Nursing Shortage: A Real Public Health Crisis
The national nursing shortage has surpassed a crisis pitch and it appears not only inevitable that it will continue at its current pace, but that the gap between patient demands and available healthcare providers will only widen. America’s supply of registered nurses, after a decade of quantity decline, must be recuperated to address evolving public health needs. But the field’s workforce growth has been dramatically outpaced by the swelling population of the nation’s elderly. With the baby boomer generation now entering senior citizenship, the population of retirees in need of medical attention is projected to overwhelm the capacity of our healthcare system. Unfortunately, this has caused an unfavorable ratio of nurses to patients in hospitals and long-term care facilities, diminishing the time and, therefore, the quality of the individual care given each patient. The primary research question, therefore, will concern exactly what the impact of the nursing shortage is on the quality of healthcare standards.
The literature review conducted in the interest of answering this research was raised on the based of the following search keywords: nursing shortage, nursing crisis, national healthcare crisis, nurse-patient-ration. The hypothesis guiding this review would be that the nursing shortage is reducing healthcare quality and raising mortality rates in the United States.
A 2002 article by Kristine Goodwin provides a firm basis for orienting this discussion. Containing a bevy of negative indicators, the research suggests that there is reason from within the universities, the healthcare industry and governmental bodies at the federal and state level to believe that we have already reached a point of critical need. Identifying key figures such as the negative nurse to patient ratio, poor working conditions for current healthcare staffs and a general absence of important educational scholarship programs for motivating a greater interest in the occupation, the study elucidates the inherent perils, resulting there from, to the state and quality of American healthcare.
This study corresponds with Carolyn Veneri’s published overview on the issues of labor shortage which had begun to appear in a variety of sectors during the 1990s. In her text, the economics analyst offers with specificity to the nursing issue and also in more generalized labor-market terminology a demonstration of the ways in which shortages can be anticipated by measuring enrolled nursing students against projected patient populations.
The research contained in Grohmann and Lane’s study, while somewhat outdated, is actually quite informative in that regard. It provides a quantitative examination in presumption of our current nursing crisis which reveals the duality in perspectives on the matter. Taking an economic approach and what the research terms as a ‘non-economic’ approach to interpreting personnel indicators, the research finds two different but nonetheless equally provocative fiscal and practical signs of the problems facing the healthcare industry.
In a 2003 article, Darlene and Paul Clark discuss the perception of this problem from within the nursing field itself. Herein, they delineate what national and international nursing associations alike view as the roots of the nursing shortage crisis. Citing macro-level causes such as the worldwide AIDS crisis and more institutional issues such as an economic recession in congress with inflation in healthcare costs, the article provides an empirical review of the myriad systemic instigators of the problem.
The research composed by Rose Ann Dimaria & Lynne Ostrow is contextualized by its focus on professional education and details a two-part basis for analysis of the nursing shortage at the center of this review. In attributing the problem to a symptomatic shortage of would-be nurses completing proper certification courses, and establishing a connection between this and the yet more determinant shortage of nursing educators, the 2004 study points the way to a possible course for addressing the problem.
The collected data on the nursing crisis, particularly at a national level, makes more lucid the nature of our problem. This study is underscored by the texts’ common perception that, regardless of the terms of measurement employed, there is indeed reason for concern. The concern is notable in such studies as that by Grohmann and Lane. Prophetic in its anticipation of the nursing crisis, it grapples with the very subject of those variables which should most sensibly be measured. It finds, at least in part, that there is cause to measure such presumptive variables as nursing school enrollment shortages and patterned population maturation in order to classify shortages on the direct horizon.
The education enrollment variable finds direct support in articles by Dimaria and Veneri, which both recognize that a nursing shortage must be examined beyond the simple consideration of hospital and longterm care facility conditions. Such employment figures must further find their pretense in the stagnation of investment or growth in educative and certification sectors.
This is a variable buffeted by such occupational detractions as those explored by Goodwin, who remarks upon the accelerating absence of the job’s attractiveness, stimulated by a job made too rigorous in the compensation of personnel shortage. Paul and Darlene Clark, similarly, identify such affecting variables as the pull of global-economic indicators on broad labor trends.
The host of research articles combine to indicate that the defining attribute of the nursing shortage may either be categorized as a currently undesirable ratio of patients to nurses, wherein individual patients are not afforded sufficient healthcare attention due to the overextension of caregivers, or the shortage may be categorized as the anticipation, due to a combination of census and economic indicators, that such a negative ratio will soon be reached.
