Shortages of Health Care Providers

Informatics Telehealth and the Health Care Shortage
Snavely (2016) shows that the looming nursing shortage is due to hit America hard in the coming years, and that shortage is now evident more than ever with the arrival of the novel coronavirus in America—especially in hard hit areas like New York City, where the hospitals are being overrun by patients infected by the virus. Shortages of health care providers is a major concern in the US, especially since the US is meant to be a world leader among other nations—and yet an element of its critical infrastructure, health care, is sorely lacking in support in the form of providers. Now that the country has gone into lockdown mode, it is only making matters worse from an economic point of view: going to school for medicine is expensive and individuals and families may reassess their commitment to the field if they see a recession or, worse, a depression coming as a result of the lockdown that is putting millions out of work and shuttering businesses right and left—potentially for good. If economic woes persist for the remainder of the year, the shortage of health care providers could grow considerably, as Snavely (2016) intimates, which will only worsen the problem with the current pandemic that realistically speaking has no end in sight.
Shortages of health care providers is an issue that has to be addressed—but why is it happening? Currently, the US is facing an aging population that will have a chronic need for increased care in the coming years, and the Affordable Care Act passed under the Obama Administration has ensured this population that care will be provided for them. Yet the American Nurses Association has noted that through 2022 there will be more positions available for registered nurses than for any other job in America (Haddad & Toney-Butler, 2019). The Bureau of Labor Statistics has projected that some 11 million nursing positions will need to be filled in the coming years and that the health care industry is going to grow more than any other industry in the country over the next six years (Haddad & Toney-Butler, 2019). But shortages, high turnover and poor distribution of health care providers persists. What are the reasons for this and what can be done to address them?
The Institute of Medicine (2010) has noted that access to care needs to be improved in the US and one way to do that is for states to allow APRNs to practice to the full scope and extent of their education and training. O’Brien (2003) points out that, indeed, Advanced Practice Registered Nurses were originally trained to take the place of doctors leaving primary care for specialized medicine. APRNs in other words have been trained and educated from the beginning to fill the gap in health care—yet some states still refuse to allow them to practice independently of physicians, even though APRNs have the education and training to do so. The shortage of health care providers thus persists in part because of bureaucratic hang-ups regarding the adequacy of nurses to do what doctors do. Another problem leading to the shortage of health care providers is the lack of readiness that providers have to make the transition from school to the real world. Turnover among nurses and care providers is still too high to ensure proper nurse to patient ratios in most facilities. Is there a solution from an informatics point of view to address this shortage of health care providers?
According to Clemmer (1995) there is: informatics can play a big role in telemedicine, which can be used to address the shortages of health care providers and improve access to care by allowing care providers to communicate with and monitor patients from long distances using the Internet. Instead of having patients come in to facilities and endure long wait times and lead to facilities being overrun, telemedicine can eliminate space and time obstacles and get care to patients simply and easily without much fuss or exertion. This can ease up backlog and reduce the impact of health care provider shortages.
The way that informatics can informatics helps in telemedicine is by providing the computer technology and databases that care providers rely upon for the information they need to readily help patients. With electronic health records, for instance, nurses and doctors can immediately bring up a patient’s data on computer file and make faster decisions based on accurate patient health history, previous treatments, medications prescribed and so on. Computer technology helps to improve standardized care and assist in monitoring via telemedicine so that it requires fewer nurses present to tend to more patients (Clemmer, 1995). As Demiris (2003) shows, telemedicine is actually a very important part in informatics because it allows health care providers to use telecommunications technology to overcome time and space obstacles and bring quality care to more patients in a more effective and efficient manner.
Another way to tackle this problem is for informatics to be used in a way so as to improve health care provider education. Currently nurses are trained, for example, in schools—but as Foster and Sethares (2017) show there is a need for informatics to play a larger role in the curriculum that nursing educators are using, the reason being that informatics can improve quality of care for patients and yet it is not as receiving as much attention as it should be in nursing education. Nurses are getting their degrees and certificates and entering into the field and being surprised by the role that informatics plays in the field. They are stunned by this and cannot cope with the technical nature of the job in the 21st century because they were not adequately prepared for his aspect of nursing. This in turn leads them to feel unsatisfied in their jobs and causes high turnover rates to occur. Because of high turnover, the shortages of health care providers persists. What is needed is for educators and professionals in the field to get together and create a curriculum that is more real world oriented so that nursing students are not so surprised when they get their jobs in the real world. Hasbrouck (2016) argues that nurses need to know more about informatics before they graduate and that they need to be trained especially in informatics in order to be successful in the field.
