The Nursing Shortage
There have been a number of shortages of health care workers throughout history. The current nursing shortage is worldwide and it is a serious one. Factors contributing to the shortage include an aging work force, a decline in enrollment in nursing programs, a significant growth in the population and the fact that the baby boom generation is rapidly approaching both retirement and an age where they will require more intense health care services.
As we all work together to solve this shortage, nursing will emerge a stronger and better profession. In my thirty years of nursing, I have seen the pendulum swing to both extremes and I have seen nurses come into their own as professionals. We are no longer considered simply handmaidens to physicians, but a strong, independent, and vital part of the health care team. We have a voice and we have learned to use it to stand up for our own rights and to advocate for the rights of our patients.
The Baby BoomThe baby boom bubble holds a major key to understanding how this shortage came about and why it is so critical. From 1946 to 1964, the post– World War II years, the number of babies born exploded. In the United States alone, approximately 76 million baby boomers were born during this time frame. The 1990 census reported a population of 77 million boomers. (This includes immigrants and subtracts deaths.)
In the eleven years immediately following the baby boom, 1965–1976, there was a significant decline in the number of births. This group is often referred to as the baby busters and more recently, Generation X-ers. At the time of the 1990 census, there were 44 million baby busters (including immigrants and subtracting deaths). There was a small baby boom from 1976–1981 and as those known as Generation Y come of age, there will be a slight improvement in the ratio of the work force as compared to the baby boomers.
As the baby boomers age and retire, the number of available replacements significantly declines. As of 2005, the baby boomers range in age from forty-one to fifty-nine. By 2011, the first of these boomers will turn sixty-five. By 2020, half of the current R.N. work force will reach retirement age.
Compound this decline in new members available for the work force with the fact that by 2008, the number of jobs for R.N.s will grow by 23 percent (according to the U.S. Bureau of Labor Statistics) and you can see the crisis that looms just ahead.
By 2012, the U.S. Bureau of Labor Statistics reports that there will be a need for more than one million new and replacement nurses. The average age of new nurses graduating today is thirty-one. This means these new nurses will have a shorter time span in the work force and with the ever-increasing need for more nurses; this shortage is not going to be short-lived.
According to a report published by the American Association of Colleges of Nursing (AACN) over 32,000 qualified applicants to B.S.N. and graduate nursing programs were turned down for admission for the 2004–2005 school term. The reasons cited were insufficient qualified nursing faculty, lack of classroom space and clinical preceptors, and budget constraints. Of the schools reporting, 76.1 percent cited faculty shortages as the reason for not accepting all qualified applicants.
As anyone can imagine, this shortage already has had and will continue to have a huge impact on health care. Staffing shortages have caused a great deal of job dissatisfaction for nurses everywhere, not just in hospitals. This dissatisfaction has lead to burn out and nurses leaving the nursing profession altogether. Obviously this doesn't help solve the shortage.
Coping with the ShortageOne of the ways hospitals and other health care facilities have tried to help nurses out is by hiring a core of unlicensed assistive personnel (UAP) to assist with patient care.
You might have encountered this in your own physician's office. The person escorting you to the examining room is most likely not a nurse. These staff can weigh you and even take your vital signs. However, when you call the office and ask to speak to the nurse about a prescription renewal or other question, it becomes quite obvious that this person is not a nurse.
The high costs of medical care, combined with the restraints imposed by managed care and lower reimbursement rates, are causing doctors to find alternative ways of doing business. Clinics, hospitals, nursing homes, and assisted living facilities are also turning to unlicensed personnel to provide more and more care, leaving nurses free to attend to the more highly technical aspects of patient care, while reducing the costs of doing business.
Under most circumstances, this can work: However, no matter how dedicated and conscientious the unlicensed personnel are, they have not been trained to interpret their findings. This puts the nurse, who is responsible for supervising these UAPs, at risk. For instance, the UAP reports that the patient's blood pressure is 180/92, but neglects to tell the nurse he is also complaining of a headache and has difficulty finding words. An hour later the M.D. is demanding to know why no one reported that the patient was symptomatic before he stroked!
Not just anyone can be a nurse and unlicensed personnel cannot be expected to do the job of a nurse.
What Can Nurses Do to Help?One of the most important things is that nurses are banding together to advocate for their own cause. Legislators working with nursing organizations have passed laws in several states to reduce the patient-to-nurse ratio. This is a Catch-22 situation that forces hospitals to close beds if they don't have enough staff to care for the patients. However, it reduces the potential for harm to patients when inadequate staffing is allowed to continue.
Patients are being made responsible for their own health care issues. In past years, a patient might spend several days in the hospital for a minor illness or injury. Today, patients are being sent home much sooner with instructions for self care. A whiny hypochondriac might spend a few hours in an emergency room (ER), but won't necessarily be admitted without due cause and waste valuable time and resources.
In the United States today, much more emphasis is being placed on promoting health and wellness. A holistic approach including diet, exercise, personal hygiene, and lifestyle issues presents nurses with an expanding role in patient education and promoting healthy living. Nurses are not only becoming more specialized and skilled, but are also being asked to assume many roles within that specialization to improve patient outcomes and quality of care issues.
An ICU nurse is no longer just highly skilled in handling an acute illness and all the tubes and machines involved. Now he is involved in discharge planning for that patient as well. This involves educating the patient and family in the nature of the illness, how to prevent a recurrence, when to report symptoms to the M.D., and follow up care at home. The nurse has to understand the reimbursement issues for the patient's insurance, what community resources are available and how to set in motion all the aspects of care to prevent re-hospitalization.
Industry and communities are funding grants for education of nurse educators as well as for nurses. These funders are also helping to partner with and fund educational institutions to help provide more facilities for nursing education. There is also a major emphasis on B.S.N. and advanced degree education for nurses.
Health care facilities are listening to nurses for clues for improving the retention of the staff they have as well as for recruiting new staff. Nurses are encouraging others to explore nursing and the many career paths and options available.
