Nursing Shortage the Cold Hard Facts and Possible Solutions

The United States is expected to have such as large shortage in nurses that it's going to intensify as baby boomers retire and the amount of health care grows. Nursing colleges and universities across the country are struggling to expand enrollment levels to meet the rising demand for nursing care. According to the American Association of College of Nursing (AACN), In 2014, the U.S. Bureau of Labor Statistics (BLS) projects healthcare employment to grow by 26 percent between 2012 and 2022, with an increase of about 4.1 million jobs. (""Healthcare: Millions of jobs now and in the future"", 2014) Hospitals, long-term care facilities, and other ambulatory care settings added 36,000 jobs in October 2018. Over the past 12 months, health care employment grew by 328,000. As the largest segment of the healthcare workforce, RNs likely will be recruited to fill many of these new positions. (""Employment Situation Summary"", 2018)

As a nurse I know the importance of my role and also know that my contribution now in the healthcare is as much appreciated and needed part of several people's lives. Without Medication Techs, Certified Nursing Assistants, Certified Medical Assistants and the variety of nurses the quality care would be a lot different than how many facilities' care for them. The efforts in reducing the nursing shortage is currently apparent and will become more apparent as the nursing shortage grows. I feel the nursing shortage is not fully being addressed in the efforts to improve the number of nurses to fill the huge current and upcoming gap of jobs in healthcare. I will start by addressing some important numbers and problems that attribute to the nursing shortage.

I spoke with Danielle Conrad in 2012 during her term as senator about a bill that she had addressed as an interim study to examine the nursing shortage in Nebraska. As a potential nursing student at that time I knew the importance of my role as a future nurse. After reading through the public hearing, it has been estimated that by the year 2030 there will be vacant positions of nearly 3,838 RN's, nurse practitioners, midwives, and faculty teachers. Juliann Sebastian, dean of the University Of Nebraska Medical Center College Of Nursing spoke about how Nebraska is not alone in the nursing shortage. Nurses provide a great amount of care to healthcare sectors, which are vital to the public. With qualified nursing applicants turned away in 2011, other avenue need to be explored to reduce the nursing shortage.

Nebraska is not alone in facing a serious nursing workforce shortage that threatens public health and undermines economic opportunity. The U.S. Bureau of Labor Statistics predicts that, in addition to hundreds of thousands of positions that will be vacant by 2020 due to replacement primarily for retiring nurses, a total of 581,500 new nursing positions will have been created by 2018. Nearly one-third about 262,000 jobs are expected to be for registered nurses. (""Healthcare: Millions of jobs now and in the future"", 2014) Nursing care is vital to the health of the public and nurses provide care in every sector of healthcare, including hospitals, Long-term care, and primary care. There are two key issues in Nebraska related to the nursing shortage. First, we have a shortage of the number and type of nurses needed to care for Nebraskans now and into the future. Second, we have a shortage of faculty to expand nursing programs throughout the state. Seventy-three of Nebraska's ninety-three counties have fewer nurses than the national standard. Rural areas are particularly hard hit by the nursing shortage. The Nebraska Center for Nursing estimates that Nebraska will have a shortage of 3,838 nurses, registered nurses, by the year 2020. In 2010 schools of nursing around the United States turned away over 7,000 qualified applicants to baccalaureate and graduate degree nursing programs. In Nebraska, 402 qualified applicants were turned away from baccalaureate and graduate nursing programs in 2010. If another 402 applicants were enrolled each year in Nebraska schools of nursing, the shortage projected by the Nebraska Center for Nursing for 2020 would be significantly reduced. (LR 285 Hearing Transcript)

Although interest in nursing careers remains strong, many individuals seeking to enter the profession cannot be accommodated in nursing programs due to faculty and resource constraints. AACN data showed that 39,423 qualified applications were turned away in 2009, which is comparable to that in past years. Another problem in accepting all qualified applicants is not only space, but funding, clinical sites, and faculty.

As the shortage increase and the number of nursing students is limited, much of the problem is factors such as space and funding, but a huge part is the faculty.

According to AACN's report on 2016-2017 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 64,067 qualified applicants from baccalaureate and graduate nursing programs in 2016 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Most nursing schools responding to the survey pointed to faculty shortages as a reason for not accepting all qualified applicants into baccalaureate programs. (""Nursing Faculty Shortage Fact Sheet"", 2017)

Looking at these numbers asks the valid question, How does this impact patient care? Hospitals in 2016 experienced an estimated 16.5% of turnover rate of registered nurses. It's estimated that it takes approximately 54-109 days to recruit an experienced RN. The lack of adequate numbers in nursing staff can affect patient well-being in a number of ways. One of these ways is higher mortality rates. An increase in 1 full time RN per 1000 inpatient days decreased patient mortality rate by 4.3%. Hospitals with fewer nurses witnessed a 2–7 percent increase in mortality. With a shortage of nurses leads to an increase in the workload of the existing workforce, which results in a increase in medication errors. These can range from infusing medicines at the wrong rate (most common) to giving the wrong medicine or mixing up medicines between patients, which easily can result in fatal consequences. Lastly, we are seeing overcrowded emergency departments with longer wait times to see providers. (""The Nursing Shortage and How It Will Impact Patient Care"", 2017).

