The Nursing Shortage: Everyone's Problem and Everyone's Solution - Essay Example

The Nursing Shortage: Everyone's Problem and Everyone's Solution The skyrocketing figures on nursing shortages are alarming and the future looks even more terrifying. It is projected that the current shortage of just over 100,000 nurses will balloon to almost a million vacancies in the nursing profession by the year 2020 (Gerson and Oliver). It will affect hospitals, physicians, nursing homes, and government agencies. These staggering numbers will impact the quality of care and further degrade the working conditions for the nursing industry. The solution lies in decreasing the demand, increasing the supply, and managing nursing skills effectively. The shortage is everyone's problem and the solution will need to come from the federal government, the states, hospitals, professional organizations, and local medical institutions. The Federal Responsibility The nursing shortage is a national crisis and any solution will need to have the support of the federal government. The Nurse Reinvestment Act of 2002 appropriated funds to aid in the recruitment and retention of nurses at all levels, but has seen budget cuts in recent years. The bill expires in 2007 and the Congress should reauthorize the bill and increase the funding from $150 million in 2007 to a minimum of $200 million in 2008. This is the level that had been recommended by the Nursing Organizations Alliance and many other members of the nursing community (Beu 1063). Known as Title VIII, it funds nursing grants, education, retention grants, loan repayment, scholarship programs, faculty loans, and diversity grants. An expansion of these programs is a necessary foundation for increasing the supply of qualified nurses. In addition to increasing the funding for Title VIII, the federal government also needs to make a legislated commitment to enhancing the educational infrastructure. In 2005, nearly 150,000 qualified nursing school applicants were turned away because there were too few places to train them (Cooper and Aiken 68S). This was due partly to a lack of faculty, but was also a result of a lack of facilities. This extends from the classroom into the clinical setting. Attracting new student nurses through scholarships and loan repayment programs can only be productive if they have quality programs to enter. The federal government should also set a policy on limiting immigrant nurses. Though there is a substantial pool of qualified nurses in developing countries, it may be counter-productive for the US to depend on this international resource. The US should pursue bilateral agreements with countries that have served as a major source of nurses. It is in the international ethical interest that the US does not deplete the nursing supply in the developing nations and leave them in a medical crisis. These agreements would also protect our nation's supply of nurses as the world becomes more mobile. Buchan warns us that though the US is currently the premier market for working nurses. " ... I think you will see some more nurses moving from your country to others, perhaps for reasons other than purely financial" (23S). By cooperating to keep the source countries at a healthy level, we can assure that this international resource will not run out. The State Responsibility While the federal government can stimulate the supply of nurses, it is up to the states and the institution of nursing to retain them. A survey by Lynn and Redman in 2006 reported that the two most important factors for nursing retention was an increase in pay and "a climate of retention in health care facilities" (685). The intangible climate that the nurses spoke of included team work, decreased workload, communications, and being a part of the staffing decision process. A policy of employee empowerment would reduce psychological burnout. Women who have traditionally made up the bulk of the nursing staff have been presented with opportunities in competing career areas. Hospitals and medical institutions need to reevaluate pay scales and working conditions and adjust their policies accordingly. Working conditions for nurses have been exacerbated by the growing shortage as the workload increases and the hours get longer. States need to step in and pass legislation that regulates the allowable patient to nurse ratios and limits the amount of overtime nurses are required to work. Though the hospital industry has been critical of this approach, several states have been successful at regulating staffing levels (Stone, Clarke, Cimiotti, and Correa-de-Araujo 1988). Increasing staffing through legislation has the long-range effect of increasing retention and reducing the nursing shortage. State regulations can also help the licensed practical nurse (LPN) bridge the gap on registered nurse (RN) shortages. State law controls the functions of the LPN and the legal restrictions on their job description. Many of these LPNs are working their way toward becoming an RN. According to Seago, Spetz, Chapman, and Dyer, "If the scope of practice for LPNs is sufficiently broad, they might be able to perform many of the same tasks RNs perform" (40). It is incumbent upon state regulators