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One need only read the newspaper "Classified" ads to realize that employers are trying many clever marketing tactics to attract prospective nurses into their organizations. Many are offering sign-on bonuses, extra benefits and other amenities to attract a limited supply of nurses. As both the general population and the elderly population grow, the number of nurses needed to care for them increases proportionally as well. The number of people choosing to pursue nursing as a career has been on the decline, mainly due to long working hours, low pay, high job stress and other factors. These factors will not resolve themselves if the nursing deficit continues to increase. In addition, graduate nurses find it difficult to enter the workforce due to their lack of experience and a shortage of mentors to teach them. The solution is simple, more nurses are needed, and soon. Novice nurses are fresh graduates who usually conduct their work under the close supervision of a more experienced nurse. These nurses offer a good pool of qualified nurses and, under the strict supervision of more experienced nurses, could offer a solution to the current nursing crisis.
The National League for Nursing (NLN) says that one single factor cannot be blamed for the current nursing shortage, but rather that it is a complex issue with many factors. Less nurses are entering the workforce than ever before. The National League for Nursing has been unable to accurately ascertain the size of the gap. Numbers from the U.S. Department of Labor Relations reports the number of nurses entering the field is increasing at a steady rate. This would lead us to believe that there are enough to fill the current needs (NLN, 2002). However, the National League for Nursing cautions that these numbers are deceptive because the demand for nurses does not increase in proportion to the general labor demand. For the nursing profession, the number of patients is increasing at a disproportionate rate and will continue to increase for quite some time. In places where shortages are most severe, hospitals are closing wings and canceling surgeries due to the lack of nursing staff (NLN, 2002).
The decrease in the number of nursing students entering the field is not the only problem. The average age of nurse has been growing older. There is not only a shortage in nurses, but there are fewer and fewer PHD nurses to teach upcoming classes. There are several factors cited as threats to recruiting potential nurses. These include low pay rates, dissatisfaction with the job, few supervisory or career prospects, excessive workload and long hours due to shortages in staffing. Unless these issues are addressed within the profession, it is not possible to solve the nursing shortage and it will continue to grow at an alarming rate (NLN, 2002).
The problem is apparent, but how do we solve it? The first issues that need resolved are those that create an undesirable work environment for nursing staff. In a book by Dr. Karl Pillemer, he summarizes the reasons as this,
Many nursing assistants begin with a sense of enthusiasm, sound intrinsic motivation, a desire to help others, and a sense that he or she is making a meaningful contribution, yet workers get burned out, not only by stressful conditions and heavy workloads, but also because of a lack of recognition and respect," (Pillemer, 1996)
According to Brian Vastag (2002), the U.S. Department of Health and Human Services (DHHS) has launched an aggressive program to encourage young persons to seek a career in nursing. By the next decade, 600,000 new nurses will be needed to fill vacancies and meet increased demand (Land, 1996).
The novice nurse could be used to fill some of these vacant positions, however, this raises some important issues regarding their lack of experience. Medical mistakes can cost lives and cause serious repercussions against the health care provider. There is a concern, that due to their lack of experience, the rate of medical mistakes would rise if novice nurses were used to cover a large gap in the existing structure. A Newsday article of 2002 gives two examples where novice nurses improperly administered medication in the incorrect dosage and almost caused the death of the victim. In both cases the novice nurse were not properly supervised.
According to Pepper (1985), drug administration takes up approximately one third of a nurse's time. They estimate that mistakes occur in approximately 5% of all drug administrations, but also states that this estimate may be low. There was no indication as to whether these errors were due to novice nurses, but there was an indication that most errors peaked in nurses with under six months nursing experience. Lack of experience and stress were cited as reasons for nursing staff to make mistakes. The solution to this problem would then be to reduce stress on the staff by decreasing the workload. It is nearly impossible to reduce the number of patients, so the logical alternative would be to increase the staff. The pool of nursing school graduates is shrinking and novice nurses could fill the gap. In this respect it would seem as if introducing more nurses from the pool of novice nurses would serve to decrease drug errors, instead of increase them. It is crucial that the novice nurses work closely with experienced nurses and that they be provided with adequate training.
Another case against using novice nurses is that they are inexperienced and may miss subtle signs that may lead to the prevention of serious complications or missed serious disease. This again can be remedied by having the novice work closely under an experienced nurse. In addition the novice nurses could take on some of the more menial tasks and free time for the experienced nurse to do other, more critical tasks, including training.
Both the concern over novices making mistakes on medications and missing signs of serious illness are valid concerns. However, as most of these scenarios occur due to high stress in the workplace, they could be avoided by reducing the incredible workload being placed on the current nursing staff. Adding more nurses, even those less experienced, could lead to a reduced workload on all staff members. This would give the experienced nurses adequate time to properly train and supervise the novice nurses. This would lead to a better situation for everyone involved, including the patient who would benefit greatly from having less stressed nurses caring for them. A less stressed nurse is less likely to make a mistake than one who is tired and thinking about something other than her job.
Novice nurses provide a willing pool of nurses ready to step in and fill the gap. However, many staffing specialists ignore them because they are inexperienced and there is a general perception that they will be more trouble that they are worth. Novice nurses must work under an experienced nurse who acts as a mentor. Hospital staffing specialists argue that novice nurses put even more pressure on an already stressed experienced nursing staff.
Novice nurses have been through school and are eager to learn their professions and this eagerness makes them quick learners. When novices make mistakes it is more than likely for the same reasons that an experienced nurse makes the same mistake. The key to solving both is to reduce workload by spreading it out over more people.
Th next problem with hiring novice nurses is how to retain them. Many novice nurses quit after a certain time because of the problems that plague the industry in general. They enter school, enthusiastic about becoming a nurse and helping people in need. However, when they graduate and begin preparations to obtain their license they are confronted with the realities of the real world of a working nurse. Many do not finish their novice period and quit. They find the pay lower than expected and the working conditions similar to a sweatshop. These issues must be dealt with, both for the patient's sake and for the student's. A nurse who is less than enthusiastic about his or her job is more likely to make a serious mistake than someone who has a different perspective. The nursing profession must become an attractive employment option.
The scope of the shortage in nursing care is overwhelming and will only get worse both in the short run and in the long run. Novice nurses provide a ready and willing source of new nurses, willing to do the job. There are, however concerns over their lack of experience. These shortcomings could be reduced by hiring sufficient nurses and novices to fill the requirements and reduce stress on the current staff. Experienced nurses make mistakes too; adding new novices would reduce the workload and allow them to devote more time to precision and care. Novice nurses could take over some of the more menial tasks of experienced nurses, filling both the gap in workload and getting vital experience and education at the same time.
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While it would have been unquestionably beneficial to the patient and indeed to this nurse to be able to engage in a more meaningful, enlightened, and research-based discussion of her condition and methods for addressing it, this nurse simply did not have the time to devote to reading the latest research on diabetes care in addition to remaining prepared for all patients. The policies of the organization in which
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