It is no secret; the United States has faced many nursing shortages throughout history however, the current nurse shortage Americans face today is unlike those of the past. Due to the many changes in the American economy, politics and education, the nursing profession has encountered an epidemic that seems to have no current resolution. Researchers have thoroughly examined the causative factors that contribute to the nursing shortage and the strategies used it however none have been successful and here’s why.
The nursing shortage we are about to face has many different causative factors that combine to create “the perfect storm.” ANA Health Care Economist Peter McMenamin on the Nursing Shortage Outlook indicated that there are six causative factors that contribute to the nursing shortage; they include the economic recovery, the baby boomers, the Affordable Care Act, employer changes, market changes and care coordination. Changes in the delivery of the healthcare, the increase in retiring healthcare professionals and economic recession continues to leave a strain on the nursing profession by eliminating staff nurse positions, freezing hiring, and creating a large amount of registered nursing positions without a pool of employees to fill these positions. Along with these causative factors, the United States Bureau of Labor Statistics (2018) states that the projected employment growth will be 15 percent from 2016 to 2026, which is much faster than the average for all occupations. This projected growth along with the current nurse shortages we face across the country raises issues of concern for the succession and progression of the nursing profession.
Economically speaking, the recession of 2007 had a direct effect on the nursing shortage we are faced with today; the recession of 2007 led to a profuse amount of budget cuts, layoffs and hiring freezes in hospitals nationwide. With nurses being the largest professional group in healthcare, these cost-effective changes have strongly impacted the nursing profession. Economic downsizing has triggered several negative outcomes within the profession which includes poor retention rates, job dissatisfaction, and nurse burnout. Huston (2018) states, “one of the most significant yet least addressed factors leading to the current RN shortage is workplace dissatisfaction, resulting in high turnover levels and nurses leaving the profession.” Low autonomy, heavy workloads, and the inability to ensure patient safety has caused high turnover rates, leaving hospitals and skilled nursing facilities extremely understaffed. American Nurse Today (2012) reports that 30% of new graduate nurses (NGN) will leave their jobs within the first year and 58 % will leave during their second year. These high turn over rates leave hospital and nursing facilities with the task of figuring out how they can retain new nurses to help fill the gaps left from the retiring generation.
Due to the gradual increase in the aging population and number of patients who will require treatment for chronic diseases such as chronic obstructive pulmonary disease, diabetes and coronary artery disease, the projected increase in registered nursing positions will contribute to the current issue we face with nursing shortages. AMN Healthcare 2017 survey suggest a “long- predicted wave of retirements among baby-boomer nurses”; this information amplifies the crisis of nurse shortage and as healthcare professionals continue to experience the negative impacts of this shortage, the expectancy of improvement continues to decline. AMN Healthcare indicates that
“nursing shortages are already being felt throughout the country, and they are expected to intensify as the retirement wave becomes a more significant factor. The retirement wave is combined with other macro trends, such as the rising demand for healthcare services from our aging general population, to create a perfect storm of steadily worsening clinical workforce shortages.”
The AMN accurately describes the current nursing shortage as the combination of events as “the perfect storm”. Due to the combination of events that have directly influenced the current nursing shortages, an epidemic has been created that could not have existed independently by one single cause.
Reforms in health care acts such as the Affordable Care Act (ACA) have also directly impacted the demand for RNs. The increase in insured clients has caused an increase in emergency visits; clients who were once reluctant to seek medical advice due to financial status no longer worry about hefty hospital bills which is why nurses and doctors currently encounter heavier caseloads. The ACA also has a direct impact on the places RN’s work and the skills they require to be successful in settings other than the hospital. With healthcare moving more toward the community setting, an array of positions continue to be created to keep clients at home and out of the hospital. According to Spetz (2014)
“Registered nurse employment is expected grow most rapidly in outpatient settings – particularly physician offices – and home health care. In these settings, RNs will be expected to serve as care coordinators, case managers, patient educators, and chronic care specialists.”
This shift in healthcare has created an array of positions outside of the clinical area without adequate supply of qualified nurses to fill positions. In addition to the increase in demand for RN outside of the clinical field, many of these positions such as telephonic assessment nurse requires advance skill and experience which new grads do not possess.
From an educational standpoint, reasons why there is a nursing shortage in the United States include low funding which resulted in the closure of many nursing programs, vacancies in teaching positions which resulted in a lack of faculty to educate nursing students.
“Budget constraints, an aging faculty, and increasing job competition from clinical practice sites have contributed to the nursing faculty shortage across the country which has resulted in limiting student capacity at a time when the need for professional registered nurses continues to grow (American Association of Colleges of Nursing [AACN], 2017).”
Snavely (2016) reports that nursing schools reported a substantial amount of shortages in faculty, restricting nursing programs from enrolling an optimum number of new students. According to the AACN, U.S. nursing schools turned away nearly 80,000 qualified applicants to baccalaureate and graduate programs in 2012 “due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints”. Some nursing schools have even gone as far as to close nursing programs due to funding. Despite the steady increase in enrollment in school, the increases are not enough to replace the nurses who will be lost to retirement in the coming decade. Increases in federal money for nursing education over the last decade. Vacancy in teaching positions and financial encouragement for nursing students to complete their studies and assume teaching positions.
Experts have attempted to fix the nursing shortage in many ways. Huston (2018) identifies one of the problems in nursing recruitment to be the focus on recruiting young nurses instead of bringing unemployed and part time nurses back into full time positions. However, what experts failed to realize is that the recession of 2007 forced many unemployed and part time RN’s to return to full time positions. In a sense, experts were depending on a resource that had already been tapped out. The shortage has also been alleviated in part by the importation of RN’s from foreign markets. This has served as a temporary fix as the shortage continue to rise at a steady rate while foreign nurse return to their country after the expiration of visas.
In my opinion, the nursing shortage is an issue that must be addressed from a multiple focal approach. There are many political, economical and social issues that contribute to the nursing shortage and in order to fully resolve this issue nursing leaders and experts must approach each issue individually in order to come up with a solution that is conducive to the improvement of nursing shortages.
References:
American Association of Colleges of Nursing (2017). Nursing faculty shortage fact sheet. Retrieved from http://www. aacn.nche.edu/media-relations/fact-sheets/nursing-facultyshortage.
Huston, C. J. (2016). Professional issues in nursing: Challenges and opportunities. Philadelphia: Lippincott Williams & Wilkins.
Spetz, Joanne (2014, January/February). How Will Health Reform Affect Demand for RNs? Retrieved from https://www.questia.com/read/1P3-3251006261/how-will-health-reform-affect-demand-for-rns
