The Nursing Shortage Crisis in the United States
Term Paper Class
14 June 2007
Think of the word “dominos”. The word conjures up either thoughts of ready-made pizza or images of those black tiles that little kids (and, perhaps more often, adults) stand on end in fascinating designs and then push over. Let’s examine for just a minute what happens in the activity with the small black tiles. First, the dominos are set up in the design that is most desirable to the builder and then pushed over, causing one of the dominos to crash into the next, causing all the tiles in the design to collapse.
Now, I’m not going to explain to you why ready-made pizza is so convenient or how dominos are created, but let’s draw some parallels here: Imagine that the healthcare system in the United States is like a design of dominos. Now, it’s true that the system was not set up to collapse, but when it does, the effect is the same. The number of qualified nurses has been pushed over by the concern for reducing costs in the healthcare system, leading to the over-working of remaining nurses, and forcing them to provide a lower quality of care to a higher number of people.
Before we get into the statistics and issues surrounding the nursing shortage in the United States, let’s first take a brief look at the history of nursing. Nursing has not always had a good reputation. Although Florence Nightingale was a pioneer in the nursing field and did excellent work for the British during the Crimean War in 1855, the profession was looked upon with suspicion and thought unsuitable for young ladies before and during the 1930s for four reasons. It was considered “demeaning physical labor for a young woman”, it required “‘unwholesome’ mingling of the sexes”, it meant treating people with diseases one would rather not talk about (such as STDs), and it meant a lot of exhausting training (Monahan & Niedel-Greenlee, 2003). Despite the difficult work involved in nursing, as well as the negative attitudes toward it by the majority of Americans, by the end of World War II, 59,000 nurses had volunteered to join and serve in the military (Monahan & Niedel-Greenlee, 2003). This resulted in the expansion and improved reputation of the nursing profession. Because nursing became a more honorable profession, it was added to the list of career choices for girls. Young ladies born before 1950, mainly during the Baby Boom, were given three career choices after graduating from high school: teaching, secretarial work (or, in the case of African-Americans even in 1975, social work), or nursing (Monahan & Niedel-Greenlee, 2003; Balfour, 2005). After nursing made it on the list of acceptable jobs for girls, many took up the profession.
Nursing became a popular profession during and after World War II, but its popularity began to decline. In 1992, the number of hospitals was reduced; the remaining hospitals hired fewer and fewer newly graduated nurses, preferring nurses with more experience. Today there are 126,000 vacancies for nurses in hospitals and long-term-care facilities around the United States. To put that into perspective, that’s the size of a small city (Satterly, 2004)!
Not only are there so many vacancies right now, but by the year 2020, it is projected that 400,000 more nurses will be needed than are available (Satterly, 2004). That is the amount of about four small cities.
Many nurses are missing, and that problem will only grow in the future, so we need to see WHY this is happening in the United States. The first reason for the nursing shortage today is not self-solving, as we might want it to be. It is the result of social changes in the latter part of the 20th century, which allowed girls to have more career choices, most of which were previously only available to men. This is both fortunate and unfortunate.
The fact that girls have more career choices today is fortunate because it means that they have an opportunity to do many things. They can become specialists in whatever fields interest them. This is nice because it means they can use their God-given skills in ways that their mothers, grandmothers and great-grandmothers never even thought of. The opening of the career world to girls is also unfortunate because 95% of nurses are women, and the nursing profession has lost many potential workers to other jobs (Satterly, 2004). No longer are girls, fresh out of high school, left with only the options of nursing or teaching. Now they have the opportunity to become CEOs of major corporations, join the military, or other "exciting" things that only men used to be able to do.
Because girls have more opportunities, there will not be enough experienced replacements for the nurses who will be retiring shortly (Satterly, 2004). The older generation is what is keeping the nursing shortage from skyrocketing. In fact, in 2000, only 9 percent of the registered nurses were younger than 30, which is a significant decrease from the 25 percent in 1980 (Satterly, 2004). This doesn’t seem that bad until you realize two things: as said before, a majority of current nurses will be retiring shortly, and secondly, hospitals lose valuable help in acute-care facilities because older nurses are less willing to work in those areas than younger ones (Satterly, 2004).