So, what do we do about the problems that are leading up to a big gap in the number of nurses? I think that there are a few areas that we specifically need to look at to improve this problem. The first being with current healthcare employees, the second with nursing programs, and thirdly with potential nursing students.

Current demand for RNs is high with a limited supply, considering this fact it is noted that one half of RNs are not satisfied with their salaries. By paying more or offering bonuses to those individual who sign on can go a long way in helping to rectify this problem. Providing more training and educational opportunities already in the existing field allows for better growth and personal/professional development, which can create a sense of loyalty. Lastly considering the use of temporary nurses during surges in hospital admissions and common illness seasons.

In the article The Shocking Truth about the Nursing Shortage in the United States, in speaking about the nursing shortage it mentions that, fewer nurses means the ones who are employed experience a higher workload, and often have to cover shifts or work overtime to keep patients covered. The combination of high pressure situations and more hours worked can lead to staff burnout, both emotionally and physically. Compassion fatigue can affect caregivers who aren't able to take time for themselves or who are too stressed in their work environment. Minimal sleep from picking up extra shifts, combined with the emotional energy required to care for additional patients, can contribute to burnout and inadvertently cause the quality of patient care to decline. This can be frustrating if your schedules don't allow for adequate breaks and basic human needs like enough sleep. So, rather than asking nurses to do what feels impossible under these circumstances, employers need to accommodate their nurses' basic needs and listen to their feedback. (""The Shocking Truth about the Nursing Shortage in the United States"", 2018)

Hospitals in Buffalo, New York are partnering with international corporation and local headquarters to help pay for people to attend nursing school if they promise to work for the hospital after graduation. More and more hospitals around the United States are more desperate for nurses and are using sign-on bonuses of $1,500-$2000 and even as high as $8,000-$10,000 to help obtain nurses. But these sign on bonus are not enough to make a long term change. Furthermore, It's not about the bonus check; it's about respect, better working conditions, and job satisfaction. Hospitals have typically responded to past nursing shortages by offering bonuses to nurses who sign up to work there. Why aren't the sign-on bonuses effective at recruiting and retaining nurses in U.S. hospitals like previous years? According to the National Council of State Boards of Nursing, the current shortage is different from past shortages. This one is worse, and the traditional solutions aren't likely to work. Liz Jacobs, RN, spokeswoman for the California Nurses Association said, Nurses need the profession to return to a place where we can do the things that give us job satisfaction, like patient education and basically feeling like you're not jeopardizing patient care and your license every day. With the nursing shortage some places are taking more acting such as the Tallahassee Memorial Hospital. I think nurses want to be paid adequately and recognized for their performance, said Ann Evans, RN, senior vice president for nursing for Tallahassee Memorial Hospital. I think they want to work in a place with good outcomes. People want to work where they're respected. Tallahassee Memorial Hospital is also using a market-based pay strategy to remain competitive and regularly re-evaluate its wages. They are adjusting its pay strategies to better suit its employees' needs and has instituted a tuition reimbursement program as an incentive for its nurses to continue their education. The California Nurses Association's Jacobs suggests that mandatory nurse-to-patient ratios, which California recently announced, may also improve the work environment for nurses enough to draw more nurses back into hospitals. Jacob says, Nurses want to feel the importance of their work, nurses want to feel valued for their work, and nurses must feel they have a voice in decision-making that impacts their practice and work life. Nurses are the glue, the backbone of the healthcare system. (Larson, ""Creating Solutions to the Nursing Shortage"", 2016)

Nursing programs are a very important step in adding more RNs to the workforce and will require more in-depth approach then sign on bonus. Assistance in replacing nursing school faculty is of key importance so that nursing classes can continue to be staffed adequately. When it comes to nursing programs one-third of facilities that educate nurses described their salaries as uncompetitive. Higher salaries and additional incentives, monetary as well as non-monetary, can help retain existing talent and attract better teachers into the profession. Another way to make nursing financially attractive would be to facilitate faster and easier payment of nursing student loans. One in every four RNs owes a student loan, which can be a contributing factor to the industry's high turnover. (""The Nursing Shortage and How It Will Impact Patient Care"", 2017)

The third area that we need to take into consideration is the potential pool of nursing candidates. Grants, loans, and scholarships in order to attend nursing school would allow students who might not be able to afford nursing school attend. This can increase the number of nursing students and future number of nursing staff. (""Solutions for the Current Nursing Shortage"") The problem also lies in hopeful applicants. Many are turned away or waitlisted. Much like those who cannot afford to pay for initial schooling, the nurse's who further their education the costs add up. We invest years of time and money into certification, clinical hours, and so forth. Loan forgiveness and ways to help pay for the increased education would help nurse continue to further their education and improve their knowledge for patient care.

There are many theories as to the best strategies to address the shortage, but the strategies that focus on improving workplace have a greater potential. Many places are already struggling to provided enough nurses. Jan Rabbens, spokeswoman for the Minnesota Nurses Association says, Nursing needs money, social commitment, and efforts to improve working conditions, or patients will suffer the consequences. And nurses do not want to feel that they are compromising patient safety. Not just one solution will be enough to fix the problem; a solution will most likely require changes across the board. In order to keep a quality number of healthcare providers to meet the demand the US needs to come up with more nursing colleges or find ways to improve space and increase faculty numbers. If things to improve the shortage are not addressed, you might be the one on the short end of the stick when it comes to quality care received.

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