Nursing is an occupation making up a majority of the medical workforce. It is an “important component of the US health-care system” (Bakhamis, 2019) and without nurses, a majority of the patient care would not be accomplished. Nursing shortages have been a topic of discussion in the past few years. It is estimated that there will be a nurse shortage in the upcoming years due to many factors such as the baby boomer generation, nurses leaving the profession early and not enough new nurses to replace the retiring nurses. The nurse shortages have been occurring in cycles which is dependent on supply and demand and retiring nurses and citizens. “According to the US Bureau of Labor Statistics, 2.8 million registered nurses (RNs) worked in the US health care system” (Bakhamis, 2019).

The Immigration Nursing Relief Act of 1989 allowed nurses from foreign countries to migrate to the U.S as an alien to seek for employment. The act targeted the nursing occupation at the time because of the shortage that was declared by the Department of Labor. Nurses from the Philippines were a majority of the migration act, having more than seventy percent of the nursing relief. Since then, nurse immigration has tripled since 1994. There were some opinions regarding foreign nurses’ competencies to practice in the country. The Commission on Graduates of Foreign Nursing Schools (CGFNS) was established to qualify foreign nurses to practice safely in America. It promoted patient safety while supplying additional nurses in the United States. The shortage occurred again when President Bush signed the Nurse Reinvestment Act in 2002 encouraging citizens to join the nursing workforce. The American Nurses Association requested 250 million dollars to fund and assist nursing schools, policy makers, nursing organizations, and society to bring the nursing shortage into attention. Hopefully in due time the reinvestment act will encourage citizens to pursue the profession.     

The Baby Boomer generation is known as the massive increase in births after World War Two. Citizens in this population are born between the years of 1946 to 1964. There are approximately 75 million people under this generation. Currently, this population have begun retiring since 2011. As they retire, patients in hospitals, nursing homes, home care and private care will increase as they need more nursing care in which will need additional nurses. The baby boomer generation and the “aging population will exacerbate the nursing shortage” (Bakhamis, 2019). According to Bakhamis, “more than 55% of current RNs are 50 years or older and expect to retire” (Bakhamis, 2019). The increase in the number of patients and decrease in the supply of nurses will result in a nurse shortage because the supply is unable to meet the demands of health care.

Poor staffing ratios is an ongoing problem for nurses throughout the United States. The average hospital medical-surgical nurse should take between four to six patients. More than six patients would increase the risk to patient safety and mortality. The risk of patient death increases by seven percent “for each additional patient the nurse must take on at one time”. The probability of a medical error increase as the nurses takes more than six patients in their assignment. Management perspective may have to require nurses to stay for mandatory overtime as a last resort to fill in empty spaces in staffing. Mandatory overtime defined by Huston, is also called “compulsory or forced overtime, occurs when employees are required to work more than are standard” (Huston,) of forty hours per week. Facilities with less nursing staff may have the difficulty finding adequate staffing for the shift. They then require nurses from the previous shift to stay overtime. This frustrates the staff as they are forced to stay with extreme exhaustion present at the end of their scheduled shift. California is the only state to have mandated safe staffing laws since 1999. Research has shown mandatory safe staffing improves patient care and safety, according to McHugh, Kelly, Sloane and Aiken. Decrease mortality rates in patients has been found with more nurses on staff. California being the only state to have mandated safe staffing laws indicates adding additional nursing staff shows “better outcomes, compared to outcomes for patients treated in hospitals in states without a similar law”. Other states should follow the state of California to improve patient outcomes.

  Burnout is defined by Freudenberger in 1974 as “the state of emotional exhaustion in which the individual feels overwhelmed by work to the point of feeling fatigued, unable to face the demands of the job, and unable to engage with others” (Bakhamis, 2019). Symptoms of burnout include dulled emotions, compassion fatigue, lack of motivation and dissatisfaction. The term is relevant in nursing as more nurses are experiencing burnout early in their career.

According to Erickson and Grove’s research, “the rate of burnout amount RN’s younger than 30 years was 43.6%” (Bakhamis, 2019) compared to older nurses with the rate of 37.5%. Bakhamis states “80% of the RNs sampled complained that they had no time for rest because of a heavy workload” (Bakhamis, 2019). Continuing burnout results in “RN turnover rates, poor job performance, and threats to patient safety” (Bakhamis, 2019) which is the number one goal for the Joint Commission. Chronic stress in nurses can result in “severe headaches, sleeping complications, high blood pressure, and cardiovascular illness” (Bakhamis, 2019). Experiencing too much burnout will drive nurses to leave the occupation altogether, causing an even larger shortage. There were up to sixty-five percent in Bakhamis’s study who “left their jobs as a result, which as contributed to a nursing shortage” (Bakhamis,2019). Burnout can be prevented in nurses by teaching the importance of the motto “self-care before healthcare” so nurses can provide the highest quality care they can when their health is being taken care of as well.

