Nicole Fazio

Ryan McDaniel

Holly Metz

Professor Michael Parsons

College Writing II

December 9, 2010

Nursing Shortages

There is a national shortage of nurses which threatens to be one of our country’s largest problems in the next several years. The shortage stems from many reasons including people leaving the field because of unfair working conditions, students not being taken into schools because there is not enough room for them, and even current nurses retiring. There have been proposed solutions to all of these problems but they must be implemented before they may take effect. President Obama along with other politicians has been working on legislature to try and prevent any future problems from occurring because of the shortage. When there are not enough nurses to care for the nations sick and dying what will happen?

The nursing shortage in Ohio has skyrocketed tremendously over the past few years and is only going to get worse. Currently there is a concern that there is a deficient amount of nurses already practicing in all aspects of the nursing field, including hospitals and nursing homes. There is also a decreased amount of nursing professors at the colleges, leading to a decreased amount of nursing graduates and more rigorous programs. But the largest issue is the amount of baby boomers that are currently working in the field. Baby boomers took over the nursing field decades ago, they are going to eventually retire, and then the real shortages will begin. They may in fact be so bad that there is going to be a crisis. Accommodations should be made now in order to have the proper preparations for this projected issue, but that all depends on money and programs.

The nursing shortages will be affecting not only future nurses, but patients as well. There will be a considerate decrease in nurse to patient ratios, meaning that there are fewer nurses than the patients. This will become dangerous to the quality of patient care. The influx of patients is out of the control of a hospital. But regardless of nursing staff, people will always be sick and need care. In effect, there will always be a demand for nurses. It is clearly not safe or acceptable to have a deficient amount of nursing staff that does not meet the demands of the patient. This becomes dangerous to not only the patient, but to the nurses profession as well. Nurses are going to be working a lot harder to try and take care of their patients. They will become stressed out, when being a nurse is already a high stress job. There is already a high demand for more nurses, “Currently, there are approximately 126,000 nursing positions unfilled in hospitals across the

Country” (Ohio Nurses Association). The shortage occurs across the country but when you compare these numbers to the United States as a whole it is definitely a lot. “January - March, 2007 -- This report encourages the health care system to improve nurses' poor working environment. It cites current studies linking fewer registered nurses to poor patient outcomes and danger to patient safety. It encourages improvements to move beyond superficial solutions to increasing the status of nurses, and "clearer roles and educational reform defining specifically who is a nurse, and what a nurse can and should be able to do, can assist in making nursing a more desirable profession." (Lin, Laura) It seems as though there are a lot of people that want to become nurses but they cannot due to the lack of funds. Plus the lack nurses that have current positions are less likely to give up their job and retire until they are ready, which will cause an even greater shortage of nurses. And if the old nurses are unwilling to educate the new nurses, the new nurses will never know what their doing. The new nurses will not be able to perform their job effectively without the guidance of an older nurse. This makes it dangerous for the patient’s safety. For example, a certain patient may need help but their nurses may be busy taking care of five other patients at the same time. Deaths of patients could have been prevented if there were a proper nursing staff.

Until the field needs more nurses to be hired they somehow need to make sure that people do not get discouraged from wanting to become a nurse. They need to make sure that there are enough people that still enroll in the nursing programs. But this is doubtful considering colleges are not accepting an adequate amount of students that fit the demand currently. Based off of (figure 1) there is going to be predicted demand for almost three million nurses by the year 2020 and the predicted amount to actual nurses is only going to be around two million. This is quite disturbing and is going to be a major problem in the near future.

People go to hospitals for a reason. Emergency rooms are where people usually need immediate attention. People go into the hospital so that they can be cared for 24/7 and get the attention they need, when they need it. If there aren’t enough nurses this reflects badly on the hospital. Critical care nursing in the emergency rooms and intensive care units need the most nursing staff. Especially in the intensive care unit there is a patient or two for every one nurse. Those patients need the most care, and vitals need to be watched constantly, which is why most of the nurses stay in the patient’s room. This is not a place that the cuts should be taken from. But if there are not enough nurses then eventually they will start being affected. Although it may be more expensive for the hospitals to hire more nurses they should at least consider taking measures to increase their nursing staff. The current stress put on the nurse could become too much and make them want to quit, or it could prevent them from doing their job efficiently and effectively. It is proven that the increase in nursing staff will increase the outcome of patient care. “The largest study examined in the report, which looked at medical records of 6.1 million patients treated at 799 hospitals during 1993, found that higher levels of RN staffing were associated with lower rates of hospital-acquired pneumonia, urinary tract infections (UTIs), failure to rescue, shock or cardiac arrest, upper gastrointestinal bleeding, and longer hospital stays. More staffing at all levels of nursing was associated with decreases in some adverse outcomes.” (Kennedy, 211). It is a lot better to have a higher nursing staff than one that doesn’t have enough. Especially when working on a surgical or intensive care floor. Patients in these areas already need an extensive, constant, amount of care. The risk of infections and complications increase if there is not a reasonable amount of nurses to take care of those patients.

