Current Issue in Nursing: Nursing Shortage Nursing quality and adequate staffing are intertwined. Adequate levels of nurses, lower nurse to patient ratios, and also more highly trained nurses are associated with better health outcomes and lower mortality rates. But despite the fact that there is high demand for nurses, and also increased interest in entering...
Current Issue in Nursing: Nursing Shortage
Nursing quality and adequate staffing are intertwined. Adequate levels of nurses, lower nurse to patient ratios, and also more highly trained nurses are associated with better health outcomes and lower mortality rates. But despite the fact that there is high demand for nurses, and also increased interest in entering this very exciting profession, retaining qualified nurses and recruiting new nurses is a struggle for many hospitals. Also, in a desire to cut costs, many institutions are often unwilling, despite evidence-based research supporting higher staffing ratios as leading to lower-cost and superior patient outcomes, to hire more nurses as healthcare staffing makes up as much as 40% of all intuitional operating costs (“Nursing Shortage,” 2019).
The attempt to cut costs by reducing staff levels reflects an unfortunately misguided view of the value of the nursing profession. It also reflects a misguided view of an aging patient population which increasingly consists of patients with multiple chronic conditions, many of which must be managed with long-term care and guidance. Nursing has gained respect a profession within the healthcare industry as a whole, as more nurses are performing functions once filled by physicians, but nurses must be treated with the respect they deserve in terms of reasonable patient loads and scheduling. Nurse leaders must offer realistic institutional approaches to circumvent burnout. This paper will attempt to address the causes of the nursing shortage, and also make suggestions for improving the problem. Nursing faculty shortages, an inability to admit all qualified candidates to nursing schools, combined with a dramatically expanded and diverse patient population with higher rates of chronic versus infectious diseases are all contributing to the need for more nurses, combined with quality of life issues for many nurses. There are also some positive societal shifts, such as an increase in the number of patients with health insurance, which still increases the patient load for nurses as a practical problem and must be addressed.
Synthesis of References
According to ANA Health Care Economist Peter McMenamin (2019), many nurses who deferred their retirement during the so-called Great Recession of 2008 have now finally started to retire; the Affordable Care Act (ACA) brought forth many new formerly uninsured individuals into the healthcare system as regular health consumers. There is a projected 15% job growth for nurses, a faster rate than all other occupations (Haddad & Toney-Butler, 2019). The population is aging, and older people require more healthcare, and have a higher rate of comorbidities. But the nursing profession is itself aging, and one-third of the current workforce of registered nurses will be eligible for retirement by 2029 (Haddad & Toney-Butler, 2019). It is vital that the profession take action in the here and now to supplant this deficit, so as the last of the Baby Boom generation of nurses retire, there is a new generation of qualified and trained nurses to rectify this threatened deficit.
McMenamin (2019) also notes that the nursing population is becoming more educated than it has been historically, with greater mastery of complex concepts like disease management and greater technical knowledge. This has resulted in advanced practice registered nurses (APRN)s practicing independently in many states, and more than half of all health insurers reimburse APRNs for independent practice (“ANA Health Care Economist Peter McMenamin on the Nursing Shortage Outlook,” 2019). But the demand for nursing education, particularly for graduate-level degrees, also means a subsequent demand for highly trained and qualified faculty, which is not itself being met. Lower faculty versus professional nursing salaries, a lack of interest in teaching versus practicing, and a number of other environmental pressures, including limited resources for nursing programs themselves, have ensured a discrepancy between demand to enter such programs and openings for students (Bond, 2017).
The shortage of qualified nurse faculty to staff educational programs thus is critically linked to the shortage of nurses. Programs may be forced to turn away qualified and willing candidates, simply because of a lack of faculty members to teach them. When programs are already struggling financially they cannot compensate professors fairly, cannot offer faculty and student support and encouragement, and because of negative teaching experiences many nurses do not perceive becoming faculty members as desirable (Bond, 2017). This is also significant for nurses who wish to return to university to increase their credentials.
A systematic review by Crawford (2019) found that in six separate studies of trauma units, adding advance practice registered nurses (APRNs) to the treatment team resulted in reduced lengths of stays for patients. Better educated nurses with higher levels of training in evidence-based research can serve as nursing leaders and also provide higher-quality care, based upon measurable health benchmarks (Crawford, 2019). But without access to such programs, even highly motivated nurses cannot become APRNs. This is despite the fact that APRNs can provide more cost-effective solutions to the deficit of physicians in general practice; nurses should both be allowed to practice to the fullest extent of their qualifications and add to those qualifications (“Nursing Shortage,” 2019).
