The nursing profession is and has been experiencing what is often described as an unendurable shortage of clinical nurses. Organizations are having difficulty recruiting new nurses and retaining current staff.1 The U.S. Bureau of Labor Statistics predicts the demand for registered nurses to grow from two million to 3.2 million between 2008 and 2018, a 60% increase. Ideally, a sufficient number of new graduates will fill the demand; however, according to Benjamin Isgur, Assistant Director of Price Waterhouse Cooper’s Health and Research Institute, the projections aren’t great. Of the 320,000 who applied to nursing school in 2008, only 78,000 graduated and 23% are currently working as nurses.2 After graduation, about 30,000 nurses stay in the field, but 50% leave their first job after two years. Compounding this staffing problem is the increasing age of the nursing population and their anticipated retirement.

Problem identification

Without a sufficient number of nurses, patient care and safety may become compromised, while nurses themselves may be overwhelmed, distressed, and dissatisfied. High patient-to-nurse ratios have been shown to lead to frustration and job burnout, which is linked to higher turnover. 3 An inadequately staffed nursing force has been found to play a negative role in patient outcomes. In contrast, studies have demonstrated that hospitals with low nurse turnover “have the lowest rates of risk-adjusted mortality and severity-adjusted length of stay.”3 In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a met-analysis that found “the shortage of registered nurses, in combination with an increased workload, poses a potential threat to the quality of care…Increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stays.”4

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