Another large problem in the nursing field is the number of baby boomers that are currently about to retire in the next few years. It is predicted that the number of nurses that are currently employed are of middle age and are ready to be ending their careers or moving on to less demanding positions. Which means there is going to be a huge decrease in the number of nurses with experience. “America has had a nursing shortage for years, said Peter Buerhaus, workforce analyst at Vanderbilt University School of Nursing in Nashville, Tenn. But by 2025, the country will be facing a shortfall of 260,000 RNs, he said. "In a few short years, just fewer than four out of 10 nurses will be over the age of 50," said Buerhaus. "They'll be retiring out in a decade. And we're not replacing these nurses even as the demand for them will be growing." (Smith) The number of nurses in the field is great right now. But the numbers of nurses that are of the older age bracket are going to start retiring, and the hospitals are recognizing that there is going to be a shortage of nurses, but they are not doing anything about it. It is clear that a majority of the nurses that are currently employed have the most seniority, and a considerable amount of new nurses are going to be needed in the future. The hospitals are more likely going to keep the older nurses with the experience in the fields, rather than hiring the newer nurses right out of college. Nurses that are coming out of school are having difficulty finding a job because it’s not to the point where they need nurses to be hired right away. In effect, this is going to decrease the number of nurses with experience in the field down the road when they need nurses to start working. They are not going to have the experience. And although newer nurses may have the most up to date techniques that are learned in the clinical’s, patient care will be more difficult for the new hires that don’t have the experience to back them up. They have to start finding ways to train the nurses for their future job, while the demand for the nurses goes up, ensuring that the nurses keep up on their skills and follow proper policies for their careers.

Weather the hospitals and medical facilities are aware that they are going to have a shortage of nursing staff may or may not affect the actual outcome. If it is predicted that there is going to be that much of a shortage, hiring new nurses now will probably not even be able to come close to the amount of nurses that will need to be hired. When you think about it, if a majority of nurses are baby boomers, as soon as they retire the medical community will already be in a severe deficit. Currently, with the baby boomer nurses still employed there is a shortage. In effect it will be so bad that the hospitals will not know what to do. The main reason is because the colleges are not able to allow students into their programs. This leads to stress on the schools for not accommodating the medical community. And people that really want to become nurses and cannot due to a cap on students allowed into a program every year will only be discouraged, making nursing a less desirable career. The benefits for nurses are being generously increased by hospitals in hopes that their bonuses and promotions will lure nurses into working for them, but will also improve the longevity of their career at that hospital. These are all small measures that the hospitals can control until they come to the crisis that they are about to face, when they will really have to throw down a large amount of cash to allow these students to become nurses and get into the nursing programs.

Hospitals that are as big as the Cleveland Clinic want all of their nurses to have bachelor’s degrees. They want their staffing to be the best of the best, with no room for any mistakes. But even a hospital like that is going to be facing the crisis if they haven’t been already. With the technology that is being invented and used will also cause a higher demand for nurses that can perform the tasks asked of them by the doctors and the patients. There is a constant need for nursing staff, people are also not going to stay in the same area of nursing. Someone might be a cardiac nurse for five years and then want to switch to pediatrics for a few months. In order to satisfy the nurse, the hospital will be inclined to give them what they want. But they also need to make sure they have someone to fill up the position that was being left, which is where extra nurses would come in handy.

A main reason why nurses are projected to have a shortage in the future is because of the lack of professors. There will be a strong increase in the demand for nurses, and with schools putting a cap on the number of students accepted into the nursing programs each year, it will decrease the number of nurses that are trained after the demand goes up. A lot of the nurses do not want to take the teaching positions because they will not pay as well as if they were working in the hospital. Therefore it is very difficult for the colleges to find adequate nursing professors that are willing to teach. "They need to pay nursing faculty a wage that is attractive enough," said Peterson of the ANA, "You have nurses working in hospital units who are making more than the nurses in education." (Smith). Nurses that are working in the hospital make a much larger salary and are likely to have a higher opportunity to increase their salary, when nurses employed by the schools make a flat rate based off of the classes they teach. Plus the raises usually occur at the schools are they have worked there for a long time. “The average starting pay for an RN is about $56,000, according to the American Nurses Association. Mundinger said that the most ambitious graduates can earn as much as $90,000 if they're willing to work long hours, including weekends and night shifts, in busy metropolitan hospitals.” (Smith) The salary is yet another reason why nursing is a highly desired profession. If you are a good nurse and you work at the right hospitals there will be a chance of obtaining a higher paying nursing job. This is why most nurses will prefer to work in the clinical setting of a hospital. The hospitals are the first people that have to acknowledge the fact that there is going to be a nurse shortage. Following that it will become the responsibility of the schools to make sure that they have a sufficient amount of properly trained staff.

