nursing shortage
DESCRIPTION
The problems facing the health care industry with regards to obtaining nurses and the vicious cycle preventing the education and training of the professionals needed to care for the growing, and aging, population.TRANSCRIPT
Running Head: THE NURSING SHORTAGE1
The Nursing Shortage
Does It Really Exist?
Jamie A. Adesso
Empire State College
Author Note
This paper was prepared for Planning and Finalizing the Degree
taught by Professor Daly
The Nursing Shortage2
On June 3, 2011, the United States Bureau of Labor Statistics reported that the
healthcare industry increased its number of employees by 44,600 from April to May of
this year. Among these new healthcare professionals, Registered Nurses made up
almost a fifth of the employees hired during this one-month period, leading some to
believe that there is no longer a nursing shortage (Bureau of Labor and Statistics [BLS],
2011). However, the fact that there are somewhere between 150,000 to 200,000
available nursing jobs at present that need to be filled strongly supports that there is in
fact a nursing shortage (American Association of Colleges of Nursing [AACN], 2011,
para. 9; The Spokesman-Review, 2011, para.1). While this appears to be the case, as is
believed by medical professionals, students, and patients, Registered Nurses that are
unemployed believe that if there really were a nursing shortage, they would have a job.
Definition
A shortage, by definition, is “a condition that exists when demand exceeds
supply because of a lack of equilibrium in a market” (The American Heritage New
Dictionary of Cultural Literacy, 2005). In regards to a nursing shortage, the definition is
not much different, as it states that, “a nursing shortage is a condition in which the
delicate balance of nurse supply and nurse demand are not at equilibrium. [It] is defined
as a situation in which the demand for employment of nurses exceeds the available
supply of nurses willing to be employed at a given salary. A nursing shortage is not just
a matter of understaffing, [which] can occur in conditions of shortage, equilibrium, or
surplus…” (Huber, 2006, p. 587). If the demand for nurses is in fact greater than the
actual supply, as suggested by the AACN, then what is the cause behind this shortage?
Contributing Factors
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Several theories exist as to why there may be a nursing shortage. Some people
believe it is because of the lack of educators, while others believe it has to do with
funding. It is also possible that there is a shortage due to high employee turnover, lack
of job applicants, or strict hiring guidelines. Any or all of these issues could be
contributing factors to the nursing shortage, and each deserves a closer look so that a
cause may be determined.
A lack of nurse educators in colleges is, without a doubt, an issue. A survey done
in 2005 by the Michigan Center for nursing determined that almost a fifth of current
nurse educators intend to retire over the next few years, and more than a third of the
nursing programs surveyed are claiming to have a hard time filling these job openings
(Beeke, 2008, para. 3). Another issue facing college nursing programs is the shortage
of clinical placements, which allows nursing students to gain the hands-on and work
experience they need before starting their career as a nurse. Without the cooperation of
a hospital, the students cannot fulfill all of the program requirements, which leads to the
programs suspension or elimination.
The number of students enrolling in nursing schools or programs has steadily
declined over the years, which is another contributing factor to the nursing shortage. If
no one wants to be a nurse, there is nothing anyone can do short of offering incentives.
Currently, the number of students in nursing programs is significantly smaller than those
needed to fill hospital positions (AACN, 2011, para. 16). The nursing profession is either
being overlooked or students just cannot obtain the funding to attend these schools.
Funding is a problem facing both, schools and hospitals. Teacher funding is an
issue that needs a resolution, since additional education is necessary to become a
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nursing instructor. This extra and expensive cost is one that does not result in a pay
increase and, since nurses make significantly more money working in hospitals, there is
no incentive for them to transition to educators (Tieman, 2011, para. 6). So, even if
schools could obtain more funding for nursing programs, they still would not be able to
hire the necessary number of instructors because the pay would still not be comparable
to that of nurses.
