The Effect of the Nursing Shortage on the HealthCare Industry
1.0 Introduction
Nursing shortage describes a situation when the hospital need for nurses far outweighs the supplied and products from colleges/schools of Nursing. Usually the recommended nursing to patient ratio is 1: 5-8. The present situation of nurse shortage in the United States and some other popular nations calls for the attention of the general masses to embark on solidarity participation in search for a permanent solution that can stand the test of time. The solution of which is also expected to serve template for other involved regions of the world. The required level of nursing commitment in the health care sector is fast increasing at an almost geometric progression compared to the increases prevalence of range of old and newly discovered diseases. There is not only an economic struggle from the implication of nursing shortage, there is equally ravaging social instability, fear of the unknown, gradual loss of confidence in the citizens’ perception of assured medical security or safety of lives, and overall doubt of medical competency on how Government of the States meet the health need of the people. The issue of health is a fundamental human right that should dare not be subjected to any porosity or bargain before delivery. The sequence of this discussion shall research on the background of this subject, few literature reviews on the topic, the general implication of the shortage on health and nursing care, recommendation to effect equilibrium in exit and entry of qualified nurses in the profession.
2.0 Background
For every human survival on earth, it is worthy of note to applaud the crucial and irreplaceable role of Nursing profession in the upbringing. Nursing impact in the health care industry is essentially the backbone of the camel upon which the hospital practice is based. Think of any field in other industries, they do not exist independent of nursing impact in the process of medical services’ delivery. More than often we all have occasions to seek medical intervention in order to carry on with our daily activities without been hindered by the perpetual struggle to live in ill health through involvements in stress. Stress could be psychological, physiological or mechanical trauma brought in the course of living our daily adventures. Owing to the general impact the profession of nursing has in every individual, irrespective of the industry or social status, the gradual decrease in registered nurses practitioners is worrisome and has thus, become the cynosure of all eyes. We could not but address this issue as one of the most important professional concern to save the genealogy of human race from indirect and silent extinction on earth. Very few people can take the innumerable responsibilities characterizing this profession. The economic implication of the shortage in the supply of nurses to health care industry is huge and must be quickly addressed as a matter of urgency at such a time like this where the government and other political waves are gathering issues of societal importance to gain power. The attention of all the concerned at this historical period is needed to guide our choice of desired future health industry from avoidable collapse and mess.
Before asserting succinct central query for this research, some authors have argued for wage increment as a solution to close the wide gap between the demand and supply of nurses, diplomatic blockage of exiting nurses in the profession to discourage brain drain in the profession, we shall objectively observe in this report on the various factors responsible for the shortage in a view to affirmatively extrapolate why educative nursing programs, enforcement of economic and social policies remain the only hope to successfully arrest the looming crisis in health sector owing to scarcity of nurses.
Reports show that incidence of reduction in the number of registered nurses began to gain the attention of the public about ten years ago. The noticeable decrease is much pronounced in the populated Western States. A survey in England reported an estimate of nurses’ position vacancy of about 10.5 to 14.5%. It is a pathetic situation that most published predictions are yet to arrive at a suggestive end when the shortage shall be lifted. To our great surprise, Bureau of Health professions posits the likely extension of this shortage to about seven to eight years by an approximate of over 800,000 nurses.
Country
Number of Nurses
Density per 1000 population
Year
Canada
309576
9.95
2003
China
1358000
1.05
2001
India
865135
0.80
2004
Japan
993628
7.79
2002
New Zealand
31128
8.16
2001
Nigeria
210306
0.28
2003
Philippines
127595
1.69
2000
United Kingdom
704332
12.12
1997
United States of America
2669603
9.37
2000
Zimbabwe
9357
0.72
2004
Table 2.1 Source: Data from the World Health Organization (2006)
From a reliable US data base, a projection of at least about 20% of US population growth would shortfall more than one million shortage of nurses by the year ending in 2020 (Brush et al, 2004). The demand for healthcare clinicians will increase to a projection of about 2 million within this century. Imagine a survey conducted in 2001 by an American Hospital Association, a round documentation of seven hundred and fifteen hospitals have vacant position of 126,000 qualified nursing offices (Spetz et al. 2003). Hospitals compensation in this situation is implicated in recruitment of untrained or less skilled nurses as replacement for qualified nurses in an attempt to boycott expert standardized wages. This gives additional reason on when the employment growth rate is not commensurate with the shortage report analysis conducted in some nursing literatures worldwide.