Currently at Kent State University there is already a shortage of nursing faculty. This is why the school will only accept one hundred students per semester at the main campus. This means that a majority of the students will not get into the program and will have to either repeat classes or switch their major. It will also elevate the grade point average of the nursing students applying for the program. Right now students need to get close to a 4.0 gpa which would be getting straight A’s with an occasional B in order to get into the program. This puts a lot of stress on the students and defers them from the nursing field, which in the end will cause an even lower amount of graduated nurses. This is not only the case at Kent State, but has become a problem for schools and students all over the country. “Faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for nurses continues to grow. Budget constraints, an aging faculty, and increasing job competition from clinical sites have contributed to this emerging crisis.” (Rosseter) . The amounts of fund necessary for nursing schools is more than schools can obtain. The salary for professors is high and the schools are unable to meet their needs. Therefore until the colleges can come up with a feasible salary and the funds, they will continue to have that problem. “According to the American Academy of Nurse Practitioners, the average salary of a nurse practitioner, across settings and specialties, is $81,060. By contrast, AACN reported in March 2009 that master's prepared faculty earned an annual average salary of $69,489.” (Rosseter). Anyone in his or her right mind would take a $12,000 pay cut. Which if these nurses that have the proper training and degree they should be the ones getting paid the same rate as those who are working in the hospitals. This would either have to come from outside funds or from the colleges to properly accommodate the teachers. By schools restricting the number of students they allow into their programs will eventually deter a lot of people from even attempting the program. And the number of graduates coming out of the programs is only about half of what it should be. As those registered nurses retire, the supply of working RNs is projected to be 20 percent below requirements by the year 2020. This means that there will be a massive shortage of nurses by the time all of the baby boomers retire. This means that proper measures should already start to be taken in order to accommodate them.

Without a doubt the upcoming national healthcare reform will weigh heavily on anyone who is trying to become a nurse or currently working as a nurse in the field. The healthcare reform will also greatly affect the patients that nurses so meticulously care for. For decades millions of Americans have had no insurance at all and millions more have been severely under insured, nurses have not been able to readily access nursing programs due to long waiting lists and lack of educators, advanced practice registered nurses have not been able to exercise to the maximum capacity of their skills, and patients seeking preventative consults have had to pay large sums of money out of pocket for healthcare services (Barclay 2010). With the passing of the healthcare reform in 2010 the medical field will witness the dawning of a new era in which many of these once insurmountable obstacles shall be removed from sight.

The healthcare reform as most people call it is officially referred to as “The Affordable Care Act.” The Affordable Care Act was signed by President Obama on March 23, 2010, and includes many reforms which will come to fruition over the next four years with most of them becoming active in 2014. Some of the more immediate actions of The Affordable Care Act include providing small business health insurance tax credits, allowing states to cover more people on Medicaid, relief for four million seniors who hit the prescription drug “Donut Hole,” extending coverage for young adults, preventing insurance companies from rescinding coverage, and rebuilding the primary care workforce. The Affordable Care Act was herald as one of the most successful and necessary reforms of American history.

The Affordable Care Act will greatly impact patients who were previously unable to procure healthcare for themselves and their families. The bill will provide insurance for people who are incapable of obtaining insurance or prior to this year not financially stable enough to establish insurance. It is estimated that the bill will extend healthcare insurance to thirty million Americans who were without. The bill is also estimated to provide for an additional twenty five million Americans who were underinsured, or in other words had insurance but that particular insurance didn’t extend coverage to the necessary procedures or medications that the patient needed (Barclay 2010). Now thanks to The Affordable Care Act nearly fifty million Americans who were financially unable to obtain insurance can now rest assured.

The Affordable Care Act also contains legislature to help reduce the massive nursing shortage which is threatening to plague the healthcare field by 2050. The bill has provisions to invest a large quantity of funding into nursing education programs. These programs are specially designed to build and retain workers in the nursing field into the future. One way the bill will work to reduce the nursing shortage is by strengthening and expanding the nursing “pipeline” (Barclay 2010). What this means for aspiring nurses is that more programs will come available through various portals such as state schools, community colleges, certificate programs, and on the job training. The major problem holding students back right now is that there is a shortage of funding being directed at the employment of educators. The Affordable Care Act will provide adequate funding to these programs so that educators may be sufficiently staffed and more students may be accepted into the program at a given time thus decreasing waiting lists and difficulty of entering such programs.

The Affordable Care Act also extends all the way to Advanced Practice Registered Nurses. An Advanced Practice Registered Nurse is a Registered Nurse who has continued their education for either one or two years after completing their bachelor’s degree. Advanced Practiced Nurses are in positions such as CRNA’s (Course Registered Nursing Anesthetist) and NP’s (Nurse Practitioners). A Nurse Practitioner holds a role very similar to a doctor in the perspective that they are able to write prescriptions for medications and act as a primary care provider when working with patients. Nurse Anesthetists often assume the role of the Anesthesiologist in the operating room. The Anesthesiologist will select the proper anesthesia for certain clients and it is the Nurse Anesthetist job to see to it that the medicine is administered correctly and the patient stays properly sedated throughout the procedure.

