Nursing Shortage Across the United States

In recent years, there has been a notable trend of a nursing shortage across the United States. This prominent issue has many contributing factors, such as inadequate job satisfaction, but if the problem is not addressed the number of nurses in the workforce will continue to decline. Additionally, change needs to happen in nursing classrooms to better educate future healthcare workers on how to overcome the challenges that lead to nurses quitting their careers. The nursing shortage does not simply affect nurses, it also contributes to the care of patients. A decrease in the amount of nurses working puts an extra workload on those who remain in the healthcare field and nurses that continue to stay in their profession but are unhappy are less likely to treat patients efficiently. Nurses play a role in maintaining patient safety and autonomy, this cannot be accomplished if nurses have no sense of value in their work. Disruptions to a nurse's responsibilities could also potentially lead to medical errors. Lastly, the nursing shortage extends beyond hospital care, it has an impact on nursing research itself. 

Causes of the Nursing Shortage There are several factors that contribute to the nursing shortage, one of the key reasons is due to the work environment in hospitals themselves. According to the journal Promoting a Healthy Workplace for Nursing Faculty and Staff (2012), unhealthy workplaces cost institutions financially and emotionally. It is stated that over 90 percent of healthcare employees experience incivility at work and the work-related stress in the United States is costing these corporations around 300 billion dollars. A lack of mentoring in positive ways can create competition instead of helping nurses work together and communicate efficiently. Organizations, such as the AACN, are trying to combat this problem by setting standards in hospitals like true collaboration and effective decision making. Staff members are not likely to be recruited or be retained if an apparent negative dynamic exists between faculty and their facility.

Other Issues

Wilson (2012) states in the journal Redesigning OR Orientation that other causes contributing to the nursing shortage include poor orientation to units and high patient acuity. Patient acuity is highly associated with patient safety, therefore as acuity increases so does the need for more nursing resources to provide safe care (Wilson, 2012). Nurses will have increased work to do as the need for safety grows. This includes double checking orders, properly dispensing medications, and other safety precautions that fall under the nurse's job description. According to Wilson (2012), some hospital units function based on a team member hierarchy built on roles and knowledge. When a hierarchical environment exists, it becomes a source of stress for nurses who have low confidence in their practice due to feeling inferior and incompetent (Wilson, 2012).

Effects of the Nursing Shortage on Patients and Nurses

The journal A pilot study to evaluate mindfulness as a strategy to improve inpatient nurse and patient experiences (2014) states that patient outcomes can be improved through mindfulness training for the nursing staff. Without this intervention, dealing with a shortage of nurses would be even more stressful to currently employed nurses and patient satisfaction would be minimal. Nurses on units tend to experience a feeling of burnout or mental exhaustion, which often leads to them leaving their positions. This pilot study stated that burnout scores improved when participants returned from the mindfulness training program (Horner, Piercy, Eure, & Woodard, 2014). Utilizing techniques to develop mindfulness can combat the challenges that come with the nursing shortage, such as nurses having to handle more responsibilities involving patients. When it comes to the effects the nursing shortage has on patients, Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care (2018) discusses how families and patients are losing valuable time trying to find nurses to help. Specifically, there is a lack of nurses that perform home care which is leading to extended hospital stays for ill patients. Families spend about 10 hours a month searching for additional nursing coverage. Children with complex health issues that depend on family members to take care of them are impacted on multiple levels. Members of the family describe suffering from a lack of sleep, loss of employment, reduced income, and less time to socialize (Weaver, Wichman, Bace, Schroeder, Vail, Wichman, & Macfadyen, 2018).

Effects on Nursing Research

According to National Survey of Hospital Nursing Research, Part 2 (2013), hospitals where the research environment was predominated by physicians decreased the amount of nursing research. When questioned, multiple respondents stated that other disciplines were not aware that nurse led research existed. Another thought that was often expressed was that it was believed that only medical staff could conduct research. There is also a lack of policies for nursing research (Turner, Speroni, McLaughlin, Kelly, & Guzzeta, 2013). Even in hospitals with procedures in place for nursing research, the number of participants may be small due to the shortage of nurses. In addition, there are less nurses to advocate for the need for nursing research. Nurses might feel unheard and might resort to leaving their facility.

Ways to Correct the Shortage Increased Earnings/Job Satisfaction

In the article Ensuring the Availability of the Nursing Workforce Through Philanthropy Bolton, Swanson, and Zamora (2014) conclude that job satisfaction could increase through philanthropy and more educational opportunities for currently employed nurses. The main case for this movement is the federal dollars allotted for nursing education have in large part remained relatively ?at over the last 5 years, according to the HRSA's Sequestration Operating Plan for FY 201. More funding and increased education, like specialty certification, are necessary for quality healthcare services to patients and their families. These educational options lead to higher job satisfaction for nurses which in turn leads to higher patient outcomes and satisfaction for patients. Several elements are included in this plan for more education, such as internship programs to meet complex needs of patients, on-site academic advancement in nursing degree preparation, expanding leadership mentoring for emerging nursing leaders, more evidence-based practice for better patient care, and increase the number of students entering and completely nursing programs. Implementing these concepts could cause a decrease in the amount of nurses retiring which was recently predicted at about 30% of current nurses leaving their work by the year 2020. According to this case study, speaking to community groups and elaborating on the importance of nurses in a community's health care system is vital to increase donors for these programs (Bolton et al., 2014). Having these supporters for higher educated nurses are crucial to better patient outcomes and it makes the nurses feel valuable. Therefore, if nurses feel as though they can grow and improve themselves as professionals, they are more likely to stay at their job.

