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Nursing Shortage

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The shortage of nurses is not only in healthcare but represents a diverse cross-section of health care profession. “The nursing shortage emerged in 1998 and peaked in 2002. In the late 1990s, as government and private payer reimbursements declined, hospitals downsized and cut nursing positions as a cost-cutting initiative (Allen, 2008). The nursing shortage will have an adverse effect on health care delivered in the future. There is a need to address the issue and implement a plan to provide a long lasting solution.

Both registered nurses (RN) and licensed practical nurses (LPN) are accountable for the majority of health care delivered. RNs make up the largest group of health care providers ,and  have worked primarily in a hospital setting; the rest have worked in other organizations like physician practice clinics, home health, and long-term care nursing homes. While RN’s can work in specialty areas, their primary duties are to treat patients, the education of their patient and family members about their medical conditions and treatment modalities, they also provide emotional support and information about support groups for their patients. LPNs are the second-largest group of health care providers and they provide basic direct patient care under the direction supervision of either a physician or RN. Certified Nursing Assistants (CNAs) work in hospital organizations, patients’ homes, or in Assisted Living Facilities and Nursing Homes where they help with activities of daily living such as dressing, feeding, and bathing. CNAs work under the supervision of an RN or LPN. Most nurse aides work in nursing homes.

Influence of mass media on people's health

Generally, what people see on T.V. or read in newspapers tend to effect what they think about health care professionals and especially nurses. When the public surveys health care professionals, nurses are often ranked at the top of the profession ahead of physicians. While the public is also being exposed to the shortage of nurses ,and how they are overworked, it has left many to questions, is it safe to leave one of their loved ones in a hospital, or long term nursing home if the nursing staff are few, will that lead to errors being made? .There are images of nurses trying to help conditions for its member by going on strike or the opposite , nurses are being laid off due to changes in the managed care system. Everywhere there are stories about nurses making errors leading to the death or injury of a patient entrusted into their care. Some images that many see or hear have led to the thoughts that the nursing profession is a very high risk and low reward. In order to help change the public opinion of nursing, nurses need  a more active image. A voice out in the public lets the press take a few unfortunate incidents and paint an awful portrait of the nursing profession.   “With every article about the shortage of nurses, positive letters to the editor acknowledging the challenges of nursing and recognizing the rewards are needed. Negative, complaining letters perpetuate the image, that nursing is not a good career choice” (Erickson, 2001). Nurses can help the general perception of nurses and not discouraging children of not pursuing the nursing career .When surveyed, most nurses would not recommend nursing career to their own children or relatives. This is different from other professions were their parents would encourage them to assume their role. Nurses frequently report that they do not encourage their own children to consider nursing as a career. When out in public, nurses might criticize their work conditions, peers, superiors or just what they do instead of talking about the positive things or people that they have helped. It may seem  a simple solution ,but nurses need to pay close attention to what they say and where they say it. When talking to your peers or a spouse, because holding o to what went wrong  in the day at work can be destructive to the mental health. Nurses must realize that the best recruiter for nurses are nurses themselves, and it may not always be in a social or academic setting. The shortage of nurses experienced today started in the 1990s. During that time, the people making decisions about the future of health care predicted a decrease in the need for nurses because of fewer patients’ beds in hospitals. The state of California was first to start this system and other states anticipated they would be doing the same.  The health care profession experienced downsizing of nurses .This was meant to decrease cost, time patient relationships  to  increase profit for their organizations. The plan devised by the health care executives was to reduce cost by hiring CNAs and other assistive care staff to take the place of nurses. Either the action caused a lot of nurses to take early retirement or they were laid off.  “The skill mix changes and movement of patients from acute care to homecare or ambulatory settings forced many nurses to evaluate their personal decisions. Feeling devalued and disenfranchised, nurses left the profession” (Erickson, 2001). These actions led many students  to change their  career path. Another problem was the turnover in the faculty needed to run many schools of nursing. The faculties at these schools were laid off later or were at that ages were they would need to retire soon. This caused a problem because even if the school of nursing wanted to enroll more nurses ,they could not, because the school did not have enough qualified staff to teach the current student population.  Other issues that contributed to the shortage of staff were the work environment and pay. So what do the schools of nursing do when they have to hire older nurses that may not meet the physical demands of the job? First, develop a new curriculum that will  take advantage of what is available and  find creative ways to help supplement the nurses needed.  One solution is to work with the hospitals where clinical will be conducted and hire some nurses to come in during their time off to help educate the nursing students.

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The ability to retain nurses has always started with the way they are treated and how the nurses perceive the organization feels about them. Often health care executive view all staff as expendable especially when they are trying to cut cost and when it comes to nursing you can pay new nurses less that more experienced nurses. Healthcare executives should view staff as a valuable commodity; failure to which organization receives a unsatisfactory reputation from the public . They should try and find different and creative ways to help increase revenue and decrease overhead cost.