The surge in demand for nurses is a profound historical shift in terms of how nurses have traditionally been viewed as ancillary to physicians. Moreover, the patient-focused approach adopted by the nursing profession which takes into consideration the patient’s environmental and social situation, not merely the patient’s health status, is often the most useful way to encourage proactive changes in lifestyle. Given the spike in diabetes, heart disease, and obesity, such a holistic perspective is uniquely relevant. A focus upon primary rather than more intensive secondary and tertiary care is more cost-effective and also less damaging and stressful to the patient’s health and psyche. The more quickly chronic disease can be contained, or ideally prevented, the better, and APRNs and nursing approaches offer a cost-effective solution to do so; thus, the need is greater than ever to bring nurses to the forefront of the health system.
Unfortunately, given the need for nurses and the demand is not commensurate with the currently available numbers of nurses within the profession, existing nurses are increasingly burdened with long hours and high patient loads. As a result, there are significant concerns about the quality of life for nurses in the workplace. Despite the significant professional investment nurses make in their educations, the national turnover rates for nurses is estimated as ranging (depending on region and specialty) from 8.8 % to 37% and healthcare workers are considered by the World Health Organization to be the profession with the highest risk of violence in the workplace (Haddad & Toney-Butler, 2019).
Navigating the nursing profession is a challenging transition time for all nurses, but when inexperienced nurses are faced with high patient loads that would daunt even a trained nurse, many seek to leave the profession, despite the fact there is a desperate need for their presence. Older, more experienced nurses may experience battle fatigue as well, given the observed change within the profession as they are able to spend less time with patients, and they feel the stress of long-term caregiving.
Nursing is a profession, and requires extensive education and training. But it is also a hands-on, high risk profession. Furthermore, violence is not only directed by patients, at least in physical form. The phenomenon of nurses eating their young, or being cruel, condescending, and bullying to less experienced nurses is often a threat to retention and can shut down lines of communication in the workplace, impacting the care of patients in a negative fashion (Gillespie, et al., 2017). Caregiver burnout can lead to “physical symptoms, such as tiredness, insomnia, emotional liability, frustration and anxiety” and compromise the health of nurses and patients, causing more nurses to leave the workplace, further shortages, and thus compound the problem (Vincent, et al, 2019, par.5).
Shortages in and of themselves have been linked to attrition, stress and burnout. According to one study, an “increase of one patient per nurse assignment to a hospital's staffing level increased burnout by 23%” (Botha, Gwin, Purpora, 2015, par.4). Thus, addressing the nursing shortage is a quality of life issue for nurses as well as patients. Stress can also lead to higher rates of nursing errors and less time spent with patients. This further compounds the level of stress experienced by nurses working on units, which them must work to compensate for the mistakes of others, and are (rightly) subjected to greater scrutiny because of higher rates of patient recidivism, poor follow-through on the part of patients regarding discharge orders, and lower rates of patient satisfaction.
The nursing shortage is a complex, multifactorial problem. But it is not an insurmountable one. Higher salaries for nursing faculty and incentives for nurses to teach at the undergraduate and graduate level are needed. It may also be necessary to allow qualified nurses with experience but without PhDs to teach certain classes. Universities must expand and fund their programs. Increasing online enrollment may be helpful in permitting nurses to increase their qualifications at minimal cost while still working full-time. Healthcare institutions must be willing to pay nurses commensurate with their experience and qualifications, and consider hiring nurses to undertake duties of leadership and primary care formerly assumed by physicians. Such leadership can be empowering to the status of nurses within healthcare, as well as reduce costs. There must also be a stress reduction program and a zero tolerance for harassment, as well as adequate staffing levels to minimize burnout and interpersonal friction.
Summary
The nursing shortage is a national crisis. It is a crisis for patients, whose care is compromised due to highly stressed healthcare workers. It is also a crisis for nurses who should not have to cope with bullying and punishingly long hours and caring for more patients than is feasible. The nursing profession offers a unique, holistic approach to patient care that can be highly beneficial, given the unique conditions and challenges of healthcare in America. But nurses must be equipped to leverage their expertise in a positive way.
Current Issue in Nursing: Nursing Shortage
Nursing quality and adequate staffing are intertwined. Adequate levels of nurses, lower nurse to patient ratios, and also more highly trained nurses are associated with better health outcomes and lower mortality rates. But despite the fact that there is high demand for nurses, and also increased interest in entering this very exciting profession, retaining qualified nurses and recruiting new nurses is a struggle for many hospitals. Also, in a desire to cut costs, many institutions are often unwilling, despite evidence-based research supporting higher staffing ratios as leading to lower-cost and superior patient outcomes, to hire more nurses as healthcare staffing makes up as much as 40% of all intuitional operating costs (“Nursing Shortage,” 2019).
