Nursing Shortage and Use of Unlicensed Assistive Personnel, Research Paper Example

Introduction

Rising demand for qualified medical help, along with lack of specialists, has created a shortage of nurses in hospitals and other health care centers. Having no other option but to hire unlicensed assertive employees, medical institutions put patients at risk of getting unprofessional help, which appears to be more harmful than beneficial. In fact, the lack of qualified personnel can be a result of insufficient staff training programs and deficiency in funding, thus resulting in relatively low quality of medical treatment. Nursing shortage did not come out of nowhere, for a certain trend of rising job dissatisfaction can be monitored throughout the last decade. The beginning of nursing crisis is believed to occur in the late 1990s, when hospitals and health care centers cut the number of registered nursing positions. Because of hard economic conditions, a high-qualified personnel was partially replaced by the employees with relatively low experience and medical practice. Looking for better career solutions most of RNs either found jobs at privately owned clinics or simply changed their occupation. Decline in the quality of medical treatment was rising and peaked in 2004-2005. “The top four reasons for the nursing shortage as identified by RNs were salary and benefits issues, more career options for women, undesirable working hours, and a negative work environment.”(Allen, 2008) Certain steps to improve the situation have recently been taken, such as increased salary, rising number of training programs, and enhanced working conditions. Nonetheless, the Bureau of Labor Statistics states that more than one million of registered nurses will be needed to provide US citizen with appropriate medical treatment by 2010.(Allen, 2008).

Unqualified and unlicensed assistive personnel usually supplement lack of professional nurses. As 33 states have experienced nursing shortage since 2000, the number of unprofessional employees has skyrocketed. Both rising demand for medical workers and diminishing number of students have created such situation, when suitable nurse/patient ratio is physically impossible. For instance, “enrollment in schools of nursing is not growing fast enough to meet the projected demand for nurses, because enrollments must increase by 40 % per year to replace the loss of nurses projected through retirement”.(Kleinman, p.163) Legal authorities tend to reject the idea that RNs will be substituted by unlicensed assistive personal (UAP). However, there is sufficient evidence to assert that State Boards of Nursing considers UAP as employees who are specially trained to assist certified medical workers in a variety of treatment activities.(Kleinman, p.163) Not only do they identify requirements for hiring UAPs at hospitals and health centers, but also set different occupations that involve direct contact and partial treatment of the patients.

Though US government has found excellent way to economize costs of public health care system, the quality of medical care is yet to be questioned. If fact, this issue is contradictory because of the influence it has on the population. On the one hand, lack of qualified registered nurses can be substituted by UAPs in order to increase operation capacity of hospitals and health care institutions. On the other, postponing the problem itself is not the best solution as it may lead to insufficient medical care system and worsening of the health of US nation. Moreover, employment of unlicensed assistive personal can affect nursing as a faculty and the number of people enrolled in medical education programs.

Relevance of Nursing Shortage and Use of UAPs to Nursing Practice

This topic is relevant to nursing practice as it addresses such points as RN/UPS ratio at public hospitals and health care centers and the number of students enrolled in nursing classes. Additionally, it emphasizes the reason why most professional employees suffer from worsen job conditions and competition, created by inexpensive labor force. To identify the reasons why unlicensed assistive personnel are considered to affect nursing practice negatively one needs to give proper definition to UAP. “The American Nurses Association defines UAP as individuals who are trained to function in an assistive role to the registered professional nurse in the provision of patient/client care activities as delegated by and under the supervision of the registered professional nurse.”(Zimmernamm, p.312) Therefore, the role of this labor force is to supplement, but not substitute, registered nurses. Government policy regarding the wages of nurses has attracted a lot of people willing to work for rather low salary, thus causing mass dissatisfaction among RNs. In fact, long-term education and medical practice of professional nurses is replaced by no more than 75 hours of average UAP preparation. Statistics have shown that “registered nurse respondents in a 1996 survey reported a reduction in the numbers of registered nurses providing direct patient care in their institutions within the preceding year (60.2 %) and the current hiring of UAP to provide direct care previously provided by registered nurses (41.9).”(Zimmernamm, p.312) This data was almost unchanged since the late 1990s. In other words, unlicensed personnel’s duties have shifted from performing secondary tasks and clerical job to providing treatment of the patients. Originally employed to be helpers of certified nurses, they have ultimately changed the ratio of RN and UAP hired by hospitals and health centers.

