Addressing Nursing Shortage - Research Paper Example

? Addressing Nursing Shortage Affiliation introduction Prior to 1980s healthcare was solely a physician’s concern and certain problems like cardiac malfunctions were not considered problems until after symptoms were developed. This caused a lot of financial stress on the patients when they were treated at late stages of the disease. As a result of research it was suggested that care provided before the advent of symptoms can cost far less than the care provided after symptom development. Since then the trend of “Preventive Care” that is avoidance of disease or accident before it occurs, evolved. Managed care is the current concept for running a successful healthcare system which is a pre-planned treatment of the patient. In this system patient is considered as a client whose health is continually monitored and evaluated and treated accordingly. Health Maintenance Organizations (HMOs) are examples of managed care system. This concept has entirely changed the healthcare scenario. The role of physicians and nurses has been redefined (Rosdahl & Kowalski, 2008). Health Care system of united states: A brief overview According to World Health Organization, a commendable health care system is one which provides quality services to people in need. The components of a good health system vary from country to country, however the basic mechanisms like, adequate financing, well-trained physicians and medical staff, reliable information on which policies are made, fully-equipped facilities and delivery of quality medicine and modern technology to the patients should remain the same everywhere. The health care system of United States is one of the best systems in the world in terms of funding and modern technology usage but it is also characterized by a lack of central planning, direction and control. The system is a blend of public sector and private health providers. This system is highly decentralized and complex and on top of that costly services make it quite unaffordable for a certain population. Two major health insurance programs Medicaid and Medicare are funded by the federal government. Medicaid is funded jointly by federal government and the states and it serves the low income and poor people. While Medicare is a federal government funded two-part program that cover hospital costs and few nursing home services and physician services respectively (Nagelkerk, 2006). Despite these efforts the rising health care costs have proved to be a significant hurdle in the betterment of the system. Many problems are faced by the U.S healthcare system, a major problem being the uninsured public. According to U.S Census Bureau the number of uninsured rose to 49.9 million in 2010 from 49.0 million in 2009. Another problem which we will study is the nursing shortage. The term refers to a situation where the professional nurses’ demand exceeds the supply. The phenomenon is observed both nationally and globally and in the developed and developing countries. The shortage can be measured in terms of nurse-patient population ratio. Nursing: A Brief overview Caring for the sick and injured has been a centuries old tradition. It has evolved throughout the years from a domestic work to professional arena. Care is practiced in different ways in the world but United States has set an example for the rest of the world. Before we discuss modern care we take a look at the nursing history in the States. Nursing is an integral part of any health care system and it plays a significant part in attaining patient care outcomes. The nurses care for the patients, work in collaboration with the medical team and assess and treat the problems. The nursing work force mainly includes director of nursing (DON), registered nurses (RNs), Licensed practical nurses (LPNs), certified nurse assistant (CNA) and other staff such as aides, orderlies and personal care attendants (Buerhaus, Auerbach, & Steiger, 2009). Following chart shows the percentage breakdown of nursing facility employees in various categories (American Health Care Association, AHA, 2011) Nursing is the largest healthcare faculty in United States comprising of 2,618,700 registered nurses (Bureau of Labor Statistics, Department of Labor). Today nurses have many roles apart from patient care; they play a key role in meeting the Joint Commission’s National Patient Safety Goals in fields like medication safety, communication and patient safety. This allows the nurses to be a part of quality improvement process since quality improvement has become an integral part in the health care system. The most focused areas are regulation, quality assurance and improvement and patient safety. According to Hall, Moore and Barnsteiner, (2008): “The growing focus on providing high-quality care suggests that nurses’ involvement in quality activities is likely to increase in coming years. By actively participating in the improvement of healthcare, nurses benefit their patients and stimulate joy in their work.” The Institute of Medicine