ABSTRACT
There are a number of factors that contribute to the nursing shortage: Staffing shortages are impacting the stress level of nurses thus impacting job satisfaction. The change in demographics requires a need for more nurses to care for the aging population. A significant sector of the nursing workforce is approaching retirement age. Even though the causes of nursing shortages are multi-faceted in nature, there is growing evidence of the impact of low staffing levels on health care delivery and outcomes. The public health significance of organizations to retain nurses is twofold: by focusing on nursing leadership styles as a recommendation to alleviate some of the problems that are emerging as a result of nursing shortages and nursing job satisfaction.
INTRODUCTION
Nursing shortage is defined as an inadequate number of qualified nurses to meet the projected demand for nursing care within healthcare settings. The nursing shortage is not a recent phenomenon; however, in the last few years the shortage has begun to have a significant impact on our healthcare systems. In this essay, I will explain the causes for the shortage of registered nurses (RN), and the necessities to improve the quality of work in the nursing profession.
WHAT’S EXPECTED FROM NURSES
According to the American Nurses Association, a Registered Nurse (RN) requires one to assess, plan and intervene to promote heath, help patients manage illness and prevent diseases. While providing care to patients, their duties include observing, assessing and recording patient symptoms, reactions and progress. RN roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, directing complex nursing care systems, conducting clinical research and teaching in nursing programs, as well as practicing in many other invigorating settings. RNs also develop and manage nursing care plans, instruct patients and their families in proper care and help individuals and groups take steps to improve or maintain their health. Their roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, directing complex nursing care systems, conducting clinical research and teaching in nursing programs. Although there are many specialties that fall within the realm of nursing such as Critical care, Emergency, Nurse Educator, Hospice care/Palliative care, I am interested in learning more about the nursing shortages that effect in a hospital setting overall.
The current nursing shortage and high turnover is of great concern in the United States because of its impact upon the efficiency and effectiveness of any health care delivery system. Research suggests that the current shortage is the product of several trends including (Cullen 2010):
While opportunities in health care are expanding, issues within the nursing profession are beginning to emerge as a significant proportion of nurses are retiring. Registered Nurses represent the largest single healthcare profession in the United States. The result of cyclical shortages of nurses in the United States health care system will have a direct effect on the quality of patient care and is a multifaceted and complex issue, with causes stemming from training as well as compensation and retention. In 2000, there were 110,000 open nursing positions, indicating that demand for RNs were 6 percent higher than the available supply. In 2008, according to the American Health Care Association’s report of vacancies in long-term facilities as well as the American Hospital Association’s report of hospital vacancies indicated an even larger shortage of 8.1%. It is predicted by 2025, the shortage of RNs is projected to grow to an estimated 260,000 FTEs, twice as high as any US nursing shortage since the 1960’s (Cullen, 2010). The Nursing Management Aging Workforce Survey found that 55% of registered nurses intend to retire from the nursing profession between 2011 and 2015. Nurses reported high levels of job dissatisfaction due to work scheduling, heavy workloads, mandatory overtime, as well as the lack of responsiveness to concerns from upper level management as major reasons for high turnover and early retirement among RNs (Beauhaus, 2009). According to the American Association of Colleges of Nursing (AACN), nursing leaders play a critical role in helping to give nurses a voice in the development of patient care environments. Leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work. This demands a pattern shift from a more traditional command-and-control style of staff supervision toward a transformational style of leadership in which leaders enhance the motivation, confidence and performance of their follower groups.