Careful research on the reasons of nursing shortage shows both past and future trends in medicine, how they may affect nursing practice and profession itself. According to the article, entitled “Nursing Shortage” and published in British Medical Journal, there are three main factors that affect this issue. Firstly, government and political leaders tend to lobby their interests of saving money and they are interested in keeping this information in secret. Secondly, as there is lack of evidence, nursing shortage is still unconfirmed. Thirdly, lack of motifs restricts development of medical skills and talents. (Buchan, 1996)

Good knowledge of this issue is beneficial for both practicing nurses and students involved in studying. This topic addresses one of threats employees of medical institutions may face. Understanding of nursing shortage and tracking the process of the development of this problem can help individuals evaluate their chances to make goods career and be prepared to some negative outcomes connected with this issue. It is not a secret that diminishing number of medical workers will not stay unnoticed. Worsening of the situation can also bring a lot of benefits to students, who take courses, and practicing nurses. As soon as legal authorities realize that there is a lack of qualified employees, various programs that create interest in this particular profession, will be implemented. Therefore, by being prepared to the change of government policies and knowledgeable about this issue nurses will be informed enough to request higher wages and improvement in working environment.

Discussion

To cover some of the most important aspects of nursing shortage three different sources are used. Reports of American Nurses Association (ANA), addressing nursing shortage legislation and ethical issues connected with hiring international employees, show present situation and those problems medical workers are experiencing. Americans for Nursing Shortage Relief Alliance’s Testimonial proposes accurate data on missing nurses’ positions and funding to maintain appropriate supply of specialists. Information provided by a Nursing Camp for Prospective Nursing Students depicts actual situation of what is going on in education institutions.

American Nurses Association believes that the primary reason affecting the number of employees willing to work at hospitals of other medical institution is highly affected by working conditions. Despite there is a decreased number of graduated students, it does not influence the nursing shortage too much. This idea has marked direction, in which help has to be provided. “The ‘Nurse Retention and Quality of Care Act of 2002’ will provide grants to healthcare facilities to develop and implement strategies, or ‘best practices’, that will make the workplace attractive to nurses”.(Medscape Medical News, 2002) By rewarding qualified registered nurses ANA tries to remove dissatisfaction of workers with harsh condition in their workplaces. American Nurses Association is trying to find people willing to work as medical personnel by any means. In fact, standards established by this organization allowing medical institutions to hire UPAs are no longer beneficial, for even with their implementation lack of nursing cannot be prevented. For this reason a new trend of hiring international nurses is being monitored. “’We believe every qualified nurse has the right to seek employment in the United States, just as we believe U.S. nurses should have the same opportunity to practice in any other country of their choice,’ said ANA president Mary Foley, MS, RN”.(Trossman, 2003). Because of incompetence and attempts to neglect rising nurses’ shortage, it is now proposed to be resolved with the help of international labor force, which is again attracted by much smaller wages.

Americans for Nursing Shortage Relief (ANSR, p.2) Alliance’s Testimony addresses another aspect of this problem – nurse faculty. Lack of people enrolled in education is considered to be the most serious problem of diminishing number of medical workers.

In 2005, the American Hospital Association reported that hospitals needed 118,000 more RNs to fill immediate vacancies, and that this 8.5 percent vacancy rate is hampering the hospitals’ ability to provide emergency care. Government estimates indicate that this situation only promises to worsen due to an insufficient supply of individuals matriculating in nursing schools, an aging existing workforce, and the inadequate availability of nursing faculty to educate and train the next generation of nurses.(ANSR, p.3)

It has been also proved that approximately 88’000 qualified applications were denied in 2006 because of deficiency of faculties, classrooms, or medical placement for undergraduates. In 2009 ANSR has requested a total of $200 million to sponsor trainings and courses for students. In fact, this sum is 30% less than the one requested a year before. It was accomplished through halting “Advanced Education Nursing” program.(ANSR, 2008)

Relating to Southern Missouri Hospital, the article written by B. Bowman and M. Stilson describes the situation of one particular medical institution. Thought it concerns only one single Campus, the idea of the problems connected with education of nurses in the country can still be observed. As there was a small number of students willing to become nurses in future, administration of Southern Missouri Hospital decided to create Nursing Camp that could help young undergraduates decide on their occupation. Hospital staff has detected the problem of nursing crisis and prepared one possible solution to this problem. “The planning committee held its first meeting the fall of 2002 and established the following goals: (1) to expose young people to the registered nurse role in various clinical and nonclinical settings; (2) to make nursing an attractive career option to male and female students of diverse ethnic socioeconomic backgrounds; (3) to make camp an enjoyable fun-filled week of exploration of not only the nursing career, but also the life’s of nurses.”(Browman, p.512) In other, words what was planned by various legal authorities and institutions was implemented in life through the initiative of public hospitals. Southern Missouri Hospital has already hired Campus graduates for assistive positions, while students continue their education.

Information written above gives detailed explanation on why unlicensed assistive personnel is offered so many jobs at health care centers and public hospitals. According to C. Kleinman, hiring of UAPs who have direct influence on the health of the patients, is connected with both lack of RNs and financial problems. “It is critical that healthcare organizations continue to maintain high quality care and patient satisfaction despite the dilemmas posed by this care delivery model and staffing mix”.(Kleinman, p.164) American Nurses Association believes that only working environment is important when dealing nursing shortage, thus increasing the number of UAPs. Satisfactory job atmosphere does not take away lack of registered nurses, but only affects UAP/RN ratio. Both Americans for Nursing Shortage Relief Alliance and Southern Missouri Hospital’s direction board have discovered effective ways of solving this problem. Nonetheless, the size of nursing recovery campaigns should cover all territory of the United States, and not separate states or even locations.

