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 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