Nursing Shortage in United States: Causes and Effects Term Paper

Introduction

Modern nursing is changing with new roles and working practices. Professional nursing is an art and applied science. Nursing is a self-motivated profession or as an art of science with a growing body of knowledge that is supported by research within the profession. It focuses on supporting human beings of their wellness/illness continuum. Today, the nursing profession is serious problem of shortage of staff that it becomes difficult for giving the patients the best risk free environment. The worldwide nursing shortage is a matter of concern to every one.

If we look at the healthcare industry, it is growing fast when compared to other industries. However, with the increase in population, an increased number of healthcare professionals are needed to care for them particularly in the case of epidemics and disasters. This is also a serious problem in United States healthcare sector. The goal of this paper is to review the literature and trace out the causes that are causative to the nursing shortage in the US. Additionally it also discusses the impact of nursing shortage on the industry and its future. The paper also presents possible solutions to nursing shortage.

Causes and Effects of Nursing Shortage

Though healthcare industry is a growing industry, more and more nursing staff is required to support this industry. In thousands of hospitals in the United States and around the world there is a severe shortage of nursing staff. As a result the existing staff is under the pressure of working overtime. This affects their personal life particularly if they have a family whom they support. In fact if these nurses face an emotional challenge due to working overtime, they do not perform to their full potential and there are also instances when many of them opt to quit this industry. Therefore, the shortage of nursing staff itself triggers the further reduction in their numbers.

Today, many of the healthcare set ups are concern about the patient safety. For instance, a study conducted by Aiken and his associates showed that trends in hospital use and staffing patterns have brought together so much of problems especially related to hazardous conditions for patient safety. The study exposed the fact that high patient perception levels, collectively with raise in admission and discharge cycles and less number of nurses pose serious challenges for the delivery of safe and effective nursing care (Aiken, et al., 1996). The increased number of patients also increases the pressure on existing nursing staff. It is estimated that nurses in general will have to work on an average twelve to even sixteen hours that may not follow the traditional pattern of day, evening, and night shifts. Above all the nurses who are serving for specialized units such as surgery, dialysis, and intensive care are often required to be available to work extra hours other than their regular shifts. These shifts may be randomly scheduled. In emergency units twenty four hour shifts are becoming more common (Rogers, et al., 2004). The results of this study also found that working extra hours creates stress in the nursing staff and may end in medication errors.

Adequate sleep is a basic need of human beings. In today’s busy schedule of nurses they face serious problems of sleep depriving. Nurses frequently shortchange themselves on sleep, getting by on an average of 6.8 hours of sleep on their work days instead of the commonly recommended 8 hours per 24-hour period. This may result in reduced vigilance, reaction time, memory, psychomotor coordination, and decision making (Stutts, et al., 1999). Besides, studies show that speed of mental processing also slows during the night under conditions of sleep deprivation (Monk, et. al., 1997).

In another study it was found that nurses who worked rotating shifts were more sleep deprived and more likely to fall asleep while they are at work as a result they were nearly twice as likely to make a medication error when compared with other nurses who predominantly worked day shifts (Gold, 1992). In fact, some research also point at the reality that nurses ignore the role of fatigue that might play in critical incidents. Nurses working in intensive care and operating room were questioned about error, stress, and teamwork, approximately 60% of them agreed to the fact that they work even when they feel fatigued and they think that in critical times they perform effectively (Sexton, et al., 2000).

Landrigan, et al, (2004) conducted a study and found that interns made considerably more serious medical errors when they worked over and over again on shifts of 24 hours or more than when they worked in shorter general shifts. The sample size corresponded to a total of 2203 patient-days involving 634 admissions. The main findings of the study was that interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more non-intercepted serious errors (P<0.001). Interns also made 5.6 times as many serious diagnostic errors in the traditional schedule as in the intervention schedule (18.6 vs. 3.3 per 1000 patientdays, P<0.001) (Landrigan, et al, 2004). Similarly, nurses who work overtime may also commit serious medication errors.

It is essential to promote more and more people to join this service industry through good education. Increased numbers of healthcare professionals in the nursing profession are needed not only to care for elderly patients, but also to replace retiring professionals. According to national statistics the average age of nurses is rising where as the rate of those entering the profession has slowed over the past decades. The reason for the nursing shortages are many and includes the average age of nurses is 45 years, the image of the profession, work environment issues especially the high stress situations and the faculty shortage. The three major reasons for shortage of nurses include shortage of hospital nurses, faculty shortage, and a shortage of highly- trained nurses. In addition, issues such as job burnout and dissatisfaction with the current working nurses also add to these problems.