Year
Supply
Demand
Shortage
Percent
2000
1,889,243
1,999,950
-110,707
-6%
2005
2,012,444
2,161,831
-149,387
-7%
2010
2,069,369
2,344,584
-275,215
-12%
2015
2,055,491
2,562,554
-507,063
-20%
2020
2,001,998
2,810,414
-808,416
-28.8%
Table 2.2 Table showing U.S. supply and demand projections for registered Nurse by the year 2020
3.0 Briefly on Causes of Nurses Shortage
While arguments have supported the poor working environment in the hospital as the root of shortage, statistic shows that the practice of nursing is barely influenced by this subjective factor in as much as they equally have a very important role to play in ensuring good working conditions. Some nurses recognize this as a factor responsible for nurses’ withdrawer, claiming the poor condition is born out of derogatory values placed on the profession. In the mid 90s, considerable numbers of hospitals took advantage of introduction of medical machineries to substantially reduce the number of nurses in order cut cost; the shortfall experienced is yet to be recovered. Claims hold that demand for nurses is not responsive to wage increase. Reason alluded to introduction of states and federal regulation that govern staffing of registered nurses; this regulation does not vary wage increase in proportion to nurses’ demand (Coffman J., 2003). Furthermore, the incapability of the educational system to admit interested applicants is discovered a big limiting factor since the shifting in equilibrium of entry and exit of registered nurses in hospital tends towards insufficient supply. It is important to see this as a major factor limiting the resource of nursing personnel in hospitals. The international immigration of non-indigenous trained nurse lessens the extent of the shortage only temporarily, hence, the reason for many countries advocating to limit immigration of nurse form oversee. Poor image of nursing portrayed by the society that nurses are physicians’ junior assistance or handmaiden has persistently limited the enthusiasm of the young individuals to develop interest in the career. The career is a noble profession that does not warrant this illiterate-like perception. Very few people really got right the importance and the glorious role played by this profession in the health sector (Nevidjon & Erickson, cited in Janiszewski Goodin H. 2003). Some traced the conception to the presence of three different referencing of registered nurse; the associate degree holder, diploma and baccalaureate. Majority of registered nurses are within the associate degree holder followed by diploma. However, studies keep ruling out the intensity of wage as been a major factor for the sharp decrease in Nurses workforce in the health care industry.
4.0 Literature Reviews
Spatz & Given (2003) researched into the actual problem and the how to reverse the effect of nursing shortage in their report on “The Future of Nurse Shortage: will wage increase close the gap?” They further queried how high registered nurses must be paid to reverse the current and future trend of this unhealthy shortage. But one must be quick to realize that whatever necessary wage increase policy one may suggest to be instituted, deliberations on such recommendation should expect a feedback implication for the profession. One would foresee a situation where the pay rise will drastically lead to influx of registered nurses to a level that cannot be sustained and hence, the economic crisis and devaluation of the noble medical care services in the country. The society argues excess influx is preferred to the current shortage, so would relatively raise little concern (Janiszewski 2003). Then to what extent must the wage increase be sustainably regulated? Economic expert with perfect understanding of this crisis could possibly help the forecast. Australians nursing researchers, John Buchanan and Gillian (2001) coincidentally challenged that “hospital is being run like an investment body with issues pertaining to patient care not taking as the primary purpose prior to budget drafting” (cited in Spetz et al. 2003). He strongly argues that beyond business-like running, it is essential to equally prepare for patients’ emotional support, education, and counseling which come from time to time. In doing this, John and Gillian (2002) moves for more focus on clinical responsibilities of the inpatient on admission through the strengthening of nursing capacity in terms of number and their welfare (cited in Spetz et al. 2003). One would agree that both researchers are bordered by the relative reduction in the productivity of health sector, as such, are curious for a lasting solution to reverse the trend from the statistic base provided by the Bureau of Health professions. Similarity in their concern raises the need for redistribution of financial focus with an objective aim of providing incentives that will naturally command supply. A counter literature was reported in the findings of Spratley (2004) in his work on Registered Nurse Population: Findings from National Sample Survey, he who claimed from his preponderance of findings, “…nursing shortage is unresponsive to wage increases”. He researched that during educational prerequisite to supply trained nurses, there was shortage from time lag, making the supply for nurses to rise;
However, the data and research suggest that the nurses labor market has little room for short-term supply increases. In the provided data, in about 3 million U.S. licensed nurses, 82% were employed in nursing in 2000. Of those not employed in nursing, nearly 70 percent were age fifty or older in at the same year (2004)
5.0 Implications of Nursing Shortage for Nursing and Health Care Systems
For health care industry, the shortage of nursing officers has been implicated in range of iatrogenic complications owing to the consequential lacuna left in the hospital protocol. Where such hospital routine is interrupted, it does this with limited strength due to insufficient man power. Firstly, there is increase in hospital susceptibility to medical errors. Nursing clerking and records are important to assist in the explicit understanding of justification for any proposed treatment options that may be selected. The human brain can be trusted but documentation affirms the accuracy better than mere memorizing. Furthermore, nurses and others officers in medical practitioner are usually on shifting duty schedule, prior documentation by n outgoing nurse would help any in coming attendee to continue the judgment of next choice of treatment and care from where the documented data stopped. The documentation also provides avenue for cross examination of method applied in taking care of the patient to general recuperation of the patient.
