The Good Nurse
Nursing in the News
The Nursing Shortage
A Gallup poll recently found that for the 16th year running, nurses were the most trusted profession in terms of honesty and ethical standards, with 82 percent of Americans describing nurses' ethic as high or very high.
Nurses are skilled health care professionals who look after us when we're most vulnerable, but there's long been a concern that there might simply not be enough of these providers to go around as demographics and care trends have changed.
In 2000, Peter I. Buerhaus, a professor in the College of Nursing and director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, and his team published a sobering report about the U.S. nursing workforce in the Journal of the American Medical Association.
They projected that by 2020, "if the policies don't change, we could be facing a huge shortage of nurses – more than four or five times larger than any prior shortage in the country, roughly 500,000," Buerhaus says. "And that was because, at the time, there was a noticeable downturn in people coming into nursing – five or six years of steady declines. We said, 'If that trend continues and we have the baby boom generation of nurses retiring, we're in big trouble."
Because nurses constitute the largest group of health care providers in the country, this forecasted shortage puts many hospitals, colleges and other organizations on high alert. They needed more nurses, and the sooner the better, as the declining number of young people choosing nursing as a profession would not be able to offset the anticipated wave of retirements from an aging workforce. The paper's predictions spurred a number of private and public sector entities to make policy changes that would encourage younger people to choose nursing as a career.
Fast forward to today and the picture has changed significantly. But it's not a simple case of having eliminated a shortage of nurses across the board. Rather, while there has been overall improvement in the size of the workforce, some areas are still facing a shortfall and addressing those needs is an ongoing battle. The workforce will grow unevenly across the country.
It's apparent that there are some places and kinds of facilities where it's really hard to get RNs such as in rural hospitals and rural primary care settings. This is not a new issue. A lot of new graduates are attracted to working in the hospital. But even in urban areas there are some facilities such as nursing homes and rehabilitation hospitals that have trouble finding enough nurses.
Pay is a large part of the problem as some long-term care facilities and rural locations can't match the pay expectations of many urban or larger hospital systems. That said, this hit-or-miss aspect to the nurse staffing numbers makes it harder to address the issue from a policy level. Instead, it often falls to states, communities or individual hospitals to recruit the nurses they need by perhaps offering incentives.
One of the reasons smaller and rural community hospitals find it more difficult to attract nurses is because there tends to be a lack of opportunities for specializing or advancing in their careers in those locations. There aren't opportunities to get into other kinds of care settings like you do in urban areas. Some of it is specialty related – if you're a nurse who wants to work in a surgical intensive care unit, you're probably not going to have that in a small, rural hospital.
That age piece is compounded by the fact that the nursing workforce itself is also aging. Although the Great Recession delayed the retirement of many nurses, now that the economy has improved, older nurses are leaving the workforce. This mass exodus of older nurses is putting pressure on many hospitals and health care facilities around the country, and finding a way to bridge the gap between baby boomer generation nurses who are leaving the workforce and millennial nurses who are entering has been both a challenge and an opportunity.
This group of younger nurses is pursuing a career in greater numbers than baby boomers and is opting for nursing for a number of reasons because it provides a steady employment outlook. This is the generation that lived through the economic downturn. They want a career where they're going to have a job, and nursing gets you that.
While there simply may not be enough bodies to fill jobs in certain parts of the country, Buerhaus says there's a qualitative concern as well that is less tied to geography. The baby boom generation of nurses has 20, 30 and sometimes 40 years of experience and knowledge. Not just clinical knowledge but organizational experience. They know the doctors and the administrators, and they know how to get things done for patients in hospitals.
Another reason for the nursing shortage is due to a faculty shortage at nursing schools around the country that has resulted in a lack of opportunity for would-be nurses. A recent report from the American Association of Colleges of Nursing found that "U.S. nursing schools turned away 64,067 qualified applicants from baccalaureate and graduate nursing programs in 2016 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints."
Newer nurses coming into an organization do not have that intuitional or professional experience yet, and so providing the same quality of care as a more experienced nurse isn't always possible, especially when you consider that most patients who need this kind of care are sicker than they were a decade or two ago.
The bar to be hospitalized has been raised as technology and care advances mean that more procedures can be performed on an outpatient basis, and patients who might have needed to spend a night or two in the hospital a decade ago no longer need to be hospitalized.
The people who end up in the hospital often have multiple chronic conditions and present a more complicated care picture. In those instances, a more experienced nurse may have the edge over a younger nurse who is still getting up to speed on how a particular organization operates.
The solution here is essentially the equivalent of succession planning in any other business setting. Older nurses, and especially nurse managers and administrators, should have the opportunity and the incentive to spend more time mentoring newer nurses to transfer the knowledge that they have before they retire. In addition, schools need to do a better job of preparing nurses for the real life environment. Many schools and hospitals are employing these practices already, but the increased interaction between experienced nurses and new recruits must increase to make sure the the transition will occur more seamlessly.
Lastly, one simple way to make nursing a more desirable career and to reduce nurse burnout and practitioner wear down is to address concerns that nurses sometimes raise. Treat the nurses well. It's not always about money. It's about making sure their voice is heard where they're employed. If they're talking about violence and feeling unsafe in their workplace, don't tell them to just get de-escalation training but actually address the safety issue. Keeping nurses injury-free, safe at work and practicing to the full extent of their licenses can go a long way toward making sure there will be enough of them available when and where they're needed.
