Nursing Shortage Background and Current Reality

The shortage of nursing staff in the workforce has become a global crisis. Numerous research articles and even books have been written on the subject from all around the world, all giving causal factors and possible solutions. As far back as 2002, "90 nurses' organizations, representing 69 countries and every geographic region of the world, reported shortages in their countries" (Clark & Clark, 2003). Moreover, the United States is drawing many immigrant nurses into the profession as a result of higher pay, further depleting the numbers in other countries such as "Oceania, Africa, Central America (including the Caribbean), and in central and eastern Europe" (Clark & Clark, 2003).

Although there have been nursing shortages reported off and on for the past 60 years (Spetz, 2005), the labor force has been able to gradually "correct itself" over time; however, in this case the shortage is already several years underway and is not expected to reach the height of its crisis until the year 2020. In that year, the United States alone is predicted to need 300 to 500 thousand additional nurses. This means that "graduation rates must rise by 50% to meet the increased demand and make up for impending retirements" (Manthey, 2008)

Something must be done to correct the nursing shortage before patient care is seriously undermined. Already "reduced nurse staffing levels have been linked to poorer outcomes for hospital patients, when compared with higher levels of nurse staffing" (Hogan & al, 2007). These negative outcomes include increased lengths of stay, increased infection rates, drug administration errors, accidents, and even deaths (Hogan & al, 2007).

In addition, nursing shortages are associated with even higher rates of staff turnover, which not only negatively affect patient care but lead to increased hospital costs such as "advertising, interviewing, temporary replacement and terminal payouts" (Hogan & al, 2007). Furthermore, when nurses are already overwhelmed with responsibilities, it is especially difficult for them to take new recruits under their wing and properly train them. Already, highly educated and experienced RNs are being effectively "replaced" by LPNs and CNAs who are unable to provide the same level of care. Many people don't realize that the nursing school required to become an RN is in many ways as challenging as medical school, and on-the-job demands are arguably more strenuous than for doctors (Perkins, 2010).

In the recent past, many hospitals were able to offer pay raises to lure more nurses into the profession, but with the entire nation facing a harsh economic downturn and health care costs escalating rapidly, it is unlikely that pay raises are a practical long-term solution to the problem. This research will attempt to uncover the true root of the crisis and offer some potential practical, long-term solutions.

Causal Factors

While the obvious answer to the question of why is "an aging population" with too many nurses retiring and too many older people needing health care, current literature suggests the problem is deeper than that. And while the obvious answer to solving the problem is to increase pay, current research also shows little correlation among nurses between high pay and job satisfaction.

Pay

In one study published in 2002, Cowin found that pay was the "most commonly raised theme" brought up by nurses with respect to job satisfaction (Perkins, 2010). However, other studies do not show that raising pay levels lowers or prevents attrition rates (Hogan & al, 2007). This contradiction may be due to the fact that it was not feasible for nurses who desired higher pay to be reinterviewed after receiving a raise, in order for researchers to properly determine whether higher pay truly resulted in improved job satisfaction. In fact, a thorough review of the literature in 2007 left one researcher with the conclusion that "results showed the strongest association between job satisfaction and job related stress, indicating that nurses who perceive more stress experience less job satisfaction. A further result from the study showed that there is an insignificant relationship between current salary class and current job satisfaction" (Hogan & al, 2007).

Aging

With the "Baby Boomer" generation nearing retirement age and facing their own health concerns, the number of nurses retiring is increasing just as the numbers needed in hospitals are on the rise. One study in Australia, where they are facing a similar crisis, found that the "average age of a registered nurse working in Queensland Health in 2005 is 42 years of age, with 47% of the workforce over 46 years of age and around 20% of nurses over 56 years of age" (Hogan & al, 2007). While the current state of the economy in the United States...

The reasons for this lack of interest or perseverence in nurses' training are discussed in the following sections.
More Opportunities

Even with the difficulties in today's job market, nurses' roles are always changing and expanding. Especially for highly educated and experienced RNs (precisely the ones hospitals need to keep around) new opportunites are popping up to lure them away from routine work. These often more lucrative and less stressful subfields include "prevention, education, ambulatory care, industry, and law" (Lee, 2002). Furthermore, many "Baby Boomer" nurses entered the profession because it was one of the few fields widely open to women at that time. In the 1990s, ironically, "downsizing initiatives" actually deterred some students from entering the nursing profession out of fear of not finding a job upon graduation (Quinn, 2002). But even in today's economy, with so many options to choose from that offer higher pay, less stress, and "more desirable work schedules," women who used to choose nursing are now looking into business, medical, law, and technical schools, to name a few (Lee, 2002).

Satisfaction vs. Stress

The list of complaints from nurses about their work environment is long: "restrictive management practices, closed management styles," poorly trained managers, lack of support, lack of effective leadership, work overload, scheduling issues, low morale, "lack of recognition of professional status," and stresses and anxieties resulting from all of these and more (Hogan & al, 2007). The many complaints about management may be a revealing clue to possible solutions because in many cases "nurse employees leave managers and supervisors more than the actual organization or profession" (Hogan & al, 2007). A former nurse-turned-educator said in 2010, referring to her early disillusionment on the job: "My lack of experience and the responsibility for caring for this number of acutely ill patients left me emotionally and physically exhausted. In addition, the lack of support from the unit manager greatly contributed to my job dissatisfaction. The encouragement and support of my unit manager would have decreased the high levels of stress that I experienced. However, looking back, I can only imagine how the stress of her responsibilities may have influenced her behavior" (Perkins, 2010). Of course, nursing management is also in need of supportive measures to promote a less stressful work environment, allowing them to pass that support on to their staff.

In addition, high turnover rates exacerbate stress by forcing experienced nurses to add another responsibility to their already overburdened workload -- training novices. One study from 2009 focused entirely on this specific problem. Although the investigational study was only conducted with six nurses assigned to work with student nurses, the results revealed several problems and stress-inducing issues arising from the apprentice-type pairings, including: "poor understanding of legal liability issues for student nurses, role confusion, lack of communication regarding students' learning objectives, differences in beliefs about nursing education, and lack of monetary or workload compensation" (Hathorn & al, 2009). The nurses expected to perform "on the job training" with recruits also complained of a need for additional support in terms of "increased staffing, instructor availability, improved communication between academia and service, teaching staff nurses how to work with nursing students, adjusting nursing staff assignments when working with student nurses, assigning student nurses to spend prolonged times with nurses, and recognition or reward for nurses who take the time to properly train others" (Hathorn & al, 2009). To compound the problem, nurses who are unhappy or over-stressed as trainers admit to being short-tempered or unhelpful with students; this of course leads some students to turn away from the profession when they are needed most (Hathorn & al, 2009).

Other nurses complain of job stress related to the bureaucratic and hierarchical nature of hospitals (Hogan & al, 2007). Excessive emphasis on rules, regulations, and costs leads to resentment in many cases because nurses themselves are concerned with "growth, job satisfaction and contribution" (Hogan & al, 2007). Patients are referred to as "consumers" or "customers" by the bureaucrats, and nurses are downgraded from caretakers to "providers" or "workers" (Quinn, 2002).

A lack of respect for their profession is in itself listed as a reason for higher stress and lower…