No Program Space Amidst a
Nursing Shortage?
by Angela Schenck
Michael Dembrow
Writing 123
Abstract
Table of Contents
Page
I.
Introduction 1
II.
Body 2
Past Problems 3
The Current Shortage 6
Why is There a Nursing Faculty Shortage? 8
Professional Strategies 13
III. Conclusion 17
IV. Works Cited 18
Introduction
There is a
healthcare crisis in
Registered
nurses don’t want to be teachers because they can get paid more outside the
classroom. After receiving a degree and
license, nurses don’t want to spend the time and money to obtain a master’s or
doctoral degree. The Nurse Reinvestment Act will help nursing
educators pay for these additional schooling requirements, but is it incentive
enough?
As a
pre-nursing student, I have encountered problems completing all of my
prerequisites classes for the bachelor degree program. Classes like Anatomy & Physiology and
Microbiology are immediately filled, with scheduling conflicts because there
aren’t enough courses offered at my community college. I am applying for nursing programs this
winter and am very hopeful that I will get in, but it is really competitive. I’ve encountered other students who have been
waiting for a few years to get into a program.
Why is it so difficult when we really need registered nurses?
We need
more instructors, laboratories, and placement sites. We need the simulation mannequins to practice
on that
In
this essay I will discuss the past and present facts, and what the experts say
about the future of nursing. I will
touch on the reasons that nurses and faculty have given for leaving the
profession, as well as the strides toward increasing enrollment in nursing
educator degree programs. I will talk
about the strategies of nursing leaders in
Patient
care is ultimately suffering and will continue to decline if more nurses aren’t
trained in a hurry. If we don’t act now,
our baby boomers and expanding population will be left to “nurse” themselves.
Body
We are in a
state of crisis in healthcare right now.
There are many people who are uninsured, with no adequate means of
providing healthcare. Even if they could
afford to pay for services, there may not be enough registered nurses to
provide them. According to the U.S.
Health Resources and Services Administration, there was an estimated 6%
shortage of full time equivalent registered nurses in 2000 (“Projected Supply”
2).
Registered
Nurse is the job in most demand in the “Occupations with the Largest Job
Growth, 2002-2012” by the Bureau of Labor Statistics, with projected growth of
27%. With 2.3 million RNs employed in
2002 which is the biggest occupation in healthcare, about 623,000 new jobs will
be created by 2012. This growth is due
to the increasing number of older people who require more nursing care, the
large amount of replacement RNs for those who will be retiring, the “increasing
emphasis on preventative care”, and the advances in medical technology that
allow more illnesses to be treated (Registered Nurses).
Past Problems
The current
shortage of nurses has been fostered by past social and economic issues.
Shifting Social Perceptions
Women have
more careers to choose from now. Faye Satterly surveyed fellows of the Infusion Nurses Society at
their annual meeting in May 2002. Nurses
interviewed who were born before 1950 named teacher, secretary, or nurse as
their list of occupations. By the 1980s
and 90s “careers had few gender limits,” she discovered when reviewing
responses from nurses born after 1970.
“With 95 percent of the nursing profession made up of women, it is only
reasonable to expect that nursing would be impacted” (34).
Hospital
Economics
Hospitals
used to charge patients on a fee-for-service basis. Equipment, services, and supplies were
recorded and billed, with patients charged for their rooms separately, based on
hospital overhead. Payors
rarely questioned the invoices, paying them in full. This encouraged physicians to overuse
expensive new equipment and hospitals to discharge patients a little ‘less
timely.’ With changes in federal Medicare
and Medicaid programs in 1983, most other health insurers also started grouping
illnesses and treatments into categories, paying a set rate based on the
severity of the case. This led hospital
CEOs to cut costs like staffing, new equipment, and the number of inpatient
beds to maintain profit because they were not fully reimbursed by
insurers. Some hospitals went under in
the 1990s, with others suddenly realizing that they
didn’t have enough beds or nurses to care for patients (Satterly
65-69).
Job
Dissatisfaction
Many nurses
left the field because they were so unhappy.
Even though 81 percent of Infusion Nurses interviewed said that “making
a difference” or “helping” was their greatest source of job satisfaction,
others responded that burnout was overwhelming their contentment (Satterly 38). Wages
compared to the level of responsibility, working weekends and holidays, nurses’
desire for respect, paperwork, not enough time for patient care, personal
safety, and liability all made the list of complaints from the nurses in 2002 (Satterly 45-8).
