Essay on "Nursing Shortage in the US"

Essay 6 pages (1776 words) Sources: 5 Style: APA

[EXCERPT] . . . .

U.S. NURSING SHORTAGE

Background, History, and Significance of the Problem

nursing profession has been experiencing a staffing shortage for approximately a decade, with certain medical areas and specialties being more affected than others. Demographic changes and trends in the U.S. will only exacerbate the problem unless the profession experiences a dramatic resurgence of interest, mainly because the median age is rising as a function of the numbers of post-World War II "Baby Boomers" the first wave of whom are already beginning to reach retirement age (Kennedy, 2006).

There are varied reasons for the reduction in nursing employment including significant operational trends in professional practice and the resulting low retention rates, increasing reliance on foreign educated nurses (FENs) and the difficulties many of them experience once in practice in the U.S. (Albaugh, 2004). Economic considerations and the need for hospitals and other medical facilities to cutback on expenses have substantially increased the problem as direct result, primarily because staffing cutbacks almost always necessarily increase the work load of remaining nurses (Reid, 2009). In addition to further decreasing the vocational satisfaction among those remaining in the profession, it also increases the risk to patients to nursing medical errors and reduces the overall quality of service in general (Gordon, Buchanan, & Bretherton, 2008; Ulrich, 2003).

Resolution of the problem will require a comprehensive approach of legislative controls over maximum patient loads and working hours, increased educational funding, and an effort to provide post-graduate training for FENs who work in the U.S. medical field. Meanwhile, failure to take concrete steps in that direction could eventually cripple the U.S. medical community because of the imminent increase in demands by virtue of the increasing age of the American population (Kennedy, 2006; Moon, 2004).

Analysis of the Issues

In the U.S., the vast majority of medical care is actually delivered by nurses; the demands on physicians' time in the age of managed care already severely limit the amount of time that physicians can spend with their patients, routinely completing patient examinations and consultations in less than half an hour (and often barely more than half that time) just to manage their patient loads (Kennedy, 2006; Reid, 2009). Without nurses to schedule patients, conduct their initial intake, administer routine medical procedures such as tests and vaccinations, administrate medical offices, educate patients, and conduct follow-up care inquiries, the modern practice of medicine would be practically impossible (Gordon, Buchanan, & Bretherton, 2008).

While physicians conduct examinations, develop diagnoses, prescribe medications, and perform surgery, most direct contact that patients have with their medical providers is through registered nurses rather than physicians (Reid, 2009). In that regard, the implications of the current nursing shortage are ominous for the state of national healthcare because the trend (resulting from economic conditions and the necessity to provide care in the most time-efficient manner possible) is to further increase the practical responsibilities of registered nurses.

The fact that the need for medical services are expected to increase steadily for at least the next several decades means that the nursing shortage could hardly have begun at any worse time (Reid, 2009; Ulrich, 2003). The increasing median age of the U.S. population also means that the numbers of patients suffering from long-term debilitation from Alzheimer's disease and other similar causes of cognitive decline among elderly patients will require more assisted care facilities and nurses to staff them (Kennedy, 2006; Reid, 2009). This actually represents two separate problems in relation to the nursing shortage because it increases the need for nurses generally while likely also further reducing those who choose to work in hospitals, largely because of the ways that economic concerns of their employers have already begun to make the practice of hospital nursing more demanding and less desirable than working as a nurse in other settings such as nursing homes (Reid, 2009).

The current trend of cutting back on nurse staffing is one of the most consistent complaints of nurses and substantial empirical evidence suggests that it has also been a contributing factor in increasing the risk of medical errors (Albaugh, 2004; Gordon, Buchanan, & Bretherton, 2008). At many hospitals, nurses experience considerable pressure to work overtime whether or not they want it and the constant pressure resulting from increased patient loads and compressed time to accomplish large volumes of work have resulted in lower job satisfaction rates among nurses, particularly among recent nursing school graduates. They tend to experience more pressure than experienced practitioners in general; the additional pressure attributable to the new demands of caring for more patients with fewer nurses is believed to play a large role in the fact that higher levels of new nurses than ever before are leaving the profession within five years of their graduation from nursing school.

