Managing the Nursing and Physician Healthcare Shortage Crisis - Essay Example

INTRODUCTION Physicians and Nurses are important constituent of hospital and related health care operations. It has been observed that there is significant reduction in the enrolments of physicians and nurses, and it is expected that if the situation persists, a major shortage of physicians and nurses will cause major jolt in health care sector. In March 2005, the Association of American Medical Colleges called for medical schools to boost their enrollment over the next decade by fifteen percent, which would result in an additional 2,500 graduates per year. The dearth has sent major shock wave, and there have been reports on current shortages in major states such as California, Texas, and Florida. In addition to the shortage of doctors in all areas, there is an even more dire shortage of nurses. A report updated in September 2006 by the American College of Nursing, reported the following summary numbers from a variety of sources. An HRSA study released in April 2006, projects that the nations nursing shortage would grow to 1 million by 2020. All 50 states will experience a shortage of nurses to varying degrees by the year 2015. Currently, according to a report from the American Hospital Association released in April 2006, U.S hospitals need approximately 118,000 registered nurses to fill vacant positions nationwide. This translates into a national vacancy rate of 8.5%. Another survey reported that 85% of hospital CEOs reported shortages of RNs. Another study conducted in 2004, found that a clear majority of RNs i.e. 82% and doctors i.e. 81% perceived shortages where they worked. In Australia, the Australian Council of Deans of Nursing has observed that by the end of year 2006, the country had only 60 per cent of the registered nurses it required. In Canada, there is concern about the exodus of a third of the registered nurses due to retirement. Similar trends have been observed in Europe, Asia, and Africa. (Pat Salisbury, Reverse Shortage of Doctors and Nurses. Executive Intelligence Review. January, 2005. EIR Publication) MANAGEMENT AND SOLUTION FOR THE SHORTAGE It is important that such research and pilot programs should be launched that can be helpful towards the creation of new nursing models and further, relate their effects on patient outcomes and satisfaction with care. This can be performed through, 1. Redesign of nursing work environments, with a significant emphasis on application of new technologies to facilitate the medical and nursing practices. 2. It is important to create Nursing leadership, and new professional models should be introduced. 3. It is important to reinvent nursing education to better prepare students for and reflect the current work environment. The shortage crisis can be managed by attracting and retaining generation of nurses and physicians and by ensuring that new medical and nursing workforce is the representation of ethnic and racial diversity. It is important to focus on reinvention of nursing education and work environments to address the needs and values of the new nurses and physicians. This will foster the creation of new training and educational models and new community-based roles that utilize the unique skills of physicians and nurses, while fostering satisfaction and competence. It is important to develop replicable demonstration projects to attract and retain men, minorities and special populations. It is also important to establish a national nursing workforce measurement and data collection system, which can provide consistent and comparable data that, can be aggregated and compared at national, state and county levels. The shortfall can be reduced by introduction of a clearinghouse of effective strategies to advance cultural change within the nursing and medical profession by creating a comprehensive, updated website that is non-territorial, easy to access, and provides important information for health care leaders about research, programs and models that have proven successful in advancement of nursing and medical profession. (American Association of Colleges of Nursing. (1998) As RNs age, nursing schools seek to expand the pool of younger faculty. Issue Bulletin. Washington, DC) LONG TERM SOLUTIONS The shortfall and crisis in nursing can be controlled and resolved by adoption of certain long term plans. The first and important solution towards the resolution of the issue is to conduct recruitment and training of a significantly larger pool of nursing students. This will require major economic commitment so as to facilitate the recruitment process, and commitment of significant resources for the expansion of nursing faculties and nursing schools. In addition, it means capital expenditures needed to create the best training environment for students. Well-funded federal, state and private programs must be established to help cover the costs of nursing education. Most importantly, the workplace environments nurses enter once they are recruited must support their needs both as caregivers and as human beings. If not, the shortfall of nurses will persist and rise significantly. Immigration of foreign trained nurses and physicians can be