Nursing Shortage
I. Introduction
The medical work force is of huge import to health sector of the state since the group is responsible for catering to the well being and health status of the members of the State. The complicated network of medical profession includes nurses—those that provide for doctor’s assistance and cater to the health status and palliative care of the patients. Nurses are an indispensable member of the healthcare arena (or institutions). Unfortunately, healthcare, according to medical statistics, are undergoing crisis in terms of the number of health-providers and the legalities of palliative care; many health practitioners have been a victim or recipient of the Medical Tort Bill owing to their “carelessness,” “ineptitude,” “incompetence,” etc.
Nursing shortage—the lack of it, the scarcity, and the deficiency— refers to a condition wherein the economic demand/necessity for registered nurses is greater than the current supply/reserve. Nursing shortage is measured at a particular area over a particular unit of time (usually per year basis). The shortage of nurses is perhaps the most menacing, even though it is not the only dilemma met by healthcare departments in the approaching years. In the United States alone, the number of nurses (and nurse aids) have decreased by 407, 583 from 2000 to 2001 (Mitchell, 2003). While the overall supply of nurses is at present adequate in some parts of the United States, summation of other factors is projected to cause a decrease of nurses’s number within the ten years (Buerhaus and Staiger, 1999). As of late, there is an unequal distribution in terms state geography in the current nurse supply, and some practice/masteral fields (e.g. perioperative field) are experiencing a shortage now. Contemporary shortage in nurses can be found in areas that include hospital emergency rooms/departments, critical/intensive care units, and operating theaters (Beu, 2004).
.
These hospital areas are the most challenging and necessitate specialized education in nursing profession and experience. In 2000, ninety two percent the medical institutions/hospitals stated vacancies in RN positions and seventy one percent stated unfilled LPN jobs(Forsythe and Mackenzie, 2006).
While it is true that the present nursing statistics is of vital importance, the larger issue that relates here is how to mitigate the projected decreased in the nursing profession by examining the problems within the nursing profession and the social and economic events surrounding it. To attain this objective, some problems and most probable solutions are suggested in the paper. Nurse, as an adaptive and internationally accepted profession is also assessed on the broader world systems economic approach. In the paper, three major problems will be identified.
II. The Problems in the Nursing Profession and Jobs
A. Problem 1: Economic Problem, the Market Reality
Nursing Shortage viewed from the economic scope is not the lack of demand; In point of fact there is considerable increase in the percent demand of nurses as per the increasing number of patients and the number of hospitals. It is only natural to assume that as there is an increase in the number of population, there is corresponding increase in the number of patients.
What is slowing down RN employment? To answer this we have to look at the descriptive statistics of the nurses over the past years. Statistics show that the workforce is consisting of aging nurses whose average age is proximated at 47 (National Sample Survey of Registered Nurses March 2000). Although it is still uncertain, predictions show an alarming 15 % decrease from 1980 to 2001 in the number of nurses above thirty. This is referred to as the baby-boomers crisis and this suggests that after decades or so, the number of workforce will decrease because of retirement and this will be insufficient to provide for the health care of the upcoming growing population (Forsythe and Mackenzie, 2006).
Women maintain monopoly over the nursing profession by an astounding 95% (National Sample Survey of Registered Nurses March 2000) and one of the problem’s associated with the shortage is that there are more economic opportunities for women; technology and change of perception and times had opened more “job” opportunities for women. Instead of opting for nursing profession, career women would trundle towards the world of politics, business and legal sector. Additionally, minorities are underrepresented in the workforce who constitutes only 13 % —Blacks, Asians and Spanish —of the nursing arena (Schott, 2001).
Sometime in the past, the healthcare committed the error of predicting decreased number of patients owing to well-managed healthcare system and medical technology. Cost containment measures in the health care system resulted to shorter hospital stays and changes in staffing models which in turn produced “nursing movement” towards other career options. The number of the numbers that had left the field cannot be retrieved now.
Solution 1: Supply and Wage Increase
Market realities are something to contend with and the antiquated yet most effective response to such shortage is to tip the favor for the nurses by increasing their wages and non-wage benefits. Non-wage benefits should include paid vacations, 14th month pay and others (Buerhaus, Straiger, and Auerbach, 2000). Also, the nurses should have well fortified cap insurances in cases wherein they faced the medical torts (Buerhaus and Staiger, pp. 1999). Although the effect is short-term, such benefits will attract the wide variety of persons who are looking for sufficiently paid jobs.
Additionally, the medical institutes should not be extremely choosey in terms of “race” or apply the injudicious racist method of selecting nurse faculties and employees. Importation of registered nurses from other countries is also a good solution (Schott, 2001). Those countries that depend on dollar remittances are highly amenable to such method.