METHODS
Integrative literature review of published literature was reviewed on the current nursing shortage in the United States as well countries abroad from 1997 to 2011. The literature review conducted for this paper was conducted by looking at journal articles, online books and web articles that addressed the topic of nursing shortages and to provide specific recommendations to address the nursing shortage. In order to further my understanding on this topic, my literature review was also conducted through online research that was obtained through published articles and newspapers. Published literature was identified by searching the following bibliographic databases: with in-process records via PubMed; and CINAHL. The main search concept in conducting this research were: nursing shortages, nursing shortage solutions, job satisfaction, ageing RN workforce, stress, recruitment, retention, image, students, future of nursing, nursing shortages trends, common administrative issues in hospitals. I then searched within these articles for acute care and ambulatory facilities by entering key words such as ER, ICU, NICU, Urgent Care, Ambulatory Surgical Center, Radiology, Acute Care Facilities, etc. After pulling 36 articles I once again narrowed my search and criteria were limited to nurse staffing that focused primarily on the registered nurses and staff nurses when considering nursing perspectives.
Data collected for the review included surveys, questionnaires and direct interviews. The types of questionnaires and surveys utilized were: Multifactor Leadership Questionnaire, Index of Work Satisfaction Effectives Questionnaire (CQEW) which measured the perceptions of workplace empowerment; Job Activities Scale (JAS) was used to measure nurses’ perception of power in the work setting; the Leader Empowering Scale (LEB) measured the empowering behaviors of their managers and lastly the nurse perception of informal power was measure by the Organizational Relationship Scale (ORS). The Anticipated Turnover Scale (ATS) is an instrument which has been used in research to measure anticipated turnover. I utilized these studies as they were relevant to understanding the reasons for rising concerns of nursing shortages over the last several decades.
REASONS FOR NURSING SHORTAGE
The reasons for the nursing shortage are multifaceted in nature, which reflect the changes in population demographics, women’s employment patterns, the healthcare system, and nursing work (Rosseter, 2011). Together, these changes pose significant challenges both in recruiting new RNs and retaining currently employed RNs. There is an increase in the demand for nurses as a result of population aging. Projected shortages should be viewed in the context of expected increases in demand for nursing services (Rosseter, 2011). Between 2000 and 2020, the US population will grow by 18 percent (31 million) overall, but the over-65 population, with more health care needs, will grow by 54 percent (19 million people). Furthermore, there are broad changes in social and employment patterns for women. Women who are born after the 1950s have more career options than their predecessors, and fewer have chosen to enter the nursing profession (Rosseter, 2011).
In response to the rising costs of health care, the growth of managed care in the 1990s created cost pressure, particularly on hospitals, the largest employers of RNs. In the early 1990, areas with higher managed care enrollment had slower wage and employment growth for RNs than areas with lower managed care enrollment. As managed care spread, RN wage and employment growth slowed at the national level by the late 1990 (Rosseter, 2011). These changes followed shifts in hospital payment systems designed to reduce spending, leading to shorter lengths of stay in hospitals. As a result, hospital RNs treat patients who are sicker on average, and their work is thus more intensive. Nurses have been overloaded with work in response to health care cost pressure in the 1990s (Rosseter, 2011). Hospitals reduced staffing and implemented mandatory overtime policies to ensure that RNs would be available to work when the number of patients admitted increased unexpectedly. The workload for RNs increased, and their control over scheduling and flexibility decreased as weekend and night shifts were no longer readily available as preferences to RNs. However, additional workload does not mean increased compensation, but, as mentioned above, RNs wages were flat over this time period, due to the more competitive health care environment. With all the factors prominent in the workforce, it is expected that many individuals are hesitant to enter the nursing profession (Rosseter, 2011).
CONCLUSION
As a literature review has shown, there are several factors contributing to the nursing shortage. Today’s nurse executives, nurse managers and unit nursing leaders face the challenge of finding ways to shape changes in healthcare. Nurses by their nature are visionary, passionate, committed people who have innovative ideas about how to transform healthcare. Nursing executives, nurse managers and both formal and informal nurse leaders with a transformational leadership style can tap this font of nursing knowledge to move nursing and patient care in a positive direction for the future. Whether the issues impacting the nursing shortages are resolved or improvements are made in the work environment will determine the future for the nurse workforce.