Clinical Problems Coping With the Nursing Shortage

¶ … Clinical Problems: Coping With the Nursing Shortage Like many healthcare institutions, Nightingale Home Care Inc., in La Mesa, CA is suffering from a severe staffing shortage. The nursing shortage has been a persistent problem within the profession for many years due to what has been called a perfect storm of circumstances. First, the aging of the population as a whole has increased the demand and need for more nurses. People are living longer yet require more assistance from the healthcare profession to navigate the problems of aging.

Chronic diseases such as heart disease, diabetes, and osteoarthritis are likewise on the rise in the elderly population and this requires continued monitoring and support. Secondly, the current population of RNs is itself aging and leaving the profession for retirement. A third, concurrent problem is that nursing schools lack sufficient faculty to admit and teach even all qualified candidates who do wish to become RNs. The nursing shortage can have severe repercussions for patient health.

According to a 2011 New England Journal of Medicine study, "insufficient nurse staffing was related to higher patient mortality rates. These researchers analyzed the records of nearly 198,000 admitted patients and 177,000 eight-hour nursing shifts across 43 patient-care units at large academic health centers" (Rosseter 2014). The reasons for this include nursing fatigue and poor judgement that results due to being overwhelmed by the volume of care demanded.

Shortages result in an increased need to work long hours, back-to-back shifts, and it is very difficult to be responsive to all of patient's needs under such circumstances. A 2004 National Survey on Consumers' Experiences with Patient Safety and Quality Information survey found that patient satisfaction was impacted by the nursing shortage as well. Patients "reported that the most important issues affecting medical error rates are workload, stress or fatigue among health professionals (74%); too little time spent with patients (70%); and too few nurses (69%)" (Rosseter 2014).

Unfortunately, many of these issues are systemic in nature and Nightingale Home Care Inc. cannot solve them single-handedly. However, there are some proactive strategies which can be taken to improve staffing issues, one of which is "forming strategic partnerships and seeking private support to help expand student capacity" (Rosseter 2014).

In the future, Nightingale will work with local universities to offer educational opportunities for students and help programs expand their capacity to admit qualified students in the RN, OT, and PT programs which are necessary for Nightingale to provide its critical services. In 2015 alone, "7% of nurse faculty positions nationwide remain vacant, 78,000 applicants to bachelor and advanced-degree nursing programs were turned away last year because there weren't enough faculty available to teach them" (Robeznieks 2015).

Unfortunately, the faculty shortage and corresponding nursing shortage results in a spiraling problem, given that overburdened staff are more likely to become burned out and frustrated and leave the profession. A number of institutions are developing creative solutions to this problem which Nightingale could adopt in the future -- for example, one facility "pays for two years of nursing education -- up to $6,000 -- in exchange for a two-year commitment to work" (Wood 2008).

Nightingale will also expand opportunities for continuing education for its staff members who are not currently RNs, including tuition support, in acknowledgement of the fact that higher levels of qualifications are associated with lower patient mortality rates. A 2009 study by the International Journal of Nursing Studies "found a significant association between the number of baccalaureate-prepared RNs on cardiac care units and in-hospital mortality" (Rosseter 2014). At home care also requires advanced knowledge of occupational and physical therapy to help rehabilitate all patients and care for geriatric patients in an optimal fashion.

As well as attracting qualified new nurses, enhancing retention is also essential. Offering retention bonuses "on a graduated scale" can also be an effective technique to attract new nurses, for example, for nurses who work for "two years [can] receive a $3,000 bonus, those employed for five years earn an extra $5,000, and those who stay on for 10 years receive an additional $10,000" (Wood 2008).

Although sign-in bonuses can also be effective, retention bonuses are thought to be even more effective as they encourage nurses to remain within the institution, even when they face the initial challenges and difficulties of transitioning.