The Nursing Shortage: Strategies and Solutions

Introduction

The nursing shortage in the United States is a complex problem. It is a problem that can have serious and far-reaching effects. The shortage is currently less severe than in the past, primarily because of the cyclical nature of the healthcare industry. During economic downturns, when the demand for healthcare is less, many nurses are laid off. Job dissatisfaction is high, yet nurses are more likely to stay in nursing during a shortage if they are unhappy because job prospects are better and they can usually find better-paying jobs.

When the economy rebounds, the shortage of nurses grows more severe as increased demand for healthcare coincides with a decreased supply of nurses. The aging of the population, the longer life expectancy of the population, the increase in the number of individuals with health problems related to lifestyle factors, and the increase in the acuity of inpatients have combined to escalate the demand for nursing care.

Requirements for patient safety instituted by regulatory bodies and state legislatures have increased the demand for nurses. Hospitals and other healthcare organizations must ensure an adequate supply of nurses to meet the minimum requirements of mandated staffing levels. Failure to do so results in loss of accreditation, loss of funding, or punitive action by state regulatory agencies. Establishing minimum nurse-to-patient ratios addresses the symptom of the nursing shortage without addressing the underlying causes of the shortage. Minimum ratios do not meet the needs of patients or nurses and can result in poorer patient and nurse outcomes.

Causes of the Nursing Shortage

The current nursing shortage is a complex issue with many contributing factors at the local, national, and international levels. As a result, the image and work environment of nursing are major causes of the current and projected nursing shortages. Dissatisfaction and burnout cause many experienced nurses to leave the profession. This loss is in addition to the number of nurses who are retiring. Recognizing the association between adequate staffing levels and both nurse satisfaction and retention, it is imperative to address the shortage not only from the supply side but also from the demand side. Nursing leaders must advocate for organizational change that creates environments in which nurses can practice to their full capacity, which, in turn, will positively affect both nurse retention and the quality of patient care. The consequences of the nursing shortage are not only felt within the profession of nursing but also have an impact on the public at large. Part of the social contract for a profession is to ensure an adequate supply of professionals to meet the needs of the public. The size and composition of the nursing workforce affect a community’s ability to provide quality, accessible healthcare services. When the workforce is in short supply, there is a direct effect on the ability of hospitals, healthcare systems, and other employers of nurses to deliver appropriate and safe care to patients. The current nursing shortage has become a national issue, with federal and state governments, employers, educators, and labor responding to calls for action.

Strategies to Address the Nursing Shortage

There are many efforts taking place to encourage individuals to enter the nursing profession and to help retain those already working as nurses. Recruitment efforts are taking place not only in the US but in other countries as well to strengthen the nursing workforce. Improved working conditions, adequate support from other healthcare team members, and opportunities for professional growth are important for both new and experienced nurses and will help to strengthen the nursing workforce. Government, business, and healthcare organizations form partnerships to work together to help solve the nursing shortage. Initiatives and strategies at the national, state, and organizational levels are being developed and implemented to help address the nursing shortage. These initiatives include providing funding to increase the capacity of nursing education programs, career ladder programs to help other healthcare workers move into nursing, internship and mentoring programs for new graduates, improving working conditions to help retain nurses currently in the workforce, and managing the demand side of the equation by looking at how and by whom care is provided. The nurse shortage is a global issue, and in a flat world, we must also look at how we can learn and benefit from initiatives taking place in other countries. Sharing best practices can help all countries strengthen their nursing workforce. Only by working together will we be able to successfully address the nursing shortage.

Innovative Solutions

As health care reform moves to the forefront of the nation's policy and political agenda, the shortage of health professionals, particularly nurses, is garnering national and international attention. From nursing organizations, foundations, and federal and state governments to the popular media, there is a surge of interest in addressing the multiple contributing factors initiated by nursing. This heightened interest presents an unprecedented opportunity to develop innovative solutions and new directions that will not only resolve the nursing shortage but also transform the profession in ways that make it stronger, more vital, and better able to respond to the changing health care needs of the population. This chapter examines a number of innovative initiatives from a variety of settings designed to stimulate and enhance the interest of nurses currently working to increase the numbers of nurses available to provide direct care as well as to facilitate the continued involvement of experienced nurses in clinical practice while enhancing the knowledge and skills of all nurses.

These solutions and others describe novel approaches not only for recruiting and retaining nurses across their work life span but also for making more efficient use of current nursing resources. Rather than working in isolation, these new initiatives support collaborative working relationships among all nursing and health care stakeholders, as well as among members of other professions, in the service of enhancing patient care delivery while addressing the broader policy issues raised by the shortage of nurses. Not every initiative described in this chapter will be appropriate or feasible in every setting; however, each of the initiatives is intended to stimulate creative thinking and planning for addressing the nursing shortage in every locale and specialty of nursing. With the collaboration and engagement of all stakeholders, the nursing profession can be transformed in ways that will sustain it into the future.

Conclusion

Although the causes of the recent nursing shortage are complex and related to geographical maldistributions, cyclical economic downturns, short-term abridgments of strategic healthcare market forces, and long-term demographic and training factors, many of the solutions are within the power of individual and state as well as federal policymakers. The best nursing shortages strategy remains common sense, compassionate, evidence-based public policies to retain smaller numbers of its most experienced senior staff nurses, boost schools of nurses recruiting and retention of younger apprentice nurse and other nursing ancillary staff, and contemplating the commitment of nursing leaders who have consistently shared institutional or organizational as well as delivery community interests. Optimally beneficial in the collective recommendation for addressing the cyclical nursing shortage would be: legislative oversight monitoring of the aggregate negative effects resulting from its free market forces, enhanced support of such effective public policies and provisions and education and training nursing appropriations necessary for achieving cyclical or long-term nursing shortage solutions, and greater awareness role responsibilities over the healthcare organization needs and values of nursing.

If Americans genuinely aspire to a global or national commitment that the U.S. healthcare system will provide optimal health services that meet the unique health needs, wants, and preferences of all individuals' long-term beneficiaries living within its treatment milieu. Then, in the short or long-term statures of work theory, proposition arguably, universally applied by the U.S. global or national healthcare policymakers would motivate access to a growing population of nurses. A forecast of national demand for health professionals grows as the increasing proportions of citizens over fifty-five; many or most working within an environment where age weight or work methods also become detrimental to health care quality and providers health planning. Similarly, in spite of the widespread use of alternative nursing delivery methods, staff levels being below or at the prevailing minimum and under reconstituted nurse disposition levels which had been reduced since 1987, will be neither sustainable nor ameliorative to archiving optimal and low equitable healthcare countries' conditions of inadequate staff for patients' safety responsive clinical environment quality.

Did you like this example?

273

11