Cross-Sectional Study to Determine Factors in the Educational Advancement of the Licensed Practical Nurse to the Registered Nurse in the State of North Carolina
According to the Harvard Nursing Research Institute, United States nursing school enrollments dropped by 20.9% from 1995 to 1998 (Healthcare Review, 2000). Behind headlines such as this one are the overwhelming issues which threaten the nursing workforce: 1) staffing cuts, 2) mandatory overtime, and 3) the use of unauthorized personnel to perform care, all at the cost of the patient's safety. The state of nursing in this country is very disturbing. There are hospitals grossly understaffed by registered nurses and with practical nurses who are being told to perform tasks beyond their skill and training levels (Mee & Robinson, 2003).
The pervasive nature of the problems which are present within the nursing profession are being acknowledged by the nurse-researchers, themselves, "Every article, speech, and interview about the nursing shortage notes that it is a different shortage from those of the past." (Nevidjon & Erickson, 2001). Health care experts are worried that a national nursing shortage could become widespread later in the decade - just as the aging U.S. population requires more care. The "baby boomers" are getting older and will create a demand for more hospital beds, more competent staff, and better programs aimed at keeping the most desirable people in the profession. A recent study at Vanderbilt University's School of Nursing in Nashville, Tennessee, found that the numbers of full-time registered nurses was projected to peak in 2007 and then decline steadily as more nurses retire along with the "Baby Boomers" ("Some worry nursing shortage could put patients at risk. Http://www.CNN.com.heath.Retrieved: 03/18/2003).
The Scope of the Problem
There have been two major nursing shortages within the past century, but there are distinct differences between them and the one we are presently in. According to Unique Staffing, the labor and population trends are causing massive disruptions in the supply of nurses, while at the same time the need for nursing care has begun to skyrocket (Mee, C. & Robinson, E., 2003). The current workforce shortage is different and more critical than the previous deficits because it is projected to be of unprecedented severity and to endure long into the future, it demands significant attention and innovation (Sorensen, E., 2001).
What caused this problem? Secretary of the Department of Health and Mental Hygiene in his testimony before the U.S. Congress, Dr. Georges C. Benjamin, M.D stated, "...nurses are not entering the profession, they are not staying in the profession, and they are not happy when they are there." (Romig, 2001). Carolyn F. Scanlon, president and CEO of The Hospital and Healthsystem Association of Pennsylvania, stated at the organization's April, 2002 meeting, "The nursing shortage is a result of many factors, including declining enrollments in -- and graduations from- nursing schools, and existing workforce that aging, and an older and sicker patient population." As evidence of that statement, below are the numbers of people who took the NCLEX-RN Examination for the first time for the years 1995-2002:
Number of Candidates Taking the NCLEX-RN® Exam
First-Time, U.S. Educated Candidates Only
Program 1995 1996 1997 1998 1999 2000 2001 2002 Diploma 7,335 6,346 5,240 3,978 3,161 2,679 2,310 2,223 Baccalaureate 31,195 32,278 31,828 30,142 28,107 26,048 24,832 24,421 Associates 57,908 55,554 52,396 49,045 45,255 42,665 41,567 39,642 Total 96,438 94,178 89,464 83,165 76,523 71,392 68,759 66,286 The American Association of Registered Nurses, Media Backgrounder outage. http://www.aacn.nche.edu.-The Nursing Shortage
Cheryl Johnson, president of the United American Nurses, stated on the highly esteemed National Public Radio program, "Talk of the Nation," "I think there is a variety of reasons, but I think probably the single biggest thing is just the amount of work that nurses are incurring right now. In an attempt to save money in hospitals and get around the shorter reimbursements or lesser reimbursements that they are getting, hospitals are asking nurses to do more with less. That means that you have less nurses and you have less resources around you to assist you in getting the work done." (Conan, N. "Shortage of registered nurses in the U.S.").
In the same radio broadcast, Dr. Peter Buerhaus, senior associate dean of research at Vanderbilt University School of Nursing, made this statement: "It is a myth that there is a shortage of trained nurses in this country, there isn't. They are just not willing to work in a hospital setting where the caseloads are huge, the support staff is smaller that it should be, and where 'corporate cuts' keep them from having the relationships with their patients as they once had. They have too many patients to care for and too little time to complete the large number of tasks they are expected to carry out. (Conan, N. "Shortage of registered nurses in the U.S.," National Public Radio).
In The Journal of Perinatal and Neonatal Nursing, Elaine Sorenson writes:
It finally happened. The forces we warned about - increasing system complexity, high costs, greater technology, decreased nurse staffing, increasing age and battle fatigue among nurses decreasing public esteem, and general disarray of health care institutions - all came together and drew nurses into the crisis.
Nurses had enjoyed public trust as patient advocates and had remained largely invisible in the conflict for power in the health care system...until that quiet September morning when copies of The Chicago Tribune landed on 500,000 doorsteps with the headline screaming, "Nursing Mistakes, Kill, Injure thousands."
Sorensen goes on to say that now the nurses, probably the only health care professionals whom the patients still trusted, had been moved into the enemy camp by the headline. The fact is, nursing mistakes have risen, people have died from them, and good nurses have lost their jobs because, in the name of good business management, one nurse might have two to three times the number of patients to care for than is safe. Nurses are human, humans make mistakes, especially if they are exhausted, have too many non-nursing tasks to attend to, and are not treated as professionals by the "suits" in the large, glass-enclosed offices whose main concern is the bottom line, not the lines on the monitors in their patients' rooms. Thus, the result is good people suffering from nurses' mistakes and good nurses leaving the hospital setting because they can no longer take the hours, the stress, and the general feeling that they don't matter much to anyone.
The Causes of the Nursing Shortage
In a problem as complex as the nursing shortage is there is no "right" side and "wrong" one. Many factors over several years have finally come together to create what many fear will be a juggernaut aimed to destroy the quality of healthcare in our country. When a search is begun to investigate the major conditions and attitudes which have caused this healthcare disaster, it should begin in the business offices of healthcare facilities as well as in the legislative chambers of all fifty states. According to a CBS news special entitled, "Nursing Shortage is in the Critical Stage" hosted by Leslie Stahl and broadcast on January 17, 2003, "There is a major reason for the shortage. Ever since the mid-'80's, young people have been choosing more lucrative careers. At the same time, the nurses we (Ms. Leclaire, one of the nurses interviewed) do have are getting older; the average age is now 45. Just as the baby boomers are starting to need more nursing care, the pipeline is running dry, and it's going to get much, much worse."
What Are Some Solutions?
There are many "plans" being made to correct this healthcare crisis involving collaboration, research, and cooperation among healthcare specialties which are worthwhile undertakings, but will not come to fruition for several more years. One college, The Ohio Valley General Hospital School of Nursing, has even gone so far as to promise a tuition-free education with the assurance of a job at the time of graduation for anyone who completes their nursing program (AORN Journal, April, 2001). The solutions which must be sought are those which will send competent, educated healthcare professionals back to the hospitals where they are so desperately needed. These solutions must not take many years to affect change, because the healthcare system as we know it doesn't have many years to wait around. Too many good nurses are leaving the only career they ever wanted, and too many mistakes are being made by their under-paid, over-worked colleagues who have remained in the hospitals for now.
One solution which is being tried by several hospitals in this country is to look overseas for nurses to fill widening gap. According to Carolyn Banks, vice president of labor and workforce development at the Massachusetts Extended Care Foundation, which represents nursing homes, "Our members are choosing the overseas route just out of frustration, of not being able to find nurses here" (Rowland, 2002). Many hospital officials go as far as to travel to South Africa, a country where…