Requiring
nurses to work weekends and holidays after so many years of service and tenure
seemed like an insult to some nurses who wanted to spend family time before
their children were grown. One nurse
responded, “after twenty years, it seems like I should
be getting something” (Satterly 39).
The level
of documentation grew more intense and diminished the nurses’ time devoted to
actual patient care. More regulatory
agencies like the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) sprouted due to the increasing amount of legal issues. Though more
attention given to patient complaints such as pain regulation meant more
extensive charting of information; where the pain was, how long it lasted, it’s character and intensity, and all attempts by the nurse
at distracting the patient from it. Any
medication administered to relieve the pain had to be closely monitored for
level of effectiveness and then documented.
Patient restraints could not be applied until ordered by a physician,
even though preventing falls was the nurses’ responsibility. Patients were screened for risk of falls and
measures taken for prevention, like explaining the importance of calling for
help to the bathroom, had to be charted.
Even if it was just raising the bed rails, the patient’s response to the
restraint had to be charted at least every hour. More time was taken up by documenting that
they gave good care than by actually giving the care (Satterly
12-13).
Medical
advances and technology drew time away from nurses as well. New machines that regulated intravenous
fluids and feedings, monitored heart and oxygen rates, and specialized beds
were supposed to help nurses but displaced more basic care. Learning to use these complex devices took up
valuable time that nurses could have used for more basic care such as asking
how the patients were feeling. Brand new
medicines prescribed by doctors left the nurses to fastidiously research the
drugs’ actions and side effects before administering them (Satterly
12).
Another
concern from nurses was for their safety as well as the patients’. Implementing a computerized charting system
and barcoding for medications would have been more
efficient, with physicians entering prescriptions directly instead of nurses
deciphering handwriting, as well as reduce errors in administration of drugs,
but hospitals couldn’t afford those billions of dollars. Needlesticks were
another safety concern of nurses but there have been safer new supplies stocked
in many facilities. Obesity is a continuing
challenge as the last safety issue though.
With the increase in obese patients and the illnesses associated, nurses
are fearful of a debilitating back injury.
Lifting equipment and proper training would somewhat alleviate this huge
fear. (Satterly 110-2).
More
Opportunities
Nurses used
to only be able to work in any hospital nursing unit thirty years ago, but now
there are more opportunities with specialization and advanced technology. Nurses can work outside the hospital in law
firms, schools, rehabilitation facilities, and pharmaceutical companies. One nurse in the survey of Infusion Nurses
works as an independent contractor with over thirty years experience as a
nurse. She travels around her region
educating other nurses on new infusion products. Another put her knowledge and experience in
patient care and medical records to use working as a certified legal nurse
consultant assisting in medical malpractice cases (Satterly
35-6). This was great for nursing in
general, as the perception of RNs improved socially, but it has pulled them out
of patient care, contributing to the shortage.
The Current Shortage
There were
110,000 vacant full time jobs for RNs in 2000 (“Projected Supply” 2). This shortfall was not projected to happen
until 2007. The
Some
areas of the
The number
of first-time nursing school graduates, educated in the United States, sitting
for the national licensure examination NCLEX-RN® from 1995-2003 declined 20%, as
tallied by the National Council of State Boards of Nursing (see Appendix III). Almost 20,000 less students took the test in
2003 as compared with 1995 (Nursing Shortage table 1).
Why is this happening?
Specialization
is essential in nursing due to the complexity of today’s sicknesses and
treatments, but it contributes to the nursing shortage. The competency levels of nurses vary with
different training, experience, and certification needed for each area of patient
care. The distribution of the vacancy
rate is not even throughout the hospital, yet a nurse from a well-staffed unit
cannot simply substitute in another without additional training in that
specialty (Satterly 15-6). There should be float nurses that are skilled
in a few areas of practice, so that they may cover vacancies on several units,
but these kind of nurses may be hard to find because
of the extensive additional training commitment required.
With
advancement in medical technology, more hospital services are offered on an outpatient
basis and patients that are admitted are sicker and need more intense
care. Illnesses that were once fatal are
now chronic but more complex. Patients’
length of stay is shorter, presenting the nurses caring for them with more
difficulty in attending to all of their physical, emotional, and educational
needs. Nurses have to teach their
patients about their illnesses and post-discharge care in less time because of
this “revolving door” in the nursing units (Satterly
11-2).
There were
29,293 licensed registered nurses in
According
to the
The pool of
registered nurses is aging too. The
national average age of RNs in 2000 climbed to 45.2 years of age from 44.3 just
four years prior (National Sample 8).
