The Critical Nursing Shortage

There is a perceived threat to the health of the older adult in the United States. It is not a new type of bacteria or caused by a virus. The threat to the health of the older adult is a result of the increasing shortage of nurses in the United States.

Over the last few years there have been numerous articles and news reports in the press about the magnitude and causes of this dilemma. So far there are few, if any, answers to this problem. The nursing shortage will impact the oldest of the citizens the most. Older adults use health care services at a higher rate than the younger population. Advances in medicine, improved nutrition and lifestyle changes have added years to the average life span. With longer life comes a greater need for medical services, especially the services of the skilled registered nurse.

Longevity may start to decline if the nursing shortage is not addressed quickly and competently. The nursing shortage of the present is quite different from that of the past, because the nurses of today are aging along with the rest of the population. As the baby boomers age and the need for the health care grows, the demand for qualified healthcare personnel will skyrocket. Compounding this is the declining enrollment in accredited nursing programs. This decline in enrollment will eventually translate into fewer nurses for the future. With fewer nurses entering the profession, the average age of the registered nurse is climbing. Nursing schools realize that they need to reassess the kinds of degrees and training that they offer to attract new students and faculty.

Nursing in hospitals, long-term care facilities and especially nursing homes is very physically demanding. Older nurses are getting tired of the demands of shift work and the long hours. Add this to the shortage already felt throughout the United States and it is no wonder that many nurses are feeling burned out and plan to leave their jobs. Job burnout and dissatisfaction are driving nurses to leave the profession at alarming rates. All of these compound the stress on the nurse, which then impacts healthcare and the consumers. Compounding the problem, nurses' job satisfaction is far lower than that of workers in other fields, prompting them to flock from hospitals to other industries such as drug companies.

Seniors may find that obtaining good healthcare will become more difficult as the nursing shortage increases. Short hospital stays may even become shorter. The burden of the seniors' care will be placed on the family and home healthcare.

We must make positive changes in the present to correct the nursing shortage of the future. As the nursing workforce -- the baby boomers -- is getting older; we must make changes in an attempt to prepare for the future. The average age of the practicing nurse is 44 years old. Employers have not valued the new nursing graduates of the past, which is a missed opportunity to rebuild a qualified nursing workforce.

It is not too late to make some positive changes. Retention and recruitment programs need to be put into high gear. We must design effective preceptor programs with experienced staff nurses; this will allow new graduates to enter into the nursing field with confidence, loyalty and a perceived value to their employer.

There is a direct relationship between the availability of nurses and the quality of hospital care. There is also a direct correlation between staffing more registered nurses and better patient outcomes. After accounting for factors that might increase the risk of complications, including the size of the hospital and its sophistication, nursing staff has a significant impact on the chances of deadly post-operative problems.

For every additional bed a nurse has to tend, a patient's risk of complications or even death rises. The only way to have the public listen and make changes in the healthcare system is to do more research and prove that there is sound evidence that links low staffing to poor patient outcomes. There is no magic ratio of nurses to patient. In some cases five patients to one nurse is adequate or even generous -- not enough work. In other cases, five might be too demanding and too much work for the nurse to handle. Thus, the patient suffers.

Thousands of patients are dying every year as hospitals look at their bottom line. Hospitals are sacrificing patient safety and losing hospital staff in order to improve the bottom line. If you have to devote all of your time to one sick patient, then all of your other patients' medications and treatments are late. You hope and pray that nothing else goes wrong with your other patients. You cannot be everywhere all the time. There are too many demands on your nursing time.

Would it be possible to delegate some of the nursing responsibilities -- those that are time-consuming duties -- from the nurses to untrained personnel, things like answering the phone and busing meal trays?

However, correcting the patient ratios is only one of several steps that must be taken to improve the world's nursing problems. Nurses also want a larger role in setting their schedules and in shaping their futures. They want to have a say in the making of hospital policies, and want more opportunity for professional advancement.

The workplace needs to be transformed to give nurses the independence and the desire to do their work well. This creates and encourages professionalism and retention.

Recommendations to reverse the trend now instead of in the future:

1. Encourage nurses of all educational levels to pursue higher education.

2. Develop and implement strategies to promote the retention of registered nurses and nurse educators in the current workforce.

3. Develop evaluation systems that can measure the relationship of timely nursing interventions to patient outcomes.

4. Develop career enhancement incentives for nurses to pursue professional practice.

5. Practice an interdisciplinary environment and build on the relationships between nurses, doctors, other health care professionals, patients and the community.

Should nurses begin to speak out and tell the public about the unsafe nursing practices in hospitals? If the public is made more aware of this, it might just influence more people to go into the nursing profession. We must all come together -- the nurses, doctors, hospital executives and legislators -- in order to define steps to improve the nursing environment and correct the nursing shortage. Nursing is one of the most honorable professions that I can think of, and we are the least supported and compensated for going into this wonderful field.

Sharon Lesser, RN, is a pulmonary clinical nurse in the Department of Pulmonary and Critical Care Medicine at the University of Maryland Hospital in Baltimore, Md. She is an SGNA member and the pulmonary special interest group chair.