Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Effects of Shortage Of Nurses In Little Rural Hospitals Essay
To explore the impact of legislative, strategic, and organizational changes on nursing in rural hospitals since 1995. Rural hospitals have faced decreasing financial margins. This economic pressure is due to multiple reasons, and is a major issue for nurse executives. Nurse executives are responsible for assuring quality of nursing care. Nursing care affects patient outcomes. The impact of legislative, economic, and strategy decisions on nursing in rural hospitals is unknown. A focus group was conducted with 11 nurse executives from rural hospitals who attended the American Organization of Nurse Executives Annual Meeting held on April 20, 2004. Themes from the content analysis were grouped into 3 major categories: external environmental (physical isolation, patient population, services needed, legislation), internal organizational (patient acuity, volume, services, technology, financial margin and strategy, staffing, leadership, culture, and resources), and nursing infrastructure (staffing, salary, registered nurse-physician conflict, continuity of care, competency, culture, politics and leadership). Nurse executives in rural hospitals face distinctive issues and challenges. Further study of the impact of policy and strategy decisions on rural nursing is needed.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
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Rural Healthcare Workforce
Maintaining the healthcare workforce is fundamental to providing access to quality healthcare in rural areas. Rural healthcare facilities must employ enough healthcare professionals to meet the needs of the community. They must have proper licensure, adequate education and training, and cultural competency skills. Equally important, optimizing how health professionals are used and enhancing coordination among them helps ensure that patients are getting the best care possible.
Strategies can include:
Using interprofessional teams to provide coordinated and efficient care for patients and to extend the reach of each provider
Ensuring that all professionals are fully utilizing their skill sets and working at the top of their license; that is, practicing to the full extent of their training and allowed scope of practice.
Removing state and federal barriers to professional practice, where appropriate
Changing policy to allow alternative provider types, once evidence shows they can provide quality care
Removing barriers to the use of telehealth to provide access to distant healthcare providers
As the United States struggles with healthcare provider shortages, an uneven distribution of workers means that shortages are often more profound in rural areas. This maldistribution is a persistent problem affecting the nation’s healthcare system.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
This guide examines policy, economics, planning challenges, and issues related to rural health workforce, including:
Supply and demand
Distribution of the workforce
Characteristics of the rural healthcare workforce
Licensure, certification, and scope of practice issues
Programs and policies that can be used to improve the rural healthcare workforce
For additional information on rural healthcare workforce issues, please see these RHIhub topic guides:
Recruitment and Retention for Rural Health Facilities
Education and Training of the Rural Healthcare Workforce
Foundation (RWJF) is dedicated to improving the health and health care of all Americans. Central to this mission is transforming the way care is delivered at the bedside to reduce the shortage in nurse staffing and improve the quality of nursing care. 1
Nurses are the linchpins in providing high-quality patient care in hospitals. To attract high-quality staff, enable them to do their best work, and keep them as long-term employees, improvements must be made in the organization of work and use of information technology (IT); physical design and allocation of space; and hospital leadership and culture. Working with various partners, the RWJF expects to build support for a new kind of hospital that reflects the needs and realities of the twenty-first century: a hospital where patient safety is assured, quality of care is paramount, efficiencies are maximized, and staff are satisfied with and actively supported in their jobs.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Although this initiative begins with the nursing profession, the results from these efforts are expected to affect all health care workers in hospitals and the millions of patients whom they serve.
A ‘PERFECT STORM’ FOR NURSES AND PATIENTS
Throughout the past few decades, U.S. hospitals have faced cyclical shortages of nurses; in 2000 an estimated 126,000 hospital nursing positions were unfilled. 2 The percentage of nurses working in hospitals dropped from 59 percent in 2000 to a little more than 56 percent in 2004. 3 The current nurse shortage is driven by a broad set of factors related to recruitment and retention—among them, fewer workers, an aging workforce, and unsatisfying work environments—that have contributed to a different kind of shortage that is more complex, more serious, and expected to last longer than previous shortages.