Within the context of the support needs for professional healthcare providers attempting to cope with nursing shortages, there is a key morale issue which is crucial as well. Indeed, hospitals are suffering a great deal today from not only a shortage of nurses but from a morale crisis amongst those currently employed by such health organizations. This is, of course, directly related to the undue pressures created by poor ratios. To this end, “according to a study published by Dr. Linda Aiken and colleagues in the May/June 2001 issue of Health Affairs, more than 40% of nurses working in hospitals reported being dissatisfied with their jobs.” (Media Relations, 1) This is due to the inclement conditions and daunting workloads imposed upon those currently working in the field as a necessary compensation for the shortfall of needed manpower. In direct parallel, academic organizations are also suffering from the downward spiral of the field, with the discouraging nature of the current job description contributing to record lows in nursing school registration that project an ongoing hiring stagnation
The relationship between such variables as a shortfall of students enrolled in nursing facilities and the directly adherent problem of scarcely available nursing educational professionals, together in coincidence with the related factors of diminished labor conditions and increased populace healthcare demands is creating an undesirable patient to nurse ratio. This negative ratio, in turn, equals a decline in the overall quality of healthcare. Naturally, this has a fully direct impact on incoming, outgoing and continuing nursing students
This is especially true because, as our research generally reiterates under multiple statistical and clinical terms, the shortage and its resultant situation are both only likely to get worse. “According to a July 2002 report by the Health Resources and Services Administration, 30 states were estimated to have shortages of registered nurses (RNs) in the year 2000.” (Media Relations, 1) Projections for the years of 2010 to 2020, when the baby-boomer generation reaches its peak retirement age, suggest that we are ill-equipped to assimilate the coming concerns. For the posterity of America’s public health and its economy, it will be necessary to make serious changes to the job satisfaction and working conditions which greet veteran and aspirant registered nurses.
The role of the RN today is shaped by the increased responsibility to attend to groups of inpatients rather than to individual cases, forcing many nurses to take on administrative ward responsibilities that can often undercut proficiency in bedside manner and the provision of effective medical attention. Therefore, the role of the educator for a prospective or continuing Registered Nurse is one of initiation into this circumstance.
The discussion here on our nursing labor shortage is given relevance by its overview across a decade of transition. Tracing presumptions of this shortage into an actualization of such concerns, and further drawing the connection between current projections based on timely indicators and our coming outlook, the research suggests that the reasons for the nursing shortage are systemic. Stemming from economic problems, industry shortcomings and educational stagnation, the industry is due for serious reformation. A worthwhile research question for future examination may best serve the crisis by examining the most efficient way to go about improving legislative programs offering incentives for investment into the currently under-staffed field. This should be accomplished through the promotion of innovative means to education and occupational improvement.
The findings here indicate that this is of crucial concern for prospective and current healthcare professionals, who all must be prepared for such clinical realities as a less than ideal framework of time, space, personnel support and resources that are resultant of the nursing shortage. Indeed, with little euphemism, it is incumbent upon nursing educators to stress that the nursing shortage has already reached a crisis pitch and it appears not only inevitable that it will continue at its current pace, but that the gap between patient demands and available healthcare providers will only widen. America’s registered nurses, after a decade of quantity decline, have to find ways to recuperate their ranks, which naturally falls upon the courtship and competence of nursing educators and educational institutions. Moreover, the quality clinical attention which current nurses can employ through better external support and knowledge-resource will be derived from such sources as well.
It is clear that there is a crisis impacting our current national healthcare system, with a clear shortfall of working or incoming nurses resulting in a diminished quality of care, lesser individual attention to patients and a higher rate of mortality in acute care scenarios.
Works Cited:
Clark, Darlene & Paul Clark. (2003). Challenges Facing Nurses’ Associations and Unions: A Global Perspective. Labour Review., Vol. 142.
Dimaria, Rose Ann & Lynne Ostrow. (2004). West Virginia University School of Nursing Makes the Move to Web-Based Learning. Technological Horizons in Education Journal, Vol. 31, 2004.
Gohmann, Stephen & Julia Lane. (1995). Shortage or Surplus: Economic an Noneconomic Approaches to the Analysis of Nursing Labor Markets. Southern Economic Journal, Vol. 61.
Goodwin, Kristine. (Oct. 2002). States Tackle the Nursing Shortage: The Lack of Qualified Nurses Is Reaching Epidemic Proportions. States, Universities and Hospitals All Are Trying to Do Something about It. State Legislatures, Vol. 28.
Media Relations. (March 2004). Nursing Shortage Fact Sheet. American Association of
Colleges of Nursing. Online at http://www.aacn.nche.edu/Media/Backgrounders/shortagefacts.htm
Veneri, Carolyn. (1999). Can Occupational Labor Shortages Be Identified Using Available Data?. Monthly Labor Review., Vol. 122.