In regards to medical facilities, some have stopped hiring, made cutbacks, or
closed down because of new insurance policies and reduced pay out amounts, despite
increased premiums for consumers. This reduces the overall supply of healthcare and
increases the demand, which makes the shortage even worse. Medical facilities also
have a high turnover rate, especially in the Nursing department. Nurses work long
hours, often put in a lot of overtime, and have to process stacks of paper work on top of
attending to patients. “Some nurses skilled at dealing with patients and families grow
frustrated with a system that promotes them into dealing with paperwork and
administration and leave the field” (Beeke, 2008, para. 14). The most recently reported
turnover rate for Registered Nurses working in a hospital setting is 14 percent or 12,700
job openings (AACN, 2011, para. 3). The demands of this job tend to be overwhelming
and not everyone can handle the stress, especially those just starting out in this field.
Medical facilities are very strict about who they hire, which is another possible
reason for this alleged nursing shortage. Despite going to college and obtaining an
Associate or Bachelor’s Degree in Nursing, graduates do not always become nurses.
Some candidates receive poor performance reviews, others are not able to pass the
background check or the licensing exam, and a small handful never bother to utilize
The Nursing Shortage5
their education. The stronger emphasis on education is also causing medical facilities to
seek out candidates with Bachelor’s or Master’s degrees, overlooking those with
Associate’s degrees. The problem with this is that 34% of Registered Nurses have no
education beyond their Associate’s degree yet 60% of all nursing students obtain an
Associate’s, not a Bachelor’s degree (Mahaffey, 2002, para. 5). If students are seeking
a two-year degree but employers want them to have a four-year degree, the majority of
nurse applicants will not be employable.
The majority of Registered Nurses that currently hold employment are over the
age of 40 and those in their 50’s account for 25 percent of all nurses (AACN, 2011,
para. 19-20). The problem with this is that these nurses are expected to retire soon and
when they do, there won’t be anyone to take their place. This is especially problematic
because when these nurses retire, so will the rest of the Baby Boomer population and
the need for health care will sky rocket, increasing the gap between the supply and the
demand.
The Other Side
While most believe there is a nursing shortage, there are people who believe that
the supply meets or even exceeds the demand. Unemployed nurses feel that if there
really were a nursing shortage, they would not be without jobs. Others believe that if a
shortage did exist, hospitals would not be making cutbacks and laying off staff. Some
people wonder how a shortage could exist when nurses are trained overseas and hired
before they even come to the United States. By training nurses overseas, it eliminates
the funding and educational problems that nursing students are experiencing here and
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allows the hospitals the opportunity to hire qualified applicants but it increases
unemployment numbers of nurses in this country.
The number of unemployed and qualified nurses is evident by visiting
allnurses.com, a website where nurses can talk all about nursing and those that are
unemployed veterans or new graduates, talk a lot. At first glance, it seems that they
have legitimate concerns about local jobs going to foreigners but by the third page, you
start to realize that these people are complaining more than anything else. No one is
offering any facts, nurses on the site debate as to how many jobs really are going to
foreign workers, while others just appear lazy. If they put half as much effort into getting
a job as they do complaining, they might obtain employment (allnurses.com, 2011, p. 1-
3). Other than their words, no statistical data is claiming anything other than a nursing
shortage.
Resolutions
To resolve the educational issues at hand, medical and educational facilities
should form partnerships so that intern, extern, and residency programs are ongoing.
Employers should not only promote continuing education, but also require its employees
to participate in learning field advancements and procedural changes. Universities and
hospitals should work together to encourage educational advancement by creating
programs that allow nurses with Associate’s degrees to work and go to school to obtain
their Bachelor’s or Master’s degree (Mahaffey, 2002, para. 46-47). Nurse educators
should be more active in the college recruitment process because they know what it
takes to be a good and successful nurse.