Until The Affordable Care Act Advanced Practice Nurses have not been able to fully practice to their full abilities. This is a problem at both the national and state levels of practice. There has been no legislature put in place to properly define the roles and scopes of practice of these particular fields. The Affordable Care Act grants these nurses the ability to practice within their full scope of practice (Barclay 2010). Allowing these nurses rights to their full abilities will also allow more patient centered care to be given. Without being hindered by bureaucratic protocol more patients can be seen and treated by Advanced Practice Nurses which will ease the stress on the overall system.

Nurses have always been on the frontline of disease and illness prevention. One of the largest areas for improvement in this field of nursing is first degree prevention. In other words educating the general populace so that they are aware of actions which are unhealthy in nature such as proper hand washing techniques to prevent the spread of germs, low sodium diets to protect against hypertension, and proper nutrition and exercise to prevent obesity. Another aspect of primary prevention includes premature screenings such as physicals, mammograms, bone density screenings, and colonoscopies. Almost all disease processes are considered treatable if caught in an early enough stages.

Nurses have always been the largest advocacy group for first line defenses like these. The Affordable Care Act will grant fifty million dollars to support the cost of two hundred and fifty Nurse Managed Health Clinics. A Nurse Managed Health Clinic is a clinic where Registered Nurses work under Advanced Practice Registered Nurses. No physician is necessary to be on the premises. By setting up Nurse Managed Health Clinics in lower income areas healthcare will become available to people no matter what their yearly earnings or level of wealth is. The bill also sets forth a call for eliminating copayments for preventive services. This means that just to be screened for things patients will no longer be charged copayments or expensive deductibles based on what their insurance does and does not cover (Barclay 2010).

With such drastic changes approaching the medical field it is up to nurses to take responsibility for the patient’s education of such matters. Many clients will be confuses by difficult to interpret legislature. Nurses have a responsibility to be familiar with key points of the bill so they can explain it to patients as they have questions. Knowing how The Affordable Care Act will function will allow nurses to help clients utilize the bill to its fullest extent. Along with educating individual patients and their families it is pertinent that nurses work closely with colleagues, doctors, and other hospital personnel to ensure that everyone understands the reaches of the bill so they can best apply it to patients on an individual basis.

Nurses should be able to actively communicate the provisions of the bill with patients as they are the most trusted profession in the Unites States (Barclay 2010). Rebecca Patton, President of the American Nurses Association puts it best when she said, “Nurses are closely in touch – and their roles vitally intertwined – with all of these issues in their day-to-day work. This puts them in an ideal position to observe best and not so best practices, identify potential problems or policy/ procedural gaps and catalyze positive changes. So, whether it’s more efficient and effective on-rounds communication or safe patient handling practices, nurses are extremely well equipped to help identify and implement organizational benchmarks, the results of which can have a tremendous impact on larger national discussions and debates on these topics (Barclay 2010).”

As any good nurse will know the community plays an equally important role in the health maintenance of a patient. Certain community factors provide very unsafe, unsanitary living conditions. Many people live in these communities because they do not have enough money to live elsewhere. These communities are only deterring the forward progress of any healthcare workers goal by producing more and more unhealthy citizens. President Obama also has a proposition to address the growing concern of environmental issues in the health of Americans. President Obama introduced into legislation the Healthy Places Act of 2006 and the Healthy Communities Act of 2005. Together these to acts set down guidelines of what is unsafe or unhealthy. The acts will help remove environmental concerns such as a lack of sidewalks. Without sidewalks many people are forced to walk in the street to reach their location on foot. This only spurs on the incidence of motor vehicle pedestrian accidents.

Less than half of our countries children have a playground accessible to them. There is a situation occurring where there is either no playground at all in the city or the playground is inaccessible to young people because it is simply out of walking distance. The Healthy Communities Act provides money for communities to erect safe play areas for young children close to their homes. This has become an ever more important issue as childhood obesity statistics continue to grow. With estimates stating that by 2050 nearly one third of all Americans will be diabetic. A higher incidence of overweight adolescents and children leads to a higher incidence of older adults with diabetes which will put more and more strain on nurses. Together these two health care acts work to prevent many health problems and to decrease hospital influx lowering nurse to patient ratios.

President Obama is a strong advocate of the Safe Nursing and Patient Care Act of 2007. This act will force hospitals to limit the amount of overtime nurses are forced to work to extreme emergency situations. With limits proposed on the hospitals they will be forced to acquire the proper staffing levels so that each nurse has an acceptable number of patients. Nurses work very long shifts and when forced to work overtime large declines in performance occur. These performance declines may lead to errors such as medication errors, or carelessness. As a senator in Illinois Obama forced hospitals to release to the public information regarding their amount of nursing staff and patient ratios. By making this information public hospitals were exposed to higher levels of scrutiny in the form of the public eye and were forced to provide safe working and patient conditions, along with fair hours to the healthcare employees.