With continual nurse shortage, the health sector is confronted heavily with increase statistic of inpatient mortality. Reduced staffing does limit the appropriate ratio of nurse-to-patient in the ward. When nurses are over worked, the efficiency of output is diminished. This situation is more critical here because it is not a game of money but assessment of output through the rate and number of surviving inpatient following postsurgical admission of palliative admission. Nurses are required for example to prevent some hospital acquired diseases such as pulmonary tuberculosis, bed or pressure sore. When poor attention is gen to this aspect of their services owing to over usage of minimal man power available, t is merely natural to experience mishaps or total neglect on how a patient should be cared for with high level professionalism. Bed sore prevention for example, this requires constant shifting of any comatose inpatient who is unconscious on bed for prolong days. The regular rubbing of patient’s pressurized body part with powder to prevent dryness and discourage habitations of any hospital prevalent microorganism is also one of the duties performed by the nurse. The neglect of the crucial activity at the required periodicity predisposes the unconscious patient to ischemic wound. This wound is so large at time that it could result in many complications order than what the patient did present with earlier. The implication of this for health care industry is the misplacement of prioritized relief from client’s presenting complaint with the addition of avoidable complication. Mishap could also be in form of infection of previously sterilized urinary tract. This situation happens when the nursing guide to catheterization is omitted for improper practices that could get the patient.
Another salient implication of nurse shortage to the health care sector is the prevalence of medication non compliance. One of the worrisome situations discovered in health sector is the patient noncompliance to patient placement on choice of therapy. Nurses built rapport that earns the trust of the patient as such they perform the educative session better in the clinical practice. They are expected to counsel patient as per the need for strict adherence to some prescribed medications, to counsel on certain day-to-day requirements and obligations that can enhance quick recovery of presenting complaints. For example, the enlightenment and necessary feeding assistance in a patient with previous surgical appliance replacing the gut who is now advised to condone the hunger for usual meal to fluid needs to be monitored by the nursing officer in charge.
The economic theory that guides the laws of demand and supply to ensure equilibrium is one of the recent predictions by experts as being a necessary approach to rectify the chronic shortage of registered nurse in our health centers. However, another group of observers insisted that the experienced shortage started about 60 years back is a resultant of massive retirement of the belonging age group that cannot be replaced with a commensurate in take from interested society. While another opinion suggest the wage increment over the period of sixty years has not appropriately correspond to the task perform, hence the loss of interest in the profession. Some senior registered nurse argue for reduction in the discrepancy between other clinical practitioners and nursing profession, claiming to have involved in a seemingly service professionalism as others in the health sector.
6.0 Literature Based Recommendations
Industrial Policy implementation: since the direct recipient of blame is not only the government of the people, health care industry needs to show commitment into the indigenous influx of nurses into its commission. Hospitals involvement should assist in organizations of programs that can directly support and encourage educational system to accommodate the training of more registered nurses. Medical directors need to pay more emphasis on improving working conditions in the hospital environment towards leveraging a competitive edge of the professed ethics amidst other professions. Let there be complementary efforts of nurses on call with electronic medical services, this will encourage nurses’ drift into the market and equally reduce portray of nurses’ perception as merely handmaidens for physicians. The public awareness of the society on the dignity of nursing profession through the media should be enforced by the government of States. In the interest of the healthcare industry in general, policy should involved fine tuning resolutions to further clear cut any conflicting unprofessional relationship between physician and nurses.