Twenty years ago, over half of the actively-licensed RNs were under 40
years old, but in the 2000 survey by the Health Resources and Services
Administration, this dropped to less than one-third of the total population (8). The survey for
U.S.
nursing schools surveyed by the American Association of Colleges of Nursing in
2003 denied admission to 15,944 qualified students to baccalaureate programs
for that school year because of an “insufficient number of faculty, clinical
sites, classroom space, clinical preceptors, and budget constraints” (Nursing
Faculty 1). A year earlier, 5,283
applicants were turned away from all types of nursing programs (1). Of the bachelor degree programs surveyed,
64.8% responded that faculty shortages were a reason for not accepting all
applicants (1).
AACN
surveys “show a nurse faculty vacancy rate of 8.6%, which is an increase from
the 7.4% vacancy rate in 2000.” A total
of 614 faculty vacancies were identified at 300 nursing schools in 2003. Doctoral degrees were required for 59.8% of
the faculty positions (Nursing Faculty).
Why are there nursing faculty
shortages?
The average
age for employed RNs in nursing education was 49.4 years in 2000 (National
Sample 25) with 2.1% of the Registered Nurse population (12). The “lack of change in the number of nurses
in nursing education [in the past two decades] coupled with an increase in the
total number of nurses” resulted in this decline of proportion (12). This is alarming because the percentage of
RNs in nursing education in 1980 was reported to be 3.7% (12).
Poor Salaries
The
compensation for most nursing educators is lower than others in academia as
well as other nursing positions in the field.
American Association of Colleges of Nursing reported in 2003 “that
master’s prepared nurse professors earned an average salary of $60,357”
(Nursing Faculty). As listed on the
Nursing Faculty Shortage Fact Sheet, ADVANCE
for Nurse Practitioners surveyed nurse practitioners in 2003 and found that
“the average salary of a master’s prepared nurse practitioner working in an
emergency department was $80,697.” Over
$20,000 difference in earnings sends out the wrong message. That is a huge loss and risk for nurses and
prospective nursing educators to take.
Nurses working in patient care don’t want to stop making money to go
back to school and then work as faculty making dramatically less.
Aging Nurse Educators
The
median age of full-time nurse faculty is 51.5 years (Nursing Faculty). Doctorally-prepared
faculty professors average 56.8 years.
The average age of all faculty with a master’s
degree is 49.0 years of age according to AACN’s
report, 2003-2004 Salaries of
Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate
Programs in Nursing.
The average
age of retirement was found to be 62.5 years by an article published in Nursing Outlook in spring of 2002 (Nursing
Faculty). Authors of “The Shortage of Doctorally Prepared Nursing Faculty: A Dire Situation”
“project that between 200 and 300 doctorally-prepared
faculty will be eligible for retirement each year from 2003 through 2012, and
between 220-280 master’s prepared faculty will be retiring between 2012 and
2018”(Nursing Faculty). We will lose a
lot of nursing educators with no one to replace them. Jennifer Larson affirmed this in her book, “the
fact that many nurse faculty members begin this [educational] phase of their life
at a relatively advanced age,… exacerbates the
[faculty shortage] problem,” (2).
Locally,
“41% of the faculty in baccalaureate and higher degree programs in
Advanced Education
According
to
[Faculty] are moving from the role
of ‘sage on the stage’ to that of ‘guide on the side.’ Faculty focus on helping students learn
clinical judgment… to use evidence-based practices… and model and teach
leadership, and assist students to learn the principles of client teaching,
delegation, and supervision of other caregivers.
The OHSU
School of Nursing offers a post-master’s certificate option in education to
bachelor- and master’s-prepared nurses.
With a master’s in a clinical specialty, a nurse can become certified as
a nursing educator with at least 17 credit hours. A student with a bachelor’s degree in nursing
and master’s in a related field can become certified after completing 10 credit
hours in advanced nursing and a minimum of 17 others (PMCO).
The master
degree program at OHSU takes five to six quarters of full time study or
approximately three years for part time students. The PMCO in Nursing Education requires
another 4 quarters of full time study for completion (FAQs).
The tuition
for graduate programs at OHSU’s
Paying for Additional Schooling
Congress
funded the Nurse Reinvestment Act
with $20 million designed to address the nursing shortage in February
2003. Within this money includes $3
million offered to schools of nursing to dispense to graduate students that
agree to work as faculty. This loan
forgiveness program will pay 60% of a student’s loans for contracting two years
of work and an additional 25% of the total loans for their third year (Nursing
Faculty 3).