termed another concrete measure towards reducing the shortfall. The government of developed countries has taken remedial measures to encourage and appreciate the immigration of trained and experienced nurses from foreign countries. Hospitals in developed countries are compelled to recruit foreign nurses from developing countries. Unfortunately, the hiring of foreign trained nurses has presented another set of challenges for the hospital and health care department. According to the Annual Report-2003 of World Health Organization, the number of qualified nurses from these developing countries will be depleted when hospitals in developed countries try to fill vacancies. There are important ethical ramifications associated with the migration of nurses, including adverse effect on the quality of health care in developing countries, there have reported cases of wage exploitation where foreign nurses are paid less than domestic nurses and discrimination faced by foreign nurses. This issue can be resolved if the hospital administration introduce and implement diversity management initiatives, which will consequently minimize the potential difficulties in language, communication and the social integration of the foreign nurses. (Linda H. Aiken, Sean P. Clarke, Douglas M. Sloane, Julie Sochalski, and Jeffrey H. Silber. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction, JAMA, Oct 2002; 288: 1987 – 1993) SHORT TERM STRATEGIES The short term strategies can effectively reduce the existing dearth in the nursing and medical profession. It is important to create an internal environment to retain more staff. Retention is considered to be major strategy in both short term and long term. The retention of nurses and physicians can be ensured by, 1. Rewarding accomplishment 2. Providing attractive compensation and benefits 3. Providing employment stability 4. Respecting and recognizing the premier care-giving role of the nurse in the health care setting 5. Elevating the status of nurses within the workplace setting 6. Providing on-going education and training that updates and expands a nurse’s skill level and personal development 7. Providing autonomy and self-governance. Nurses need an environment where they have the materials to do their job, where they have a supervisor concerned about their development, where they have peers interested in delivering excellent care, where they have a chance to do their best every day, where managers communicate a vision for the organization and the nurses know and understand how they fit in and make a difference. Without these qualities, stress will continue to harm every facet of the health care system, compromising quality of care, and inhibiting the very creative energy needed to revitalize the system. These strategies require a sincere commitment that begins at the top of the organization and spreads through the organization. More often than not a major change in the corporate culture of the organization is required, which can be achieved through consistent leadership development emphasizing emotional skills and self-management. Studies have shown that most institutional administrators believe they do have environments in their hospitals that reflect the characteristics on the list above, but this is often a misperception. While transformation of the culture is being facilitated through leadership development at the top of the organization, additional short-term solutions can be instituted that will help retain staff, improve job satisfaction and improve performance. These organizational efforts must be centered towards, 1. Recognize and appreciate nurse’s desire to provide quality care for her patients 2. Provide on-going stress reduction and performance enhancement programs that teach the individual to reduce the inherent stress associated with the job on a day-to-day basis. 3. The organization should listen closely to solutions nurses have to improve the work environment and the quality of patient care. The real issue is the internal environment created for the nursing staff. Their world is hurried, hectic, and constantly moving and changing. This will not go away and as organizations continue to be faced with declining reimbursement, nurses are caught in a system of providing compassionate service and doing so with less resources. FOUR STEP POLICY In order to address this nursing crisis, hospital administrators are encouraged to endorse or review a crisis management plan that deals with labor shortage. Integral to effective crisis management is a series of four steps, which include prevention, preparedness, responsiveness and recovery. According to the United States Department of Education, the four phases deal with how an organization may reduce or eliminate risks, plan for the worst case scenario, respond to crisis, and learn from the experience. The health care sector is believed to be searching for strategies to deal with the current nursing shortage and turnover crisis, and thus, is in the responsiveness stage. (Chan, C. C. A., McBey, K., Basset, M., O’Donnell, M. & Winter, R. (2004). Nursing Crisis: Retention Strategies for Hospital Administrators, Research and Practice in Human Resource Management, 12(2), 31-56). PHYSICIANS