defines that a healthcare provided should be safe, efficient, easily available, timely and patient centered. However, patient surveys show that these aims are not generally fulfilled. The errors in healthcare occur at an alarming rate with 3-4% hospitalized patients suffering serious consequences and one hospitalized patient out of two hundred dies of a preventable adverse effect. Nursing shortage in United states Even though Nursing is considered as the largest healthcare faculty in United States, the country has suffered from chronic Nursing shortage since World War II. Nursing shortage as defined above is the term used when the need or demand of nurses exceeds the supply. This shortage has also affected the patient care substantially. Since 1998 the hospitals have reported a significant shortage of registered nurses (RNs). Estimates suggest that in 2000 the demand was 6% higher than the supply. By the end of 2008 this deficiency increased up to 8.1%. However, a study reports that during the 2007-09 recession period, an increase in the health sector employment was observed (Buerhaus, Auerbach and Steiger, 2009). This may be due to the reason where the nurses have gone back to their jobs due to the job losses of their spouses or the bread earners of the family. This however, is not an everlasting trend even though there is an increase in the health sector jobs; the U.S. is expected to suffer from a major nursing shortage in the coming years (Kaiser edu.org). Analysts suggest that sufficient long term plans and policies must be made in order to cope up with the nursing shortages in future. Nuring SHortage: Statistics & fact sheet As the baby-boom generation ages, their healthcare requirements increase and therefore the demand of registered nurses increase. Following chart shows the significant increase in the older population by the year 2020: The nursing schools all over the country are emphasizing on increasing their capacity in order to meet the elevating demand. Following are the statistics of different organizations regarding the current nursing workforce and the projected shortage in coming years: According to the U.S. Department of Health and Human Services, the number of licensed practical nurses (LPN) and licensed vocational nurses (LVN) in 2010 was 730,290 and that of RNs was 2,655,020. A report suggests that by 2020 the Supply to demand ratio would lower to 73% in 2015 and 64% in 2020 as compared to the 83% in 2010. However, the demand short fall would increase from 17% in 2010 to 27% in 2015 and 36% in 2020. According to a 2007 PWC report the future trend in nursing workforce supply seems quite troublesome. According to the survey nursing shortage would range from 400,000 to more than a million (PriceWaterHouseCoopers, 2007). A 2006 aging workforce survey conducted in collaboration with Bernard Hodes Group. Nearly a thousand nurses took part in the survey which concluded that more than 55% of the respondents predominantly nursing managers will retire between 2011 and 2020. The number of retirees is obvious as the average age of a nurse range from 42.1 to 46.8 in recent years. The units which are likely to suffer will be Operating room (OR) and postoperative anesthesia care unit (PACU) since they have the older employees (Medical News Today, 2006). According to the Council on Physician and Nurse Supply, an independent group of health care leaders based in Pennsylvania University, the U.S may face a shortage of 800,000 nurses by the year 2020. An additional amount of nurses (around 30,000) should be graduated annually to meet the demand. A 2007 survey indicated that approximately 116,000 RNs are required to fill the vacant positions in hospitals all over the country with a national vacancy rate of 8.1% (American Hospital Association, 2007). According to a study the average age of nurses (43.8 now) will increase to 44.1 in 2014 and returning to 43.7 by 2025 as compared to other predictions that suggest the average age of a nurse would be 46.0 years by 2020. Also the supply would increase to 2.8 million as compared to a recent estimate which is 2.5 million by 2025. Despite this elevation nursing shortage will be observed which would reach 260,000 by 2025. According to U.S Bureau of Labor Statistics the projected employment rate for RNs will increase 22% by 2018 (Occupational Handbook, 2010-11). In a 2010 report by Institute of Medicine that suggests an increase in baccalaureate-prepared nurses in the workforce to 80% and doubling the nurses population with doctorate degrees. Currently only 50% nurses are baccalaureate-prepared (Future of Nursing, 2010). causes of nursing shortage Few of the possible factors that drive nursing shortage are briefly described below: Aging population The overall population is expected to grow by 18% between 2000 and 2020 while the population over-65 alone will grow by 54% (19 million people). With the increase in elderly population the demand for nursing will increase simultaneously (US Department of Commerce, Census Bureau). nursing school enrollment & facutly shortage A reported increase of enrollment (5.7%) in baccalaureate-nursing programs is observed. However, this elevation is not enough to meet the demands. Moreover, around 67,563 qualified applicants were rejected because of the limited amount of faculty and other resources such as clinical site, class room space and budget constraints. Almost two third nursing schools indicated limited faculty as the main reason of the rejection of applications. average age of nurses The current median age of nurses is 43.8 which means that most of the nurses will be retiring by 2020-25 which would leave a significant gap in the nursing force. Another survey by Nursing Management Aging Workforce in 2006 reported that 55% of the RNs intend to retire between 2011 and 2015 (Medical News Today, 2006). Job dissatisfaction Due to the shortage in nursing staff, workload on the existing staff has increased many folds. In a survey 75% of RNs believe that nursing shortage adequately affects quality of work and patient care. 98% of surveyed nurses believe that shortage in future will increase stress on existing workforce, 93% believed that it would affect and lower patient care quality and 93% were positive that the shortage might be a major of nurses leaving their profession (AACN). restriciton on work visas Another factor is the restriction on work visas which limit the health care organizations to hire foreign nurses to occupy the vacant positions. how does shortage impacts patient outcome? A variety of survey and studies indicate that the shortage of RNs will impact the U.S health care system with negative influences on patient care and elevated medical errors. Hospitals with low nursing staff levels are likely to have poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections. A shortage of nursing staff also results in missed care in many major categories such as surveillance, discharge planning, patient education, ambulation, feeding, emotional support, hygiene, and documentation. “Missed Nursing Care is a relatively new concept and refers to any aspect of patient care that is omitted (either in part or whole) or delayed” (Kalisch, Landstrom and Hinshaw, 2009). In a study Dr. Mary Blegen and her colleagues reported that sufficient amount of nurses in a facility results in fewer deaths, lesser emergency related incidents within the facility, low infection rates and shorter hospital stays (Blegen, Goode, Spetz, Vaughn & Park, 2011). The lower nurse to patient ratio and lower nursing retention rates are also found to be related to lower patient mortality rates. Higher patient mortality is observed in facilities have where standards are not well implemented and nursing turnover or understaffing are constant issues. Studies also suggest that patients of certain facilities are more at ease and possess better post-surgery survival odds where nurses rate the working environment as excellent which includes different factors such as nurse-physician and nurse-patient relationship and adequate support (Kaiser edu.org). Solutions for nursing shortage Classical solutions to the shortage problems such as raising wages or permitting work visas in order to recruit foreign nurses are useful but are not advantageous for the long-term because of the multifaceted issue recommendations for long-term strategies to be implemented at multiple levels are suggested. New recruitments and retention, as well as enhancing the capacity of nursing schools are the main areas of focus regarding the current and the predicted shortage in future. One of the strategies is to expand the student capacity of the nursing schools, either via partnering or seeking private funding. Most employers also offer educational benefits to their employees. An example is St. Scholastica College, Minnesota partnered with War Memorial Hospital in April 2011, to offer online skill enhancement trainings to the hospital staff. In this way around 800 employees will be benefitted. The college will offer low-cost online programs for bachelors, masters and doctorate for the employees where they can take online classes while continuing their work. Other organizations like AACN, RJWF are also working for improvement on the field. AACN announced expansion of Nursing CAS program in September 2011. The main purpose of the program is to ensure that all seats in the programs are occupied since 55000 seats were identified as vacant in 2009. Moreover, encouraging minorities and men to join the workforce are some of the strategies that would help in lessening the shortage. Currently 9% of nursing work force is male, 11% African-American and 5% Hispanics. The concept of nursing as a female-domain also discourages men to go into the profession. However, if certain barriers can be lifted, it is likely that men and other minorities will join the workforce and thus a significant reduction in the nursing shortage can be achieved. Buerhaus and colleagues, (2009) suggest that strengthening the current workforce would get better results in future. According to their