Another effective approach is on the constituent units of the workforce. Nursing consists mostly of aging workforce hence there should be preparation for the older RN work force – two-fifths of the working Registered Nurses will be over the age of 50 by 2010. Hospitals must mull over the positive effects of reconstructing work routes and environments in order for it to be ergonomically fit for nurse health assurance. Ignoring the needs of the older strata can lead to their possible lookout for more “health-safe” jobs (Buerhaus, Straiger, and Auerbach, 2000). Such needs can be answered by developing labor-efficient technology and develop training competence of unlicensed persons who suitably aid nurses in taking care of the patients (Buerhaus, 2003).
Men must be recruited into the workforce and to do so would increase the numbers of workforce. Such method is only possible if a thorough understanding of ‘why men do not trundle into such a profession’ is analyzed and reinforces techniques to recruit them inside.
B. Problem 2: Workplace and Environment
The other side of the increasing look-out for alternative profession/s is the increasing perception of nursing as an unattractive career choice. Recruitment was duly impossible because of these perceptions. The nursing profession is associated with nerve-racking working environment— night and weekend shifts, possible contact with contagious diseases, reduced time for palliative care for the patients, and poor employment policies— made the profession unattractive, [as it had before]. Surveys conducted by American Nurses Association (ANA) on more than 7,300 nurses give a revealing insight on the assessment of the workplace of most nurses. More than half, or 56 % of the survey population commented that the have less time for the patients for the past years and 76 % said that the health care quality that they provided has been badly affected by the increased in workload heaped upon them. Three-fourths of the samples indicated that possible decline of nursing care is due to poor staffing, holdups in providing fundamental and crucial care, and the immediate discharge of patients (Forsythe and Mackenzie, 2006).
Almost 50 % stated that stress, exhaustion and discouragement are what they feel after their duty; there is also pressure in work accomplishment overtime, the inability to attend higher degree or masteral programs, and increased stress-related illnesses. What is most daunting is that more than a half of the respondents do not recommend the nursing profession as a career for their relatives/families and friends, and one-fifth expresses active discouragement for the career (Forsythe and Mackenzie,2006).
Solution 2: Alleviating the Workplace Setting
The Board of Regents has liability for regulating the flows in nursing practice although the number of hours is not within the scope of their department. It has been generally recognized by the medical workforce that a stressful, short-staffed working environment can promote circumstances of medical malpractice resulting from negligence. The Regents argued over this subject comprehensively from 1996-97 within a report on the probable effects of the environment on medical malpractice acts by the RNs. The reactionary or the report was more of a response due to increase of litigation charges involving medical negligence [of the nurses], web/media-hyped medical errors, bad rumors comments/complaints on palliative care and of course, decreasing number of nurses (2000 New York State Board of Regents Strategic Plan)
Studies indicate that financial cutbacks—layoffs, eliminations, use of unlicensed assistive persons—-plus increased in keenness of patients, are the major reasons why “nurses” are recognized as partakers to the increased frequency of reportable events on negligence and negative patient results. Those that have been beset by negligence claims have been found to have multiple jobs (concurrent), only less than half a decade in practice, and those overtime workers. Nurses who usually do overtime reason it to understaffing. Whereas further research needs to be performed, there is no doubt that the gradually more severe workplace setting and employment load has directed to increased incident of second-rate patient care (Buerhaus and Staiger, 1999)
The shifting hours of the nurses were de-limited by the regulatory commission so that future incidences on malpractice and negligence are avoided. (Buerhaus and Staiger, 1999).While it is true that there are small numbers of negligence cases, a larger portion of the negligence claims are exaggerated and prevaricated so that they will be able to get the “financial settlements”, most especially in states where state medical premiums are high. Hence, it is important that other proposals that would provide protectorate policies be considered by both the legislative and the regulatory commission and this includes—clarification of professional misconduct and patient abandonment, job hours maxima, clarification of individual practitioner’s responsibility, extensive and alternative routes for healthcare providers (other than forced overtime). Data collection and its provision and the right of patients for “waivers” should not be neglected. Elements of the medical malpractice claim—injury resulting from negligence—should be noted at all times (2000 New York State Board of Regents Strategic Plan).
A comprehensive and accurate data from surveys—supply and demand– must also be mandatory so that proper decisions regarding professional health care be made. Nurse practice or the specific roles/jobs of the nurses be properly identified so that there is no question to the legal responsibilities of the health practitioner. Additionally, proper assignation of the licensed and unlicensed employees should be duly performed. Information or the lack of it can have erroneous impact on the workforce, and this technical insufficiency can be provided by proper information in the web or in print. Also, reviewing the “nurse” movement from other states and probable adoption of the methods that have been effective in mitigating problems is made (2000 New York State Board of Regents Strategic Plan).
