Health Care Policy - The Nursing Shortage Redux - Essay Example

A Policy on Healthcare; The Nursing Shortage Redux Nursing Shortage, being a continuous problem seems here to stay unless concrete policies are putto place by private organizations and government agencies to alleviate it. Studies show that projections of a substantial nursing workforce imbalance in the coming decade have pushed policymakers, providers, private foundations, nurses, and others to extend aggressive and sustainable strategies to improve the looming shortage. The solutions are mainly centered in policies that seek to increase supply. "Analysis of the 1992-2000 National Sample Surveys of Registered Nurses shows that increasing losses from the active workforce, stagnant wages, and low levels of job satisfaction pose major impediments to bolstering supply. Strategies focused on working conditions and retention should occupy a central position in any nursing workforce revitalization plan"(Sochalski J, 2005). In connection to this, different national professional nursing organizations have chosen to play an active role in assisting legislators with not only insights but overview of this issue. The main focus of most organizations now is to increase the supply of nurses in different health institutions and act as bargaining arm in behalf of the nurses' concern. Some organizations would rather focus on long term solutions such as increasing the number of students enrolled in nursing courses, giving incentives, salary increase to existing nurses to give them more reasons to stay. Whereas, other legislators would opt for more short term solutions such as opening more opportunities for nursing to foreign workers. Needless to say, the demand for more nursing professionals compels not only the health care industry, but also the government to act fast in this continuous problem. In this writer's opinion, high tech facilities, modern equipments can only be as good as top of the line services provided by hospitals. Without the latter, nothing much can be expected. Looking at the abundance of legislative activity at both the state and federal levels is reflective of the growing awareness of the nursing shortage.As mentioned by (Chiha Ya, 2005), here are specifically five areas that have been introduced in policymaking related to this field: Increasing supply via education- scholarships, forgivable loans in return of service to underserved areas; funding for increased school capacity and faculty; incentives such as scholarships, tutoring, transportation and child care to attract minority students. Such policy can be well directed to education institutions, or colleges that only offer nursing courses. And probably, the government may also look at trying to recruit more males in this industry to balance out the depreciation of nurses leaving because of pregnancy, child rearing duties. Increasing supply via immigration- Expand the H1-C category for visas, which aims to bring foreign-trained and licensed nurses t the United States to provide service to underserved areas. This is a very good strategy considering that migrant workers will come to the US as full time nurses and will have their full attention to their jobs. Given that they are away from their families, they will have more focus on what they are ought to do. The government however, must make sure that qualifying exams are really at par with the quality standards of our healthcare industry. Data and Planning- establish commissions, studies, task forces and committees to analyze or monitor the nursing workforce, expand duties of nursing licensure boards to collect, monitor and utilize nursing workforce data. Probably this is the same with organizing our very own think tank, or an organization that focuses on research communications to be the main source of data related to this field. Work Environment- limit overtime, impose mandatory overtime, post staffing ratios in hospitals to inform the public, define associated disciplinary actions. Licensure Compacts- interstate recognition of nursing licenses; promote mobility. Other- acknowledge nursing shortage; urge attention to address the shortage. As mentioned by (Sochalski,2005) of August 2001, a total of 110 "nursing shortage" bills had been introduced to 34 states during the year's legislative season. And on the same year, a total of five "nursing shortage" bills had been introduced in either the US Senate or US house of Representatives. And of which, only 2 bills were signed into law. Also, the scarcity and lack of consistent data point to the difficulty of understanding the changes that are occurring in nursing, and perhaps the hardships of making a firm case for policy changes to address the issue. A report from the US General Accounting Office states that "National data are not adequate to describe the nature and extent of workforce shortages, nor are data sufficiently sensitive or current to compare nurse workforce availability across the states, specialties or provider types"(US General Accounting Office, 2001). . Such shortage is not only limited to the US. According to (Sochalski, 2005), lot of highly industrialized countries, other than the US, such as Great Britain, Australia and Canada are currently suffering the effects of severe shortage of registered nurses in their respective territories. In the US, labor supply models for currently trained RNs are estimated by gender and marital status using the 1992, 1996, and 2000 data from the National Sample Surveys of Registered Nurses. Statistics show the prominence of the female sex in the field of nursing which makes such role susceptible to changes being experienced by women in their personal and family life such as (pregnancy, birth, child rearing). . In this case wages come as second priority. The RN's own wage had minor effects on both labor force participation and hours worked given participation. The RN wage is still a relevant variable since it has a significant and positive effect on the number of people who enter first-degree nursing programs in the US. These results are important to policy-makers in light of the current shortage of RNs. Such concern has already ignited the interests of the public sector. In several congressional hearings according to (Kimball, 2002), different groups were able to discuss the implications of shortage of nurses and its implication in the quality of care. Definitely, the medical profession cannot be likened to typical labor production, because health care is a continuing service, and failure to deliver high quality service in this field is a direct threat to the lives of patients concerned. Proposed Federal Legislations, such as in the State of Pennsylvania, intends to authorize scholarship and loan programs for basic nursing education that would support current funding for advanced education as well as funds for recruitment efforts. Other state legislatures have responded through different initiatives to increase the supply. Policymakers are also looking at possibilities to recruit former nurses back to the service. Statistics show that there has been a stable proportion of RNs who are no longer working as nurses. "In each survey year 71-73 percent of these RNs were not working in nursing, and