Making matters even worse, large numbers of nurses (many of them Baby Boomers as well) are also approaching retirement age, with the median age in the profession being over 50 (Albaugh, 2004; Reid, 2009). In addition to the fact that the profession will be losing more and more of its most experienced senior practitioners in the next decade, the current hiring and recruitment trends in the industry that are already resulting in an influx of inexperienced nurses, many of whom speak English only as a second language and will not likely be able to advanced levels of practice as quickly as many of their U.S.-trained predecessors. Considered in that light, the increasing retirement of the most experienced supervisors coincides with what many observers believe is a relative decrease in the relative quality of many new nurses who will be replacing them eventually (Gordon, Buchanan, & Bretherton, 2008).

Foreign educated nurses may be even more adversely affected by these trends than their native U.S. counterparts (Ulrich, 2003). Many FENs are comparatively unprepared for life and work in the U.S. when they graduate from nursing school because their educational programs stress academics, often to the nearly complete exclusion of practical training to prepare them for life and work in a completely foreign environment and social culture in the U.S. In many cases, their English language skills lag considerably behind their medical training as well.

As a result, many FENs experience considerable difficulty acclimating to their new lives in the U.S. And that issue is only worsened by the volume of the responsibilities they face by virtue of ever-increasing patient-nurse ratios. The high-pressure climate in nursing units that is often one of the consequences of staffing reductions also tends to reduce the patience of coworkers and supervisors and manifests itself in social rejection, ostracism, and even outright abuse in the workplace directed against FENs (Albaugh, 2004).

According to industry analysts, the current rate of loss in the nursing profession projects to amount to a net loss of as many as one million nurses within the next decade, representing a likely employment shortage of one-third throughout the U.S. healthcare system (Reid, 2009). In 2004, Congress enacted the Quality Nursing Care Act (QNCA) and many state legislatures have begun considering formal requirements that prohibit inadvisable increases in the patient-nurse ratio in hospitals (Taylor, Lillis, & LeMone, 2005; Reid, 2009).

As if the nursing profession were not already facing enough problems, the increasing loss rate due specifically to attrition (i.e. not including retirements) has triggered a disturbing cycle that could further exacerbate the problem. There have been insufficient numbers of nursing science educators replacing those that are retiring for approximately as long as the profession has been experiencing shortages (Moon, 2004). Consequently, nearly 10,000 qualified nursing school applicants are rejected every year in the U.S. strictly because there are no longer enough nursing professors and instructors to accommodate all of those who wish to enter the profession. That fact tremendously complicates the prospect for resolving the nursing shortage (Moon, 2004), especially to the extent it is beneficial not to decrease the ratio of American-trained to foreign-trained nurses.

Finally, even well qualified FENs have experienced increasing difficulty securing professional positions in the U.S. after completion of their studies. That is because the post-9/11 national security environment has complicated the process of satisfying immigration and professional certification requirements that are obvious prerequisites to nursing employment in the U.S. (Ulrich, 2003).

Resolution

There is little doubt that the current professional nursing shortage in the U.S. is already a significant problem in American healthcare. At the current rate of attrition, the profession will be tremendously understaffed, reaching as high as a one-third job vacancy rate within the decade. Reversing that trend will require a comprehensive effort on several fronts.

Legislative attention must limit the maximum numbers of patients for which nurses are responsible and must impose other restrictions that are appropriate to the evidence connecting staff reductions to medical errors and other risks to the quality of patient care. In that regard, guidelines are needed for the same reason that aircraft flight crews may not work more than federally mandated limits: overworked nurses endanger the health, safety, welfare, and the lives of patients.

Additional funding must be made available to… READ MORE

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