Too few new nurses are being trained (largely because of a shortage of nursing school faculty), but to a greater extent, the current shortage results from the reluctance of newly educated nurses to make their careers in hospitals. Nurses cite stress-related burnout and the large amount of time they must spend on nonnursing tasks as top reasons for feeling dissatisfied with their jobs; 43 percent of nurses report that they plan to leave their jobs within three years. 4 Thus, the average age of hospital nurses is in the mid-forties. Effects of Shortage Of Nurses In Little Rural Hospitals Essay
On average, nurses work eight and a half weeks of overtime every year. 6 Recent studies continue to show that taking care of too many patients and working overtime and long shifts—twelve- and sixteen-hour shifts are not uncommon—are associated with errors and poorer quality of care. 7
A kind of vicious circle surrounds the nursing profession. Fewer people are working in nursing, which has led to a shortage. Because of the shortage, nurses who remain in hospital work must care for more patients under increasingly difficult working conditions. Because of these strained working conditions, more nurses leave the hospital workforce, thereby worsening the shortage and making recruitment of new nurses more difficult.
The nurse shortage also has important cost implications for hospitals. 8 Although estimates vary widely, the cost of recruiting and training one new nurse for a medical-surgical floor is usually equal to 100 percent of a nurse’s annual salary—$42,000–$60,000; that investment is much higher for an intensive care or emergency department (ED) nurse. Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Although there has been an increase in the number of registered nurses (RNs) in recent years, most of the growth is accounted for by nurses over age fifty and foreign-born nurses. 10 Many hospitals are hiring temporary nurses through staffing agencies to address their shortages. This practice has raised concerns about the consistency and quality, as well as the cost, of care provided by temporary staff. The morale of nurses employed directly by the hospital also might suffer when they work alongside agency nurses who earn higher wages and enjoy more flexible scheduling. 11
These short-term fixes are not viable long-term solutions. Without immediate action, the nurse shortage will continue to worsen. By 2020, estimates suggest that the United States will have at least 400,000 fewer nurses than today, just when baby boomers will be in their seventies and eighties. 12
Instead of focusing on efforts to attract more new students into nursing schools, an admittedly important strategy, the RWJF is concentrating on the underlying issues that can make the hospital a more appealing and functional workplace.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
THE RWJF’S APPROACH: TRANSFORMING THE HOSPITAL WORK ENVIRONMENT
The RWJF has a long but inconsistent history of supporting nurses, having invested more than $140 million in nursing programs since 1972, but not in a particularly targeted or strategic fashion. 14 Early initiatives included development and training programs for nurse practitioners, fellowships for nurse faculty, and a scholars program for clinical nurses.
The RWJF has continued to support experienced nurse leaders through the Robert Wood Johnson Executive Nurse Fellows program, an advanced leadership and mentoring program for nurses in senior executive roles in health services, public health, and nursing education. The RWJF has, to date, invested $29.7 million in this program, which has supported more than 125 executive nurses since 1997, to give nursing and nurses a more influential role in transforming the U.S. health care system.
In 2002 the foundation commissioned a report to help people better understand the current nurse shortage and suggest a possible response. 15 The report concluded that the shortage in 2002 was different from past shortages, which had resulted from mismatches between supply and demand. In contrast, the more recent shortage reflected nurses’ widespread dissatisfaction with their profession and greater competition from other career opportunities for women.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
The contents of this report helped shape the RWJF’s current work to improve the quality of care by focusing on the retention of experienced nurses. One of the foundation’s long-term goals is to see a dramatic increase in the proportion of new nurses who work in the same hospital for more than two years after graduation.
The foundation’s objective is to help convert hospitals into places that are designed to promote healing, not just provide treatment; places where workers are engaged and supported in their jobs; and places where better work processes and culture increase institutional vitality and enhance patient care.
TRANSFORMING WORK PROCESSES.