President Obama has also been a strong advocate for the Re- Empowerment of Skilled and Professional Employees and Construction Trade workers (RESPECT) Act. The RESPECT Act will push out one small piece of former President Bush’s law the National Labor Relations Board. The NLRB removes the rights from individual workers and makes it impossible for individual workers to organize. A provision of the NLRB classified hundreds of thousands of nurses as management positions and removed their right to be protected by federal labor law. The nursing field is unlike many other fields of employment in the job market today. As a nurse often times regular registered nurses take on extra responsibilities around the hospital. These responsibilities are not promotions and there is no pay increase for accepting them. However, it is vitally important that they are taken care of because patients’ lives are on the line when it comes right down to it. The NLRB makes it so that accepting these extra responsibilities would classify those nurses who do so as management positions. Those nurses who were doing their jobs and who were putting the patient first to provide for their safety and wellness would then be at a drastic risk for losing protection from the federal labor law. It is estimated that nearly eight hundred thousand nurses would be affected by this law. With Obama’s RESPECT act the former President Bush’s law would be changed so that only nurses who are truly in managerial roles would be classified as managers and not those nurses who are just accepting responsibility to protect patients.

Many nurses are faced with drastic role strain. Being a registered nurse qualifies the holder of the licensure to perform a very wide variety of tasks in the clinical setting. Anything from floor nurse, to emergency room nurse, to nurse manager or office personal may be carried out by a person considered to be a registered nurse. This is one of the major reasons why the nursing shortage persists. Young students are graduating from school and becoming nurses but they very quickly realize that they may have wanted to do something other than what they are doing and will switch to a different area of the hospital leaving one particular area understaffed. A large number of older nurses are retiring early or leaving the healthcare field all together because of unfair or unsafe working conditions. As a solution President Obama would like to provide more opportunities for people who may be considering becoming nurses. Obama would provide more incentives training programs; improve working conditions by placing maximum shifts on hospitals and minimum staffing requirements, and protecting the nurses’ right to organize (How Barack Obama Will Affect Nurses 2009). All of these items are small steps to fixing one larger problem. President Obama has been a rapid healthcare advocate and recognizes that there is a real problem and strong action needs to be taken immediately to correct it.

Another large problem the president is looking to address is the high rate of on the job injuries to nurses and other healthcare workers. According to the federal Bureau of Labor Statistics, “Six of the top ten occupations at highest risk for back injuries are in health care.” As a nurse it is part of the job to move patients when they are unable to move for themselves. This can be a daunting task as nurses come in all different shapes and sizes and so do patients. A large majority of patients are morbidly obese and unable to move on their own. Due to this factor combined with short staffing, or poor body mechanics it is not difficult to see how injuries can occur. The president believes it is of the utmost importance to teach nurses how to properly implement the “safe lift” technique (How Barack Obama Will Affect Nurses 2009). Along with more appropriate teaching the president will provide federal financial assistance to hospitals to help with the purchasing of patient lifting machines (How Barack Obama Will Affect Nurses 2009). Patient transfer machines are vitally important to safely moving a patient from a bed to a chair or even from a bed to a bed. They are much safer than other techniques such as a transfer belt or the log roll technique. The problem is they are very expensive and a large hospital will only usually have one or two of these machines, and a long term care facility might not have any at all.

The picture below is a good example of a patient lift machine; the patient fits snugly in the harness and with the push of a button can be safely lifted out of the bed and lowered to a wheel chair with no injury caused to the worker at all. Machines like this are overly vital to the safety of nurses while they are on the job.

President Barack Obama is a strong advocate of the healthcare field and has passed legislation to protect nurses. It is extremely important for legislation like this to exist if the nursing shortage will ever be resolved. President Obama has made a strong attempt to provide every citizen in American with adequate healthcare coverage so that each and every person is just that, a person, not a number on a receipt. The healthcare bill also provides nurses with more opportunities for work as they have a wider variety of patients to care for now. Along with work the healthcare bill provides for more and more prospective nurses to attend and graduate a school of their choosing which will undoubtably lead to a brighter future for nurses and America as a whole.

There have been many proposed solutions to the nursing shortage. Selecting a solution to this problem is quite difficult due to the financial support these plans require. Three solutions that would have the greatest impact on the shortage focus on aiding students, nursing schools, and nurses individually and collectively. The nursing shortage is primarily due to three factors. The cost of education is very expensive and students or schools cannot afford adequate training for enough nurses to decrease the shortage. Another concern regarding the education of nurses is the amount of time and training it takes to complete a degree. The nursing shortage is not only due to lack of future nurses; but nurses currently working in the field. The shortage of nurses has increased the responsibility and quantity of work that nurses must complete as a result of less staffing. This unmanageable workload has been shown to discourage many nurses from working in the field. Solutions to these three areas of concern have become a main focus to many in the healthcare field to enhance the quality of care for patients and to improve work conditions for nurses and other healthcare professionals. (See Image)

One proposed solution to the shortage that has potential to make a dramatic impact is providing nursing students with the financial support to attend nursing school and providing schools with appropriate faculty. Training to become a nurse can become costly to most students and the expense of obtaining a degree could be difficult for many to afford. The use of grant money to provide more scholarships and financial assistance to these students could result in a substantial increase in RNs and nursing faculty.

