Nurses in the American Health Care System

Nurses hold an important and unique place in the American health care system. As members of the largest health care profession, the nation's 3.1 million nurses work in many different settings. They are the frontline providers. Some nurses work independently and under the supervision of healthcare providers; in hospitals, nursing home, private home, clinics, assisted livings and more. Nurses are turned to by millions for healthcare services, health advice, education, and counseling.

The Great Depression was a time of a lot of turmoil, mass unemployment and hardships. Those who hired nurses for private home care could no longer pay for their service. Nurses attempted to find hospital setting jobs but encountered problems. Unemployment rates for nurses raised drastically during the early years of the depression. Health care and nursing leaders used a trio of strategies to deal with this twentieth century shortage of nurses.

The first was to increase the supply of nurses by increasing the admittance rate to nursing schools. The second was to shorten the amount of schooling needed for nurses to produce more nurses. Lastly, they increased the use of less educated and trained personnel either to substitute for or to extend the work or professional nurses.

For several decades, health service researchers have reported association between nurse staffing and the outcome of hospital care.

As the shortage of nurses was persistently continuing to drop into later decades, health care policies continued to promote the trio of strategies. Which in return became successful at what they were planned to do.

Due to being unaccustomed to nurse shortage, hospitals took a longer time to react. Some went as far as to blaming the nurses for the shortage. They said they weren't living up to what they were expected of and refusing to work.

When the U. S entered the world war II, the immediate need for nurses was obvious and unavoidable. By the wars end, over 77,000 nurses joined the military services, (Where Did All the Nurses Go?, 2018)

That was about 25 percent of the nurse population gone towards the war effort. Doing so only compromised the need for nurses in the civilian community. A proactive response was needed so they took practices used in the past to deal with shortages.

Hospitals began a nurse educational system as the primary means of maintaining adequate nurse services. So, while students nurses were learning the basics and important things of the profession, they were also being used to deliver a majority of patient care. This system is like the saying 'Killing two birds with one stone.'

It became popular, so many hospitals operated nursing schools and relied on the students for bedside nursing care. Hospitals were hoping to help with the shortage of nurses by just admitting more students. This strategy unfortunately wouldn't work forever. It backfired and was becoming a problem for the hospitals.

The three years required for a woman to graduate from nursing school, the working conditions; like the low salaries, long hours, and requirements that nurses live within hospital grounds, made the nursing field less attractive for young people to consider.

Many in the healthcare system believed that the availability of less educated nurses would solve many problems. In the late 1930s into the 1940s, the licensed practical nursing movement began. The short training programs for LPNs appealed to hospital administrators because they wanted more nurses faster, which they got with LPNs. The lower cost also added to their list of reasons for wanting them. The admission to LPN programs were less strict than nursing school and it was believed that it would attract a wider population of students.

Registered nurses, formerly seen as the main caretakers of patients, were viewed as scarce and thought to be better utilized as supervisors of those with less training and education. Patient care provided by professional nurses declined by 70 percent to only 30 to 40 percent in 1951. The shortage of nurses resulted in the U. S. Department of labor to conduct a study examining the causes.

According to (Where Did All the Nurses Go?, 2018), the U.S. Department of labor conducted a study that was called, Economic Status of the Registered professional Nurses. The study confirmed a rising demand for nurses at the same time the nursing profession was experiencing a loss of practicing nurses and an enrollment of new students. Nurses were noticing a lack of retirement pension, the low pay rate and limited opportunities. These in turn became the sources for dissatisfaction with their jobs.

The shortage continued well into the 1960s and the government decided to take action. The 1964 Nurse Training Act was brought about. It was intended to increase the supply of nurses by providing funds for a nursing education.

The need for healthcare within the United States is continually growing. According to the Bureau of Labor Statistics, the number of available nursing jobs is expected to grow by 16% by 2024. With the number of nurses expected to leave the workforce in the next few years, it's projected that there will be more than 1 million unfilled job openings for nurses by 2024.

The nurse shortage is a worrisome trend for nurse executives. The shortage is making it difficult to run a profitable medical facility while balancing patient care and creating a good work culture. It's hard to have great patient care while there is not enough staff to properly take care of those in need.

In nursing home/ rehabilitation centers, just like a hospital, shortages of nurses are a big problem. Nursing home and rehab centers can carry well over 200 beds. A plethora of different medical issues are seen in clients daily. Proper staff to patient ratio is important. The amount of work one is assigned can be detrimental to the patient. If a person is overwhelmed with the work they're assigned and is expected to do, it may not get done properly or get done at all.

Nurses are only human and although the career comes with a lot of work, it can still be hurtful to patients. Some patients like the elderly and mentally unstable must be watched consistently. Those who are fall risks and at risk for elopement may need to be checked upon every half hour. An intervention that may lower those risks is having those at-risk patients moved to a room closer to the nurses' station. Delegating the proper assignments to the proper staff can help with making sure everyone is taken cared of how they should be, and making sure work is getting done to continually care clients.

Assignments should be broken up between what's less and more important, to nurses and aides. Things like vital signs, feeding, bathing and other activities of daily living can be assigned

to an aide. While medication administration, assessing, dressing changing, diagnosing, and reporting, to name a few, will only be done by nurses.

Maintaining proper nurse staffing ratios does not just ensure better care, it is the law. Federal regulation 42CFR 482.23(b) requires hospitals certified to participate in Medicare to have adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.

Without giving a clear figure, it is left up to each state to determine how to ensure that staffing is appropriate to patients' needs."

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