Nursing, like other professions is inundated with her own practise issues. These issues are of a major concern to nurses, to administrators, to the health care team, patients and even the whole populace. These issues have dire consequences on the image of nursing and are capable of affecting the quality of service rendered by nurses negatively. Some of the practice issues in nursing include work related injuries, nursing shortages, chemical dependence and nurse-to-patient ratios to mention a few. However, this paper will X-ray the issue of nursing shortages.
Nursing shortages is a global phenomenon as it affects the highly industrialised countries such as Canada, United States of America, Great Britain, Australia and other parts of Europe. However, this shortage is not limited to the developed economies as the developing economies of Africa and Asia are not left out of this problem. Though the causes of shortages in the developing economies vastly differs from what obtains in the Americas and Europe. In the developing economies which have a higher number of African and Asian countries as members, their nurses leave the shores of their countries in search of the Golden Fleece and a better life. In addition many of these nurses are attracted and recruited by these industrialized countries to come and fill up the vacuum created by the nursing shortages in their own country. Registered nurses are regarded as the single largest group of health care professionals in America (2003, P. Keenan). Present and projected shortages of nurses is attributed to the fact that fewer people are venturing into the nursing profession. Before, nursing shortages arose because of wage increases and an increases need for registered nurses. It is projected that by the year 2020, a reduction in the number of available nurses will occur due to an increased need for the services of nurses because the baby boom generation is aging fast. The nursing profession encompasses three sets of workers, vis-a-vis; registered nurses, nurse aides and licensed practical nurses. The registered nurses are saddled with the task of providing direct care to patients and they also manage nursing care. Licensed practical nurses also administer patient care but they do so under the direction of a physician or registered nurse. Nurse aides on the other hand assist nurses in carrying out routine care activities such as dressing, bathing and feeding patients. They are seen more in nursing homes and health agencies that receive Medicare or Medicaid funds. The shortage of nurses is a serious issue that if not checked on time could spiral out of hand. Available data suggests that the issue could get worse earlier than expected. For example, in 2002, shortage of registered nurses was estimated at 125,000. By 2020, the projected estimates of registered nurses shortage are put at 400,000 to 800,000. This is due in part to the reduction in the number of students enrolling to study nursing coupled with the fact that fewer of them eventually graduate from the programme. Also, the present crop of nursing tutors are declining with few replacements available which will consequently reduce the available nursing faculty. Presently, about 82 percent of registered nurses are really working as registered nurses.
Several reasons have been attributable to the nursing shortage. The reasons range from changing pattern of population demographics, employment pattern of women, the nature of the health care system and nature of the nursing work.
Increased demand for registered nurses due to the aging population, other career options, wages, responses to health care cost pressure and workload and the work environment.
It is projected that between 2000 and 2020, the American population will increase by about 18 percent which translates to about 31 million people all together and the population of those older than the 65 years bracket with increasing health needs will also increase by a staggering 54 percent which translates to about 19 million people. In essence, an increased aging population with medical and nursing needs without a corresponding increase in numbers of registered nurses will result in shortage of nursing services.
OTHER CAREER OPTIONS
The country has experienced various changes in both employment patterns for women and social changes as well. Women who were born after 1950 have diverse career options than those born before them and few of them chose to enter the nursing profession. Women who were born in the middle of 1950 had the likelihood of becoming nurses than those who were born after and before that period. Also, those born in the 70's were 35% likely not to enter the nursing profession, and also those born in the mid 70's were 40% less likely to join the nursing profession.
RESPONSES TO PRESSURE OF HEALTH CARE COST
The advent of managed care in the 90's caused a lot of cost pressures on the hospitals. Since hospitals are the highest employers of registered nurses. Areas that had increased managed care enrolment witnessed reduced wage and employment growth for the registered nurses more than areas that had low managed care enrolment. With the entrenchment of managed care in the nation, the wages of registered nurses and employment growth slowed down nationally towards the end of the 90’s. All these changes resulted in hospital payment systems as they needed to cut costs to stay afloat. It lead to shorter hospital stays for the patients, some registered nurses were laid off leading to nursing shortage and increased workload for those still in service.
WORKLOAD AND THE WORK ENVIRONMENT
Managed care led to various changes in hospitals, ranging from administrative, finances and hospital staffing. Hospitals laid off some workers and mandated overtime work for the retained workers. Registered nurses had a monumental workload and their control over their schedules vanished, shifts and holidays were drastically reduced. It was thought that the administrators would compensate nurses for the increased workload, but alas, their wages remained the same during the period in question and afterwards. This alone is enough to deter anyone interested in joining the nursing profession. This led to massive cases of nurse’s dissatisfaction, nursing burnout and sometimes breakdown. Also, the attention and hype given the profession by the media could scare away potential nurses from joining the profession. The media most times focus on the challenges and difficulties faced by nurses rather than the good and rewarding parts of the profession.
