential growth exists for this population, especially since Auerbach, Buerhaus, and Staiger state that “recently published projections indicate large, demographically driven shortages [are] developing in the next decade” (as cited in Buerhaus, Donelan, Ulrich, Norman, DesRoches, Dittus, & Wfcthan, 2007, para. 4).
Exposure of nursing to the public however is not enough to quell the shortage. Nursing school enrollment has gone from a 3.7% increase in 2001 to a 13% increase four years later, yet in 2005 over 147,000 qualified applicants were rejected from nursing schools due to a lack of faculty to teach them (Larson, 2006). In addition there has been a 72% percent growth in faculty who desire to teach only part time. Coupled with the fact that the influx of about 180,000 new RN’s between 2002 to 2004 were over the age of 50 and that almost a third of them plan to retire within three years, recruiting seems to have little benefit (Buerhaus et al, 2006). However, what if the retiring nurses were to become faculty? Even if they desired to teach part time, enough part time faculty members could make up for the lack of full time members. Retiring nurses could enjoy a less demanding schedule with a chance to impart the wisdom they gathered throughout their nursing career. If they require further education before being able to teach, the government is currently debating on two programs to assist potential faculty in financing their education, the Nurse Faculty Education Act and the Nurse Education, Expansion and Development Act which might prove convincing for those interested in returning to school to increase their education but are deterred by the cost (Larson 2006).
Though the burden of more patients looms ever closer to nurses, strategies exist to help cope with this challenge. By forming committees committed to alleviating any concerns nurses may have about their work environment, the number one desired change by nurses may be addressed and improve work morale. This in turn helps keep nurses from leaving the field. Exposing the community to nurses through public health fairs, free blood pressure tests, or simply by word of mouth is also an excellent way to attract new nurses. Finally, nurses who have had enough of the business environment of health care, but would still like to be involved in helping people, have the chance to spread their knowledge and experience by becoming teachers. Government programs even exist to assist in financing nurses who need further education. The journey ahead may be difficult, but nurses are by no means without the power to do something about it.
a. Intervention 1- Retiring Registered Nurses further their Education and become Teachers
i. Disadvantage 1- Difficulties with Distant Education
In order to maximize productivity of time, RN’s with a desire to continue their education while still working have the opportunity to do so via distant learning (otherwise known as fully online classes). Though benefits of online classes include elimination of distance between student and classrooms and a more flexible schedule, a study of students done by Sit, Chung, Chow and Wong revealed some learning hindrances to be “inadequate opportunity to study with others, lack of confidence, difficulty applying concepts taught, and inadequate opportunities for discussion with faculty and to establish peer support” (as cited in Murphy, 2007, para. 16). Murphy (2007) states that technical expertise is important when taking an online class which might be difficult for retiring nurses with little computer experience. Also, a survey done by Atack and Rankin which evaluated RN’s who took online classes at home and at work showed general dissatisfaction when classes were performed at the workplace (as cited in Murphy, 2007).
ii. Disadvantage 2- Funding
Though scholarships and programs exist to help finance RN’s with desires to continue their education, there are not a whole lot of them. According to Livsey, Campbell, and Green, the Nurse Training Act passed in 1964 puts Title VIII in the Public Health Service Act which is responsible for funding nursing education. However, less than 3% of resources from Title VIII were directed towards faculty development and many Title VIII programs expired in 2002 (2007). Due to a lack of sufficient scholarships most RN students who pursue a doctorate are part timers which in turn decrease the graduation rate. Also, to make matters worse, not all nursing doctorates decide to become faculty with a 23% reporting that they will take a practice related position due to the better financial reimbursement (Livsey, Campbell, and Green, 2007). Thus limited capital for continuing nursing education in the hopes of producing teachers is wasted.
b. Intervention 2- Increased Exposure of Public to Nursing
i. Disadvantage 1- High School Student’s Perceptions on Nursing
With students in high school graduating and deciding what career to pursue, exposing them to the nurse’s role is critical to provide an accurate idea of what the vocation entails. Unfortunately though, high school student perception of nursing is somewhat negative and a vast majority has little interest in pursing a career in nursing. A study done by Steven and Walkers showed that of 642 high school students only 7.7% (about 49) considered nursing as a future career. This lack of interest also extends to other cultures as another study done by Tang et al. with 789 non English speaking students from 36 different high schools had a majority state that they did not view nursing as a potential career due to their impressions of it being non influential and poor paying (as cited in Catz, 2007, para 26). This impression was verified by Warda who found that negative impressions of nursing included the facts that nurses were powerless, poorly paid, and worked in poor conditions (as cited in Catz, 2007, para 27). Those working to expose high school students to nursing have a bit of an uphill battle to fight.
Ii. Disadvantage 2- Males in Nursing
While recruitment of men into nursing represents a huge potential work force, the public perception of male nurses has generally been negative. An informal survey of the public by Rallis stated that men disapproved of male nurses and often they were mistaken for doctors (as cited in LaRocco, 2007, para 4). Some male RN’s stated it was difficult to establish themselves in a female work group (LaRocco, 2007). Male RN students recollecting some perceived barriers during nursing school included no mentorship programs for male students, a pressure to prove themselves because people expected women to be nurses, no opportunity to work with male nurses during clinical settings, fear of accusation of sexual inappropriateness when providing intimate care and no guidance provided on the appropriate use of touch (O’lynn, 2007). Males interested in pursuing nursing have the difficulties of social expectations and then barriers present during RN education.
References
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