predictions the current senior RNs will continue to work for several years in future therefore, it is necessary to make improvements in the ergonomic environment of the clinical. As compared to younger nurses, older nurses are more experienced which can be particularly more useful in detecting patient problem. However, older nurses are more susceptible to injuries and take longer time to recover therefore special concern on their physical health is required. These measures will help in older nurses for longer time period. Another strategy is to transform the work environment; one such example is efforts of RWJF which is working toward its goal to make hospitals places for healing and not just treatment, where workers are engaged and fully supported and thus make the institutions a reliable and enhance sources of healthcare. On Federal level certain policies and regulations are being proposed to cope with the future shortage. In February 2009, Senator Richard Durbin proposed Nurse Education, Expansion and Development Act (NEED) which focusses on the authorization of Capitation Grants for nursing schools to expand their student and faculty capacity. Many states are also taking initiatives to administer the RNs shortage as well as Nurse Educators’ shortage. One such example is the announcement of Pennsylvania Governor to invest $750,000 in order to address the shortage of RNs. While the private sector funds $870,000, this public-private relationship will help nursing schools to provide education to more students and hire more faculty members (AACN). quality & nursing Quality Before discussing the role of nursing in quality care and how both are related, it is necessary to understand quality. The definition as described by Institute of Medicine (IOM) is the most quoted definition: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality assurance, the measurement to ensure the reliability of a product under certain standard has been incorporated in the field of healthcare since 1980s. This focus on quality assurance leaded to discussion regarding validity of quality measurement and assessment of its results. Evidence-based care and significance of Healthcare informatics emerged during the 90s. Since then quality care processes to improve healthcare gained significance within the healthcare organizations. A study reported that healthcare workers need to gain more than professional knowledge to improve the quality of care (Hall, et. al., 2008). Quality & safety education for nurses (qsen) QSEN is funded by Robert Wood Johnson Foundation (RWJF), designed to develop and implement innovations in nursing education. (QSEN) leader defined six core competencies like, Patient centered care, Evidence-based practice, Safety, Teamwork and collaboration, Quality Improvement and Informatics. The development of these core competencies will help nurses to improve and enjoy their work. These competencies however, cannot be developed in a day or with a single crash course. Nursing education must properly incorporate QSEN within the course because improvement comes from gaining knowledge and applying it appropriately. This process is cost effective and produces better outcomes by using systemic methods and interprofessional approach. It is proved that applying these competencies reduce errors, improves patient outcomes and enhance patient satisfaction. Incorporating in the curriculum, models such as prospective and retrospective models and tools such as flowcharts, histograms, control charts, check sheets, cause and effect diagram and scatter diagram as described by Hall and colleagues, (2008) could prove to be useful in the implementation of better care. conclusion Nurses are not only the cornerstone of the healthcare industry; they also serve as the change agents that bring about quality in patient care. Currently the emphasis is on the predicted shortage of nurses in the U.S. which is going to be a big challenge in the coming years as baby boomers age and their healthcare requirements increase. Many strategies are proposed to address the predicted shortage which includes expansion of nursing institutes, increase in faculty, awarding scholarships, encouraging men and minorities and strengthening the current work force. Also the incorporation of Quality and Safety Education for Nurses is reported to achieve better patient outcomes such as low mortality rates and patient satisfaction. Investment in this field is recommended so that nurses can perform their roles satisfactorily, improve their skills and build their careers. BIBLIOGRAPHY Addressing the nursing shortage. (n.d.). Retrieved from: http://www.kaiseredu.org/Issue-Modules/Addressing-the-Nursing-Shortage/Background-Brief.aspx American Health Care Association. Department of Research. (2011). Report of findings2009 nursing facility staff retention and turnover survey. Washington: D.C. Blegen, M. A., Goode C. J., Park, S. H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet® and non-Magnet hospitals. 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