Other concerns in terms of nursing shortages are an aging workforce, nurse burnout, the needs of families that impinge upon the care providers decision to have a career in health care, the regional effect in which there are nursing surpluses in some parts of the country and shortages in others simply because of the population and the level of education and opportunities there, and the issue of violence in the health care setting (Haddad & Toney-Butler, 2019). Ironically, Haddad and Toney-Butler (2019) also see informatics, which is a booming sector in health care right now according to them, as part of the problem in causing nursing shortages. Haddad and Toney-Butler (2019) argue that because informatics is a specialty it is drawing nurses and health care providers away from the field of primary care and into the field of technological services. This thus exacerbates the nursing shortage issue.
The solution here is that there has to be more integration between informatics and nursing in general because this is the 21st century after all and the digital age has arrived. The digital age means that everyone today has to become a digital native so that they can understand digital technology, the way computers work, and how information can be used to create solutions in health care. Nurses and care providers have to be as skilled with using computers as they are in treating patients. Computer usage should not be a specialized form of health care medicine but rather a staple that all health care providers learn about.
The mistake that doctors were making back in the 20th century was leaving primary care for specialized medicine because the pay was better and insurance was then becoming a benefit provided by companies to attract workers. That pursuit of greater profits meant that gaps in care were occurring in the primary care field, and today nursing students are leaving the primary care field for informatics because they see that technology is the wave of the future and that health care facilities are going to need specialists in informatics in order to keep their systems operating in an efficient manner. However, there is only a limited number of people who are interested in health care, and if they are all being pulled away in different directions from primary care the shortage is only going to get worse.
At some point the issue is cultural because the shortage could be addressed if part of America’s cultural understanding was to focus on the importance that health care is for society. This is currently being seen to some extent now that the COVID-19 crisis is wreaking havoc in the country. People are beginning to express their gratefulness to health care providers in the same way they would stand up and salute and support our soldiers and firemen in the years following 9/11. When Americans begin to realize who the real heroes are they respond generously and it draws attention to the field and inspires more young people to want to pursue a career in a field that they see as legitimate and honorable.
So while Haddad and Toney-Butler (2019) lament the fact that informatics as a specialized field in health care may be drawing potential primary care health care providers away from the field, the reality is that informatics are needed and is a necessary part of what it means to be a health care worker today. Informatics are required for getting information out fast and allowing care providers to know what is going on with a patient immediately. It is good for recording information accurately and standardizing the care process.
The best part of informatics and how it can help with the shortage situation that it may or may not be partly to be blame for is that it assists with telemedicine which is a new approach to health care that can help to close the gap and address the health care shortage issue. The more that telemedicine and telehealth can be incorporated into the health care system overall, the more of an impact individual nurses can have on a greater extent of the population. Through telemedicine anyone with an Internet connection can gain access to the care they require, can be monitored, or can meet with health care providers to go over options, and so on.
Health care shortages are an issue, but the possibilities afforded by communications technology in the 21st century show promise. Informatics may be luring potential nurses away from actual nursing, but the plus side is that informatics supports telemedicine in a big way and makes it possible for the former to work efficiently. So whether one sees informatics as a problem in terms of the nursing shortage or as a benefit, the reality is that there are many factors that are contributing to the current health care shortage—but the field of informatics is definitely a field that is required because it will support the health care approaches of the future, which are found in telehealth.
References
Clemmer, T. P. (1995). The role of medical informatics in telemedicine. Journal of Medical Systems, 19(1), 47-58.
Demiris, G. (2003). Integration of telemedicine in graduate medical informatics education. Journal of the American Medical Informatics Association, 10(4), 310-314.
Foster, M., & Sethares, K. (2017). Current strategies to implement informatics into the nursing curriculum: an integrative review. J Nurs Inform, 21(3).
Haddad, L. M., & Toney-Butler, T. J. (2019). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing.
Hasbrouck, L. (2016). Strengthening local health department informatics capacity through advocacy, education, and workforce development. Journal of Public Health Management and Practice, 22(Suppl 6), S3.
IOM. (2010). The future of nursing. Retrieved from http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
O’Brien, J. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy, 60(22), 2301-2307.
Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economics, 34(2), 98-101.