to draft practical requirements for LPNs and RNs. Institutional Level Programs In addition to pragmatic considerations, nurses need to be presented with a path for career advancement. Institutional policies of ongoing education are vital. They need to be considerate of time off as well as tuition reimbursement to advance nursing skills and increase the level of nursing competency (Jacobs 144). In addition to promoting an atmosphere of respect and esteem for the employees, it would increase the pool of qualified nursing instructors. These policies should extend to specialized training as well as to the Doctorate level. A pro-active policy of career advancement would help to supplement other retention efforts. There is also a critical a need for a collaborative program between educational institutions and hospitals to accommodate clinical services. The current methods of securing a clinical site in a large health care system are complicated by a lack of coordination between the schools and the hospitals (Hodges and Kline 268). Regional consortiums that can coordinate the clinical placement of nursing students at the most advantageous locations would relieve the load from the hospitals and maximize the benefit of the clinical experience for the student. Innovation While government and institutional policies can recruit, train, and retain the nursing workforce, there are a number of innovative programs that that can maximize the nurse's productivity and minimize the demand for nurses. Nursing role reclassification may be able to stretch the workforce coverage. Unlicensed assistive personnel (UAP) may be "cross-trained in a variety of skills such as those required for performing a phlebotomy, taking an electrograph, and changing dressings" (Lookinland, Tiedeman, and Crosson 75). Together with patient care technicians (PCT) they could work under close supervision of the RN who is accountable for the quality of care. This model helps alleviate the nursing shortage and frees the RN to address more professional concerns. The nursing shortage is being aggravated by an aging population base that is increasing the demands on the health care system and an aging workforce that is reaching retirement age. The Center for American Nurses (CAN) and the American Nurses Association (ANA) have recommended setting policies that will delay retirement or lure recent retirees back into the workforce. They suggest a wide range of policies that include "... phased retirement, health benefits for part-time work, more paid time off, flex time, self-scheduling, and job sharing" ("How to Lure" 34). Policies that encourage delayed retirement retain the most experienced nurses in the system. In conclusion, there will be no magic bullet to eliminate the severe nursing shortage that we will face in the coming decade. We will need to increase the supply, reduce the demand, and manage our existing resources. The federal government will need to increase funding to assure every qualified applicant has a facility to attend class at and a plan for financing their education. State governments need to step in and regulate the working conditions of the workforce in an effort to increase employee retention. Reduced overtime and increased staffing are mandatory to reduce nurse turnover. Institutions working with government regulators should pursue unique solutions through ability management. This could serve to cover unfilled vacancies with available and qualified workers. The nursing shortage is everyone's problem and it is the responsibility of the entire medical community to get involved with the solution. Works Cited Beu, Burke. "The Nursing Shortage and the Nurse Reinvestment Act." AORN Journal 79.5 (2004): 1061-63. Buchan, James. "The Impact of Global Nursing Migration on Global Health Delivery." Policy, Politics, & Nursing Practice 7.3 (2006): 16S-25S. Cooper, Richard A., and Linda H. Aiken. "Health Services Delivery: Reframing Policies for Global Migration of Nurses and Physicians - A US Perspective." Policy, Politics, & Nursing Practice 7.3 (2006): 66S-70S. Gerson, Jason, and Thomas Oliver. "Background Brief." Addressing the Nursing Shortage. Aug. 2005. Henry J. Kaiser Family Foundation. 28 Mar. 2007 . Hodges, Jan, and Kay Kline. "The Clinical Placement Consirtium." Journal for Nurses and Staff Development 21.6 (2005): 267-71. How to Lure Retired Workers Back to Work." Nursing 2006 36.3 (2006): 33-34. Jacobs, Phyllis M. "Streamlining an RN-BSN Program for Nurses." Nursing Education Perspectives 27.3 (2006): 144-47. Lookinland, Sandra, Mary E. Tiederman, and Amy Crosson. "Nontraditional Models of Care Delivery." Journal of Nursing Administration 35.2 (2005): 74-80. Lynn, Mary R., and Richard W. Redman. "Staff Nurses and Their Solutions to the Nursing Shortage." Western Journal of Nursing Research 28.6 (2006): 678-93. Seago, Jean A., Joanne Spetz, Susan Chapman, and Wendy Dyer. "Can the Use of LPNs Alleviate the Nursing Shortage" American Journal of Nursing 106.7 (2006): 40-49. Stone, Patricia W., Sean P. Clarke, Jeannie Cimiotti, and Rosaly Correa-de-Araujo. "Nurses' Working Conditions: Implications for Infectious Disease." Emerging Infectious Diseases 10.11 (2004): 1984-89. Read More