With the ever increasing pressure on the nursing staff their retention rates has also got affected. It is estimated that first-year retention rates for new graduate nurses is only between 40% and 65%. In other words it can be said that as many as 6 out of 10 new nursing graduates quit nursing practice within one year of graduation (Rosebrough, 2005). There are several reasons for this and one of the main reasons for them to leave the profession is the workplace violence they experience particularly in the initial years of their practice.

Workplace violence is one of the most complex and dangerous occupational hazards facing nurses and it has become another reason for it is a common that nurses experiences violence from both patients as well as co-workers. The risks arise from the experience to violent individuals collectively with the absence of strong violence prevention programs and protective regulations. These factors combined with organizational realities such as staff shortages and increased work pressure creates substantial barriers to eliminating violence. Statistics point out that as many as 72 per cent of nurses do not feel safe from assault at work (International Council of Nurses [ICN], 2004). Health-care professionals are at the highest risk for being attacked at work, when compared to other professions such as prison guards, police officers, bank personnel or transport workers (Kingma, 2001).

According to reports from the National Institute for Occupational Safety and Health it is estimated that 9,000 healthcare workers are assaulted at work every single day. According to the Bureau of Justice reports up to 429,100 nurses were victims of violent crimes each year from 1993 to 1999. In fact these are the only reported cases, there are a number of cases which goes unnoticed. Researchers have found that this kind of violence can be linked to certain environments in a facility that are more conducive to violence than others. For instance, working in a high-stress department such as the accident care department or critical care unit can create situations of stress. Additionally working with a few co-workers in an isolated setting or a high-stress department can also result in problems (Lillian, 2003). What ever be the case, workplace violence especially in the healthcare sector needs more attention.

The following are some of the common factors that explain why nurses are at a greater risk of violence in the workplace: Frequent shift work, including commuting to and from work at night; Lack of good security measures in health facilities and unrestricted movement of the public in clinics and hospitals; Interventions demanding close physical contact; Lack of privacy, which violates people’s sense of personal space; Home visiting and its associated isolation; and Long waits in emergency departments or clinics, which increase patients’ stress; and all these can be easily linked to insufficient staffing levels and supervision that may create stress and contribute to violence (ICN, 2000).

Nurses who have to work overtime will have to be paid extra but the performance will only decrease with more work and stress. Violence can also result in increasing number of nursing staffs quitting the profession or changing the organizations. This will put increasing pressure on the present nursing staff and also on the organizations as they will have to divert their time and resources to appoint new staff and also train them to accustom to the organizational culture (Registered Nurses’ Association of Nova Scotia, 1996).

There are several researchers who have worked specifically on the issues related to nursing shortage in United States. According to a study conducted by Alspach (2000), during the 70s and the 80s, this shortage was mainly due to the growing population after the world war II and the shortage of nurses was aggrivated due to the dissatisfaction with working condition and lack of professional autonomy. In recent years the trends have changed and factors such as aging staff, declining enrolement, change in working conditions, poor image etc. has contributed to the shortage of nurses in US (Goodin, 2003).

It is estimated that a large number of nurses will reach the retirement age as their average age is presently 45. More than 50% of the nurses are planning retirement between 2011 and 2020. The challenge today is to get prepared for this situation and recruit new nurses. Further, it is estimated that a shortage of more than one million nurses will be felt by the year 2014 and predicted creation of over 700,000 new nursing jobs during this time. This statistics came out from the United States’ Bureau of Labor Statistics Report (travelnursesnow.com, N.D.).

In general, several researchers have pointed out that the present day nurses are overworked due to the shortages of staff, and most of them become dissatisfied with their jobs. As a result often these nurses take the decision for leaving the profession and seek for other work. Studies also show that the nurses below 30 years are also seeking out for other jobs that will create a great void in the number of nursing staff and can disastrously impact the healthcare industry.