AND NURSES: DIFFERENCES AND APPROACH It is essential that physicians and nurses should be offered professional respect and recognition by hospital administrators; many of the nurses have dropped their profession for this reason. The shortage of nurses and physicians is also related with the differences between the both authorities. There have been certain complains forwarded by the nurses, regarding the inferior approach adopted by the physicians and hospital management towards the nurses, physicians on contrary are not satisfied with the approach of the hospital authority towards them, and have expressed their dislike towards nurse broadening role and scope of responsibilities. According to Professor Judy Lumby, Executive Director of the Australian College of Nursing, nurses are working within hospital hierarchies that are 100 years out of date. In such a hierarchical environment, doctors are seen as the only credible professional voice in health and nurses are merely handmaidens, even though they are highly trained employees who outnumber doctors fourfold. (Childre, D., Cryer, B., and McCraty, R. (2003) “Pull the Plug on Stress,” Harvard Business Review, July issue) The global shortages of the nurse have to be taken with serious note, it is important for the hospital administrator to realize and practice their responsibilities towards nurses with seriousness. The physicians have to nurses as valued professionals and key members of the health care teams help to create an environment that may result in high levels of voluntary nurse turnover. If the rough and unfair attitude of physician is cause of anger, despair, and depression among nurses, and this has resulted in increased stress, decreased work performance, absenteeism, and higher levels of turnover. It is therefore important that, those who are involved in bullying nurses should be confronted and directed to change their behavior, with written reprimands and progressive disciplinary actions being taken until corrective behaviors are observed. If fair attitude is adopted towards the nurses, it is expected that their lost interest can be recovered. One of the most effective ways to prevent turnover of nurses and physicians is for administrators to do their utmost in ensuring that there exist perfect coherence between the professionals and their job requirements, from the onset of the employment relationship. If realistic job previews are provided to the nurses and physicians, unrealistic expectations about the job that almost inevitably lead to subsequent job dissatisfaction can be avoided. If physicians and nurses are provided with salient information about negative, as well as positive, aspects of the job, the applicants can be encouraged to self-select a job only if it is perceived to be a good match with their own specific needs, skills and competencies. A U.S. medical centre which implemented this type of mentoring program reduced the turnover rate of new nurses from 34 per cent to eight per cent in just one year. (Childre, D. and Cryer, B. (2004) From Chaos to Coherence: The Power to Change Performance. Planetary, Boulder Creek, California) CONLUSION It is important to recognize that in some circumstances administrators may be largely powerless to control and minimize turnover behavior. Although in many cases, turnover is a steady process of the withdrawal of the individual from the hospital setting, the situation is never the same. Such situations that involve catastrophic turnover takes place only when one specific incident or issue triggers the immediate exit of the individual from the organization, and little or no previous indication of intentions to quit was evident. Managers are victims of external economic conditions and can do little to control or influence these environmental factors. Turnover may be pervasive in some occupations and industrial sectors if the supply of certain types of skilled personnel is scarce, and employment prospects in the outside job market are conducive to worker movement. Numerous studies have corroborated the strong inverse relationship that exists between unemployment and labor turnover rates. This relationship extends to poor performers, who exhibit a much greater tendency to quit their jobs if external job opportunities are plentiful. REFERENCES 1. Linda H. Aiken, Sean P. Clarke, Douglas M. Sloane, Julie Sochalski, and Jeffrey H. Silber. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction, JAMA, Oct 2002; 288: 1987 - 1993. 2. American Association of Colleges of Nursing. (1998) As RNs age, nursing schools seek to expand the pool of younger faculty. Issue Bulletin. Washington, DC 3. Childre, D. and Cryer, B. (2004) From Chaos to Coherence: The Power to Change Performance. Planetary, Boulder Creek, California. 4. Childre, D., Cryer, B., and McCraty, R. (2003) “Pull the Plug on Stress,” Harvard Business Review, July issue. 5. Chan, C. C. A., McBey, K., Basset, M., O’Donnell, M. & Winter, R. (2004). Nursing Crisis: Retention Strategies for Hospital Administrators, Research and Practice in Human Resource Management, 12(2), 31-56. 6. Pat Salisbury, Reverse Shortage of Doctors and Nurses. Executive Intelligence Review. January, 2005. EIR Publication. Read More