The Nursing Shortage Isn't Due to Lack of Interest
As the baby boomer population gets older and 32 million Americans gain access to healthcare under the Affordable Healthcare Act, the demand for nurses has steadily increased. According to the Bureau of Labor Statistics, healthcare jobs are among the fastest growing jobs in America, with a predicted increase of 526,800 registered nurses by 2022. The American Associate of Colleges of Nursing (AACN) has evaluated data from as early as 2002 to show that the demand for nurses is quickly growing and chronicled it through the years. While this is promising news for anyone looking to start a career in healthcare, nurses are suffering from heavier workloads, and that can directly affect patient care.
Shortage of Talent
In 2013, a survey by the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers, it was reported that 55 percent of registered nurses are nearing retirement. And the Health Resources and Services Administration predicts that within the next 10 to 15 years, 1 million RNs will reach retirement. This mass exodus of nurses is bad enough, but when looking at the statistics around nursing students studying to enter the nursing workforce, it’s even worse.
The current lack of nursing students does not stem from a disinterested generation, but rather from a lack of funding and educational resources to accommodate qualified applicants. The AACN reports that in 2013 there was a 2.6 percent increase in enrollment of students in baccalaureate nursing programs. That number isn’t enough to meet the growing demand for nurses when considering the baby boomer population and the 32 million Americans that now have access to healthcare under the Affordable Care Act. While people are certainly interested in starting a career in nursing, the AACN reports that 79,659 qualified students were denied entrance into baccalaureate and graduate nursing programs for the 2012-2013 school year due to a shortage of nursing faculty and educational facilities. Plenty of these candidates were perfect fits for nursing, but two thirds of nursing schools report that they were forced to deny applicants due to a shortage of faculty, classroom space, clinical sites, and budget constraints.
In order to respond to this shortage, the Board of Nursing might need to reevaluate the role of LPNs in order to offer support to RNs that are already stretched thin. Legally, there is a difference in the type of procedures and care that LPNs and RNs are able to perform, but if the Board of Nursing reevaluates what LPNs are able to do in the workplace, it could help alleviate some of the pressure on RNs. Michael T. Irvin RN, RN and Healthcare Consultant and President of MLTC Consulting states, “Hospitals will have to continue to hire more nursing assistants and other ancillary staff to assist in care. [The] Board of Nursing will need to expand the amount and types of services that nursing assistants and LPN's can perform under the supervision of an RN.” By expanding the capabilities of already certified LPNs, hospitals might be able to help relieve RNs of some of their duties, freeing up more nurses to work with patients.
A shortage of nurses isn’t only bad news for healthcare facilities trying to staff hospitals, nursing homes, and doctor’s offices; it’s also bad news for patients. In 2005, Dr. Peter Beurhaus published an essay in Nursing Economic$ that found 98 percent of nurses felt that the nursing shortage would negatively impact stress levels and 93 percent agreed that it would negatively impact patient care. Additionally, in a study published in the BMJ Quality & Safety in May of 2013, Heather L. Tubbs-Cooley found that the instance of patient readmission increased when nurses were assigned four patients or more.
Errors and mistakes can extend far beyond beside manner; the stress caused by the nursing shortage can result in safety concerns for patients. Irvin states, “There is a great potential that the nursing shortage creates an environment where medication errors and other potential healthcare accidents may occur.” And the data supports this idea that stressed out nurses might not be able to offer the best level of care that they are normally capable of.
When nurses are faced with higher patient loads, hospitals experience a higher patient readmission, which only increases nurses’ daily workload. In a 2012 study by Dr. Jeanne Cimiotti published in the American Journal of Infection Control, it was found that when nurses had an increased patient load of just one patient, it was associated with a greater risk of infection. Cimiotti’s study also found that nursing burnout is a contributor to poor patient care and stress levels for nurses and that by reducing nursing burnout, it can positively affect nurses and patients alike.
