Nursing Shortage: Solutions of the Problem

Introduction

The field of nursing holds multiple roles and responsibilities that lead individuals into different aspects of the career field. Many of the roles that a nurse plays a part in are caregiver, manager, educator, advocate, and more. The down side to working in healthcare is the multitude of issues that people have to deal with, such as staff shortages, needle stick incidents, and HIPPA violations. After years of research, individuals have begun developing possible solutions to several of the major nursing issues that every nurse deals with on a daily basis.

Nursing Roles

A nurse is not defined by just one role, but by several specific roles and responsibilities. There is a long list of roles that the nurse plays a part in during their daily work routine. Caregiver, manager, educator, and advocate are just some of the major roles that are easily recognized by other individuals, such as patients and other healthcare professionals. There are several tasks that are involved in the nursing roles that can be delegated to other health care professionals. These individuals consist of LPNs and UAPs. UAP stands for an unlicensed assistive personnel, and LPN is the abbreviation for licensed practical nurse. Due to having less education than RNs, LPNs and UAPs are restricted to specific tasks compared to the wide ability of a registered nurse. All of the nursing roles are combined together and performed to benefit the patient in every way possible.

Caregiver

The role of a caregiver is not limited to one task, but a multitude of duties. The nurses responsibilities as a caregiver are care provider, comforter, healer, helper, nurturer, rehabilitator, and support agent (Zerwekh & Garneau, 2015, pg. 138). As a care provider, the RN assist the individual with activities of daily living, medication administration, ambulation, and more. The RN provides comfort to the patient during the times of good news, as well as the heartache of bad. The registered nurse comforts the family just as often as they do with the patient. As a healer and nurturer, the nurse administrates treatments to help the individual become healthy before being discharged. The role of support agent is observed in a nurse when they help a patient make a decision and they support the individual’s choice, even if they do not agree that it is the right one. Therefore, a caregiver is one of the most important and essential roles in nursing.

As a licensed practical nurse or an unlicensed assistive personnel, the role of a caregiver is slightly different compared to a registered nurse. The LPN is still able to provide medication administration, where as an UAP is not. The UAP is restricted to activities of daily living, ambulation, gathering information (intake and output, vital signs), feeding, and documenting all the care that they provide (Association of Women’s Health, Obstetric and Neonatal Nurses, 2016). In most hospitals, nurses usually have their RN or even higher educational status. In rare occasions, LPNs may work in a hospital setting, but most of the time they work in nursing homes, schools, doctors’ offices, and home health care. In the case of a licensed practical nurse working in a hospital, they are able to provide the same care as a registered nurse except for tasks that involve extensive intravenous care. These tasks include: starting or discontinuing IV catheters or fluids, critical medications that are related to the heart or blood pressure, administrating IV push medications, or care of central IV lines (Working as a Licensed Practical Nurse (LPN), 2019). Compared to a registered nurse, LPNs and UAPs provide care that is just as important as the larger tasks that RNs provide on a daily basis.

Manager

The second role that is important when it come to taking care of patients is managing the situation at hand. As a manager, the nurse plays an important role in leading, planning, coordinating, initiating, evaluating, and making decisions regarding to the patients and staff (Zerwekh & Garneau, 2015, pg. 138). As the founder of modern nursing, Florence Nightingale believed that a nurse being able to manage in such a role was an important part of nursing (Zerwekh & Garneau, 2015, pg. 141). In the role of manager, RNs need to be able to organize the care provided to the patient so other health care professionals would be able to carry on the care without the presence of the other nurse (Zerwekh & Garneau, 2015, pg. 141). The term manager was not established for this role until the late 1970s. The role was first named as charge nurse, supervisor, and coordinator. The responsibilities of the nurse as a manager are being responsible and supervising the staff members and the care they provide, enforcing agency policies, developing improvements in patient care, motivating staff, solving problems, and providing staff and patients with effective resources (Zerwekh & Garneau, 2015, pg. 141). Depending on the facility, the nurse’s role as a manager becomes less hands on and more behind the scenes compared to the other important roles of nursing.

