Shortage of Nurses in the USA, Essay Example

Abstract

This paper explores the current shortage of Nurses in the US Healthcare system. The paper is divided into five distinct parts: (1) Introduction – Defines the problem and the current state of nursing shortages in the US healthcare system. Considers the international perspective and offers a comparative analysis (2) Causation Factors – What has led to this crisis and how will the problem be addressed. How serious is the problem and what are the future trends. Consideration of ethical matters (3) Remedial Actions – Consideration of Political, Economic and Social Trends impacting the nursing profession. Precisely what can be accomplished and the critical success factors to achieve same. (4) Action Plan – A suggested outline plan of action and the components within same. (5) Conclusions – The benefits to be derived from resolution of the problem and how potential risks might be mitigated.

Literature Review

There are a large number of sources in the medical and professional journals covering this topic. In addition a number of white papers have been produced from qualified members within the nursing profession.  This paper will examine this literature and focus upon a number of key papers that include:- A paper produced by Debbie Elliott on 3^rd June 2007 addressing the critical nursing shortage. A report from the Centre for Nursing Advocacy addressing a series of questions on the US nursing crisis with emphasis on causation.  A paper produced by Moira Hebet for business week looking at the critical shortage of nurses and the impact on baby boomers. The American College of Nurses and the Nursing Shortage fact sheet produced by Robert J Rosseter on September 2010. Finally an international paper produced by Reuters on the US Healthcare system pinched by nursing shortage, produced by Will Dunham in March 2009.

Introduction

The healthcare system in the USA is one of the most controversial political debates currently taking place today. An integral part of this is the acute shortage of qualified nursing professionals and the threat that this poses to effective patient care in the years to come. “The US healthcare system is pinched by a persistent nursing shortage that threatens the quality of patient care, despite the fact that tens of thousands are being turned away from nursing schools” (Dunaham, 2009).  It is estimated that there are 116,000 unfilled vacancies for registered nurse positions in the USA. This shortage is expected to deteriorate further in the years ahead with 78 million baby boomers entering the retirement age.  The problem is believed to be a bottleneck in the nursing schools where there is insufficient teaching faculty to progress students through the training system.  In 2008 this resulted in some 50,000 applicants being turned away; the figure including 6,000 who were earning Masters or Doctoral degrees in the profession. President Obama has referred to this as the front-line in the healthcare crisis and a recent $500 million stimulus should see $100 million going towards addressing the shortfalls in the nursing profession (Dunaham, 2009).

There are about 2.5 million registered nurses in the USA.  With the shortage of nursing trainers the concept of cyber applications becomes very appealing.  Nurses can interact with sophisticated software programs and research and apply simulated techniques in a safe zone.  Additional technology advancements in robotics, artificial intelligence and expert systems will increase the versatility and reliability of the simulations. In the future it may be possible to conduct surgical techniques on a simulated human.  Students are reacting very positively to nursing computer simulation studies and this is seen to be increasing the value of learning  …” Use of computer simulations was studied as a strategy to evaluate clinical decision-making skills of 64 senior baccalaureate nursing students who were randomly assigned to experimental and control groups. All students completed Kolb’s Learning Style Inventory, a pre- and post-test that was a computer assisted instruction (CAI) clinical simulation specific to the student’s clinical placement, and a 36 item attitudinal and evaluative questionnaire developed for the study” (Lowdermilk DL, 1991).

How will the emerging crisis of shortfalls in nursing professionals in the US Medical system be addressed in the next five years ?

Causation factors

Low wages – Pay for registered rose by just 1.34% in 2006-7 which trailed well behind inflation. One cause has been indicated that this is due to the large amount of foreign nurses being brought into the US system from abroad. “ In recent years nearly 1/3^rd of Registered Nurses joining the US workforce were from overseas countries” (Herbst, 2010). This problem has been blamed upon Hospital Administrators who are aiming to bring in low paid nurses from overseas. Many of which do not have the formal qualifications of US trained nurses and as such this impacts the more highly skilled trained nurses.  There is also the question of quality and how this might impact patient care both now and in the future. Peter Buerhaus a Professor of Nursing at Vanderbilt University has stated that nurses remuneration needs to be higher.  This is a reflection of how the nursing markets are being impacted and changed by concepts of globalization.