Nurses spend much of their time searching for medications and doctors, hunting down needed equipment, and completing redundant paperwork. Better and more efficient systems of delivering nursing care must be developed.
Transforming Care at the Bedside (TCAB), a collaborative project between the RWJF and the Institute for Healthcare Improvement (IHI), involves thirteen hospitals in a pilot program for medical/surgical nurses to identify and implement changes that will improve care in their units.
Changes initiated through TCAB make it easier for nurses to spend more time with patients and less time on administrative tasks. In most cases, these innovations have been cost-neutral or have even saved money. In 2006, when the pilot phase of TCAB is complete, the foundation expects to develop a demonstration phase of the program that would reach a broader spectrum of U.S. hospitals.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
The TCAB hospital units have begun implementing a number of innovations that appear promising, but early results are still being evaluated. Several sites have initiated the use of rapid response teams, which enable a nurse to call on a team of clinicians to intervene when a patient’s condition appears to be deteriorating. This practice provides overt validation for nurses’ professional judgment and provides needed assistance for patients before they reach a more irrevocable point of crisis.
Many of the TCAB projects are instituting small, simple changes to improve the work environment and the quality of patient care. For example, some units have established “peace and quiet time” for an hour during each nursing shift to promote a calming, healing environment for patients to rest.
Several units have reduced nurses’ “hunting and gathering” time by moving supplies from a central location on the unit to patients’ rooms, ensuring that each room is stocked with the correct supplies for a particular patient and allowing nurses to spend more time providing direct patient care.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
TRANSFORMING PHYSICAL DESIGN.
Hospitals are also dangerous; patients are exposed to infection and injuries that could be prevented if hospitals had better designs. 16 An analysis of more than 600 studies, which was funded by the foundation and conducted by the Center for Health Design, demonstrated a direct link between hospital design and a wide variety of patient outcomes, patient and staff satisfaction, and staff efficiency. 17 The hospital sector is experiencing a major building boom: More than $200 billion is expected to be spent on new hospitals and nursing homes in the next decade. 18 Using the evidence about the benefits of physical design, we can ensure that future hospitals will be safer, quieter, and less stressful healing environments.
Key characteristics of the ideal hospital unit include single-patient rooms, positive distractions such as windows and artwork, enough prominently placed hand-washing stations, and ceiling and floor surfaces that absorb noise rather than amplifying it.
Another promising design intervention is the acuity-adaptable room, which features the equipment and functionality to allow patients to remain in the same room, even when their condition changes during their hospital stay. This capacity is particularly important, given the risk of medical errors and infections, as well as the resources and staff time required, when patients are transferred from one room to another.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
The foundation will continue to support research and dissemination efforts to inform architects, hospital executives and trustees, and state regulators about the growing evidence showing the necessity to design hospitals that support patients’ and caregivers’ needs.
TRANSFORMING HOSPITAL CULTURE.
As hospitals invest in changes to their physical environment, they must also be mindful of the institutional work environment. An organization’s vitality, values, and culture profoundly affect its employees. Hospital nurses have difficult, demanding jobs; they need to feel inspired by their work and supported as professionals if optimal patient care is to be achieved.
The RWJF is only beginning to explore the opportunities in this area and is learning from leaders who have initiated changes to improve their hospitals’ culture. To date, the foundation has commissioned a white paper on organizational culture that examines the characteristics of positive hospital culture. Early in 2006 the RWJF expects to fund several hospitals to produce reports or case studies that describe successful approaches to improving organizational culture. These might include fostering relationships between new nurses and more experienced mentors; using new models of communication to improve information exchange between nurses and physicians; and exploring opportunities for all hospital staff to feel valued and respected.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Industries outside of health care might offer important learning opportunities to improve organizational culture; to initiate changes in hospital culture, the RWJF is interested in testing models used in other fields. For example, the airline industry has used a Crew Resource Management model to develop highly functional teams and foster a culture of trust in which staff at all levels feel empowered to communicate their opinions—and, more importantly, their concerns about safety or errors—without fear of blame or retribution. Adapting this approach to teamwork and communication could be valuable for nurses and other health care providers—and, ultimately, patients and families—in hospitals.