Nurses are not motivated to proceed with additional education after their baccalaureate degrees. Schools of nursing require students to practice a specific amount of hours in the practice to provide clinical experience and readiness into the profession. Professors teaching the curriculum may require masters or doctorate degree to teach. There were approximately fifty-four thousand applications denied “because of insufficient faculty, lack of sites for clinical placement, budget constraints and other factors”(Egenes, ). Eugene calls this “the other shortage” as the shortage of “qualified faculty members for schools of nursing”(Egenes,). Nursing faculty members are expected to retire within the next ten to fifteen years, exacerbating the nursing shortage because they are relied on to teach future nurses. The number of faculty members will decrease as nurse educators are retiring and current nurses are not pursuing further education degrees to assist with the nurse faculty shortage.

The inability to fulfil vacancies in nursing will eventually cause an increase in medical error occurrences. Medical errors are preventable mistakes occurring in the care of patients which may or may not cause injury, harm or death. The existence of medical errors in healthcare has brought into attention by the U.S Institute of Medicine with a report written in 1999 called To Err is Human. According to Olds and Clarke, it was “reported that 9.6% of RNs in their sample had a contaminated needle stick or serious injury, 15.1% provided the wrong treatment or dose to their patients, 19.8% had caused injuries to their patients from falls, 32.8% had experienced work-related harms, and 35.2% got infections”(Olds and Clarke, 2010). Nurse shortage, unsafe staffing, constant stress, mandated overtime and distraction while administering medications are some of the many factors nurses can make medical errors.

Shortage of nurses will result in low staffing, “poor level of patient care, patient dissatisfaction, an increased number of medical errors, higher infection rates, and higher mortality rates” (Bakhamis, 2019). “The problem of a shortage of nurses in the U.S. is cyclical in nature” (Egenes,). Staffing issues are always a topic of discussion at work, in which the unit is understaffed almost everyday or every other day. Stress levels rose when the lack of staffing was found out during rounds. They are more patients than nurses to count especially with the growing retiring population requiring more nursing care than society can supply.

The demand for nurses is “fueled by a growing elderly population with a longer life expectancy, advances in medicine that require well-educated nurses, increased numbers of patients requiring care for chronic conditions, and hospitalized patients with higher acuity levels” (Egenes,). Increasing the nursing workforce can “improve the quality and safety of patient care in the United States” (Buerhau, 2005). Nursing contains a stigma when it is mentioned as an occupation to strangers. It is automatically assumed that a lot of blood is dealt with during my day to day basis and the occupation is opt out entirely. Blood is one of the reasons why people are not encouraged to join the profession. My future plan is to pursue a Masters of nursing in Nurse Practitioner or Nursing education but ideally, I would like to do both. I want to be the inspiration and assistance that I was not fortunate to have during my time as a nursing student. Assisting others to achieve their dreams as a nurse will motivate others to assists others as well and fix the nursing shortage.

References:

 

Contradicting Fears, California’s Nurse-To-Patient Mandate Did Not Reduce The Skill Level Of The Nursing Workforce In Hospitals. Health Aff (Millwood). 2011 July ; 30(7): 1299–1306. doi:10.1377/hlthaff.2010.1118

Olds DM, Clarke SP. The effect of work hours on adverse events and errors in health care. J Safety Res. 2010;41(2):153-162.

Davis, Catherine; Nichols, Barbara (2002). Foreign-Educated Nurses and the Changing U.S Nursing Workforce. Nurs Admin Q. 26(2): 43-51.

Bakhamis,L. ; Paul III,D. ; Smith, H. ; Coustasse A. Still an Epidemic: The Burnout Syndrome in Hospital Registered Nurses (2019) The Health Care Manager. Volume 38, Number 1, pp. 3–10

Huston, C. J. (2017). Professional issues in nursing: Challenges and opportunities (4th ed.). Philadelphia, PA: Wolters Kluwer.

Buerhaus, P.;  Donelan K.; Ulrich, B. ; Norman, L.; Williams, M.; Dittus, R. (2005) Hospital RNs’ and CNOs’ Perceptions Of the Impact of the Nursing Shortage On the Quality of Care. Nursing Economics. September-October Vol. 23/No. 5