A lack of nursing faculty has become a growing concern in the field of nursing. Factors that contribute to this decrease are the long periods of clinical practice, salaries, and dissatisfaction with faculty career. It takes many years of education and experience to become a nursing instructor. Those who complete advanced training are rarely compensated in their salaries and most professors would receive higher wages in clinical practice. “A 2007 report on the 32,000 U.S. nurse educators by the National League for Nursing and the Carnegie Foundation found that nurse educators earn only three-fourths of what faculty in other academic disciplines earn.” (nursingadvocacy.org) Dissatisfaction of a career in nursing education is a significant factor in the shortage of faculty. Nursing primarily deals with patient care and many nurses may feel educating students in a classroom is quite unsatisfying. Teaching larger class sizes in result of the shortage in faculty also creates much strain and complications in education. Treating the underlying problems that contribute to this shortage in faculty is very important to resolving the nursing shortage. Developing training for faculty that condenses clinical practice, yet provides adequate learning opportunities is one way that this problem can be treated. Offering higher salaries to nursing instructors has the potential to provide an incentive for nurses to leave clinical practice and become educators. This could be counterproductive to the shortage in the short term, but the increase in nurses could be substantial considering the number of students obtaining training and degrees in nursing as a result of an increase in faculty. The problem in supporting these solutions to the faculty shortage is the large amount of money it will take to implement these ideas.

Increasing the faculty in nursing schools is one of the main initiatives to assisting students in obtaining the education requirements to achieve a degree in nursing. Additional faculty is required to train an increasing numbers of students. A likely cause of the nursing shortage is not that there are too few students; but that there is a decreasing amount of faculty.

“According to the American Association of Colleges of Nursing’s (AACN) 2009-2010 annual survey, schools of nursing turned away 54,991 qualified applicants to baccalaureate and graduate programs primarily due to insufficient numbers of faculty.” (aacn.nche.edu/government) Although it can be quite expensive to obtain basic certification in nursing; it is even more costly to achieve a degree of higher education such as a Masters degree or to become a Nurse Practitioner. Becoming a professor or nursing instructor takes years of dedication and the cost of completing a program is unaffordable to many. In making schooling more affordable it is possible that the shortage can be helped. There have been many schools and colleges throughout the United States that have already implemented new programs in order to improve access to training for students and nurses.

There are various scholarships and grants available to nursing students across the U.S; but more emphasis has been put on supporting higher education for nurses.

“Duke University School of Nursing has received a $1,276,000 grant through HRSA's Advanced Nursing Education Expansion program to fund a five-year project called "Advancing the Number of Primary Care Clinicians through Nurse Practitioner Education." Dr. Queen Utley-Smith, associate professor and chair of Duke’s Master of Science in Nursing (MSN) degree program, is the project director.”(acn.nche.edu/Publications)

The grant received at Duke University is one of many that have been implemented in various colleges across the country. Programs such as these have been implemented to increase the number of Adult Nurse Practitioners (ANP), Family Nurse Practitioners (FNP), and Master of Science (MSN) degrees. Improving the number of faculty in the nursing field has been shown to have a significant effect on the shortage. The Public Health Service Act and the Federal Department of Labor have begun to understand the impact faculty has on the nursing shortage and have developed ways to resolve this conflict.

“Title VIII of the Public Health Service Act supports education for faculty positions by providing grants to nursing education programs for traineeships and loans toward graduate training for faculty careers, coupled with loan forgiveness for time spent in the faculty role. Furthermore, the federal Department of Labor (DOL) is providing support for the training of nursing faculty and mentors.”(folio.iupui.edu)

States have already used the DOL Workforce Investment Act funds to provide loans for faculty training. Health care institutions are also providing time off with pay for employees pursuing graduate training.

Another factor that contributes to the lack of nurses in the field is the time and dedication it requires to obtain a nursing degree. Nursing careers usually involve years of school and training and many students cannot complete certain degrees due to this aspect of becoming a nurse. This has been recognized as an issue that contributes to the nursing shortage and has led to the development of many accelerated programs. Accelerated programs in nursing have become a popular way for students to achieve careers in a shorter amount of time. It has led to an increase in not only licensed practical nurses (LPN) and registered nurses (RN), but also specialized nurses and nurse faculty. These programs offer students the opportunity to complete various degrees in nursing in sometimes half the time that it normally requires to obtain them and can potentially provide students education at less cost.

