Associate Degree in Nursing: Addressing the Shortage Crisis

Introduction: The Nursing Profession in Crisis

This essay focuses on the current educational levels available in the professional nursing arena and proposes a minimum educational standard that should be required for the Registered Nurse boards at the associate degree level. This work should be considered a formal recommendation to the State of Connecticut Licensure Board. We are at a time of crisis in the nursing profession, and new educational standards may be the only solution for the future.

Throughout our modern circumstances, we have developed a crisis-driven healthcare system marked by hospital downsizings, restructuring of whole systems, and in some cases complete system failures. These are but a few of the many issues healthcare professionals now face. These phenomena, coupled with a host of other challenges, have led to a great deal of upheaval — especially in the nursing community. Nursing shortages, union concerns, deliberate short-staffing as a cost-reduction measure, and the associated pressures of those staffing shortfalls continue to drive the nursing community to search for solutions to current and future workforce gaps.

All of these concerns will eventually reduce the overall quality of care nurses are able to provide for their patients. The nursing profession is also an aging system in which older, more experienced nurses are leaving in large numbers while the profession struggles to replace them. As one observer has noted, "Largely because of current conditions, veteran nurses are leaving the field and potential new entrants are being discouraged from joining the profession. Just as the population is aging and in need of more nursing care, the nation now faces a new nursing shortage." (Gordon) It will therefore be an important function of the current licensure board to adopt new standards that both maintain high levels of professionalism in the nursing field and promote the profession to a younger generation that has not entered the field in the same numbers as previous generations.

This recommendation strongly urges the State of Connecticut Licensure Board to recognize a new RN Associate Degree in Nursing in order to recruit more potential nurses into the field and to provide a clear advancement pathway for qualified individuals who have already attained the LPN credential. This educational approach would greatly increase the number of opportunities available and thereby dramatically raise both the quality of and access to the nursing profession.

Furthermore, an RN Associate Degree in Nursing could increase the collaborative efforts of nursing faculties in teaching, practice, and research, enhance the profession's ability to educate nurses for practice, prepare future nurse educators, and advance nursing science — all at a time when the number of professional nurses, qualified nurse faculty, and nurse researchers is dwindling.

Many other professions with similar standards and levels of professionalism have already reduced the time required to achieve licensure. The nursing profession should follow suit so as not to allow a lengthy educational process to drive away additional candidates. As a profession, we should look to our leaders to develop a condensed yet detail-oriented RN Associates program.

Problems Faced by the Nursing Profession

This program should model the positive attributes of existing nursing leaders, provide a well-defined foundation of professional expectations, and offer insights into the healthy communication processes required by the vocation. The key, however, would be to take full advantage of current trends in technology so that the program provides flexibility — beginning with reduced complexity in early coursework and gradually increasing in rigor as experience is gained.

One would think that the high costs associated with successfully recruiting, training, and retaining qualified nurses would compel nursing schools to pay close attention to the many reasons why the profession has been losing potential students. In general, the people who enter the nursing profession tend to have a strong sense of duty. Nursing is an environment where quality of patient care is the primary driving factor — it is fundamentally a caring vocation first and an economic industry second.

Because many nursing programs are not prepared for the twenty-first century student, they will be unable to produce enough nurses for a staffing mix capable of sustaining high levels of care. Attention must be paid to the needs and characteristics of today's potential nursing student. The system will continue to need more registered nurses and licensed practical nurses throughout medical facilities, and the healthcare system cannot afford to wait.

Consequences If No Action Is Taken

There is a well-documented correlation between lower registered nurse counts and increased rates of medication errors, hospital-acquired infections, and diminished patient satisfaction. The Associate Degree program would therefore help reduce the time it takes to bring more nurses into the workforce and consequently improve care quality and satisfaction ratings across healthcare settings. For further context on the nursing shortage in the United States, the scope of the problem is both national and growing.

The United States healthcare system currently includes health plans, physicians, hospitals, clinics, consumers, public health programs, and — crucially — nurses. As the median age of the nation's population continues to rise, more and more Americans will require the services of this system. If nurses remain in short supply, the consequences will be significant and unavoidable.

The current nursing shortage has been clearly documented in the media and in academic research. One analysis found that organizational commitment among nurses "is most related to personal factors, opportunities for learning, job satisfaction, plan for retirement, monetary benefits, patient care, coworkers, cultural factors, and job security, in that order. Lack of organizational commitment is most related to conflict with personal needs. However, lack of learning, lack of appreciation and fairness, inadequate monetary benefits, patient care situations, poor relations with coworkers, career developmental stage, and lack of job security are also discussed." (McNeese-Smith) With such widespread recruitment and retention challenges already present, the system will only deteriorate further as the population ages.

The current crisis is intensifying. As has been the case for decades, demand for nurses and other skilled healthcare workers will increase while the aging workforce reduces the available supply. Baby Boomers nearing retirement will shrink the nursing census at the very moment more practitioners are needed. "Therefore, healthcare administrators must work harder to promote and develop methods for building organizational commitment among nurses, and among other clinicians, before that imminent shortage occurs." (McNeese-Smith)

Multiple factors are working against the healthcare industry simultaneously. The population is aging and cannot simply replenish nursing ranks on its own. Even given well-publicized forecasts, the industry has been slow to build capacity in nursing schools as current nurses approach retirement age. Like many other industries, existing healthcare management teams have been forced to do more with less. "As administrators consider the enormous costs of turnover and a limited supply of nurses, they should create effective strategies for retaining long-term affective commitment of skilled nurses." (McNeese-Smith)