Workforce Shortage in Rural Area, Research Paper Example

Patients being admitted to acute care hospitals in the USA rely on the quality and professionalism of the nurses.  It is expected that the nurses will be both qualified and experienced in this specialist work.  During the 1990’s a considerable amount of restructuring took place and this witnessed the replacement of many costly trained nurses with that of less experienced unlicensed nurses.  Consumer groups were quick to react raising concerns in the decline of the quality of nursing care.  This further resulted in researchers studying the effects of nursing care on patient and organizations.  ” In general, researchers have focused on patient variables such as medication errors, falls, decubitus ulcer incidence, nosocomial infection rates, and patient satisfaction”  (Anon, 2007).  Most of the move towards using unqualified nurses is the reduction in costs and this has been measured in accordance with identified work-breakdown. For example: ” Several studies have suggested that as much as 40% of a nurse’s time is spent on indirect patient care (charting, preparing medications, seeking consultation), about 30% is spent on direct care (administering medications, basic physical care, treatments and procedures) and 14% in personal time”  (Greta L. Krapohl, 1996).

Positive Impacts

Despite the obvious reduction in costs.  It has been found that many of the unqualified nurses have been less prone to error, particularly on the medical administration side.  Statistics have illustrated ” In one study monitoring 7,140 doses of administered medication (2,820 RN doses and 4,320 UMAT(unqualified)  doses), RNs were responsible for 11.38 times as many errors when compared with UMATs (Burruss et al., 1993). (Anon, 2007). The study was later found to be inconclusive. There have been many other project redesigns looking at an integrated approach with qualified (RN’s) and non qualified (UMAT’s) using supporting technicians.  Over 4 months study it was found that patient satisfaction remained relatively unchanged, whereas nursing satisfaction significantly decreased.

Negative Impacts

It is clear that Registered Nurses derive the most satisfaction by working with peers within the profession.  Adding unqualified staff increases the administrative burden and need for increased vigilance over the technicians and non qualified staff.  Rural areas are significantly hit by workforce shortages and finding qualified resources in these areas represents a severe challenge” Rural facilities took significantly longer to fill nursing vacancies than did urban facilities for 15 out of 22 nursing specialties, according to a survey released by the American Organization of Nurse Executives in February”  (Barbara Tone, 1999).  The USA is not the only country that is facing this crisis.  The situation is being represented in many other parts of the world including Europe and Australia ” In rural areas, we are now seeing the beginnings of catastrophic health workforce shortages that without action will cripple the health care system. ”  (Kenny, 2009)

Financial Impact

In the United States the nursing situation started to deteriorate in the 1990’s and has been in steady decline ever since.  Qualified nursing positions being cut primarily in the areas of managed care in order to make financial savings.  ” curtailed public and private sector insurance reimbursement rates and placed many hospitals and care facilities in difficult financial positions”  (Claire Fagin, 2009).  Many of the senior financial administrators did not seem to understand or value nursing and as such placed financial priorities elsewhere.  Despite extensive restructuring throughout the system the model has ended up with the qualified Registered Nurses being over burdened with drastic unrealistic workloads.  ” Many tasks formerly performed by nurses–tasks that enabled nurses to perform critical nursing assessments–were now performed by unlicensed assistive personnel, or not performed at all.”  (Claire Fagin, 2009).  This has seen alarming numbers of nurses leave the profession because of health reasons or “burn out”.  2005 recorded that over half-million Registered Nureses in the USA had left the profession.

Conclusions

It is clear that these trends still remain of significant concern for Health Administration in the USA.  With an aging population from the ‘baby boomer period’ the demand for skilled qualified nurses will increase.  Current legislative measures have had no significant impact in terms of making a difference.  A number of states have been trying to introduce incentives and programs to address the shortage but still not enough to have any enduring or meaningful impact.

The trends indicate that the winners will be those affluent nations that can afford qualified nursing resources and the poorer nations losing out ” the migration of many of the most skilled developing world nurses to much better paying positions in developed nations with shortages, with a devastating impact on already overburdened health systems in the poorer nations.”  (Claire Fagin, 2009).

Works Cited

Anon. (2007). The impact of nursing on patient and organizational outcomes. Nursing Economics .

Barbara Tone, R. (1999, 3 25). Green Acres. Retrieved 2 1, 2010, from Looking for a job? : http://www.nurseweek.com/features/99-3/rural.html

Claire Fagin, P. M. (2009). What is the nursing shortage and why does it exist? Retrieved 2 1, 2010, from Center for Nursing: http://www.nursingadvocacy.org/faq/nursing_shortage.html

Greta L. Krapohl, E. L. (1996). The impact of unlicensed assistive personnel on nursing care delivery. Nursing Economics .

Kenny, P. A. (2009). Nursing shortage cripples the regions. Retrieved 2 1, 2010, from La Trobe University: http://www.latrobe.edu.au/news/articles/2009/opinion/nursing-shortage-cripple-the-rural-areas