Nurses make up the largest segment of the health care workforce in the United States. There are more than 3.1 million registered nurses nationwide and about 85% of these RNs are employed in nursing. Yet, some states are predicted to experience a nursing shortage during the next decade as the result of changes in health care policy, an aging population, and nursing schools struggling to make space for more students.
A report from the Georgetown University Center on Education and the Workforce titled, “Nursing: Supply and Demand Through 2020,” predicts a shortage of approximately 193,000 professional nurses by 2020 based on the age of the current nursing workforce, the size of graduating nursing classes, and nurses’ career decisions. A 2012 report titled, “United States Registered Nurse Workforce Report Card and Shortage Forecast,” concurs. It predicts a nursing shortage by 2030 throughout the country, especially in the West and South, because of projected changes in population.
Nursing@Georgetown’s online FNP program created the graphic below based on data from a 2014 HRSA report, “The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025,” to show which states will have a shortage of nurses and which will have a surplus.
To learn more about the nursing landscape, visit Nursing@Georgetown’s website to read the original blog post.
There’s no denying the correlation between nurse staffing levels and patient outcomes. As the Baby Boomer generation continues to retire, the need for additional medical attention increases (hospitals, aging facilities, etc). But because the nurse population mirrors the overall population, this means we also face a bubble of nurses entering retirement, reducing the number of experienced health care staff available to serve patients and creating new stresses on health care teams and health care facilities. A recent article in the Wall Street Journal stated that the United States is in the midst of a nurse retirement epidemic. These and other trends are creating exposures nurses are facing today and into the foreseeable future.
Risk experts at Nurses Service Organization (NSO) identified key risks for nurses as a result of staffing shortages:
1. Higher patient loads.
The Affordable Care Act has impacted the volume of individuals with health insurance, including individuals with complicated issues who once used to only seek treatment when necessary through the ER. This larger and more complex patient load places additional pressures on nurses. When care suffers, positive outcomes are negatively impacted, which only strikes down hospital reimbursement rates, making it all the more difficult for hospitals to be able to afford additional highly qualified nurses. It’s a vicious cycle.
2. Extended hours.
As shifts stretch (often last minute), fatigue becomes more of a factor, mental acuity may suffer, and the opportunity for an incident increases. When combined with increased patient ratios, nurses have more opportunities to, inadvertently, make mistakes and injure those they serve or themselves. These added hours also can create job dissatisfaction, which stresses health care teams and staffs.
3. Increased responsibilities.
Nurses are at the center of patient care, acting as an advocate between patients and physicians, and patients and family and friends. More and more, nurses are becoming accountable for the coordination of care and providing informed discharge notes for patients, which extend the potential to impact outcomes and the nurse’s exposure beyond the facility walls.
4. Greater likelihood of “floating.”
The nursing shortage creates gaps in coverage and the need for additional nurses to ‘float.’ Unfortunately, when nurses are assigned to an area they are unfamiliar with, or when a team of nurses has a professional from another department entering their zone, it can create confusion and issues. In fact, the most recent NSO claims report shows agency nurses (who often are sent to help facilities fill gaps in coverage) were involved in nearly 25% of the closed claims in the study. We can expect these workplace dynamics will continue to evolve as facilities move nurses as needed to address shortages on the fly.
5. New nurses entering the workforce.
The next eight years will see a steady stream of new nurses entering the workforce to replace those retiring. Much like nurses who float, these new nurses will need experience, on-the-floor training, and mentoring to acquire the skills needed to master their environment.
As the country continues to see an increase in the number of people ages 65 and up as well as more patients entering the health care marketplace, the nursing shortage will continue to be a concern. This rising concern has the potential to place all nurses into higher risk working conditions they need to protect themselves, and their careers, against.
In an effort funded by the US Department of Health and Human Services, St. Louis University (SLU) received over $2 million in federal funds to provide nursing scholarships to disadvantaged students over the next three and a half years. Similar scholarship programs at schools around the country are being put into effect to address issues facing the nursing profession as a whole (i.e. lack of diversity, nursing shortages).
The first year of the grant will provide 20 scholarships to SLU students – 10 to freshmen and 10 to sophomores. Mentoring is part of the award package, a huge benefit to students who are participating in a high pressure program and career. In the future, high school students will be recruited specifically from disadvantaged campuses.
A 2010 Institute of Medicine report titled Future of Nursing specifically addressed diversity as an issue. Compared to the general US population, nursing students show both gender and racial disparities. In 2015 men made up just 12% of the students in pre-licensure programs, and white students were 10% more prevalent in nursing programs compared to the general population, with fewer African American and Latino students being represented in nursing programs.
The current population of registered nurses has even higher racial disparities. Nursing populations now are overwhelmingly white at nearly 75%, but the rising generation has a more representative ratio at just 61% white students. Diversity in the nursing workforce has become such an important issue because of the diversity of those being cared for. Future of Nursing’s Campaign for Action explains, “A nursing workforce that reflects the diversity of the country’s communities and populations will lead to better understanding of the many elements that affect a person’s health and emotional well-being and, ultimately, to improved interactions and treatment.”
“A nursing workforce that reflects the diversity of the country’s communities and populations will lead to better understanding of the many elements that affect a person’s health and emotional well-being and, ultimately, to improved interactions and treatment.”
Scholarships also offer another important aspect in that they form a path that leads to jobs. Many popular degrees in college today do not match up with high demand jobs so incentives to get students into fields that offer high post-graduation success is beneficial to everyone involved. There are 3.6 million registered nurses in the US, but with an aging population, the demand for nurses continues to grow.