Technical assistance in terms of financial support should be given to potential nurses and recruitment and retention is enhanced.
Problem 3: Education and Need Factor
In the United States [and in almost all parts of the globe] baccalaureate degrees in nursing are a prerequisite for hiring. Recent surveys from the NLN suggest that there is decrease in enrollments of the said course at almost any levels of program. The American Association of Colleges of Nursing, from conducted studies, found that enrollments in entry-level baccalaureate nursing programs have been plummeting repeatedly in terms of entry level baccalaureate programs (Mitchell, 2003).
Nursing shortage is directly associated the lack or the shortage of nursing faculty in almost all educational institutions. Nursing graduates are delimited by the number of faculty indirectly because it limits the capability of the educational institution to accept possible students. Furthermore, nurses do not opt for a teaching or educational career but rather, opt for other more financially rewarding opportunities in healthcare which includes positions in the administrative sector, business, and clinical research (Mitchell, 2003).
Knowledge based restriction can de-limit possible number of nurses.
Solution 3: Increased Pay for the Faculty
The market reality is that college salary of a faculty nurse is much less than the wages of a typical nurse with master’s degree. Such financial setting is a huge drawback to the number of possible recruits in the teaching field (Turner, 2005). It is only reasonable that market differentiations for the clinical and the faculty be sufficiently adjusted so that faculty positions become more attractive—adjusting means increasing the stipend or salary for the plausible candidates—so that there is more equity in the market.
Scaling market differentials provides for more competition between the disciplines of the nurses. Compensation policies are delimited by the academia’s finances and can only be mitigated by politics. In cases wherein compensation structure is untenable, the schools should scout for possible benefactors for these payments. Benefactors from the nearest medical institutes or other non-medical but amenable institutes can supply the desired compensation without disturbing the offered income schedules of the academia. Academic support systems must be included into the movement (Turner, 2005).
III. Conclusion
As evaluated in this article, key factors that are causative to nursing shortage are: the market drawbacks for the career (aging strata, gender monopoly, small salary) and the realities associated with it, disparities in the general working atmosphere,and lack of faculty in educational institutions.
Mitigation of the problems and some proposals and solutions are indicated in this article for each problem. For the first problem, fiscal and marketing strategies are of huge import—increased salaries and benefits, health assurance for the aging force, and further studies to subjugate gender monopolies in the field of professional nursing. Changing the work environment is necessary so that short- and long term benefits be reaped. For the second problem, there are legal solutions/proposals posited so that medical malpractice claims or negligence claims is avoided. Of huge import is the clarification of the nurse’s labors or the identification of individual jobs. For the third problem, lack of faculty and the lack of students thereof, faculties should be compensated well, if not by the educational institution, then, by the politics of the area, or if not, then the nearest medical institutions. All solutions combined would contribute to the general appeal of the profession, and will, in effect, recruit and facilitate increased numbers of nurses.
Health care system can still improve at this sector of workforce.
Works Cited
Beu, B. “The nursing shortage and the nurse reinvestment act.” AORN Journ., 79(2004):1061-1063.
Buerhaus , P. “Implications of an aging registered nurse workforce.” Journ. of the Amer. Med. Assoc., 283 (2000):2948-54.
Buerhaus, P. and D. Stagger. “Trouble in the Nursing Market? Recent Trends and Future Outlook..” Health Affairs, 18(1999): 214-222.
Buerhaus , P. “A nursing shortage like none before.” Creative Nursing, 6(2000): 4-8.
Buerhaus, P., Straiger, D., and Auerbach, D. 2000. “Policy Responses to an Aging Registered Nurse Workforce.” Nursing Economics,18 (2000):278-284.
Leadership & Learning. “New York State Board of Regents Strategic Plan” Goal 3, January 2000
Forsyth, S. and McKenzie, H. (2006). “A comparative analysis of contemporary nurses’ discontents.” Journal of Advanced Nursing, 56(2006):209-216.
Mitchell, G. J “Nursing shortage or nursing famine: Looking beyond numbers?” Nursing Science Quarterly, 16(2003), 219-24.
Chandler, M. “Preventative Treatment in RNShortage.” Miami Herald, 2 (1998):7.
The Registered Nurse Population. National Sample Survey of Registered Nurses- March 2000.
Preliminary Findings, February 2001. Bureau of Health Professions, Division of Nursing.
Turner, S. (2005). “Nursing Faculty Shortage”. Retrieved January 10, 2008 from http://www.nursingfacultyjobs.com/.
Schott, A. “Nurse Recruiters Confront New Shortages and New Breed of RNs”. Report. New York State Nurses Association., Feb, 2001, p.4.
