The Long & Short Term Crisis
of the Nursing Shortage
The health care crisis is as bad as predicted and it's going to get worse. All over the world, hospitals are competing for nurses at a time when fewer nurses are entering the work force and higher numbers are leaving due to age, alternative job offers, burn out and frustration.
The national Bureau of Health Professions projects that the number of health care jobs must grow from 10.9 million in 2000 to over 14 million in 2010 to meet demand. The rate of growth of new jobs in health care occupations is projected to 28.8 percent, more than twice the rate of employment growth for non-health occupations. Health occupations are forecast to be 15 of the 30 fastest growing occupations in America.
We will need 5.3 million health profession workers to fill the job openings created by departures and new positions, states the report of the American Hospital Association Commission on Workforce for Hospitals and Health System. How desperate is the need for registered nurses can be seen in advertisements in the media and on television which offer $1 or $2 thousand sign-up bonuses, choice of locations, shorter work hours, disability and dental insurance, free parking, weekend options, on site child care--you name it. Everything is on the table.
One of the members of that 2002 AHA Commission was Karen L. Miller, RN, PhD, Dean and Professor of the University of Kansas School of Nursing and the KU School of Allied Health. Interviewed recently she said, "There are really two shortage problems, the current short term shortage and the long term crisis. Our current problems are worsening because the majority of people now in health professions are baby boomers and they're thinking of retiring or shortening their work hours. We can no longer solve a shortage by increasing salaries or enticing nurses to switch from short time to full time.
"That's not working today. Throwing money at salaries isn't the issue. Demographics is the issue." The average age of nurses has increased dramatically from their early thirties to 47 in 2000. Fewer women chose healthcare as a career in the 90's and when they did, it was with different goals. Dr. Miller noted that medical school classes are now 80 percent female. "There are nine different professions in the KUMC School of Allied Health and there are shortages in all of them," she said.
Recruitment of foreign born nurses is not the answer. It simply creates a vacancy in those countries which then recruit here. Nor are men entering the profession in large enough numbers to affect the shortage. They also tend to concentrate in emergency and surgical positions, says Sharon Graves MS, Chair of the Department of Nursing at Penn Valley Community College.
"We have one male in our 2003 graduating class and he's there for a career change," said Brenda Patzel, MS, PhD, RN, Assistant Professor of Nursing at Avila University. Their fall entering baccalaureate nursing class of 28-30 students is full.
Recruiting graduating nurses and health care workers never ends." We're innundated daily by phone or fax by recruiters asking to be allowed to give spiels about their facility or to set up information booths outside the classroom", Graves said. Patzel agreed, even though Avila degree graduates still have to take a year of on site acute care.
One place where graduates of 14 area nursing schools can get pediatric training is at Children's Mercy Hospital. Karen S. Cox, RN, PhD, CNAA is Senior Vice President for Patient Care Services at Children's Mercy Hospital and Clinics and Assistant Dean, School of Nursing for Clinical Partnerships at the University of Missouri, Kansas City. In addition to membership in a formidable number of metropolitan and national commissions and task forces, she is a member of the Robert Wood Johnson National Advisory Committee and co-chair of a sub-commitee of the Kansas City Metropolitan Healthcare Council Workforce Collaborative charged with identifying opportunities to improve nursing work environment.
The nursing shortage is approaching a
critical level, and it's going to get worse
"The nursing shortage is approaching critical level," she said. "And, it's going to get worse." Everything is being looked at to attract nursing professionals: improving the work environment; redefining the doctor/nurse team; relieving nurses of non-nursing duties; utilizing more technology; redefining skill responsibilities.
Hospitals differ widely on how much technology they use. "Sometimes," Cox said, "there is simply no alternative for a caring nurse. You have to have a certain skill mix to make things work."
Sheri Hawkins, RN, MS, MBA, Vice President and Chief Nursing Officer of Shawnee Mission Medical Center agrees. "We don't look to replace nurse positions with unlicensed health care posisionts. Nurses need appropriate resources and supportive personnel."
Some health experts call for higher nurse/patient ratios. There are things we can do to make it easier for a nurse to care for a patient," Hawkins said.With Cerner of Kansas City, SMMC is automating clinical documentation and upgrading other record computerization, including Pyxis, a system which allows ready access to medication. SMMC nurses are looking forward to the delivery this month of motorized beds, relieving nurses of having to jockey patient beds out of rooms and down the halls. Now they'll drive the beds.
But new gadgets and signing bonuses, don't change the work environment." Hawkins thinks nurse support is the most important. SMMC is blessed, she added, with a 2% vacancy rate and a 7% turnover rate, "among the best in the country."
At Penn Valley, Graves is seeing different demographics at work. There, students entering for an Associate of Arts degree in nursing are younger than in the past three years. Credit has to go to increased public awareness, national advertising campaigns and programs in senior and junior high schools.
"Nursing was like other allied health careers," Graves said. An image of too long hours for too little pay and small respect decimated its ranks. With baby boomers entering years of medical care, nursing careers will increase in number and respect, she said.
Experts say the nurse's first duty is her ability to observe and assess the condition of the patient. The chance of not having that available is what makes the nursing shortage so dangerous.