a sizable share of these had retired. However, in 2000 around 81,000 of those not working were age forty-three or younger, which is the mean age of RNs currently working in nursing. Among them, 58 percent had young children (age six or younger) at home. In addition, of those who were working in fields other than nursing, around 40,000 were age forty-three or younger, and 25 percent of them had young children at home"(Sochalski J., 2005). Most RNs would rather work in other fields because of better working hours, more job satisfaction, and of course, for better pay. These two groups, (mainly the RNs who have opted to stay at home and those who have shifted to other job opportunities) are the two main targets who may be persuaded to reenter the field of nursing. In order to do this, nursing field must provide enhanced career ladders, better wages, flexible hours, child care. These strategies are not only for the purposes of convincing RNs to reenter, but also a very effective tool in giving current RNs in the health workforce to stay. Declining Job Dissatisfaction (Heinrich, 2001) During the 2000 survey, RNs working in nursing were asked to evaluate their level of job satisfaction. Result was, 69.5 percent reported being at least moderately satisfied with their jobs. According to the General Social Survey conducted by the National Opinion Research Center, during 1988-1998, 86 percent of workers in general and 88 percent of professional workers reported being satisfied with their jobs. Nurses working in nursing homes and hospitals were among the least satisfied, with one of every three nurses in these settings reporting dissatisfaction. .On a personal note, even if this writer is initially satisfied with the career choice, it is very difficult to imagine to continue working in a high pressured setting for long unless the working conditions would dramatically improve. Definitely, it is normal to seek for more comfortable working environment and working tasks as individuals age. Compared to corporate entities wherein as you climb up the corporate ladder, work load becomes "less physical" and more mental, in the nursing field, it becomes a combination of both. However, as you age, physical work and pressure become less comfortable. Studies also show that most would not recommend nursing to others unless they believed that the individual had a realistic understanding of the demanding and physical work required of them. The overall belief was that an individual must possess the intrinsic desire to work "in service of others" to be successful for the long term. Definitely, a nursing professional like this writer would consider caring for the patients and their families as primary reward of the profession. Different areas of support such as physical, psychosocial can also be sited. Positive feedback from patients and their families also provide great satisfaction. However, considering the RN shortage, this writer is also wary about the potential increased daily workload. Considering the shortage, patient assignment is bound to increase. At this period, many nurses are assigned to 8-10 patients with no ancillary support. Such increase, brings about heightened work intensity that are both physically and emotionally exhausting, and raises concerns about the safety of healthcare one may provide. Another concern is that immediate superiors might have the perception that all nurses are equally capable of performing the same level of work. The lack of ancillary support is also a concern. It is observed that administrative decisions to cut nurse technicians and professional allied health staff were made to decrease overall costs while maintaining the number of RNs. As a result, nurses have to also take the responsibilities of support staff, such as answering phones, obtaining equipment, supplies and medications and transporting patients off the unity, in addition to their regular duties. There is also that fear that RNs are the minorities in the hospital. This puts them in a position where they are somewhat rendered powerless to affect change. At this point, a lot of nurses would like to seek for immediate change such as; decrease individual workloads, provide support staff; clerical staff, nurse technicians, transport technicians, etc., empower nurse managers to be able to fully support their units, listen and take action regarding concerns in the work environment, increase salaries, encourage physicians to treat nurses as colleagues. The National Forum to Advance Nursing as stated by (Kimball, 2002) would like to focus its efforts in the following strategic areas: Creating new nursing models; developing and piloting new ideas that address both the nursing shortage and broader health and social issues; advancing the study of nursing's contribution to health care outcomes and consumer satisfaction; and creating entirely new models for health care provision. Reinventing nursing education and work environments to address the needs and values of, and appeal to, a new generation of nurses. Establish a national nursing workforce measurement and data collection system. Creating a clearinghouse of effective strategies to advance cultural change within the nursing profession. If these policies are put to place, then shortage of RNs will not only alleviated but be effectively monitored. It is inevitable that RNs at one point of their careers will try to evaluate their level of job satisfaction. Considering that most RNs are females, issues about family life will always come up. Other than that, erratic schedules are definitely not jive with family building and child rearing. Nurses who are in this stage would most likely consider other job opportunities and options such as becoming stay at home mothers and just try to look for work from home. It is also very important to take into consideration the financial rewards of becoming a nurse. Considering the long hours, the level of satisfaction and all the pressure of the job, RNs would be more satisfied if wages are increased. Indeed, becoming a nurse is not a mere profession but a vocation. It requires a higher form of calling and motivation to keep the spirit alive in this kind of job. The healthcare need of the American people has no other way but to go up through the years. Such need must be met by adequate healthcare services, and be given by highly competent healthcare professionals. Considering that humans are the most complex machines of production, still, they must not be treated as regular machines. Nurses need rest, personal life and sense of fulfillment. Thus the government must do its best to give what the nurses deserve and beyond. References: Sochalski, 2005, Nursing Shortage Redux; Turning The Corner on an Enduring Problem, pp.2-8, University of Pennsylvania Chiha Ya, 2005, The shortage of registered nurses and some new estimates of the effects of wages on registered nurses labor supply: a look at the past and a preview of the 21st century, pp.349-75, Health Policy Heinrich J. July 2001.Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors. Government Accountability Office GAO-01-944 Kimball B and EO'Neil,Health Care's Human Crisis: The American Nursing Shortage, Robert Wood Johnson Foundation, April 2002. Read More