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Attempting to turn these solutions into realities, the Robert Wood Johnson
Foundation (RWJF) came up with a policy full of innovations that address the nursing
shortage. One suggestion contained in the policy is that all new nurses must obtain their
BSN within ten years of obtaining their nursing license (AACN, 2011, para. 41). In an
effort to identify the reasons for the nursing shortage and come up with a solution,
academic and medical professionals from 47 states met at the Nursing Education
Capacity Summit. They shared strategies, talked about increasing faculty, and
restructuring the curriculum, along with policies and regulations (AACN, 2011, para. 43).
In 2010, the AACN took steps to expand “NursingCAS, the nation’s centralized
application service for RN programs, to include graduate nursing programs” (para 40).
The intent of this expansion is to omit empty seats in nursing schools at the
baccalaureate and graduate levels.
In regards to funding, during World War II, the government gave out grants to
nursing students as an incentive to help meet the high demand. These grants covered
the cost of nursing school and provided a living stipend. The incentive worked and the
country went from a nursing shortage to a state of equilibrium. Unfortunately, the
government funding only lasted for five years, after which time, nursing students had to
find other means of obtaining money for their education or they were on their own.
Some organizations, consumer groups, and foundations did help out, but they also
seem to have vanished over the years (Mahaffey, 2002, para. 7-10). Today, there are
student loans, grants, scholarships, and donations that allow students to attend school
but apparently, this is not enough to sustain a nursing program at some universities.
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The government needs to implement a new grant that helps students to become
nurses so that the shortage ends and employment increases, a task that Illinois Senator
Richard Durbin fully plans to take on. The Senator wants his Nurse Education,
Expansion, and Development Act, or NEED Act, to pass so that the number of grants
given to nursing schools increases, allowing for more teachers and students.
Additionally, the Governor of Pennsylvania, Edward G. Rendell got the state to invest
$750,000 to resolving the nursing shortage and obtained another $870,000 from private
sectors. The money from this partnership has already allowed nursing programs to hire
more educators and accept more students (AACN, 2011, para 42, 44). Despite these
efforts, more solutions need to be implemented and at an accelerated rate.
Conclusion
The BLS projects that, between 2008 and 2018, the healthcare sector will add
582,000 nursing jobs to meet the growing demand of patients (BLS, 2009, para. 11).
This number could easily snowball into a nursing shortage of one million by 2020 (PBS,
2009). As things are right now, many expect these jobs to remain vacant. If this holds
true, than the country will experience a nursing shortage, though many believe a
nursing shortage already exists, including William C. Goodman. Mr. Goodman works for
the Office of Employment and Unemployment Statistics at the BLS as a social science
research analyst and his research says there is a nursing shortage. His studies show
that the number one reason for the shortage is that women now have options, whereas
30 years ago, they did not. More women are choosing business careers where the
demands are sometimes less and the pay is sometimes higher than in the nursing
profession. The other top reason for a lack of nurses is job dissatisfaction, leading to a
The Nursing Shortage9
high turnover rate (Goodman, 2006, p. 7). These are the true causes of the nursing
shortage, which will continue if these issues, which are very personal, remain without a
resolve.
If the cause of the nursing shortage was funding, money would fix the problem
but how do you resolve a problem that is occurring based on personal choice? The only
option is incentives and, since Registered Nurses already receive generous salaries,
what more can an employer offer them? A lack of employees means no one to cover a
shift, minimal time off, many extra hours, and too many patients that all demand care.
This leaves employer’s option less, therefore maintaining the high levels of turnover,
and continuing the nursing shortage.
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Bibliography
1.) Beeke, Candace. “Nursing Schools Struggle to Find Teachers.” MLive.com Spring 2008. Retrieved from: http://blog.mlive.com/wmbr/2008/05/nursing_schools_struggle_to_fi.html
Candace Beeke, a journalist for over a decade, explains how the lack of educators in college programs is affecting the nursing shortage. She uses interviews as her main source of insight into this topic and as supporting evidence. Beeke does not refer to any previous works on this topic and her article is easily comprehensible for most readers.