Professional
Efforts to Increase Enrollment
Efforts
have been made in the field to increase the number of faculty. Nurses for a Healthier
Tomorrow (NHT) is “a coalition of 43 leading nursing and health care
organizations” which includes members such as the National League of Nursing
and American Association of Colleges of Nursing (Nurses 1). In 2001, the coalition launched a national
campaign called “’Nursing. It’s Real. It’s Life.’… to boost the attractiveness of nursing as a
profession.” In February of this year, a
public awareness campaign was launched to generate interest in careers of nurse
educators. NHT published a flyer which
can be freely downloaded from their web site and four print
advertisements. They also posted career
profiles and personal testimonials online (Nurses 2).
Another
major promoter of faculty careers is the American Association of Colleges of
Nursing. They created a resource on the
Internet in March, which offers another career profile, financial aid, and
links to faculty development programs “to support nurses considering full- or
part-time teaching careers [in nursing] called Faculty CareerLink”
(Nursing Faculty 2).
A local
effort was launched in 1999 when the Oregon Nursing Leadership Council (ONLC)
was formed. Members of it’s Education Committee are Oregon Nurses Association,
Oregon Council of Associate Degree Programs, Oregon Council of Deans, Oregon
State Board of Nursing, and Northwest Organization of Nurse Executives. These nursing leaders from
Professional Strategies
Nurse Retention
Money
and time spent on recruiting new nurses into the field could be used for luring
already-licensed nurses back into the profession. Faye Satterly (111)
notes,
Some half
million nurses have simply retired but kept their licenses active. Of the others, nearly 81,000 left their jobs
to stay home with young children.
Another 40,000 moved into new careers...
It is possible then that 120,000 RNs could be enticed back to hospitals
by providing childcare, flexible hours, increased pay, and more opportunity for
meaningful promotion that would recognize their expertise without taking them
from the bedside. That doesn’t count the
28 percent of nurses working part-time who could make a significant impact if
they could be enticed to increase their hours.
RNs were found to be more satisfied
with their jobs when they spent more time in patient care (Satterly
111-2). Increasing efforts to retain the
nurses we have will help us with new nurses who are mentored by them because
their cynical and unhappy feelings won’t seep into the new workforce (112).
Pooling Resources
More efficiently spending the monies and time will help with the nursing shortage. Harriet Feldman et al say, “hospitals and schools sharing the cost of joint appointments of clinical faculty; employment of non-nurse faculty to teach required courses such as pharmacology, information systems, management, research methodology, or other nonclinical-specific content; utilization of more master’s-prepared clinical instructors; and development of plans that help to increase revenues for nursing schools” are among the options to consider (66-7). Industry leaders, educators and public policy makers should serve as members of an external advisory group to schools of nursing for feedback, advice and networking (59).
Fostering Collaborative Relationships
Collaborative
partnerships are vital in today’s health care system. “Enhancing the role of nurses as professional
partners” would greatly improve morale and productivity. Nurse dissatisfaction “is not only a product
of environmental stressors, including inadequate staffing levels and excessive
workloads, but also due to a lack of respect and control over decisions and
processes required to provide quality patient care… It is imperative that all health
professionals be educated and prepared to work more effectively as a team, with
an expectation that the whole will be greater than the sum of its parts” as
stated by Harriet Feldman et al (65-6).
There is another
area for recruitment of nurses; overseas.
Outside the
Marketing
Johnson & Johnson launched a $20 million campaign “to boost public awareness of nursing and to attract more applicants…” Branding, advertising, direct mail, focus groups, community outreach, radio and television ads have “to stimulate interest in nursing, particularly among middle- and high-school students” according to contributors in The Nursing Shortage: Strategies for Recruitment and Retention in Clinical Practice and Education. Attitudes about career choices are shaped during kindergarten and up. Pre-Nursing academy, mentoring, shadowing, and summer camp programs can expose youngsters to and get them excited about nursing (Feldman et al 60-1).
Enrich Diversity
The minority
population in nursing does not match the
Decrease the Financial Burden of Education
Scholarships, student loans and funds raised from private sector can promote access to nursing education according to The Nursing Shortage contributors. Externship programs for senior clinical practicum students have increased the knowledge of specialty areas by allowing students to practice care in the field and reduce the orientation and training time for the employer when the student is hired after graduation (Feldman et al 62-3).