Recently the University of Rochester nursing school has received a $2.2 million grant to improve the education of their students. The university is using a large portion of this money in developing their accelerated programs for bachelors and masters degrees in nursing. The university is expecting more students due to the implementation of these programs.

““Our accelerated programs have been incredibly popular with prospective students,” Chiverton said. “For instance, we expected to start the accelerated bachelor’s degree program with eight students, and we actually have 24. Now, using Helene Fuld Health Trust funding, we can offer more scholarships, hire more faculty and support staff, and purchase equipment needed to expand. We can also aggressively market the programs to qualified minority candidates. Within four years, we expect to significantly increase enrollment in each of these programs.” (urmc.rochester.edu)

The University of Rochester is only one example of the many schools that are decreasing the nursing shortage through accelerated programs. These programs are not only beneficial to students obtaining their bachelors and masters degrees, but their doctorates as well. Few schools offer accelerated doctorate degrees presently, but these types of schools have the potential to dramatically benefit the nursing shortage. The University of Texas has recognized the effects of these programs and plans to implement accelerated doctorate programs.

“The University of Texas Health Science Center at Houston School of Nursing, a pacesetter in nursing education, is offering a creative solution to the crisis: The Accelerated Doctor of Philosophy in Nursing program, which offers financial support to students who plan to enter nursing education enabling them to complete the doctorate as full-time students and speeding their entry into faculty positions.” (son.uta.tmc.edu)

The development of accelerated programs has already been shown to benefit healthcare in many ways. These programs provide the opportunity for those with families and busy lifestyles to obtain a career in the nursing field. Accelerated programs have the potential to allow an individual to complete a degree and experience a position in healthcare that would have never been able to without the implementation of these programs. Many of those training to become a nurse have careers and responsibilities that have to be managed in the process of achieving a degree. This limits those eligible of completing a degree in nursing and by offering training to those with busy lifestyles can lead to an increase in nurses.

It has become apparent that another method of resolving the nursing shortage is not only by improving the education of future nurses, but to increase the wages of nurses currently working in the field. The nursing shortage has led to the increase in the amount of work that nurses working currently in the field must accomplish. Nurses in the field must care for more clients and work longer hours due the shortage of employees. “On average, nurses work an extra 8weeks and a half of over time per year as a result of nursing shortage.” (cwru.edu) Though there is a significant increase in work for these nurses most hospitals do not provide an increase in pay. This factor plays a large role in the nursing shortage.

“Nurses with starting salaries of $35,000 reach an earnings plateau at $47,000 and have no more

room for earnings growth, especially if they stay in direct patient care. This wage compression

discourages long-term job tenure and makes nurses move out of hospitals into other health care settings.”(people.umass.edu)

An increase in pay for nurses who have more responsibility could increase the amount of nurses in hospitals. Many nurses may not find working in a field where the workload has increased, yet their salaries stay the same appealing or fair. This has become a growing concern especially amongst an older generation of nurses. There are many nurses currently working who have experienced decades working in healthcare. This older generation of nurses may be unable to handle the increase in workload due to the nursing shortage especially without an increase in their salaries. In result to the unfair wages for these nurses many have left the field to pursue other careers. This attitude about the field is not only shared amongst the older generation of nurses, but is witnessed in new nurses entering the profession. The unfair work environment of healthcare has the potential to discourage many new nurses. An increase in salaries for nurses allows them to fairly be compensated for the amount of work they must complete during a typical workday. It also adds an incentive for nurses to enter the field and other individuals to consider a career in nursing.

A majority of nurses currently working in healthcare are from what is known as the “baby boomer” generation. The baby boomer generation includes those who are from the ages of 34 to 53 years old. As these experienced nurses retire the nursing shortage is going to increase. It has been very important that more new nurses be trained to fill the positions of these aging nurses. A career in nursing requires much dedication and devotion that may force many nurses into an early retirement. As explained earlier, the increased workload as a result of the shortage only puts more strain on the older generation of nurses. It is estimated that the loss in nurses due to retirement is going to become quite substantial.

“The demand for nurses is amplified by the fact that the average age of registered nurses has increased to age 45 and a smaller percentage is under the age of 30. More than 55 percent of nurses intend to retire between 2011 and 2020.”(app1.unmc.edu)

This is why it is important to discover new ways to recruit younger nurses into the healthcare field. It is essential that this problem be addressed before the country starts to see a further decrease in nurses than has already been established. (See Fig.2)