2.) PBS Video. “Nurses Needed.” PBS.com Fall 2009. Retrieved from: http://video.pbs.org/video/1301585391/
PBS, the Public Broadcasting Station, which has been providing educational television programs since 1969, aired a documentary on the importance of nurses and their vitality to medical facilities. The information gathered in this video was collected through multiple interviews and real life situations in a hospital setting. This video does not acknowledge any previous works and has no rating, making it appropriate for everyone.
3.) Tieman, Linda. “Is There Really A Nursing Shortage in Washington State?” Washington Healthcare News 5 (6) Summer 2010. Retrieved from:By: Linda Tieman RN MN Fachehttp://www.wahcnews.com/newsletters/wa-ltieman0610.pdf
Linda Tieman RN MN Fache, Board President for The Forum of State Nursing Workforce Centers, a previous Director of Nursing and VP of Patient Care, and currently the Executive Director at Washington Center for Nursing, wrote this article to determine if there really is a nursing shortage. She based her information on statistics from credible sources, all of which she cites at the end of the article. She does not mention previous works though she does talk about some solutions to curb the nursing shortage. Her thoughts are unbiased, as she offers mostly facts and not much opinion, and the style and vocabulary of her article makes it an easy to read piece for the average reader.
4.) Mahaffey, Elizabeth H. “The Relevance of Associate Degree Nursing Education: Past, Present, Future.” The Online Journal of Issues in Nursing 7 Spring 2002.
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Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume72002/No2May2002/RelevanceofAssociateDegree.aspx
Dr. Elizabeth H. Mahaffey is the Dean of Nursing and Allied Health at Hinds Community College, where she previously taught nursing for 22 years and has 25 years of clinical experience prior to teaching. She talks about the associate degree nursing program and the changes it has seen over the years, both in curriculum and status in the nursing community. Towards the end of her article, she mentions the relationship between the nursing shortage and those with an associate’s degree, using numerous sources, including herself, and organizations to support her information. She makes no mention of previous works and the article reading level is for someone with a college education or educated professional.
5.) Huber, Diane. “Leadership and Nursing Care Management.” Third Edition. 2006.
Professor Huber, Ph.D., RN, FAAN, NEA-BC, currently works at the University of Iowa in the Nursing Department. She has worked on over 20 research projects, has written over 50 articles, books, and chapters combined. This book, with more than 900 pages, covers all aspects of leadership and care management, from health policies, to trends, to human resource and monetary guidelines. She dedicates an entire chapter to discussing the nursing shortage, which includes a definition, a history of nursing shortages and surplus’, and factors that contribute to or cause the nursing shortage.
6.) American Association of Colleges of Nursing. “Nursing Shortage Fact Sheet.” Spring 2011. Retrieved from:http://www.aacn.nche.edu/media/factsheets/nursingshortage.htm
The American Association of Colleges of Nursing, or AACN, establishes the standards for nursing degree programs at bachelor and graduate levels. This article is full of statistical information, problems, and possible solutions. It does not mention previous works and is easy for the average reader to comprehend.
7.) United Stated Bureau of Labor Statisticshttp://www.bls.gov/news.release/empsit.nr0.htm
This website provides a variety of information in regards to the current employment and unemployment rate of nurses, as well as projections for demand and growth. It uses data from multiple sources, such as the United States Census, tax information, and company records. The information is usually one to two years behind, so it is not the most accurate source, but it is as close as possible. A history of previous information is stored on this website, which is
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probably best utilized by an upper level high school student, college student, or above.
8.) Allnurses.com, 2011. Retrieved from: http://allnurses.com/general-nursing-discussion/unemployed-nurses-530527.htmlThis website is a place where nurses can network, discuss, or learn about the ongoing events in their profession. The site has a mixture of opinions and facts, so there is some bias. Opposing viewpoints do offer some neutrality because it allows the reader to see both sides and come to the conclusion that more research needs to be done to make an informed decision or opinion.
9.) Shortage. (n.d.). The American Heritage® New Dictionary of Cultural Literacy, Third Edition. Retrieved July 11, 2011, from Dictionary.com website: http://dictionary.reference.com/browse/shortage