Working conditions – Difficult and unsatisfactory working conditions are also being cited as a reason for low entrants to the nursing profession. It has been estimated that there are 500,000 registered nurses who are no longer in practice. This being the equivalent of 1/5^th of the qualified professional nurses in the USA.  If these could be enticed back it would resolve the current vacancy list. “ Nurses are getting more organized but changes are not going to happen overnight” (Herbst, 2010)

Nursing training –  The current waiting list for nursing training is running at between 1-2 years and this is a prime reason that is driving recruitment from abroad.  This is unlikely to abate in the near future as the situation is not improving. “ Nursing Educators are on average even older than RN colleagues and half of them are expected to retire within a decade” (Elliott, 2007).  Boston College School of Nursing is an example of Schools turning nursing candidates away; some 650 applicants were turned away in 2006.

A global problem – The Centre for nursing Advocacy has stated that this is truly a global problem and there is a world shortage of nurses. There are estimated to be 12 million nurses in the world and the work of these professionals is not clearly understood. The Centre believes that there is a vast knowledge gap between what the nurses do and what the public generally perceives they do.  These all contribute to the underlying causes for shortages of nurses entering the profession. (Mason, 2010). In December 2009 the Bureau Labor Statistics (BLS) has projected that “ 581,500 new RN positions will be created between 2009-18 thereby increasing the RN workforce in the US by 22%” (Rosseter, 2010)

Quantified analysis & trends

A good place to start is the disparity in wages or salaries between the different nursing types. Registered Nurses (RN’s) and those with a degree Bachelor of Science in Nursing get paid almost twice as much as Licensed Vocation Nurses (LVN’s) and Licensed Practical Nurses (LPN’s).  There is a projected shortfall of more than 1 million nurses by the time we reach 2020.  This at a time when the baby boomers will be in their 70’s and probably have the largest demand on medical care.

The chart to the right shows the basic economic supply and demand for nurses from current times to the year 2020. It easily shows the continued rise in demand for nurses outstripping the available supply.  The evidence is clear of the shortfall that will be generated unless positive action steps are taken now.

One might say that the Government has an ethical responsibility to its’ people in terms of addressing this problem now before acute shortage damages society to a point that short term corrective measures would not be a viable option. “U.S. Department of Labor projects an increased need of 21% for nurses nationwide for the decade 1998-2008 as compared to only 14% for all other occupations. As a result, a Registered Nurse shortage of about 6% in the year 2000 is expected to reach 29% by 2020.” (MacNeil, 2010).

Remedial actions

The following table illustrates the suggested remedial actions that need to be taken in order to address the nursing shortage situation in the USA. This is based upon research collected from Nursing journals, Medical Schools and other leading academicians who have reported on this problem.

Suggested Remedial Action Plan

There are undoubtedly many more aspects to this as the problem is extremely complex and needs to be addressed from a number of different perspectives. Peter Buerhaus of Vanderbilt University stated “ we must stop turning people away as they are unlikely to come back. We’re not talking a lot of money at most $1 billion which is decimal dust” (Elliott, 2007).

Conclusions

How will the emerging crisis of shortfalls in nursing professionals in the US Medical system be addressed in the next five years ?  The Obama Administration faces an extremely serious challenge with addressing not just the nursing shortage but the entire Healthcare program. It is a monumental task with no quick fix solutions when the Country is spending heavily in the defence sector, facing a recession with no major industrial stimulus in sight and having to deal with the consequences of globalization and increasing competition from overseas.  This is likely to turn out to be a slow progressive repair job taking a decade or more.  In many regards the situation has a high risk of getting worse before matters improve. Successive changes in Administration may compound this and slow the apparatus down even further.

Works Cited

Dunaham, W. (2009, 3 8). US Healthcare system pinched by nursng crisis. Retrieved 11 4, 2010, from Reuters: http://www.reuters.com/assets/print?aid-USTRE5270VC20090308

Elliott, D. (2007). US faces critical nurses shortage. Boston MA: NPR.

Herbst, M. (2010). A critical shortage of Nurses. Business Week, 1.

Lowdermilk DL, F. A. (1991). Computer simulations as a measure of nursing students’ decision-making skills. Journal of Nursing Edication, 34-39.

MacNeil, P. (2010, 4 11). The Nursing Faculty Shortage: . Retrieved 11 4, 2010, from NursingPh.D: http://nursingphd.org/articles/shortage.php

Mason, D. (2010). Why does the nursing shotage exist. Retrieved 11 4, 2010, from Nursing Advocacy: http://www.nursingadvocacy.org/faq/nursing_shortage.html

Rosseter, R. J. (2010). Nursing Shortage Fact Sheet. New York: American College of Nursing.