The Nursing Shortage Karin Mogren-Kuzma

The Nursing Shortage Karin Mogren-Kuzma

Learning Objectives The student will be able to describe the current and projected nursing shortage. The student will understand contributing factors impacting the nursing shortage. The student will be able to acknowledge the impact of nursing shortage on patient care. The student will recognize strategies to address the nursing shortage.

Introduction The nursing shortage affects every aspect of health care delivery in the United States. The problem of the global nursing shortage is cyclic in nature. Thus, it seems certain that shortages of nurses will continue to reoccur with a certain degree of regularity. The National Center for Health Workforce Analysis suggested that by 2020, approximately 36% of nursing positions would not be filled.

Shortage History The nursing shortage has commonly been referred to in terms of supply and demand. Since the World War II, the United States has gone through cyclic shortages of nurses. In the 1990’s hospitals reduced their numbers of employed RNs to contain costs. A few years later, a nursing shortage was emphasized when the hospitals experienced an increased demand for nurses.

Shortage History In the presence of good economy, many nurses moved away from traditional positions to new emerging roles in healthcare, creating vacancies in hospitals. In the recent recession, many nurses were forced to reenter the workforce to supplement or support their families economically. As the economy recovers, many RNs are likely to retire.

Where are we today? Demand by 2020 will exceed supply by 29%36%. Increased demand due to aging Baby Boom population (people born between 1947 and 1962) and nursing workforce retiring.

Demand and Supply National supply and demand projections for RNs: 2000-2020

Shortages by state States with Shortages in 2000

Shortages by state States with projected shortages in 2020

Today’s Shortage The present shortage has been described as being different in many ways from prior shortages. Several factors have been identified as contributing to the shortage: – Aging workforce – Educational bottlenecking – Changing work climate

Aging Workforce Retiring Nurses - Average age of employed RNs is 45.5 years. - 45% of the nursing workforce is older than 50 years of age. - majority of nurses intend on retiring between 2011-2020. Aging of Baby Boomers - More health care services needed.

Aging Workforce Age Distribution of RNs: 1980, 2000 and 2020 Projected

Educational Bottlenecking Nursing school enrollment is not growing fast enough to meet the projected demand of nurses. Faculty shortage - Low compensation - Insufficient number of clinical sites - Budget constraints

Changing Work Climate Stressful working conditions leads to dissatisfaction, high turnover, and low retention. - Short staffing High nurse-patient-ratio Mandatory overtime Low compensation Abusive environment

Root Cause Analysis The Nursing Shortage Aging workforce Declining enrollment to nursing schools Changing work environment causing low retention, high turnover, burnout, and change of profession

Inferences and Implications The nursing shortage adversely affects patient outcomes and satisfaction. Shortage of registered nurses, in combination with an increased workload, poses a potential threat to the quality of care. - High nurse- patient ratio is associated with increased patient mortality. RN shortage negatively impacts patient care and undermining the quality of care goals set by the Institute of Medicine and the National Quality Forum.

Inferences and Implications The nursing shortage causing insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession. The change in work environment is also causing a high turnover rate of RNs.

Inferences and Implications Licensed Registered Nurses not employed in nursing

Nursing Theory Benner’s Stages of Nursing Proficiency Process of five stages of nursing practice - Novice Advanced Beginner Competent Practitioner Proficient Practitioner Expert Practitioner

Nursing Theory Benner’s Stages of Nursing Proficiency Novice No expertise Limited practical skills Relies on rules and expectations of others for direction Advanced Beginner Marginally competent skills Difficulty establishing priorities Competent Practitioner Feels competent and organized Plans and sets goals Proficient Practitioner Views patients holistically focuses on long term goals Expert Practitioner Performs fluidly Expertise comes naturally

Social Theory Theory of Reasoned Action (TRA) developed by Fishbein in 1967. An approach to understanding individuals’ complex decision-making processes. TRA specifically focuses on the role of personal intention in determining whether a behavior will occur.

Social Theory A person’s intention is a function of three basic determinants: - Attitude - Subjective norms - Perceived behavioral control

Social Theory How it Relates to RN Turnover Intention: Leaving current position or the nursing profession Attitude: Poor job satisfaction Subjective Norms: Cultural variations, social pressure, career advancement Perceived Behavioral Control: Social support, financial ability to make a change

Social Theory

ANA Standards Quality of Practice Collaboration Professional Practice Evaluation

QSEN Competencies Patient safety Quality Improvement Teamwork and Collaboration

Quality and Safety Improvements Solutions to the nursing shortage must be addressed in ways other than short term solutions. Efforts must be aimed both at recruitment and retention. Increasing nursing school faculty. Improving work environments for nurses.

Quality and Safety Improvements Suggested Strategies Improving workplace conditions. Encourage nurses who left nursing to reenter the workforce. Enhancing education and professional development. Nurse residency programs for new graduates to help facilitate confidence, competence, and decreasing stress levels. .

Discussion Questions Discuss how the effects of the current nursing shortage impact your professional practice and your future as a nurse. Describe how quality and safety of patient care could be affected. Censullo (2008) describes several factors contributing to the nursing shortage. Pick one and explain what you think could be a potential solution to that particular issue. The work environment for nurses is often described as stressful and abusive. Name things that you can do to improve the environment for yourself and your coworkers.

References American Association of Colleges of Nursing. (2012, August). Nursing shortage fact sheet (Fact Sheet). Retrieved from American Association of Colleges of Nursing: http://www.aacn.nche.edu/media-relations/fact- sheets/nursing shortage American Nurses Association (2010). Nursing: Scope and Standards of Practice (2nd Ed.). Silver Spring, Maryland: Author Censullo, J. L. (2008). The nursing shortage: Breach of ideology as an unexplored cause. Advances in Nursing Science, 31(4), E11E18. doi: 10.1097/01.ANS.0000341417.88715.2d Dotson, M. J., Dave, D. S., & Cazier, J. A. (2012). Addressing the nursing shortage: A critical health care issue. Health Marketing Quarterly, 29(4), 311-328. doi: 10.1080/07359683.2012.732861

References Egenes, K. J. (2012). The nursing shortage in the U.S.: A historical perspective. Journal of Illinios Nursing, 10(4), 18-22. Retrieved from http://0web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S., Hongsoo, K., & Djukic, M. (2007). Newly licensed RNs’ characteristics, work attitudes, and intentions to work. American Journal of Nursing, 107(9), 58-70. doi: 10.1097/01.NAJ.0000287512.31006.66 Liou, S. (2008). Nurses’ intention to leave: Critically analyze the theory of reasoned action and organizational commitment model. Journal of Nursing Management, 17(1), 92-99. doi: 1 0.1111/j.13652834.2008.00873.x

References MacKusick, C. I., & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. Medsurge Nursing, 19(6), 335. Retrieved from http://0-g o.galegroup.com.libcat.ferris.edu/ Wyte-Lake, T., Tran, K., Bowman, C. C., Needleman, J., & Dobalian, A. (2013). A systematic review of strategies to address the clinical nursing faculty shortage. Journal of Nursing Education, 52(5), 245-252. doi: 10.3928/01484834-20130213-02 Zinn, J. L., Guglielmi, C. L., Davis, P. P., & Moses, C. (2012). Addressing the nursing shortage: The need for nurse residency programs. AORN, 93(6), 652–657. Retrieved from http://0www.sciencedirect.com.libcat.ferris.edu/science/article/pii/S000 1209212009581