Facilitating employment and immigration of Nurses: About eight years ago, over 18% of registered nurses are unemployed. Reaching these ones now becomes a major target to defend future crisis in health care industry. There is a need to create a trainable environment where preparatory session will re-orientate incoming interested old nursing officers on new practices in nursing. In as much as the shortage persists, it is not objective to disagree on the need to encourage immigrant. Government and Health policies need encourage influx but with a fundamental proviso of free enrolment in training programs. The program should be designed to provide the immigrant with necessary practicing tools pertinent of a hosting nation. This should be preceded with permanent license following satisfactory performance in regulatory examination. Brewer and Kovner (2001) submissions to this certification program include easing of entrance to immigration of foreign nurses without strict policy cited in Spetz J., 2003).
Towards long term employment facilitation, Nevidjon equally acknowledged one important strategy in his work (2001). He recommends that recruitment should begin from the early age of people in high school. Gradually, this age group develops interest as they grow old with fertile mind. The supporting argument for this is founded in the fact that the younger age groups are at the initiating stage where they begin to research into what career they defend in life. From preponderances of researches, it is safe to submit inclusion of Nursing Integrating Career or Pre-nursing Academic course into school of nursing management where older practitioners interact with the young. Taking a critical relevance of other recruiting efforts suggested by few literatures with their success reports, it would also be resourceful to derive that Government increase in the provisions of subsidized loan and grant to encourage qualitative advancement in nursing profession beyond associate degree to baccalaureate and postgraduate levels. (Cited in Janiszewski Goodin H. 2003)
Fig 6.0
A Schematic Overview of Nursing Model
Demonstrating entry and exit of nurses in hospitals
7.0 Conclusion
The research paper describes the possible outcome resulting from scarce supply of nursing practitioners in the health care sector. It has taken an in-depth study for detail understanding of the need to urgently address the pending danger the shortage posed to our health system with analysis of economic and social implications. The healthy state of the health sector itself is a direct reflection of the quality of services and the vibrancy of any Government’s policies in meeting the need of medical services in the State. From the research, it could be succinctly proposed that a re-course from current oversight of instructive nursing programs and implementation of motivational economic policy is a path to rescuing the silent deterioration of productive health sector. This is as against some authors’ emphasis on wage increase, improved working condition among others. A pending argument queries how the society can contain eventual surplus of nursing practitioners following a productive implementation of the proposed change mechanism. This is still subjected for further review because no author has researched into the likely consequence of this foreseen outcome.
References
American Nurses Association (ANA), Site Available at: http://www.nursingworld.org/EspeciallyForYou/Links/Publications.aspx (Nov. 2008)
Bureau of Health Professions. (2004). What is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses. Retrieved November 2, 2008
Bureau of Health Professions. (2004). Nursing Demand Model: Development and Baseline Projections. Report prepared by The Lewin Group for the National Center for Health Workforce Analysis.
Brush, B. L., Sochalski, J., & Berger, A. M. (2004). Imported care: Recruiting foreign nurses to U.S. health care facilities. Health Affairs, 23(3), 78-87.
Coffman J. & Spetz J., Nursing in California: A Workforce Crisis (San Francisco: California Workforce Initiative, 2003).
Janiszewski Goodin H. (2003) Journal of Advanced Nursing 43(4), 335–350. The nursing shortage in the United States of America: an integrative review of the literature
Spetz, J., and Given, R. (2003). The future of the nurse shortage: will wage increases close the gap? Health Affairs, 22(6):199–206.
Spratley E. et al., The Registered Nurse Population, March 2004: Findings from the National Sample Survey of Registered Nurses. bhpr.hrsa.gov/healthworkforce/reports/rnsurvey/rnss1.htm (1 November, 2008).
http://content.healthaffairs.org/cgi/content/full/22/6/199
http://www.mnscu.edu/business/workforceeducation/nursingshortage.html, Fact Sheet