INVESTING IN RESEARCH.
Much research is still needed to explore, measure, and better define the relationship between nursing care and patient outcomes; to uncover why newly licensed nurses tend to leave a hospital after only a short time; and to identify viable strategies for addressing the shortage of nurse faculty. The RWJF is also interested in sharing relevant findings with a broad audience; one channel for doing so is the foundation-sponsored policy brief series, Charting Nursing’s Future, which highlights some of the key research and policy issues in the nursing field. Effects of Shortage Of Nurses In Little Rural Hospitals Essay
In November 2005 the RWJF launched its Interdisciplinary Nursing Quality Research Initiative, which will support teams of nurse and nonnurse scholars to gather evidence about the relationship between nursing and high-quality patient care. This initiative will complement the RWJF’s work with the National Quality Forum and others to identify patient outcomes that are sensitive to nursing care and set priorities for developing effective measures of the quality of that care. 20
The RWJF also is supporting researchers at New York University and the University of Buffalo to conduct a cohort study that will track newly licensed nurses over four years to learn more about their career paths and the factors that affect their work decisions. Another project explores what types of employer-based benefits might bolster nurse retention. 21
The foundation is also interested in learning more about nurses who continue to work in hospitals for many years and in identifying opportunities to increase retention of experienced nurses. The RWJF has supported a white paper, expected in spring 2006, to uncover what factors influence senior nurses’ decisions to continue working in a hospital and to identify promising practices from other fields, such as education, that have had success in retaining older and experienced workers.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Finally, the RWJF will support an effort to incorporate information about quality improvement and ways to improve safety in nursing school curricula nationwide; this work will complement the training taking place in TCAB hospitals.
INVESTING IN PEOPLE AND PARTNERSHIPS.
The RWJF will continue its commitment to supporting leadership among nurses at all levels, from student nurses to hospital executives. The foundation recently established the Fellowship in Nursing Policy and Philanthropy, which enables a midcareer nurse leader to pursue projects jointly at the RWJF and Rutgers University’s Center for State Health Policy. The RWJF also is making a concerted effort to engage more nurses in its Health Policy Fellowships Program, designed to provide outstanding midcareer health professionals with a better understanding of and role in the health policy process.
In December 2005 the RWJF and the Northwest Health Foundation, in Portland, Oregon, expected to jointly launch the Partners Investing in Nursing’s Future initiative, which will support local foundations’ efforts to address the most pressing nursing issues in their communities.
OTHER ORGANIZATIONS’ SUPPORT OF NURSING INITIATIVES
The RWJF is not alone in its support for programs to address the nurse shortage and improve the delivery of nursing care. Public and private organizations across the country are investing in nursing at the local, state, and national levels. The list of initiatives described below is by no means comprehensive; rather, it is intended to illustrate the variety of strategies that different funders are supporting.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
FOUNDATION SUPPORT.
Notably, the Gordon and Betty Moore Foundation in San Francisco has allocated substantial resources to address the nurse shortage in the Bay Area of California. In 2003 that foundation committed $110 million to its ten-year Betty Irene Moore Nursing Initiative, which is designed to improve the quality of nursing-related patient care in the area’s acute care hospitals. This initiative will support efforts to increase the number of nurses graduating from local nursing schools; retain experienced nurses in selected acute care hospitals; and identify promising strategies to recruit, train, and retain highly qualified nurses. Funded projects include fellowships for doctoral students at the School of Nursing, University of California, San Francisco (UCSF); the establishment of an evening associate degree in nursing program in partnership with California Pacific Medical Center, St. Luke’s Hospital, and City College of San Francisco; and research to measure patient outcomes related to nursing care.