EFFECTS OF NURSING SHORTAGE
Nursing shortage has dire consequences on the quality of care given to patients. In a study published by the Health Affairs Journal in 2006, new evidence uncovered pointed to the fact that if hospitals could increase their investment and invest massively in registered nurses staffing, millions of dollars would be saved annually and thousands of lives will be saved. To be precise, the study reported that increased registered nurses staffing by hospitals and increased nursing hours per patient would prevent a staggering 6,700 deaths yearly and four million days of hospital care would be avoided. In addition, the financial gains of savings per each avoided patient death will be significant. This study is important because it highlights the importance of adequate nursing staffing to alleviate the sufferings of patients and prevent avoidable deaths yearly. Also, another study by L. Aiken discovered that about 20,000 people lose their lives annually because they patronised hospitals with numerous nurses that have been overworked and are suffering from burnout. The same study also discovered that Americans who had been scheduled by their doctors for routine surgical procedures have about 31% risk of dying if they were in hospitals suffering from severe nurse’s shortage. The alarming statistic refers to about one fifths of about a hundred thousand deaths that occur annually due to medical errors. In the study, the nurses cared for an average of four patients at once. This study reiterates the earlier assumption that inadequate nursing care is detrimental to patient health and safety and it even accounts for a high chunk of patient mortality. In fact, a poll revealed that about half of Americans thought that quality of health care is vastly affected by shortage of nurses.
Also, many recent studies have found a highly significant correlation between the staffing levels in hospitals and the quality of care rendered to patients in the hospitals and various nursing homes. They discovered that when the number of hours that registered nurses have per day per patient is increased there is improved outcome. These included reduced duration of hospital stay, reduced rates of contracting upper respiratory tract infections, urinary tract infections, pneumonia, upper gastrointestinal bleeding, cardiac arrest, shock and death from complications. Also, another study funded by the National Institute of Nursing Research conducted in Pennsylvania hospitals revealed a startling piece of information. The study discovered that whenever the number of patients assigned to a nurse is increased in the range of four to about eight patients, there was about seven percent odds of dying within a month of admission into the hospital and also a seven percent odds of dying following complications such as pneumonia, shock or cardiac arrest.
The QSEN Competencies involve Quality improvement, Safety, Collaboration and Teamwork, Evidence-Based Practice, Patient-Centred Care and Informatics. Informatics involves the use of information and technology to manage knowledge, to communicate with colleagues and Patients, to reduce error and support the process of decision making while Evidence -Based Practice involves integrating the very best of evidence with clinical skills and patient preferences and values for delivering optimal care. Quality Improvement involves using data to monitor care process outcomes and using the improved methods to formulate the desired change in continuously improving safety and quality of healthcare. Also, safety means reducing to the barest minimum, risks to healthcare providers and patients through individual performance and effectiveness. Patient-centred Care entails recognizing the patient and providing coordinated and well planned care based on respect for his values, needs and preferences.
TEAMWORK AND COLLABORATION
Entails effective functioning within inter-professional healthcare teams and among nurses. Fostering communication, having mutual respect for each other and shared decision making to attain excellent patient care. Collaboration and teamwork are both applicable to the issue of nursing shortage. Since the advent of shortages of registered nurses in hospitals and nursing homes, teamwork and collaboration among those on duty is germane in achieving success for the team. Helping each other out will decrease the possibility of burnout out for the person with higher workload. Also, when new nurses are not accustomed to certain tasks, be it clinical or administrative, the more experienced ones should be able to help them out and teach them how to go about such tasks without jeopardising quality care to the patient.
In conclusion, nursing shortage is a very serious healthcare problem that pervades the healthcare atmosphere worldwide. Though, more severe in some places more than the other. The managed care system introduced in the 90’s which sought to cut costs within the healthcare system was the main culprit. To stem the tide of this cankerworm, wages of registered nurses have to be increased, more people have to be encouraged to join the profession and the profession has to be portrayed in good light by the media and also the practising nurses.
P. Keenan. (2003) . The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions. The Commonwealth fund. Retrieved from http://www.commonwealthfund.org/usr_doc/Keenan_nursing.pdf
(2011). The Effects of the Nursing Shortage. American Nurses Association. Retrieved 13th November, 2012 from http://ana.nursingw orld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/NurseShortageStaffing/NursingShortage/Effects.aspx
Peter Buerhaus et al. (2007). Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspectives Health Affairs Vol. 26, No 3, 853-862. Retrieved from http://content.healthaffairs.org/content/26/3/853.full
Jean Johnson et al. (2012). Graduate-Level QSEN Competencies Knowledge, Skills and Attitudes. American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/faculty/qsen/competencies.pdf