Nursing is a high stress position that can often mean long hours, being on your feet for hours, and fast paced situations if a patient starts going down hill. Combine nursing burnout with insufficient staffing, and it’s a recipe for disaster – or at least high nursing turnover. Burnout is also often directly related to high turnover for nurses and could even be driving some nurses away from healthcare facilities, forcing them to seek less stressful positions. “We see more and more nurses changing occupations or moving into a less stressful setting such as home care due to being ‘burned out’,” states Irvin. Since nurses are already working a high stress position, the added stress of a nursing shortage could possibly drive nurses away from healthcare facilities.
Hospitals can take steps to avoid nursing burnout by offering nurses more flexibility with their schedules and offering other benefits to their nursing staff. Nick Angelis, CRNA, suggests that by “taking steps to reduce burnout among the staff, [hospitals can decrease] turnover and expensive hiring and training of new nurses. The current shortage is regional and varied, so by encouraging employee loyalty with flexible, empathetic management, hospitals will find no need for recruiters or agency nurses.” Hospitals may want to look at ways they can alleviate nursing burnout by not only evaluating schedules but by creating a better work environment by ensuring nurses have healthy food options, time off, regular breaks in the workday, time to exercise, and other benefits. Keeping nurses that are already employed will be crucial for hospitals looking to avoid a staffing nightmare caused by more nurses leaving the jobs they already have.
Affordable Care Act
Some argue that the Affordable Care Act will negatively impact the nursing shortage by increasing the demand on nurses, as more people are equipped with health insurance. While the ACA will certainly bring in more patient records and data, which will trigger a need for an increase in medical billing and coding staff, some worry that it might negatively impact nurses and patients. Many nurses are already faced with high patient loads and increasing the number of people that will walk through the door on a daily basis could lead to lower patient satisfaction as nurses find it difficult to meet the needs of multiple patients.
According to a study on The Impact of the Affordable Care Act on Health Care Workers, Amy Anderson DNP, RN, CNE states “The American health care infrastructure has had workforce shortages for decades and is not prepared to meet such a vast influx of patients effectively or efficiently. Training new physicians, nurses, and other health professionals takes years, sometimes decades. Without more graduates from nursing and medical schools and increased innovation in shared roles and responsibilities among doctors, nurses, and other medical professionals, individuals and families will face longer wait times, greater difficulty accessing providers, shortened time with providers, increased costs, and new frustrations with care delivery.”
The same study also points out the fact that healthcare isn’t only suffering a shortage of nurses; the shortage extends to dentistry, mental health, pharmacy, and more. As an influx of baby boomers and those insured under the ACA start heading to hospitals and other healthcare facilities, nurses will only be faced with more patients, which could negatively impact nurses who are already working as hard as they can.
There are a number of qualified individuals in America who worked in healthcare in another country, but weren’t able to continue their careers when they relocated to the U.S. Now programs are moving to help those with an international nursing education who have already moved to America become practicing nurses. The Welcome Back program is attempting to address the critical nursing shortage by assisting international nurses located in metro areas on what steps they need to take to become practicing nurses in America. There are currently 10 Welcome Back centers, mostly located at community colleges, across the United States.
The program guides nurses trained in other countries on how to prepare for exams and become licensed in different states. Rather than recruiting nurses from other countries and enticing them to move to America, which received a great deal of criticism back in 2006, this program focuses on those who have already relocated but are having a difficult time finding work because they haven’t received a nursing license for the state they plan to work in. The Welcome Back program helps international nurses find the right resources whether it’s how to get licensed, classes to learn English, or just guidance to help navigate the process.
Most of the issues surrounding the nursing shortage start with keeping nurses hospitals already have employed. However, burnout among nurses is common, and it can lead to staffing issues and high turnover. Hospitals and healthcare facilities can achieve a lot by listening to nurses and evaluating the systems they have in place for their current staff. Less money and time will be spent training and hiring new nurses to fill positions other nurses have evacuated, which will make it easier to retain regular staff and keep nurses happier in their work. If you are looking to start a career in nursing or change jobs, check out openings on Monster to find nursing jobs in your area.