The main issue with solving the nursing shortage is not developing a plan of action, but finding the funding to implement these resolutions. There have been many grants already awarded to nursing schools all over the country. The first area in need of financial assistance to solve the nursing shortage is education. Schools are currently receiving funds from various sources and organizations to hire more faculties and expand their programs. This has become a start to recognizing the impact that schools have on producing competent nurses. As mentioned previously, there have been several organizations that have given money to these facilities in hopes to make an impact on the current shortage. There is also some federal funding that is currently being used to implement many solutions to the nursing shortage with much emphasis on nursing education. A legislative strategy to address the nursing shortage has currently been shown in the support for increased funding for the Title VIII Nursing Workforce Development programs. These programs provide the largest source of federal funding for nursing education. “Title VIII provided loan, scholarship, and programmatic support to 51,657 student nurses and nurses.”(aacn.nche.edu/government) Though programs like these play a significant role in decreasing the shortage; it is only a start to amount of funding needed to resolve the shortage entirely. The nursing shortage does not only impact nurses and other professions in healthcare, but the country as a whole. A lack of nurses working in hospitals influences inadequate patient care and can even result in higher mortality rates. It is important that the country addresses this issue to prevent injury and death to those receiving healthcare. It is the responsibility of the government aid in resolving this problem primarily with an increase in funding.

The nursing shortage has is not a new area of concern to the country. The shortage has lasted over the last two decades and one single solution has never entirely fixed this major issue in healthcare. Though there have been many attempts at a resolution to the shortage, the current circumstances of the economy has surprisingly benefited the lack of staffing on hospitals. “In 2007-2008, registered nurse employment in hospitals increased by an estimated 243,000 (18 percent) full-time positions — the largest two-year increase in 30 years.”(mc.vanderbilt.edu) It has been said that the current recession that the country is experiencing presently has the potential to temporarily ease or even end the shortage of nurses. It is difficult for many to obtain careers and find employment in this recession. Careers in nursing often result in more opportunities for work to individuals who have lost their jobs and the average salary of a nurse can be sufficient in caring for a family. The recession has also prevented many older nurses working in the field from retirement. Current issues with the economy have left many individuals out of work. Older nurses may have to compensate for an unemployed spouse or family member and they may have to take the primary role in the finances of caring for a family. This can be very unfortunate to nurses who have already devoted many years of hard work in hospitals, but it keeps the nursing population steady until the underlying issues are resolved.

The nursing shortage is a problem with many years in the making. A quick solution to this issue in healthcare is unobtainable and many suggestions to decrease the shortage take years to implement. The most effective way to deal with the nursing shortage is to address the underlying problems with education and nurses currently working in the field. Providing funds to students and nursing schools is the main focus on decreasing the nursing shortage. Increasing faculty and nursing programs has been shown to dramatically benefit the shortage in various ways. A decrease in faculty and funding in schools has made a major impact on the shortage. Programs that offer nursing degrees in an accelerated amount of time have also currently been used to bring more nurses into the field by making an education more accessible to students. Many have recognized the need for fair work environments of those currently working in the field with much emphasis on an older generation of nurses. The increase in work while receiving stagnant salaries has caused much concern to nurses as a result of the nursing shortage. Resolving this issue in healthcare has the potential to keep the baby boomer generation nurses from early retirement; therefore increasing the amount of nurses working in the field. The problem with implementing strategies to reduce the shortage is often due to a lack of funding. Though programs and organizations are currently attempting to provide this financial assistance; the only way to make a large enough impact is through federal funding. An unexpected solution to the nursing shortage has been seen due to the current recession in the economy. The recession has resulted in the unemployment of many and a career in healthcare may assist individuals in providing for themselves and family. It is important that the nursing shortage be addressed before it increases due to the retirement of aging nurses. Figures 3 and 4 are shown below to visualize the future of the shortage if a solution is not found. Resolving the underlying issues associated with this profession will not only impact those in healthcare, but it will enhance the quality of healthcare received by the entire country.

What Nursing Shortage.2010.Photograph

Fig. 1

Aging Nursing Work Force. Chart

Fig. 2

America’s Nursing Shortage by the Numbers. Chart

Fig. 3

Number of Projected Open RN Positions United States 2005-2020. 2000. Chart

Fig. 4

Essentially unless immediate action is taken the nursing shortage will continue to grow well into the future. With rising elderly population including the current population of nurses there will be a very big problem with healthcare in the near future. Unless state schools step back and evaluate how they are running their nursing programs they are only contributing to the problem much more than they are helping. Many politicians are currently making an attempt to help the healthcare field fix some of its problems. The most notable is the president. Obama has signed his health care reform into law and it has already begun taking effect and repairing our damaged field of health care. There are several other organizations who have begun to realize there are problems with the amount of nurses working in this country and graduating school. One of which is the American Nursing Association. The ANA seeks to work with the president to provide more money for nurses to attend school and a way for hospitals to adequately staff nurses. Hospitals improper staffing levels are also driving nurses away from the field and making hospitals an unsafe place for patients. Though there is hope, many experts have proposed solutions and strategies for dealing with the nursing shortage. The problem with propositions is that they must be implemented. When it comes to the healthcare field every person in America should advocate what needs to be done as every person may one day be relying on the people who work in that field for help. The time to correct the problems that have persisted for decades is now.

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