Enhance the bonds between Nurses, Patients, and Physicians

Vogelpohl, Rice, Edwards, and Bork, (2013) in the article New Graduate Nurses Perception of the Workplace: Have They Experienced Bullying? describe methods and research to show that having a negative atmosphere at work is a direct cause of the nursing shortage. However, this study can be useful to show hospitals and other healthcare facilities what not to in cooperate in their practice. Approximately 10 percent of nurses reported that they were ordered to work below their level of competence and a portion of participants in the survey were exposed to an unmanageable workload. The main source of bullying was fellow nurses, followed by physicians and patients or the family members of patients. All the authors concluded that there is a need for advocacy for in nursing that allows for clear communication between colleagues. This is especially crucial since receiving tasks with unachievable deadlines and aggressive attitudes were details considered bullying by nurses. Also, having a team approach and being sensitive to patient's needs can ease tension between patients and nurses (Vogelpohl, Rice, Edwards, & Bork, 2013).

Maintain an Increase in Nursing through Education

It is possible to fight back against the nursing shortage by changing the curriculum in nursing education by changing teaching strategies and promoting diverse methods of learning. These concepts will better prepare future nurses for their careers and how to handle difficult situations. The academic journal A Call to Action. Dimensions of Critical Care Nursing by Ruth-Sahd (2014) lists propositions to aid in this battle. First, stated in the article is that the admission process into nursing programs should change since they can be perceived as inconsistent. Most applications to be accepted require a minimal grade point average, a letter of recommendation, and a specified score on a national test. Graduation rates for an associate's degree in nursing is only 58% and attrition rates for newly hired graduate nurses have been a little over 60%. This has a direct effect on the current shortage of nurses. Therefore, Ruth-Sahd (2014) states that perhaps those applying to nursing school could complete a 30 to 50 hour job shadowing of a registered nurse, that way they can become aware of the multiple responsibilities of a nurse (Ruth-Sahd, 2014).

Improve Learning Methods

In addition to changing the application process, A Call to Action. Dimensions of Critical Care Nursing also states that the center of nursing education programs should be direct at promoting positive patient outcomes. Stressing the importance of patient safety and health promotion gives nurses a sense of obligation to stay true to their responsibilities. Nurses will feel more connected to their work and are more likely to remain employed. More education is not going to fix the shortage by itself, it must also be of higher quality. Integrating new technology and scientific research is an essential part of nursing education. Nurses work with sophisticated technology and online programs when it comes to their daily roles, such as charting. Early exposure to these advancements will make using equipment easier. Educators must teach students how to be problem solvers and how to critically thinkers. This will allow nurses to take informed action and think of alternative options when caring for patients (Ruth-Sahd, 2014).

Lastly, learning to work collaboratively with other workers will lead to less tension in the workplace and will lead to better patient outcomes along with decreased readmission numbers. Teaching proper communication will reduce medical errors and nurses will have to fill out fewer incident reports, a critical part of their job. Due to the complexity of healthcare environments patientcare requires a collaborative, collegial approach. Nurses must understand the roles of other health care providers, so they retain their voice and power to make key clinical decisions (Ruth-Sahd, 2014). The fewer number of patients readmitted and giving nurses' a voice will cause less stress for nurses. The nursing shortage is taking its toll on healthcare facilities and beyond, but many measures are being taken to control the number of retiring nurses.

References

1. Bolton, L. B., Swanson, J., & Zamora, E. (2014). Ensuring the Availability of the Nursing Workforce Through Philanthropy. Nursing Administration Quarterly, 38(4), 327-331. doi:10.1097/naq.0000000000000053 Fontaine, D. K., Koh, E. H., & Carroll, T. (2012). Promoting a Healthy Workplace for Nursing Faculty and Staff. Nursing Clinics of North America, 47(4), 557-566. doi:10.1016/j.cnur.2012.07.008 Horner, J. K., Piercy, B. S., Eure, L., & Woodard, E. K. (2014).
2. A pilot study to evaluate mindfulness as a strategy to improve inpatient nurse and patient experiences. Applied Nursing Research, 27(3), 198-201. doi:10.1016/j.apnr.2014.01.003 Ruth-Sahd, L. A. (2014). A Call to Action. Dimensions of Critical Care Nursing, 33(1), 28-33. doi:10.1097/dcc.0000000000000020 Turner, A., Speroni, K. G., McLaughlin, M. K., Kelly, K. P., & Guzzeta, C. E., (2013). National Survey of Hospital Nursing Research, Part 2. JONA: The Journal of Nursing Administration, 43(Supplement). doi:10.1097/01.nna.0000435149.31714.7b Vogelpohl, D. A., Rice, S. K., Edwards, M. E., & Bork, C. E. (2013).
3. New Graduate Nurses Perception of the Workplace: Have They Experienced Bullying? Journal of Professional Nursing,29(6), 414-422. doi:10.1016/j.profnurs.2012.10.008 Weaver, M. S., Wichman, B., Bace, S., Schroeder, D., Vail, C., Wichman, C., & Macfadyen, A. (2018). Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care. Journal of Hospice & Palliative Nursing, 20(3), 260-265. doi:10.1097/njh.0000000000000436 Wilson, G. (2012). Redesigning OR Orientation. AORN Journal, 95(4), 453-462. doi:10.1016/j.aorn.2012.01.022"

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