Though in the past this profession was much valued and many opted to serve the society by joining the profession, today as the years have passed by there is a change in this trend. The present shortage of nursing staff is totally different than those in the past. There are several new parameters that influence this profession. For instance, factors such as aging work force, diversified career opportunities especially for women, the image of the profession, low unemployment, a shortage of nursing faculty, and a decreasing population overall are some of the reasons for the present trend. Currently, the doors of career opportunities have opened up than they did just a few decades ago as women are taking up many aggressive, attractive, and profitable careers that were not present in the 60s when “baby boomers” made their career choices. Many women take up law, medical, engineering, aviation industry as they find it much lucrative than nursing. Besides, today the number of women assuming leadership posts in the corporate sector and in government is in huge numbers. As a result, most of them do not find the nursing profession attractive.

Once there is a shortage of nursing faculty, there is bound to be problem in the educations program that produce nursing graduates that further creates a void in the nursing staff. Today, it has become essential to create awareness among the younger generation and encourage them to take up nursing as a career. As there is ample number of opportunities for nursing graduates in healthcare that includes administrative, entrepreneurial, and clinical research positions. It is also important to realize that these positions provide more financial rewards than faculty positions (op.nysed.gov, 2001).

Possible Solutions

America’s healthcare sector is shifting rapidly. Technological advancement in all fields including the healthcare sector helps the customers to get better information about the quality and cost of their care. Besides, among the healthcare sector there is an obvious competition to provide them with the best value. According to the existing estimates, approximately 15% of GDP is spent on healtcare alone in the United States, which is the highest in the world (WHO, 2006). As technology is playing a major role in all emerging fields, nursing is also growing in terms of technology. It is quite evident that the use of computer and information technologies in the healthcare increase at a faster rate and this is in turn going to improve the nursing practice and patient education. Besides, the use of these technologies can also help in storing a vast amount of data in a systematic manner. With the increase in stress due to shortage of nurses, the working staff will be handling more patients and many times it is possible that errors occur in medication. Use of computerized charting system can help the nurses in managing the data.

Advance practice nurses are one of the most important ways in which the shortage of nurses and the problems linked can be handled. It is essential to regulate the timings of working with strict legislation particularly in this health industry because the patient’s life depends on it. Besides, education the present population of nurses on stress management strategies, balancing family and professional priorities, improving the social and peer support, leadership and team-building, planning and proper scheduling work hours and shifts appropriately to match the individauls capabilities and policies to deal with violence in the organization can aid in retention of nursing staff.

Mentally, nurses are required to be alert and ‘on the ball’, making calculations for medication and responding to important questions from patients and relatives. Emotionally, the impact is felt when nurses involve themselves in empathising and helping people and working in an environment where there is pain and sadness. Additionally, the context of work may be characterised by resource constraints, poor staff support and organizational change, which add to the energy expended. Too much stress and burn out brings the discomfort of finding the nursing staff struggling (Murray, 2005).

Stress management strategies can help the nursing staff to overcome several problems. For instance coping strategies and relaxation techniques are simple stress management and are very effective and helpful in controlling anxiety levels, depression and anger. Today the scientific community has brought out a range of interventions that can reduce stress. Cognitive behavioural interventions and relaxation or the meditation strategies have proven to be successful in reducing the personal levels of stress (Mimura and Griffiths, 2003). Cognitive-behavioural interventions especially aid in promoting longer life, feel better and keep away from having self-defeating thoughts such as suicides. These interventions help nurses to understand themselves so that they may live a more fulfilling life (Kirkness and Grochulski, 2001).

Proper relaxation technique is essential skill which can be developed by every one and can become a part of life with frequent practice. This will not only help to control emotions but also improve physical well being. These techniques do not have a time restriction and can be practiced either day or night. This kind of relaxation technique is necessary for nurses working in shifts. Slow breathing and muscle relaxation technique are the two main types of relaxation which can help nurses to cope with stress (Brunero, et al. 2006).

Summary

Today, the nursing staff faces problems due to the shortage of staff. Most of the nurses have to work overtime and long hours. This not only put their personal life into trouble but also put the patients at serious risk. This paper has presented the literature review for the shortage of nurses particularly in the US and has tried to project the reasons for the same. The statistics point out that if this problem is not solved, the future of healthcare industry will be greatly jeopardized. While it is essential to train and encourage people to join the nursing profession, it is also important to retain the present population of nursing staff. Government and healthcare industry need to work of strategies to improve the present situation.

References

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