We see that the nursing shortage is caused by new career opportunities for women, but there’s also another cause of the shortage, which starts with the desire to reduce costs in the healthcare system. As discussed previously, the number of hospitals across the country is declining. The ones that still exist are encouraging the nursing shortage by getting rid of current qualified nurses and also by hiring less-expensive (and less-trained) technicians and aides to do the small jobs previously done by nurses.
Not only are current hospitals not hiring inexperienced nurses, they are getting rid of current working qualified nurses, both passively and actively. Passively, hospitals are reducing the number of nurses by not replacing nurses who leave the workforce or retire. This method has been found to be too slow for some hospitals, so they have initiated the second, more aggressive method, of cutting the number of nursing staff, causing many qualified nurses to lose their jobs (Catalano, 1996).
Although hospitals are getting rid of a lot of their qualified nurses, they still need employees who will tend to patients’ needs, such as bathing, dressing, feeding, and taking the patients to the bathroom. Qualified nurses have valuable knowledge and experience (Satterly, 2004), but are expensive to employ, so hospitals have the bare minimum of nurses and then fill in the rest of the staff with aides and technicians. While there is nothing inherently wrong with these aides and technicians, they have much less experience and cannot provide as high a quality of care to patients as qualified nurses can. When examining how much money is saved by enlisting technicians and aides to do nurse’s work, the question has to be asked if it’s worth losing the higher quality of care that qualified nurses provide (Catalano, 1996).
This issue of a quality of care leads us to the third and final point about the nursing shortage: the consequences of this shortage that hospitals and social changes have encouraged. What are these consequences to both nurses and their patients? Qualified nurses that have not retired yet or lost their jobs have greater workloads because they are fewer in number yet just as important. Patients see the consequences of the shortage when the quality of care they are getting decreases.
The few qualified nurses left in hospitals today feel the impact of the nursing shortage on a regular basis. There are fewer nurses to meet the needs of a demanding healthcare system, which means that the remaining nurses have to deal with the normal headache of working with medical technology, charts, etc. in addition to attempting to care for as many patients as possible in a very short period of time. As Faye Satterly, R.N. (2004) put it, “...with the shorter lengths of stay, nursing units had become like revolving doors. A nursing unit might start a shift with a census of twenty-three patients and end with the same number, but twelve of the names could be different.” It’s easy to understand how dealing with charts and technology could be a headache, but why is the fact that nursing units have become like revolving doors such a problem? When twelve names change in a nursing unit, it means that a nurse has to get to know twelve new people. It is crucial that the nurse get to “know” her patients so that she can know how to care for them. Otherwise, it’s like babysitting a child and not even knowing his or her name. Getting to “know” a patient is crucial to providing a high quality of care to him, but it also takes time. However, because of the shortage of nurses, they are in high demand and moved from unit to unit, despite their competence or education in a particular field (Weinberg, 2003). Moving from unit to unit, in addition to the problem of patients’ short stays, means that a nurse may spend all her time getting to “know” the patients without ever being able to do more. This seriously diminishes the quality of care that nurses can actually give to their patients.
Nurses realize that they are giving poorer care to their patients than they used to, but there’s not much they can do about it. The hospitals are concerned about saving money by cranking patients through, and the hospitals are the ones who tell the nurses what to do. Dana Weinberg (2003) quoted a nurse, who in June of 1999, stood up and said,
“I used to believe that this hospital took excellent care of every patient, and I don’t feel like that any more.... I think that it’s done with the primary focus on being expedient and cost-effective and [getting] patients in and out as quickly as you can because every minute they’re here it costs the hospital money to care for them, one way or another.”
Nurses want to provide a higher quality of care to their patients, but they have to prioritize by what issues are most important (Weinberg, 2003) because the patient might be discharged before the nurse is able to help the patient with the big issues.
Not only is moving from unit to unit difficult for the nurses because it means more work in trying to get to “know” their patients, but it can also be disconcerting when they work in a unit where they have no expertise. Despite their education, skills and experience, nurses will be moved to whatever unit needs more hands. This saves money for hospitals that have to pay the nurses, but it means less rest for the nurses, and more importantly, less skill in certain units they may be working (Weinberg, 2003).