The California Endowment also has made a sizable investment in addressing the nurse shortage in California, through a $1.4 million grant to prepare foreign-trained nurses, physicians, and dentists for the licensure exams that allow them to practice in the state.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
The Jewish Healthcare Foundation (JHF) of Pittsburgh has made important investments to address the nurse shortage and improve the quality and safety of nursing care. It has supported a program that educates middle school and high school students about career opportunities in nursing; a fellowship to develop nursing students’ skills; and a summit to inform local hospitals about the American Nurses Credentialing Center’s Magnet Recognition Program. In 2005 the JHF launched a new Nurse Navigator Fellowship program that provides $10,000 grants to foster Pennsylvania nurses’ skills in data measurement and collection to improve the quality of patient care and to promote nurse leadership.
Fostering leadership and scholarship are key components of many foundations’ initiatives to address the nurse shortage. The Palm Healthcare Foundation in West Palm Beach, Florida, has committed $2 million over ten years to its Nursing Education Initiative; the funder’s signature initiative is a community-based nurse preceptor program. Also, in partnership with the Christine E. Lynn College of Nursing at Florida Atlantic University, Palm Healthcare supports an institute to improve nurses’ leadership and clinical skills and support faculty development.
The John A. Hartford Foundation, in New York City, which focuses on improving health care for older Americans, authorized more than $40 million over eight years to support geriatric nursing programs. A key initiative is a scholarship program that has supported more than 100 nurse scholars and fellows to conduct research in gerontological nursing.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
In 2003 the Northwest Health Foundation launched a five-year, $5 million initiative to reduce the nurse shortage in Oregon and southwest Washington State. These efforts focus on improving nursing education and increasing nursing faculty, retaining nurses in the work-place, and increasing racial and ethnic diversity in the nursing workforce.
The W.K. Kellogg Foundation in Battle Creek, Michigan, also has invested in work to increase racial and ethnic diversity in nursing, primarily through a $2 million grant in support of the Leadership Enhancement and Development Project of the American Nurses’ Foundation.
And finally, the Blue Cross Blue Shield of Michigan Foundation invested $500,000 over two years to support scholarships and research training for nursing students as well as other programs to attract and retain nurse faculty at Michigan colleges and universities.
FEDERAL SUPPORT.
Federal agencies also have allocated funds to support adequate nurse staffing. In 2004 the Health Resources and Services Administration’s (HRSA’s) Division of Nursing received appropriations for nearly $142 million in support of nursing education, student scholarships, nurse retention, workforce diversity, and faculty development. Also in 2004 the Centers for Medicare and Medicaid Services (CMS) awarded more than $6 million in grants to sixteen hospitals for Patient Care Work Force Stabilization programs, designed to ensure adequate hospital staffing, address retention of experienced nurses, and secure competitive compensation for hospital employees. The CMS also is working to develop more stringent requirements for nursing homes to release public reports on their staff training, retention, and use of nonnurse staff to provide patient care.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
The Agency for Healthcare Research and Quality (AHRQ) committed an estimated $172 million to nursing issues in 2005. AHRQ supports health services research in areas such as patient safety, health care quality, and health IT. The agency also provides training grants, including dissertation grants, to nurse researchers and maintains databases that can be used for secondary analyses.
In June 2005 U.S. Secretary of Labor Elaine Chao announced a $1.1 million federal grant to support a nurse training partnership in New York City between Pace University’s Lienhard School of Nursing and the Northern Metropolitan Hospital Association. Funds will be used to train new nursing instructors and mentors.
The quality and functionality of a health care delivery system depend on
the availability of medical personnel and infrastructure to provide needed services.i
Rural communities generally have fewer physicians, nurses, specialists, and other
health care workforce, and the small population size and scale makes the loss or
shortage of a single health provider likely to have far-reaching impacts.ii
Twenty percent
of our nation’s population is rural, and rural counties are more likely to report fair to poor
health (19.5 percent rural counties compared to 15.6 percent urban counties).iii Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Rural
Americans tend to be older and less well insured;iv and chronic disease prevalence,
infant and maternal morbidity, mental illness, environmental and occupational injuries,
and obesity are higher in rural communities.v,vi,vii Rural communities tend to be poorer
than urban communities, and rural workers command lower wages and are more likely
to be unemployed.viii
Rural communities are often located in remote areas, have small
and dispersed populations, and possess unstable economic infrastructures.