The manager role is one that is typically given to a registered nurse or an individual with higher education. In the hospital setting, LPNs and UAPs are not qualified as a manager, where as in the case of the nursing home setting, LPNs have the ability to hold the position of manager or leader of a specific unit. In these setting, LPNs are able to plan care for patients, manage their health status, provide physicians with information, as well as receive information about the patient from the doctor (Working as a Licensed, 2019). Though in hospitals, licensed practical nurses are unable to take verbal or phone orders from physicians (Working as a Licensed, 2019). Unlicensed assistive personnel are never seen in this position due to not having education as a nurse. Therefore, the role as a manager throughout most health care setting is given to individuals who are known as RNs.

Educator

An important role in providing care for a patient is for the nurse to be able to educate the individual. As an educator, the RN has duties to educate the patient, the patient’s family, as well as other staff members (Zerwekh & Garneau, 2015, pg. 138) . The educator role is also seen as a counselor and community teacher. The registered nurse is responsible for educating the patient regarding the specific condition diagnosed, prescribed therapy, and the choice for a successful outcome (Zerwekh & Garneau, 2015, pg. 138). Educating the individual on information regarding their health can help decrease the patient’s anxiety. A major role as an educator is helping the patient understand what information is needed to make a critical decision regarding the right treatment for their health. Before an individual is discharged from the hospital, the nurse is obligated to educate the patient on all the information needed after leaving the unit, such as restrictions, diets, or follow-up appointments. The role as an educator is important because if the patients were not educated properly, then they would not have the knowledge to make adequate decisions regarding their health.

When educating an individual pertaining to an important decision or making sure they understand the discharge plan that was put into place, in hospital setting an individual who is typically a registered nurse is put into that role. UAPs are never placed in the role of an educator due to not having graduated with the education that a registered nurse has. LPNs on the other hand are able to perform this role in certain health care settings. The major health care setting where licensed practical nurses are seen as educators are in nursing home facilities. They educate patients on the proper ways of performing certain tasks (bathing, dressing), making choices regarding treatment, and educating staff on proper techniques when assisting patients (Working as a Licensed, 2019). The educator role is important to help patient’s perform activities and make choices on their own, no matter who the educator is.

Advocate

The role as an advocate is one of the most important in the field of nursing. As advocates, nurses are responsible for learning important information regarding their patients, interpreting information to their patients and family members, and acting as protectors and risk takers (Zerwekh & Garneau, 2015, pg. 139). In the textbook, Nursing Today: Transitions and Trends, Joann Zerwekh defines an advocate as “one who pleads a cause before another.” The role of an advocate begins whenever the nurse takes on the role as the patient’s nurse. In the 1900s, three nurse leaders, advocated for patients when individuals who were unqualified as nurses were trying to care for the ill. The state nursing board has advocated for the community when they decided that all practicing nurses have to take a written exam known as the NCLEX to measure their knowledge pertaining to nursing. These laws have protected patients from being cared for by incompetent individuals. Nurses have worked as advocates in multiple settings such as factories, communities, hospitals, nursing homes, and several other facilities. In today's settings, nurses have become crucial advocates in protecting patients from harm in cases where they are unable to protect themselves, such as comatose or paralyzed individuals. These responsibilities eventually expanded to include speaking for individuals who were unable to speak for themselves (Zerwekh & Garneau, 2015, pg. 1140). Nurses are stepping into roles such as mediators between patients, physicians, and institutions. RNs are able to question doctors’ orders, promote patient comfort and support patient decisions regarding healthcare choices (Zerwekh & Garneau, 2015, pg. 140). Nurses playing the role of advocators has protected the lives of thousands of people and counting.

As an RN, the advocate role is performed every day. They are able to perform certain tasks that relate to this role, unlike UAPs and LPNs. Even though, LPNs and UAPs are not the direct source that is questioning a task or decisions, they are still advocating for that individual by discussing it with a registered nurse or a supervisor. The role of an advocate is being performed by other health care professionals every time they come in contact with a patient.