The attempt to cut costs by reducing staff levels reflects an unfortunately misguided view of the value of the nursing profession. It also reflects a misguided view of an aging patient population which increasingly consists of patients with multiple chronic conditions, many of which must be managed with long-term care and guidance. Nursing has gained respect a profession within the healthcare industry as a whole, as more nurses are performing functions once filled by physicians, but nurses must be treated with the respect they deserve in terms of reasonable patient loads and scheduling. Nurse leaders must offer realistic institutional approaches to circumvent burnout. This paper will attempt to address the causes of the nursing shortage, and also make suggestions for improving the problem. Nursing faculty shortages, an inability to admit all qualified candidates to nursing schools, combined with a dramatically expanded and diverse patient population with higher rates of chronic versus infectious diseases are all contributing to the need for more nurses, combined with quality of life issues for many nurses. There are also some positive societal shifts, such as an increase in the number of patients with health insurance, which still increases the patient load for nurses as a practical problem and must be addressed.
Synthesis of References
According to ANA Health Care Economist Peter McMenamin (2019), many nurses who deferred their retirement during the so-called Great Recession of 2008 have now finally started to retire; the Affordable Care Act (ACA) brought forth many new formerly uninsured individuals into the healthcare system as regular health consumers. There is a projected 15% job growth for nurses, a faster rate than all other occupations (Haddad & Toney-Butler, 2019). The population is aging, and older people require more healthcare, and have a higher rate of comorbidities. But the nursing profession is itself aging, and one-third of the current workforce of registered nurses will be eligible for retirement by 2029 (Haddad & Toney-Butler, 2019). It is vital that the profession take action in the here and now to supplant this deficit, so as the last of the Baby Boom generation of nurses retire, there is a new generation of qualified and trained nurses to rectify this threatened deficit.
McMenamin (2019) also notes that the nursing population is becoming more educated than it has been historically, with greater mastery of complex concepts like disease management and greater technical knowledge. This has resulted in advanced practice registered nurses (APRN)s practicing independently in many states, and more than half of all health insurers reimburse APRNs for independent practice (“ANA Health Care Economist Peter McMenamin on the Nursing Shortage Outlook,” 2019). But the demand for nursing education, particularly for graduate-level degrees, also means a subsequent demand for highly trained and qualified faculty, which is not itself being met. Lower faculty versus professional nursing salaries, a lack of interest in teaching versus practicing, and a number of other environmental pressures, including limited resources for nursing programs themselves, have ensured a discrepancy between demand to enter such programs and openings for students (Bond, 2017).
The shortage of qualified nurse faculty to staff educational programs thus is critically linked to the shortage of nurses. Programs may be forced to turn away qualified and willing candidates, simply because of a lack of faculty members to teach them. When programs are already struggling financially they cannot compensate professors fairly, cannot offer faculty and student support and encouragement, and because of negative teaching experiences many nurses do not perceive becoming faculty members as desirable (Bond, 2017). This is also significant for nurses who wish to return to university to increase their credentials.
A systematic review by Crawford (2019) found that in six separate studies of trauma units, adding advance practice registered nurses (APRNs) to the treatment team resulted in reduced lengths of stays for patients. Better educated nurses with higher levels of training in evidence-based research can serve as nursing leaders and also provide higher-quality care, based upon measurable health benchmarks (Crawford, 2019). But without access to such programs, even highly motivated nurses cannot become APRNs. This is despite the fact that APRNs can provide more cost-effective solutions to the deficit of physicians in general practice; nurses should both be allowed to practice to the fullest extent of their qualifications and add to those qualifications (“Nursing Shortage,” 2019).
The surge in demand for nurses is a profound historical shift in terms of how nurses have traditionally been viewed as ancillary to physicians. Moreover, the patient-focused approach adopted by the nursing profession which takes into consideration the patient’s environmental and social situation, not merely the patient’s health status, is often the most useful way to encourage proactive changes in lifestyle. Given the spike in diabetes, heart disease, and obesity, such a holistic perspective is uniquely relevant. A focus upon primary rather than more intensive secondary and tertiary care is more cost-effective and also less damaging and stressful to the patient’s health and psyche. The more quickly chronic disease can be contained, or ideally prevented, the better, and APRNs and nursing approaches offer a cost-effective solution to do so; thus, the need is greater than ever to bring nurses to the forefront of the health system.
Unfortunately, given the need for nurses and the demand is not commensurate with the currently available numbers of nurses within the profession, existing nurses are increasingly burdened with long hours and high patient loads. As a result, there are significant concerns about the quality of life for nurses in the workplace. Despite the significant professional investment nurses make in their educations, the national turnover rates for nurses is estimated as ranging (depending on region and specialty) from 8.8 % to 37% and healthcare workers are considered by the World Health Organization to be the profession with the highest risk of violence in the workplace (Haddad & Toney-Butler, 2019).