In addition, the ethnic minorities, including African American, Asian, American Indian,
Hispanic, and ‘Other’ are increasing in number in rural communities. Recent census
data further indicate that persons of minority background are increasing at a higher rate
in rural areas than in urban areas. Hispanics (Latinos) are the fastest growing
population in the nation, and as a group, they make up the youngest segment of the
population.
These factors can make it difficult for rural communities to maintain local hospital
facilities and attract and retain health personnel. This can lead to rural Americans
requiring extensive travel time and incurring great costs in order to obtain basic health
care. Further, near-retirement primary care physicians (age 56 or older) constitute a
larger proportion of the rural workforce (25.5 percent urban, 27.5 percent rural, and 28.9
percent remote rural), making it likely that rural workforce shortages will increase in the
years ahead.ix
The workforce shortage puts tremendous pressure on the existing rural
workforce.x
Rural physicians, compared to their urban counterparts, tend to work longer
hours and see a greater number of patients.xi
Due to the shortage of specialists, rural
physicians are required to not only perform a greater number and greater variety of
procedures than are urban physicians, but they also must achieve and maintain a broad
range of competencies despite isolation from learning opportunities and colleagues.xii
Issue: The population of rural America constitutes about 20 percentxiii of the total
population, or nearly 62 million people living outside metropolitan statistical areas.
xiv In
2005, only 11.4 percent of physicians practiced in rural locations.
xv In recent years,
2
shortages of non-physician providers including nurses, midlevel providers, dentists,
pharmacists, radiology and laboratory technicians, and mental health professionals
have also become more apparent. Problems with the distribution of physicians and
other health professionals, as well as recruitment and retention issues in general, are
ongoing for rural areas, especially those that compete with urban areas to maintain an
adequate workforce. The National Rural Health Association (NRHA) believes that it is
essential for rural areas to have an adequate and able workforce to deliver needed
health care services.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Rural Workforce Shortages Across All Health Providers
The health care labor shortage in the United States has been widely documented and is
expected to last for the foreseeable future. The increase in population is partially
responsible for the health care labor shortage. As the health care workforce ages, the
U.S. population is expected to rise by 18 percent by 2030, and the population over the
age of 65 is expected to increase three times that rate.xvi
In addition to the shortage of health professionals, maldistribution is another prevalent
obstacle rural Americans face in accessing timely and appropriate primary health care
services.
xvii Workforce shortages are especially serious in remote frontier communities,
many of which are located in the Western region of the United States. As of June 30,
2011, the number of non-metropolitan primary medical health professional shortage
areas (HPSAs) was 4,148, representing 65 percent of the primary care HPSAs and
nearly 34.5 million people. These HPSAs would require an additional 3,959
practitioners to remove the HPSA designations and 8,851 to achieve target populationto-practitioner ratios of 2,000:1.
Physicians: The Association of American Medical Colleges projects a shortage of
124,000 full-time physicians by 2025.xviii
The Council on Graduate Medical Education
projects a shortage of 85,000 physicians in 2020, which is approximately 10 percent of
today’s physician workforce.xix
Given the broader physician workforce shortages, the
impacts in rural areas are likely to be more dramatic. In 2005, the ratio of physicians to
population in urban counties was 136 percent higher than that in rural counties.xx
Compared to almost 20 percent of the total population residing in rural areas, only 11.4
percent of all physicians practice in rural areas.xxi
Rural areas continue to have a
disproportionately smaller share of physicians and, within rural areas, distribution is
even more inconsistent.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
xxii
In addition, the percentage of minority students enrolled in
public medical institutions has stagnated over time (Lakhan and Laird, 2009). This given
the recent census data on minorities in rural areas, this fact will likely add to the
workforces shortage.
