Adapated from a WBUR radio series. Links to Audio can be found below.
America's nursing shortage has been compared to a perfect storm gathering in intensity. In just over a decade nearly 80 million baby boomers will be in or reaching retirement, their medical needs placing an immense strain on our health care system. Nurses themselves will be leaving the profession and a younger generation of nurses will not be trained in enough numbers to fill the growing needs of hospitals and patients.
In "Nursing a Shortage: Inside Out," WBUR Special correspondent Rachel Gotbaum reports on how the shortage has come about and why it matters for nurses, hospitals and patients alike. She takes us into hospitals where the longest running nursing shortage in history is already impacting care. She reports on the roots of the problem that encompass not just the changing career choices for young women, the out-dated image of nursing but also the serious difficulties faced by nursing schools trying to find nurse-educators.
Nurses explain the effect of the shortage on their care of patients and how it is influencing their commitment to the profession and whether they stay or leave. Hospital administrators describe what they need to do to recruit and retain nurses in this competitive market , and Gotbaum reports on the growing tensions over whether mandating nurse-patient ratios is an answer to the problem or an impediment.
There have been shortages of nurses in this country since the 1960's but they have always resolved themselves fairly quickly. This nursing shortage began in 1998. Although it has been slightly alleviated it is expected to get worse when considering the increased retirement rates expected in coming years.
80 million baby boomers are slated to retire in the next decade and they will need a lot more medical care. At the same time many experienced nurses will be leaving the profession. The shortage began after managed care ushered in an era of cost cutting in the early 1990s. Nurses were replaced by lesser skilled workers. In Massachusetts 27 percent of hospital nurses were laid off, the largest number in the country. The profession became unattractive to women who began to have many other career choices. But as nurses left the workforce, studies showed that patient care suffered. One study published in the Journal of the American Medical Association found that patients whose nurse cares for 8 or more people have a 30 percent greater chance of dying than if their nurse cares for four patients. The same nurses are also more likely to be burnt out and dissatisfied with their jobs.
As hospitals started experiencing acute shortages of nurses, they responded by raising salaries and offering bonuses to nurses to enter the profession. Media campaigns were launched to extol the attractions of nursing. By 2003 185 thousand registered nurses entered this nation's hospital workforce. But even with this huge influx of nurses the shortage in 2007 still existed, and as demand for nurses increases many agree the gap will steadily grow. The number of registered nurses increased from approximately 2.5 million in 2007 to under 2.7 million in 2011. Despite this increase, some states are fighting about whether to mandate nurse-to-patient ratios. The number of new nurses is influenced by a large number of external factors so pinpointing the cause is difficult, but the significance of the increase is more important. Although 200,000 sounds like a lot of nurses, this is only an 8% increase. Just as important as the number of nurses is the number of patients which rose almost 10% from 2007 to 2008 alone according to the National Healthcare Cost and Utilization Project.
Audio Links Click Here
How do you think these numbers compare to what you observe in hospitals and health care facilities? Do you think legislation is the best way to solve nurse-to-patient ratios? This creates a demand for nurses but not necessarily the supply.
2010 may have been the year when enormous healthcare changes began, but 2011 was the year these changes hit nursing. In addition, the Institute of Medicine's landmark Future of Nursing report was released at the end of 2010 and much of this year has been spent digesting its recommendations and searching for ways to put them into practice.
Here's a quick rundown of the most pressing issues for Nursing in 2012:1. Advanced degrees are no longer optional
The IOM's recommendation for 80% of all RNs to have a baccalaureate degree by 2020 has not veered too intensely into the old ADN vs. BSN quagmire. Instead, the profession is focusing on ways to engage nurses in lifelong learning so that associate degree nurses can find realistic ways to obtain BSN degrees.
In addition, BSN nurses are encouraged to be leaders in evidence-based practice and research and it's becoming more common—and crucially, more expected—for nurses to pursue master's degrees. And the creation of the doctor of nursing practice degree has taken off better than anyone could have expected.
In the last six months, any time nurse executives get together, the conversation always turns to who has already entered a program and how long it's going to take the rest of the group to do so. 2. Patient engagement gets real
If you haven't found a way to drive home the importance of patient experience to direct-care nurses, find it now. You know how much reimbursement is at stake, but the rank and file caregivers still don't get it. The term "patient experience" has a way of annoying bedside caregivers. '"We're not Disneyworld," is a common refrain; people don't want to be in the hospital. "I'm here to save patients' lives, not entertain them," is another common complaint.
Experience isn't about mollycoddling patients, however, or how flashy the in-room entertainment system is and that's what you need to help nurses understand. In fact, the nurse-patient relationship has always been about patient experience.
Your best nurses instinctively know this. They already create a good patient experience. They help patients understand their care, involve families in decision-making, coordinate multidisciplinary care, sit with patients to explain complex diagnoses, and even, occasionally, have time to offer a quick hug or hand to hold. These are the nurses who get letters from patients and families after discharge and these letters are all about the patient experience.
This is how you need to phrase patient experience with nursing staff so they understand it's not just a program, but a way of life. At the same time, nursing needs to own the cause. They may not be responsible for it in isolation, but they are literally at the center of this issue. They should take the lead and drive the agenda.3. Patient safety
Just as nurses should own patient experience, they need to feel ownership for patient safety as well. It has been written that "quality improvement becomes one more meaningless directive from 'above' unless nurses feel engaged in the process, involved in the plans, and accountable for the results."
Preventing healthcare-associated infections (HAI) is no longer simply the right thing to do, it's become the only financially viable option. Unless nurses are educated and empowered, real progress cannot be made.4. Cost cutting
Nursing knows that hiring freezes and layoffs are a constant threat and healthcare organizations are forced to put cost cutting at the top of the agenda in 2012. As the largest budget in the organization, nursing is an easy target.
Organizations can get more agile with staffing and scheduling and find creative ways to reduce cost while maximizing efficiency. Embrace change and flexibility to create the mobile, agile workforce healthcare organizations need to adapt to changing economic realities and increases in patient population.
At the same time, staffing budgets can't be viewed in isolation. There are direct links between nurse staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover. This article examines the danger of considering the cost of nurse staffing without looking at everything else. It's important to understand the relationship between length of stay, unreimbursed never events, and nurse staffing to understand the whole picture.5. Retention
It's been said before, but ignore retention at your peril. The nursing shortage hasn't gone away simply because the recession has eased its immediate effects. We all know the turnover rate for new graduate nurses is always high, so invest in nurse residency programs that have proven results for retention and for increasing the competency of new nurses.