The Nursing Shortage: Why Today's Shortage Is Unique

The Nursing Shortage: Why Today's Shortage is Unique

Introduction:

The nursing profession has experienced shortages many times in the past. This pattern was cyclical, with periods of high vacancy rates followed by layoffs and an oversupply of registered nurses. Today, we are experiencing another drought for nursing, but due to many factors, this shortage is different from anything the profession has witnessed in previous years. There are many that feel this shortage is severe and prolonged because the solution is complicated, and not simply a matter of a decrease in the number of registered nurses in the United States.

Within the content of this paper, I will be presenting a description of the current nursing shortage. An explanation of how the health care system has changed over the years and its impact on nursing will be discussed. Nursing education has also changed and the demand for more advanced education is required. It is this demand for education that has had a major impact on our current shortage of qualified registered nurses.

History of Nursing Shortages:

Hospitals are the major employers of nursing personnel, and registered nurses are the largest group of all health care givers in this country. Health care in areas outside of the inpatient hospital setting is increasing (nursing homes, rehabilitation centers, VNA), yet the largest number of nursing personnel are still working in hospital inpatient areas. Rehabilitation services in nursing homes have grown to the extent that the need for professional nursing care in these areas is greater now and is continuing to increase (Wunderlich, 1996).

In the past, vacancy rates for nursing personnel were cyclical; periods of many openings for registered nurses that remained unfilled followed by times of layoffs and oversupply. In the 1980s, hospitals across the country reported persistent vacancies and nursing school enrollment dropped (Wunderlich, 1996). A devastating nursing shortage developed very quickly. Positions were going unfilled for over a year in many facilities. Yet patients were in hospitals and required care. Home care agencies had growing caseloads, and long-term facilities were full and in desperate need of registered nurses.

At this time (1980s), states across the country set up commissions to study the nursing shortage and identify ways to address and resolve the issue. The American Medical Association proposed the creation of a new job category - the registered care technologist (RCT). This sent shock waves through the nursing profession because the "RCT was not truly part of the nursing care delivery team" (Hansten, 2004). In 1988, the Bowen Commission held hearings across the country to hear from registered nurses what issues were contributing to the current shortage. The conclusion reached was that the nursing shortage was primarily the result of rapidly escalating demand for RNs (Wunderlich, 1996).

The nursing shortage that began and peaked in the 1980s had eased by 1994. At that point in time, several major changes within the health care system triggered staff nurse layoffs. Health care reform, cost management by the government and insurance companies, and the drop in occupancy rates brought on by shortened lengths of hospitalizations in acute settings were direct influences to nurses losing their jobs, or positions remaining unfilled (Hansten, 2004). Then as early as 1998, some states began to, once again, report a growing nursing shortage. By 2000, most states were reporting severe shortages, especially in specialty practice area. This shortage is considered far more serious and definitely not cyclical. Current forecasts predict a shortage of 400,000 registered nurses in 2020 (Hansten, 2004).

Changes in the Registered Nurse Role:

Health care reform in our rapidly changing health care environment has created major changes affecting registered nurses. The length of hospitalizations has decreased dramatically, which means that patients are returning to their home settings sooner than ever before. Patients still require non-acute care after these shorter stays, and this means that home health care, long-term care, hospice care and other community-based care will continue to grow. This, in turn, means that the patients that are in the hospital are more acute and require intensive nursing care. The role of the registered nurse must now include greater professional judgment, management of complex systems, and greater clinical autonomy (Lippincott, 2003). The pressure to contain costs and meet the needs of the rising levels of severe illnesses of inpatients make it imperative for hospitals to seek out ways to redesign delivery of care without compromising quality of care (Tappen, 2004). The structure, organization and financing of health care are rapidly changing. Patients previously hospitalized are now treated on an outpatient basis, relying on care through different delivery systems. Hospital communities are trying to increase health care services while raising prices as little as possible.

Trends in Registered Nurse Supply:

The average age of RN's is increasing. In 1996, the average age of the RN was 44.3; in 2000, it was 45.2. Not only are there more older nurses in the workforce, but the average age at graduation from the basic nursing education program are also increasing. The aging of the workforce will continue and they will retire sooner.

This shortage is not going to resolve itself any time soon. With the coming overall workforce shortage due to baby-boomer retirements, we will need to develop new care models that use fewer workers to deliver more services (Hansten, 2004). This will mean that registered nurses will have to continue to develop and refine efficient and effective patient care delivery models that appropriately use all available staff to their highest educational potential.

Several journals and texts have cited nurses leaving the profession as a contributing factor to the nursing shortage. Nurses have left hospital nursing to work for managed care organizations, insurance companies, pharmaceutical firms, health care technology vendors, medical device vendors, and consulting firms. Many nurses seek regular hours, with no night or weekend responsibility. Mandatory overtime is one of the biggest issues with nursing.

Other issues facing nursing today is the high acuity of clients in hospitals. Medically complex