Registered Nurses: The average age of registered nurses (RNs) is increasing and the
size of the RN workforce will plateau as large numbers of RNs retire. Currently more
than 51 percent of registered nurses are at least 40 years old and 40 percent are at
least age 50.xxiii As demand is expected to increase over the next twenty years, a large
3
and prolonged nursing shortage is expected.xxiv
There are 19,400 RN vacancies in
long-term care settings, according to the American Health Care Association, and
116,000 open positions in hospitals, as reported by the American Hospital Association.
In 2005, the ratio of hospital-based RNs to urban population was 130 percent of the
rural ratio.xxv
The number of working RNs per capita has remained lower in rural areas
than in urban areas from 1980 to 2004, and the salaries of RNs who live in rural areas
remain lower than urban-residing RNs
Reasons for the Shortage
The factors contributing to the nursing shortage are multifaceted: a diminishing pipeline of new nurses due to a faculty shortage that has resulted in thousands of prospective students being turned away, steep population growth in several states, ACA providing increased access, and a baby boom bubble that will require intensive health care services. And these issues are occurring at a time when a significant number of nurses are retiring.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
“The biggest challenges facing healthcare are the demographic changes that are pushing expansion of the workforce and the time it takes to educate and train new health care workers to fill those needs,” said Stephen Nichols, MD, chief of clinical operations for SCP. “It seems to me that the shift away from LVNs and LPNs to RNs has exacerbated this in the hospital setting. I would expect a return to a larger team with clear roles would be helpful.”
Perhaps the most critical factor affecting the nursing shortage in the U.S. is nursing schools’ inability to increase enrollment due to a scarcity of nursing school faculty.
An American Association of Colleges of Nursing (AACN) survey reported that U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.
Also, more than 56 percent of the 714 nursing schools that responded to the survey reported 1,236 full-time faculty vacancies for the 2014-15 academic year.
The following factors have contributed to the nursing faculty shortage:
Low salaries for educators compared to clinicians;
Age-delayed trajectory of nurses obtaining higher levels of education;
Late point in career development for entering educative roles;
Inability to fill open faculty roles;
Looming retirement of large numbers of currently employed nursing educators.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
However, according to new data from AACN, enrollment in baccalaureate, master’s, and doctoral nursing programs increased in 2014 with the greatest gains found in baccalaureate degree-completion programs: 4.2 percent. In graduate schools, student enrollment increased by 6.6 percent in master’s programs and by 3.2 percent and 26.2 percent in research-focused and practice-focused doctoral programs, respectively.
Other factors contributing to the nursing shortage include:
Hospital acuity. Acuity in hospitals has been on the rise due to the declining average length of stay and new technology that allows rapid assessment, treatment, and discharge.
Aging population. As a high percentage of Baby Boomers reach retirement age, their need for healthcare will grow and intensify.
Aging workforce. A significant segment of the nursing workforce is nearing retirement age. According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55 percent of the RN workforce is age 50 or older. Also, the Health Resources and Services Administration projects that more than one million registered nurses will reach retirement age within the next 10 to 15 years.
Workload and work environment. In response to health care cost pressure, hospitals have been forced to reduce staffing and have implemented mandatory overtime policies to ensure that RNs would be available to work when the number of patients admitted increased unexpectedly. An increased workload may affect the decision to enter or remain in the nursing profession.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Effects of Nursing Shortage on Patient Care
Due to the shortage, nurses often need to work long hours under very stressful conditions, which can result in fatigue, injury, and job dissatisfaction. Nurses suffering in these environments are more prone to making mistakes and medical errors. An unfortunate outcome is that patient quality can suffer, resulting in a variety of preventable complications, including medication errors, emergency room overcrowding, and more alarmingly, increased mortality rates.
