Public policymaking processes and frameworks

Government

Examine an issue of current relevance to Public Policymaking. As you consider topics, remember that this policy paper should contain a comprehensive assessment of the intended policy and its potential consequences. When you write your paper, you should think of yourself as a staff person who must advise a policy maker facing a problem that must be resolved in the near future. As the staff person, adopt one of the four perspectives to public administration and frame your responses around your chosen approach

This is the problem

There is a high turnover of nurses in the United States.

Consider these startling facts that have recently been released:

In the July/August 2009 Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s. In the article titled The Recent Surge In Nurse Employment: Causes And Implications, the researchers point to a rapidly aging workforce as a primary contributor to the projected shortage. (Am. Assoc. Of Colleges of Nursing: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage)

In the November 26, 2008 Journal of the American Medical Association, workforce analyst Dr. Peter Buerhaus stated: "Over the next 20 years, the average age of the RN will increase and the size of the workforce will plateau as large numbers of RNs retire. Because demand for RNs is expected to increase during this time, a large and prolonged shortage of nurses is expected to hit the U.S. In the latter half of the next decade." (ibid.)

According to a report released by the American Health Care Association in July 2008, more than 19,400 RN vacancies exist in long-term care settings. These vacancies, coupled with an additional 116,000 open positions in hospitals reported by the American Hospital Association in July 2007, bring the total RN vacancies in the U.S. To more than 135,000. This translates into a national RN vacancy rate of 8.1%. (Am. Assoc. Of Colleges of Nursing: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage)

Whist more people have turned to nursing and retained their jobs as a result of the recession, statistics finds that people not only prefer other professions but that disinclination towards nursing is growing rather than decreasing. Pulse, for instance, found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005. The news is not going to get better: in the next 5 years, 55% of surveyed nurses are intending to retire. In that same time -- according to the Health Resources and Services Administration (HRSA) - the nation's nursing shortage will increase to more than one million nurses. Analysts, furthermore show, that this shortage will extend to all 50 states without exception and that the effects of the shortage will be felt by 2015...

It is, therefore, never too soon to start putting some policy in place to reverse this situation.

Examining the problem, it seems to me that the nursing shortage and high turnover is largely, although not exclusively, due to the fact that nurses get paid minimal wage.

Dean (2008), for instance, showed that the one of the factors that is most responsible for inducing nurses to quit, particularly nurses who have a heavy work-life balance and have low economic standards, is wages and working conditions. The working conditions are being seen to. Wage is something that still needs to be addressed. Nurse turnover is problematic for the United States in at least two ways:

1. Nurse turnover is expensive for the State

Nurse turnover can be expensive for the institution as a whole. The last thing our nation wants to do is accrue greater medical expense. today's number one issue for any particular company (medical institutions included) is finding and retaining new employees and even more challenging is finding employees that will help the company progress and move forward. This means that employees -- and here we have in mind nurses -- need to be stimulated. This is particularly crucial since national retention rates reveal that between 62.5% and 67.3% of nurses have been employed at the same organization for more than one year (Donoghue, 2010).

The costs of replacing nurses can be exorbitant and fall into five categories: separation costs, replacement costs, training costs, vacancy costs, and differential costs. Temporary nurses can, of course, be found, but these are likely less reliable than permanent nurses and may produce havoc to a workforce that has to be naturally consistent and stable. High turnover, in short, can be prevented by raising the nurses' salary and making them more motivated to retain their jobs.

2. Nurse turnover can be unsettling for the State

Patients need to rely on their nurses and on the medical system. We need to establish a consistency and greater atmosphere of trust. This trust is slivered by the fact that nurses are leaving in droves for other positions and that our nurse workforce is unstable. Aside from the fact that instability is unsettling for the medical field too (in that different, and possibly contradictory practices and habits are introduced), irregular nursing can also confuse patients and may lead to problems in health (for instance differences in diagnosis). This needs to be prevented.

It seems to me that this problem needs to be addressed from the political perspective since the issue of low wages for nurses has become very much of a gender issue. Contention about gender wage disparities has been historical and ongoing. Social scientists have long contended that women are, generally, paid less than men, the nursing profession is still dominated by females, and it does not help the case to point out that teaching -- also dominated by females is notorious for low wages.. I do not believe that gender discrimination in wage exists in the nursing field. If it does, it certainly needs to be addressed. But we need to prevent our critics, and potential critics from getting out of control. Feminism has always been radical; some see it entering a neo-radical phase.

To sum up: nurses are necessary for the sustenance and well-running of a civilization. They possibly hold one of the most important responsibilities for continuance of any well-running civilization and, therefore, should be paid accordingly. Failing to correct for nurses' income, as Holmas (2002) insists, would result in a downward spiral with more nurses continuing to prefer other occupations. This is my main reason for recommending Government policy that would firstly set out to investigate the statistics of nurses' salary state-per -- state, and secondly implement a policy that would not only raise nurses' salary, but also equalize this salary on an inter-state basis. If disparities exist, they need to be corrected.