The nursing shortage also has an impact on the patients, as briefly shown with the concern nurses have for not providing high enough care for their patients. We also touched on this side of things when talking about technicians and aides who do not have the training and/or experience that qualified nurses do. However, let us shift views and look more into exactly what impact the nursing shortage has on the quality of care given to patients.
First, nurses have a large part to play in assuring that patients come out of surgical procedures alive. This is evidenced by the fact that when there is a shortage of nurses and the remaining ones have to care for too many patients, the possibility of death following one of these procedures rises 7 percent for each patient (Satterly, 2004)! So the first impact of this shortage to us as patients is the fact that our risk of living after a surgical procedure decreases by 7 percent. That’s a rather grim statistic, but it shows just how important nurses are. Second, fewer nurses increase the risk of mistakes made by the remaining ones and the technicians and/or aides. When nurses get to “know” you as a patient, it is because they need to know how to treat you, what you want done, how you act, etc. You are under their wings, so to speak, and they want to give you the best care that they can Unfortunately, when there are fewer nurses in a hospital, the remaining ones do not have much time to devote to getting to know you, which can result in making mistakes such as not knowing what medicines you are supposed to be taking, how to read your charts, etc. This problem can also happen when technicians and aides take care of you—there’s just a higher risk for mistakes due to all the busyness of nurses and the inexperience of technicians and aides.
The third problem with the nursing shortage is that nurses just don’t have the time to devote much personal attention to you. They try to find out if you’re allergic to certain medications, how you react to other medications, how to chart your statistics, find out what statistics are “normal” for you, etc., but they have many other patients to care for as well. The result is that you feel like you’re in a factory where healthy (or dead!) people are supposed to be produced. This is a feeling that is not exactly conducive to quick healing.
A final and less serious problem due to the nursing shortage is the rotating of the remaining nurses. When nurses are being rotated from unit to unit, you as a patient may get a new nurse every day, maybe every hour or so! The result is not only that you feel like you’re in an unstable environment, but each time you have a new nurse, the potential for them to make mistakes because they are not familiar with what “normal” is for you continues to exist. When you are sick and hurting, what you really want is to see the same face every time, a reminder that some parts of life are stable. A new nurse every few hours does not help your peace of mind (even if some are nicer and friendlier than others).
In summary, nursing had a rough beginning but began to be popular during World War II. You’d think that because it was popular back then that it would be today; unfortunately, due to new jobs for girls and the desire to cut costs in hospitals, nursing has actually begun to see a shortage crisis. Ever seen four empty cities? This is what the shortage could look like by the year 2020.
This nursing shortage would not be so much of a problem if it wasn’t for the fact that the quality of the work the remaining nurses provides is lowered. People are more likely to die after surgery or have some mistake made in how they are treated because of fewer nurses. Less urgent but still important is the fact that they have less stability in their surroundings.
The nursing shortage crisis is not going away. In fact, it is getting bigger, and it is causing lots of problems to patients and nurses. There is a problem in this system, and it needs to be fixed. -- References Balfour, Sandy (2005). Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital. New York: Jeremy P. Tarcher/Penguin Catalano, Joseph T. (1996). Contemporary Professional Nursing. Philadelphia: F.A. Davis Company Damp, Dennis V. (2006). Health Care: Job Explosion! High Growth Health Care Careers and Job Locater. Moon Township, PA: Bookhaven Press LLC. Monahan, Evelyn M. and Niedel-Greenlee, Rosemary (2003). And if I Perish: Frontline U.S. Army Nurses in World War II. New York: Alfred A. Knopf , Publisher Satterly, Faye, R.N. (2004). Where Have All The Nurses Gone? The Impact of the Nursing Shortage on American Healthcare. New York: Prometheus Books Weinberg, Dana Beth; forward by Gordon, Suzanne (2003). Code Green: Money-Driven Hospitals and the Dismantling of Nursing. New York: Cornell University Press