Navigating the nursing profession is a challenging transition time for all nurses, but when inexperienced nurses are faced with high patient loads that would daunt even a trained nurse, many seek to leave the profession, despite the fact there is a desperate need for their presence. Older, more experienced nurses may experience battle fatigue as well, given the observed change within the profession as they are able to spend less time with patients, and they feel the stress of long-term caregiving.
Nursing is a profession, and requires extensive education and training. But it is also a hands-on, high risk profession. Furthermore, violence is not only directed by patients, at least in physical form. The phenomenon of nurses eating their young, or being cruel, condescending, and bullying to less experienced nurses is often a threat to retention and can shut down lines of communication in the workplace, impacting the care of patients in a negative fashion (Gillespie, et al., 2017). Caregiver burnout can lead to “physical symptoms, such as tiredness, insomnia, emotional liability, frustration and anxiety” and compromise the health of nurses and patients, causing more nurses to leave the workplace, further shortages, and thus compound the problem (Vincent, et al, 2019, par.5).
Shortages in and of themselves have been linked to attrition, stress and burnout. According to one study, an “increase of one patient per nurse assignment to a hospital's staffing level increased burnout by 23%” (Botha, Gwin, Purpora, 2015, par.4). Thus, addressing the nursing shortage is a quality of life issue for nurses as well as patients. Stress can also lead to higher rates of nursing errors and less time spent with patients. This further compounds the level of stress experienced by nurses working on units, which them must work to compensate for the mistakes of others, and are (rightly) subjected to greater scrutiny because of higher rates of patient recidivism, poor follow-through on the part of patients regarding discharge orders, and lower rates of patient satisfaction.
The nursing shortage is a complex, multifactorial problem. But it is not an insurmountable one. Higher salaries for nursing faculty and incentives for nurses to teach at the undergraduate and graduate level are needed. It may also be necessary to allow qualified nurses with experience but without PhDs to teach certain classes. Universities must expand and fund their programs. Increasing online enrollment may be helpful in permitting nurses to increase their qualifications at minimal cost while still working full-time. Healthcare institutions must be willing to pay nurses commensurate with their experience and qualifications, and consider hiring nurses to undertake duties of leadership and primary care formerly assumed by physicians. Such leadership can be empowering to the status of nurses within healthcare, as well as reduce costs. There must also be a stress reduction program and a zero tolerance for harassment, as well as adequate staffing levels to minimize burnout and interpersonal friction.
Summary
The nursing shortage is a national crisis. It is a crisis for patients, whose care is compromised due to highly stressed healthcare workers. It is also a crisis for nurses who should not have to cope with bullying and punishingly long hours and caring for more patients than is feasible. The nursing profession offers a unique, holistic approach to patient care that can be highly beneficial, given the unique conditions and challenges of healthcare in America. But nurses must be equipped to leverage their expertise in a positive way.
References
ANA health care economist Peter McMenamin on the nursing shortage outlook. (2019). Nursing
World. Retrieved from:
https://www.nursingworld.org/~4afb8f/globalassets/practiceandpolicy/health-and- safety/rnjobmkt_peterminterview_final_030713.pdf
Bond, D. (2017). Will BSN students consider a future nursing faculty role? Nursing Education
Perspectives, 38(1):9–17.
Botha, E., Gwin, & Purpora, C. (2015). The effectiveness of mindfulness based programs in
reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(10):21–29. Retrieved from: https://insights.ovid.com/pubmed?pmid=26571279
Crawford, C. (2019). Addition of Advanced Practice Registered Nurses to the trauma team: An
integrated systematic review of literature. Journal of Trauma Nursing. 26(3):141–146,
Gillespie, G. L., Grubb, P. L., Brown, K., Boesch, M. C., & Ulrich, D. (2017). ‘Nurses eat their
young:’ A novel bullying educational program for student nurses. Journal of Nursing
Education and Practice, 7(7), 11–21. doi:10.5430/jnep.v7n7P11
Haddad, L.M., Toney-Butler, T.J. (2019). Nursing shortage. StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK493175/
Nurse staffing crisis. (2019). Nursing World. Retrieved from:
https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-crisis/
Vincent, L., Brindley, P. G., Highfield, J., Innes, R., Greig, P., & Suntharalingam, G. (2019).
Burnout syndrome in UK intensive care unit staff: Data from all three burnout syndrome domains and across professional groups, genders and ages. Journal of the Intensive Care Society, 20(4), 363–369. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820232/
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