Nursing Issue

Today nationwide, the shortage of nurses is the most common problem affecting the healthcare system. Nurses are considered one of the most significant roles in healthcare and the career makes up the largest proportion (De Alwis & Kumari, 2015). By 2022, the United States is predicted to have a shortage of over 1 million nurses (Zolot, 2017). The nursing shortage has become an issue to where there is a large demand of patients needing care and a small supply of nurses to provide the adequate care needed.

One of the problems that is causing such a large nursing shortage is the shortage of nursing faculty at universities. Approximately, 76,000 students were denied admission to nursing programs due to the lack of faculty and clinical resources (Emerson, 2015). In 2010, a total of 880 faculty vacancies were cited (Emerson, 2015). Researchers have stated that the reasons for these issues are mainly because of degree requirements, demands of academic setting, retirement age, workload, and salary (Emerson, 2015). Universities are requiring their nursing program staff to receive more education and higher degree requirements which is decreasing the individuals who are willing to teach. The demand of the teaching setting is increasing the instructors workload and stress due to the individuals not having experience in the field of education and are becoming overwhelmed. The retirement age for nursing instructors is decreasing as the years go by. The average retirement age for instructors has reached 55.2 years of age (Emerson, 2015). The biggest issue with a shortage of instructors is the salary comparison between nursing instructors and working nurses. Nurses working at health care facilities, such as hospitals, are making 25-50% more salary than individuals working as nursing instructors (Emerson, 2015). As a whole, the shortage of faculty is playing a large role in the issue with the nursing shortages.

In the field of nursing, the increase in workload is effecting the shortage of nurses. Studies have shown that there is a positive relationship between the nursing shortage and workload (De Alwis & Kumari, 2015). This relationship is effecting the quality of care that patients are receiving from the assigned nurse. As the nurse’s workload is increasing, nurses are starting to increase their tolerance to control emotional stress while performing their duties and responsibilities. With the workload rising, nurses are becoming burnt out and the turnover rate is increasing at an annual rate of 56.2% (Richardson, 2018). Facilities are requiring nurses to work long, stretched shifts which is adding to the revolving issue of shortage.

With the older population of nurses reaching retirement age, more nursing positions are needing to be filled. The baby boomer generation is increasing the shortage because of retirement, aging, and experiencing age-related illness that keep them from working (Richardson, 2018). As the population ages, there becomes an increased demand of health services which increases the need for nurses.

Proposed Solution

Nursing shortages have increased over the last couple decades and are going to keep increasing until a solution is developed. Hospitals are working alongside universities to encourage and increase the ability for individuals to attend colleges for nursing. One solution to the issue of nursing shortages would be to minimize financial barriers when apply for college. Research has show that finances are the number one issue that is holding back students from getting a bachelor’s of science nursing (BSN) degree (Zolot, 2017). Colleges such as Cleveland State University (CSU), are providing opportunities for evening and weekend BSN programs (Zolot, 2017). These programs are admitting 64 students annually. Along with the college, university hospital systems are offering 20 of those 64 students with a $12,000 tuition contract as long as the individuals work for the hospital for two years (Zolot, 2017). The solution to one of the problems is to give the students an incentive to start the program and finish.

As the workload and turnover rates are increasing, the incentive for nurses to work should be too. Facilities need to improve benefits, offer flexible work hours, implement career ladder, and offer better pay (Richardson, 2018). Programs such as the transition to practice program should be implemented for new graduate nurses (Africa, 2017). The components of the program are communication, preceptoring, mentoring, time management, and outcomes (Africa, 2017). Programs similar to this would help build the new nurse’s confidence and decrease the chances of them becoming overwhelmed and quitting.

Conclusion

The field of nursing has more roles and responsibilities than what can be discussed. Nurses play a part in a patient’s every day routine when in their care. As nurses do their duty, there are issues in the field that are being solved on a day to day basis. Nursing shortage is just one of many issues in the career of a nurse.?

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