“The expression, "nurses eat their young", is so far removed from the idea of caring and nurturing nurse that we shudder to think it could be true”(Douglas 2011). In the real world, nurses hurt other nurses. High turnover rate is  a problem that contributes to  shortage of nurses.  About 60% of the new nurses will resign from the first job that they take after nursing school before they reach the six-month mark. In a nursing shortage that is being experienced all around the world, understanding the cause and then ensuring the development and the implementation of education to help alleviate the hostility  faced by nurses from other nurses are vital.  The research has not been done as perfectly as possible. However, this will not change the fact that when the new nurses are being questioned upon their resigning from their position 60% are saying it is because of the way they are being treated by other nurses. This is in stark contrast to the image that most people have of nurses; their impression is of an untiring, caring person that will do everything to help a patient or other staff members. The solution must start with the understanding of how the hostility was  being inflicted; educate everyone of what it is and then enforce punishment of those that continue to violate the policy.    Another issue with the shortages is not that the only problem is a shortage of qualified nurses but   also the lack of nurses qualified to do certain specialties or to work under certain conditions. It has become more and more apparent to nurses and other professionals that if  they  have  equal pay with better work conditions, there will be less stress and the ability to leave work satisfied. These things have led many nurses to leave the profession and vow not to return. It comes to a point when your own happiness must take center stage. Working where the ratio of nurse to the  patient is very high leads to mistakes in care, errors that when made is a cause for the same executives to reprimand the nurse for making mistakes even though they are the cause of the nurses being overworked and underpaid.

The effect on the nurse shrtage the U.S.

With the increase in the older patient population due to the baby boomer getting older, what will be the effect on the nurse shortage the U.S. is already experiencing?  The group that make up the baby boomers are getting older, and more are surviving helping to put even more pressure on the health care system and will require more care than ever, taxing an already strained nursing system. This is taxing the system by needing more nurses in the long-term care faculties. The ratios are even greater for those nurses working in long-term care faculties than those seen in the hospital organizations. According to recent anecdotes Stone & Wiener (2001), some frustrated providers and families are willing to give up the search for quality employees as long as they can find people to fill the positions. This crisis is not limited to the United States. It is a global problem, particularly in the European Union and Japan, where the proportion of the population that is elderly is much higher than in the United States. Across the U.S, long-term care providers are experiencing nursing staff shortages and elevated turnover rates. “Nursing homes, assisted-living and other residential care providers, home health agencies, community-based home care and adult day care programs, and individuals and their families all report significant difficulties in recruiting and retaining frontline workers”(Stone & Wiener, 2001). The information on the turnover ratio displays a very wide disparity. There are sources that show the ratio is greater than 45 percent for and around 10 percent for the home health organizations. Other reports show that the ratio is around 15 percent for private home health organizations, while it is even higher for the public organization. The turnover ratio for nursing staff in the nursing homes is yearly over 100 percent making it hard to keep the continuity of care for those patients in the nursing homes. The nursing field has been doing more with less for decades while nursing care has been greatly suffering. No longer is there time to do proper nursing education and patient teaching, taking care of activities of daily living with the patients and there are too many mistakes being made by over worked and underpaid nurses. In the 1990’s there was a greater nurse to patient ratio which meant more time to do more things for the patients, patients stays in the hospital were not determined to be as quick as possible to get the patient discharged. In the 1990s while working in the Maternal Child Health Units (MCH) the mothers were on the post-partum ward for three days, each baby was taken to the nursery so mother could get some rest after delivery. Today mothers are discharged 24 hours after and babies are in couplet care that is with the mother from the time the baby is delivered. This helped to reduce the number of nurses needed and increased the ratio of nurse to patient and decrease actual patient teaching time so the answer was showing the new parents a video. Are the videos helpful yes to some but what about all the questions that the parents want to ask and do not feel comfortable to ask in a room of 10 couples after the video is over. There is some positives to some of this, the couplet care is great because the mother and baby start to bond immediately, but still when the mother is exhausted and needs rest what do they do, especially if there is no father to help. The encouraging news is, while there is a shortage there are also plans in place to help turn the tide in favor of nursing. Hospital executives and the government are considering the problem and are trying to figure out ways to implement both short term and long term plans to help with the shortage throughout the health care profession.  “As just one example, $1.4 million dollars was raised for the sole purpose of providing scholarships to prospective RNs in Tennessee in 2007” (Nursing shortage crisis, n.d.). Schools of nursing have begun receiving funding from private organizations to help supplement the budget so the schools can hire the needed staff and increase the number of students that can attend. The rise in enrollment and ability to hire qualified teachers is a step in the right direction.  The government has been increasing available funds to schools to help with the shortages of staff. With the recession, many nurses have had to put off their retirements to help with their own finances. This also has helped with an additional amount of nurses coming back into the profession. The nursing profession has faced a shortage for some time and with the passing of the affordable healthcare act there will be an increase of the patients with health care insurance and will need care into the foreseeable future and now is the time to implement plans to solve the problem both short term and long term.

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