Individual Reaction to the Issue

The author of this paper considers nursing shortage and use of unlicensed assistive personnel to be controversial issues. Being beneficial from the economic perspective, the approach of registered nurses substitution is totally unacceptable from the side of high quality treatment and professionalism. It is always assumed that saving money benefits country’s wealth and prosperity. Nevertheless, there are some fields, which cannot be sacrificed for fast development of others. In fact, medical care should be not only controlled, but also stimulated by the government. Job satisfaction is not economic indicator, thus cannot be simply calculated.

Related to the medical treatment, nursing shortage is highly affecting both nursing preparation and practice. Thought this problem is evident, government pretends that there is nothing to worry about. By neglecting the development of nursing shortage legal authorities definitely benefit from it. Otherwise, passive role of government in medical crisis cannot be adequately explained. Even though unlicensed assistive personnel can reduce the lack of qualified personal, it does not guarantee high level of medical care provided. Only by following the original definition of UAP hospitals, the predominant number of medical institutions can get some advantages out of inexperienced employees. Nursing shortage affects not only the level of professionalism of medical workers, but also prompt health care service delivery. In several states the ratio between nurses and patients reaches 25/2’000 and is constantly growing. In fact, we can come to the situation when people with different triage levels be waiting hours in line for professional medical help and assistance.

Summary

The research written above gives sufficient evidence to indicate that nursing shortage and use of unlicensed assistive personnel affect both patients and medical workers. As author’s future career is related to medicine and nursing, knowledge of this particular issue gives her an opportunity to be prepared to possible risks associated with this issue. Moreover, good understanding of the reasons of declining number of qualified medical associates will help to handle possible obstacles in nursing career. Moreover, analysis of nursing shortage can help author of this research to prepare for future interactions with UAPs, cognitive dissonance, which may occur, and correct assigned tasks depending on experience and professionalism levels.

References

Allen, L. (2008). Introduction. The Nursing Shortage Continues as Faculty Shortage Growth. Retrieved March 23, 2009 from Medscape Business of Medicine website: http://www.medscape.com/viewarticle/572311?src=mp&spon=21&uac =17907AZ.

Americans for Nursing Shortage Relief (ANSR) Alleance. (2008). Testimony of the Americans for Nursing Shortage Relief (ANSR) Alliance  Regarding Fiscal Year 2009 Appropriations for Nursing Workforce Development Programs. Retrieved March 23, 2009 from http:/ /www.rehabnurse.org/pdf/ANSRtestimony033108.pdf

Bowman, B., Stilson, M. (2005). Journal Update. Meeting the Nursing Shortage. A nursing camp for prospective nursing students. Retrieved March 23, 2009 from the Journal of Emergency Nursing.

Buchan, J. (1996). Editorials. Nursing Shortages. Retrieved March 23, 2009 from British Medical Journal’s website from: http://www.bmj.com/cgi/content/full/312/7024/134?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=nursing+shortage&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT.

Drazen, J. (2002). The Nursing Shortage and the Quality of Life. Retrieved March 23, 2009 from the New England Journal of Medicine. Vol. 347, No. 14.

Finlayson, B., Dixon J., Meadows S., Blair J. (2002). Mind the gap: the extent of the NHS nursing shortage. Retrieved March 23, 2009 from British Medical Journal. Vol. 325.

Grindel, C. (2005). Health Care Industry. Medical-Surgical Nursing: a specialty or not? Retrieved March 23, 2009 from http://findarticles.com/p/articles/mi_m0FSS/is_1_14/ai_n17208298

Kleinman, C. (2006). Decreasing Nurse Resources. Registered Nurses and Unlicensed Assistive Personnel: An Uneasy Alliance.  Retrieved March 23, 2009 from The Journal of Continuing Education in Nursing. Vol. 37, No 4.

Lenzer, J. (2003). Reviews. ER blamed for Nursing Shortage. Retrieved March 23, 2009 from British Medical Journal’s website: http://www.bmj.com/cgi/content/full/327/7426/1294.

Medscape Medical News. (2002). ANA endorses Nursing Shortage Legislation. Retrieved March 23, 2009 from http://www.medscape.com/viewarticle/433421.

Trossman, S. (2003). Global reach of the nursing shortage: The American Nurses Association questions the ethics of luring foreign-educated nurses to the United States. Nevada RNformation. Retrieved March 23, 2009 from FindArticles.com. http://findarticles.com/p/articles/mi_qa4102/is_200302/ai_n9205710.

Zimmermann, P. (2000). Clinical Articles. The Use of Unliscenced Assistive Personnel: An update and skeptical look at a role that may present more problems than solutions. Retrieved March 23, 2009 from the Journal of Emergency Nursing. Vol. 26, No 4.