Solving the Nurse Shortage Problem
A range of solutions has been offered as a way to solve the nursing shortage problem that include subsidized funding, wage increases, hiring minority and foreign nurses, and campaigns to improve the profession’s image.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Funding options. Many experts recognize the need to increase funding for nursing education, directed toward nursing faculty as well as students.
Nursing schools are forming strategic partnerships and seeking private support to help expand student capacity. For example, the University of Minnesota announced a partnership with the Minnesota VA Health Care System in June 2013 to expand enrollment in the school’s BSN program.
ACA includes loan programs both to nursing students and faculty that are designed to help alleviate the shortage.
The Nursing Education Loan Repayment Program (NELRP) is a selective program of the U.S. Government that helps alleviate the critical shortage of nurses by offering loan repayment of up to 85 percent of outstanding loans to RNs and advanced practice registered nurses.
The Nurse Faculty Loan Program (NFLP) is intended to increase the number of qualified nursing faculty to facilitate the education of nurses.
Higher wages. Another way to address the nursing shortage would be to devote resources toward increasing RN wages. This approach could affect recruitment as well as retention of RNs already in the workforce.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Increased minorities. Increasing the number of minorities who become RNs could bolster the supply of RNs and have the additional benefit of improving delivery of culturally sensitive care.
Foreign nurses. Hiring foreign nurses would be another way to address shortages in the United States. Proponents of this approach note that hospitals have relied on foreign nurses, often brought to the United States with temporary work visas, to address past shortages. For example, in 1989, 24,400 foreign nurses worked in the United States under temporary visas.
Improved image. Lastly, experts suggest a need to improve the image of nursing. Strategies range from encouraging nurses to communicate more frequently with the press about positive aspects of nursing to launching professional advertising campaigns promoting the profession.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
SCP Consulting Services
Perhaps no group understands the challenges of the nursing shortage better than SCP’s Consulting Services, which utilizes skills and expertise from practicing clinical consultants to aid in solutions that work for clients and the nurses they employ.
“Many hospitals have tackled this issue for decades by redesigning the care delivery model and optimizing patient care services technical roles, including LPN, LVN, and many others,” said Linus Diedling, partner, SCP Consulting Services. “It is critical to approach the problem with a holistic view that the care model must be carefully designed to optimize workflow and roles to enable all care team members to work at the upper limits of licensure. This approach includes being clear about the impact on the scarce nursing resources that the patient and family may have in a continuum based patient-centered care model.”
Before offering any change recommendation, an analysis always includes the potential impact to nursing in order to maximize the benefit to the patient. By utilizing the unique skill sets of registered nurses and clinical professionals in the consulting division, SCP is able to offer clients solutions while keeping in mind their largest staff audience.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Speaking from personal experience, Traci Shortt, Clinical Operations Specialist and Lead Nurse Practitioner, said, “One of the most satisfying aspects of nursing is the personal interaction experienced in the nurse-patient relationship. In today’s technologically demanding environment, when employers can promote this interaction in their processes, nurses and patient’s both win.”
Nursing Shortage Future
In spite of these proposed solutions, with demand currently exceeding supply, the nursing shortage is not likely to diminish in the near term. There is hope for the future, however.
A 2014 report from the U.S. Department of Health and Human Services entitled The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025 (PDF) said that the change in RN supply between 2012 and 2025 is projected to outpace demand.
“Assuming RNs continue to train at the current levels and accounting for new entrants and attrition, the RN supply is expected to grow by 952,000 full-time equivalents (FTEs) — from 2,897,000 FTEs in 2012 to 3,849,000 FTEs in 2025 — a 33 percent increase nationally,” the report said.Effects of Shortage Of Nurses In Little Rural Hospitals Essay
Conversely, the nationwide demand for RNs is projected to grow by only 612,000 FTEs — from 2,897,000 FTEs in 2012 to 3,509,000 FTEs in 2025 — a 21 percent increase, resulting in a surplus in excess of 340,000 RNs by 2025. Effects of Shortage Of Nurses In Little Rural Hospitals Essay
