The Issue of Nursing Shortages and the Efforts to Counter It

Nurses Wanted: Apply Within

There is a direct link between the nursing shortage and an increase of patient deaths according to an October 2002 study by the University of Pennsylvania. Who is to blame for the shortage of United States trained registered nurses to fill the thousands of nationwide positions in hundreds of specialty areas? Fingers have pointed to the lack of formal mentoring programs, managed medical care, and implemented short-term staffing solutions. Note the typical profile of the registered nurse of 2003: Ninety-four percent are female, average age is 48 with 77% of all nurses over age 40, and thirty-five percent of working nurses are eligible to retire by 2005. Many of this generation had their first experience in a health care setting through programs such as the Candy Striper Program sponsored by the American Red Cross.

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Such structured mentoring programs today, however, are scarce which fail to provide incentives to choose nursing as a profession. Until as recently as forty to fifty years ago, most women who elected to work encountered three customary options: teacher, nurse, secretary, or flight attendant (then known as stewardess). In today's robust economy, young people are presented with many choices for careers, and nursing must compete with a more lucrative workforce. Many are more profitable and less demanding than caring for the sick. Nursing is a very difficult, demanding profession. It takes a lot of time, effort and giving. The factors that will induce young people to choose a nursing career are the same as those cited for retention of the current nursing work force.

Hospitals will have to develop personnel policies and benefits comparable to those in other lines of work and businesses, including opportunities for career advancement, lifelong learning, flexible work schedules, and policies that promote institutional loyalty. Popular short-term strategies such as signing bonuses and use of temporary personnel do not address the issues at their core. Neglecting formal mentoring programs, extensive managed health care restrictions, and frequent media attention to the problems of the nurses' work load result in few positive messages to choose nursing. Interventions to correct workplace issues must be made in concert with developing and expanding mentoring programs.

Candy Stripers are volunteer hospital workers and usually high school girls between the ages of 14 and 18. Duties vary from hospital to hospital, but generally Candy Stripers assist in the hospital's gift shop, deliver flowers and messages to patients, fill their drinks, read to them, and other small tasks to make patients' hospital stays a little nicer. Candy Stripers get to work shifts as long or short as they like, for example two hours or six hours. It is often their first experience with employment, and they often find it rewarding to function in a valued and appreciated position. Candy Striper programs, however, are declining due to lack of interest combined with the failure of the nursing profession to present high school students with a positive image. The consequence of recruitment oversight is unmistakably obvious; enrollment in American nursing colleges has been steadily decreasing in the last ten years.

Multiple interrelated factors affecting the demand for nursing services have been identified by researchers and professional organizations. These factors include: Cost-containment pressures within health care organizations resulting from managed care; an increasingly competitive health care environment; hospital consolidation, downsizing and reengineering; reductions in inpatient hospitalization rates; increased acuity of hospital patients; and a shift of outpatient care from hospitals to ambulatory and community-based settings. With more competition, coupled with no limits on the discounts that insurers could negotiate with hospitals, quick fixes led to cutting labor costs and then to more drastic measures, such as hospital closings. Labor is a huge chunk of hospital costs, and hospital managers looked there to cut, so more unlicensed health care workers are being employed. Insurance companies are no longer willing to pay for patients to recover from surgeries and long-term illnesses in hospitals when managed care facilities are available at a fraction of the cost. As a result, insurance companies promote convalescent facilities which maintain lower costs by employing nurses aides for routine patient care and a minimum of registered nurses for supervisory and administrative purposes.

Congress responded to the nation's last major nursing shortage in the late '80s by passing the Immigration Nursing Relief Act of 1989 to create a special temporary H-1A visa category for RNs. Most of those foreign-trained nurses came from the Philippines, Canada, Ireland, the United Kingdom, India, and China. More nurses have come from South Africa, Zaire and Kenya to the United States to work. Many Americans are greatly disturbed by the foreign recruitments: It's extremely unethical. It's such an egotistical view that in the United States of America, we can buy anything that exists in the world to secure a better position. Although foreign nurses are as equally qualified as their American counterparts, many patients feel unsettled by a real or imagined language barrier. Some patients are under the impression that their nurse's ability to speak English is directly tied to his or her ability to provide adequate health care. This leads to uncertainty, doubt, and anxiety in a patient already stressed by illness or injury.

Regardless of the qualifications of foreign nurses, the only long-term solutions to nursing shortages are for healthcare employers to develop programs-including mentoring and career development-that will make U.S. nurses want to work for them. While most in the field are aware of the problem, there does not appear to be a concerted effort to do anything about it. If the healthcare industry looked ahead and paid more attention to increasing salaries, providing benefits, offering training, developing career ladders, and attracting young people into the profession, the American nursing work force would stabilize. The connotation is that we need nurses and let's go get them from other countries, and then when the demand declines, we can forget about this. It gives a harmful message to the nursing profession that this is a disposable work force.

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