Nursing isn’t an easy profession, but for those talented in providing care for others, especially those who thought they wouldn’t be able to afford nursing school, scholarships like the ones being offered at St. Louis University could make a difference. The fact that these scholarships contribute to creating a more diverse nursing workforce in the US is an added bonus.
As more foreign educated nurses are working in US hospitals, health care organizations and settings are going to need to address some of the barriers that are preventing these highly skilled nurses from making a smooth transition to their workplace.
Penny Pattalitan, EdD, MSN, ARNP, FNP,BC, RN, found the discrepancies to be so prevalent, she studied what might help foreign educated nurses (her study focused on Filipino nurses) become assimilated faster when they start working in the United States and how hospitals can support the transition. The need is as great in number as it is pressing in time. With an aging and increasingly diverse US population, internationally educated nurses will fill a projected staffing gap and will more closely reflect portions of the population, which can lead to better patient outcomes, especially among ethnically diverse populations.
Pattalitan, an associate professor at the Chamberlain College of Nursing in the Miramar, Fla., campus, came to the US after graduating with a nursing degree in the Philippines. “It was a challenge,” she recalls, as she was treated as a new nurse, not one with the experience she actually had. “There were lots of challenges with how they perceived graduates from international schools,” she says.
So when Pattalitan set out to study the root of the issue, she first compared the educational systems in the Philippines and the US. “There is not much difference,” she says, noting that in the Philippines some of the work, especially related to community health, was even more intense than in the US. But US nurses had more autonomy and were used to making more patient care decisions.
But the cultural differences that make practicing as a nurse in the US challenging can be rectified.
Pattalitan found five major factors that impact the acculturation of foreign educated nurses. By doing so, she identified ways that hospitals can begin to recognize how those factors influence the ways nurses assimilate to a new working environment.
Staff support ranks high for a successful acculturation to the working environment. Placing even above things like language, how nurses were accepted into a unit and how they were treated was a big influence on their successful acculturation.
In addition, language, including both the language difference and accents, can present barriers to clear communication.
There is also a difference in clinical settings and clinical orientation that make a big impact, specifically the prevalent use of computers in the US and the paper-based system in some areas of the Philippines. In addition, the US has protocols for different units where in the Philippines, it is often one unit. “It takes a while for nurses to adjust to that,” says Pattalitan.
Nurses also found operating machinery or technology they had not used before took some getting used to and some practice.
But Pattalitan also identified certain areas where medical settings can help ease the transition. Training in machinery and technology is vital, as is a cultural orientation. Nurses also wanted to have more training on physical assessments, management of diseases, especially the acute cases that are more common in the US, and a review of medication administration and technology. Nurses in the US have much more autonomy than do nurses in the Philippines, who often wait for a doctor to give the final word on treatment.
For now, Pattalitan says this is an important step. “It will benefit the Filipino nursing graduates who will work in the settings and it will benefit the hospitals that are employing the nurses,” says Pattalitan. “[Awareness] will facilitate the process.”
Pattalitan is excited to see her research produce identifiable barriers and potential solutions. Further studies will explore the acculturation of other international nursing populations as well.
Everywhere you look there’s talk about a nursing shortage. Those already in the field complain about short staffing on the units they work, while new graduate nurses aren’t being hired for their first job as quickly as they thought. What’s the discrepancy here and why is there a so-called nursing shortage?
I’m going to let you in on a little secret….there isn’t a nursing shortage! Many factors come into play for the reason new nurses are having trouble finding a job and units are chronically short-staffed.
The first factor that comes into mind is oversaturation of nursing graduates. On average, there are 12 applicants for every one position available. I believe this statistic because in my area alone there are 4 nursing schools all within the same zip code. If the average class graduates 50 students each year, then that equates 200 students looking for employment all at the same time. Apply this formula to every nursing school in the country and the number of yearly graduates is exponential.
The next factor to consider is that many hospitals are looking to Magnet certification to measure the strength and quality of their nursing staff. Magnet status means that hospitals are hiring BSN graduates only- this leaves associate degree, LPNs (or LVNs), and diploma nurses out in the cold regardless of years of experience.
Although some hospitals only want to hire BSN or higher prepared nurses because of Magnet status, all nursing schools don’t have BSN programs. There are still a number of schools that offer LPN/LVN and associate degree programs, in which those graduates will have an even harder time finding a job after graduation.
I’ve heard rumors that hospitals in my area have been in a hiring freeze. Some may not agree, but why else would the hospital run units so short-staffed? Either they’re on a hiring freeze or they don’t care that units are short-staffed. Maybe it’s a bit of both.
We also have to remember that hospitals are businesses. Businesses want to cut costs in order to increase profit. What better way to do this then by limiting the amount of nurses hired on? Nurses do make up a majority of a hospital’s overall expenditure.
The last factor to consider is older nurses who have not yet retired from the profession. This leaves fewer jobs available for the new graduates who apply after graduation. I know many nurses who have been working 20+ years and have no plans on retiring anytime soon since the economy took a downturn a few years ago.
Do you agree or disagree that there’s a nursing shortage? Feel free to share your experiences!
In addition to working as a RN, Nachole Johnson is a freelance copywriter and an author with her first book, You’re a Nurse and Want to Start Your Own Business? The Complete Guide, to be released later this year. Visit her ReNursing blog at http://renursing.wordpress.com.
