Nursing Shortage, Healthcare Reform, and Nursing Education

The Nursing Shortage and Its Consequences

Nursing shortage is a problem in many countries. It is often difficult to recruit trained nurses, and while nurses are an integral part of the healthcare system, a shortage of trained nurses leaves a significant impact on the overall quality of care. Due to this shortage, there is often a heavy workload on the nurses who are currently serving.

One of the major concerns about the nursing shortage and the consequent workload on serving nurses is the effect on patient safety. Overworked nurses, or nurses who must attend to more patients within a limited period of time, are not able to give adequate attention to each patient as is warranted for proper nursing care. As a result, patient safety is compromised.

The job satisfaction of nurses is also affected, which leads to high turnover and creates further nursing shortages. This in turn leads to deteriorating morale and a lack of motivation, which reduces the quality of service nurses are able to provide. Since the 1990s, hospitals have reduced their nursing staffs and implemented mandatory overtime policies to meet unexpectedly high demands, largely in response to increasing healthcare costs — an indirect consequence of the nursing shortage (Hughes, 2008).

The only way this problem can be effectively addressed is through broader nursing education and proper planning by the healthcare system in utilizing available nurses to obtain the best possible care outcomes.

Nursing Opportunities Under the ACA

The 2010 healthcare reform act — the Patient Protection and Affordable Care Act (PPACA) — gave nurses a new opportunity to deliver care and play an integral role in leading change. Nurses first need to understand these opportunities and recognize how they can be part of the solution to achieving better patient outcomes at more reasonable costs. In the spirit of the act, nurses are called upon to do more to prevent disease, provide chronic care management to an aging, sicker, and more diverse population, and offer end-of-life care that emphasizes comfort and compassion.

Nurses have a role in expanding access to care and improving the quality of healthcare at lower costs. Nursing-led innovations such as nurse-managed health clinics, home visiting programs for low-income mothers, and the Transitional Care Model are examples of initiatives in which nurses can take part.

Nurses can also play an important role in shaping quality and safety through innovation. Collecting and tracking data to improve their own practice, as part of broader efforts to improve care, is one of the key opportunities for the nursing community as outlined in the healthcare reform act. This work would help build the scientific foundation for clinical practice, prevention, and improved patient outcomes.

Nursing education also needs to be redesigned, and nurses with practical experience can help in the formation and reengineering of nursing education curricula (American Nurse Today, 2010).

Innovative Care Models and the PPACA

Section 5208 of the Patient Protection and Affordable Care Act states that grants would be given to nurse-managed health clinics (NMHCs) that provide comprehensive primary care or wellness services without regard to the income or insurance status of patients. This provision has significant bearing on the nursing community, as it creates an opportunity for nurses to bring healthcare services to the underprivileged and to those who cannot afford the established healthcare system.

This section of the act also gives nurses the opportunity to become associated with an academic department of nursing, a qualified health center, or an independent nonprofit health or social services agency, and to gain work experience. With the help of government grants, nurses can run NMHCs and help reduce the nursing shortage to some extent.

Nursing students can also take advantage of the provisions under Section 5204 of the PPACA. This section allows nursing students to obtain a loan from the government or banks in exchange for a commitment to accept employment with a public health agency for at least three years. The government would repay one-third of the loans incurred by public health or health professions students. The government may also repay additional portions of the loan if students agree to provide service in priority service areas after completing their studies. This represents an important opportunity for the nursing community, as the cost of education is reduced and employment is more readily available upon graduation (Rnaction.org, 2015).

The development of innovative healthcare models is being driven by several factors, including a rapidly expanding uninsured and underinsured population caused by excessive increases in healthcare costs and insurance premiums, greater use of community clinics, and high utilization of emergency departments. These challenges are compounded by the rising shortage of nursing staff.

One such innovative model of healthcare delivery involving an interdisciplinary care team is the mobile health clinic. This model delivers comprehensive primary healthcare to patients through partnerships between patients, families, and personal physicians. By moving the healthcare facility to the patients rather than requiring patients to travel to healthcare centers, this model helps reduce health disparities and enables care to reach homeless and underserved populations who often lack transportation and other resources necessary to access traditional facilities.

Mobile health clinics, which can include nurses, doctors, and pharmacists, encourage preventive screenings and immunization, thereby reducing reliance on emergency departments. They also add value to safety-net clinics and enhance the capacity of the healthcare system to address patient needs in remote and rural areas (Maeda, 2015).

Nursing Education and Patient Outcomes

Current research has shown that lower mortality rates, fewer medication errors, and positive patient outcomes are all linked to a nurse's level of education and the degree possessed. Authorities believe that education has a strong impact on a nurse's ability to practice, and several studies have linked patient care outcomes to nursing education levels (Blegen, Goode, Park, Vaughn, & Spetz, 2013).

A study by Olga Yakusheva from the University of Michigan and her colleagues found that a 10% increase in the proportion of baccalaureate-prepared nurses on hospital units was associated with a 10.9% reduction in the odds of patient mortality. The study, titled "Economic Evaluation of the 80% Baccalaureate Nurse Workforce Recommendation," was published in Medical Care in October 2014. It concluded that increasing the proportion of care provided by BSN-prepared nurses to 80% would result in significantly lower readmission rates, shorter lengths of stay, and reduced overall healthcare costs.

Another study found that a 10% increase in baccalaureate-prepared nurses was associated with a 9% decrease in patient deaths in South Korean hospitals. This research was conducted by a team from several nursing schools in South Korea and the University of Pennsylvania and was published online by the International Journal of Nursing Studies in August 2014. The study concluded that increasing the number of degree-holding nurses would reduce the number of in-hospital deaths.

A further study, published in The Lancet in May 2014, concluded that patients experiencing complications after surgery were more likely to survive when treated in hospitals with adequate nurse staffing levels and higher proportions of BSN-prepared nurses (Aacn.nche.edu, 2015).

References

Aacn.nche.edu. (2015). American Association of Colleges of Nursing | Creating a more highly qualified nursing workforce. Retrieved July 23, 2015, from

American Nurse Today. (2010). Nursing's role in healthcare reform. Retrieved July 23, 2015, from

Black.house.gov. (2015). Biography | Congressman Diane Black. Retrieved July 23, 2015, from

Blegen, M., Goode, C., Park, S., Vaughn, T., & Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. JONA: The Journal of Nursing Administration, 43(2), 89–94.

DeNisco, S., & Barker, A. Advanced practice nursing.

Duke School of Nursing. (2011). DNP–PhD program comparison. Retrieved July 23, 2015, from http://nursing.duke.edu/academics/programs/dnp/dnp-phd-program-comparison

Gavriloff, C. (2008). Education coordinator for nursing products: An innovative role to improve efficiency, cost-effectiveness, and patient safety. Journal of Pediatric Nursing, 23(2), e2. https://doi.org/10.1016/j.pedn.2008.01.009

Hanks, R. (2005). Sphere of nursing advocacy model. Nursing Forum, 40(3), 75–78.

Hughes, R. (2008). Patient safety and quality. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.

Maeda, J. (2015). Expanding access to care and improving quality in the Mid-Atlantic States safety-net clinics: Kaiser Permanente's Community Ambassador Program. The Permanente Journal.

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