Better Utilize Technology
Distance learning is helping schools of nursing recruit and teach many more students. Simulation laboratories and mannequins have created hands-on experience which is safer than practicing on real human patients. The numbers of students per instructor will also increase because of the less-intense supervision needed in laboratory (Feldman et al 64-5).
Distance education, or distributed, asynchronous learning where individual students can learn independent of time and place (Chaska et al 165) should be developed. The Internet as well as other technology has increased the amount of students that can be taught at once. According to contributors in The Nursing Profession: Tomorrow and Beyond, the goals of educational institutions should include “increasing their market share of students and income, broadening the territory served, promoting ability to attract more part-time faculty who desire to teach from their homes or businesses, preparing students for practice in rural and underserved areas, preparing students to use the technology that will increasingly be a part of health care delivery, and providing opportunities for students to have greater access to educational programs and courses.” (Chaska et al 165).
Cultivate Leadership and Management
Proficiency
Studies of
job satisfaction reported by authors in Harriet Feldman’s book “point to a lack
of nursing leadership and management skills” as reasons for staff nurses’
unhappiness. These skills
should be more developed during basic nursing education, “to help advance the
role of nursing in the health care industry… Building leadership competency in
the profession begins with innovative educational programming that rethinks the
way professional nurses are integrated into the health care system and how they
are challenged, rewarded, and valued as a professional asset.” Front-line nursing managers need better
skills, which will promote nurse retention (Feldman et al 65).
Lobby for Nursing
As stated
in The Nursing Shortage, “schools
must take the lead in advocacy for nursing education in the public policy
arena.” Legislative involvement has
secured new funding like the Nurse
Reinvestment Act which provides scholarships, encourages faculty careers,
and support “career ladder partnerships between nursing schools and health care
facilities” (Feldman et al 63). Laws
don’t pass automatically and funding isn’t appropriated unless voted upon by
many layers of government. Nurses,
patients, and all healthcare professionals need to write letters to their local
Congress and state representatives to increase awareness of the problems in
nursing.
Conclusion
Now is the
time when a nursing shortage is happening.
It has happened before but this one is unique. They will be a major shortfall in supply and
demand. If we don’t act now, we’ll be in
an even greater healthcare crisis which may be more than we can handle. This shortage affects the future of
our parents, ourselves, and our children.
In this
paper, I’ve talked about factors in the past and present that have contributed
to the nursing shortage. I have
discussed the situation in
I have
discussed the ideals of professionals in the field and their strategies to
address the worsening prospective. There
have been strides by major nursing organizations, but we need support for the
Nurse Education, Expansion, and Development Act of 2004 (H.R. 5324). This bill is awaiting approval and
appropriations. and would provide capitation grants to
students pursuing a nursing degree in education for the next three years.
Nursing
schools would receive important money for equipment, audiovisual and clinical
laboratories as well as recruiting and retaining nursing faculty. As a prospective nursing school student, I
have experienced the fear of not having enough program space. I am hopeful that I will be admitted, so that
I may earn a baccalaureate degree and begin my work in patient care. I will move up the career-ladder to a
position in nursing where I can teach and lead future nurses.
Works Cited
Chaska,
Norma, ed. The
Nursing Profession: Tomorrow and Beyond.
“FAQs.”
Feldman,
Harriet, ed. The Nursing Shortage: Strategies for Recruitment and Retention in
Clinical Practice and Education.
Gubrud-Howe, Paula
et al. “A Challenge to Meet the Future: Nursing Education in
“Health Care Proposal – Draft 1.” Governor’s Healthcare
Workforce Initiative. WorkSource
Larson,
Jennifer. “Nursing Education 2002: The Nursing Faculty Shortage.” NurseZone Web Site. Accessed
“Nurses for a Healthier Tomorrow Launches
Campaign to Increase Number of Nurse Educators.” Nurses for a Healthier Tomorrow Web Site. Accessed
“Nursing Faculty Shortage Fact Sheet.” AACN – Media Relations
[American Association of Colleges of Nursing] Web Site. Updated
“Nursing Shortage Fact Sheet.” AACN Web Site. Updated
“PMCO –
Nurse Educator.”
Satterly, Faye. Where Have All The Nurses Gone? The Impact of the
Nursing Shortage on American Healthcare.
“Tuition
Costs.”
United States Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Professions.
United States Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Professions.
United States Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Professions.
United States Department of Labor. Bureau of
Labor Statistics. “Registered Nurses.” Occupational Outlook Handbook, 2004-05 Edition. Accessed
United States Department of Labor. Bureau of
Labor Statistics. “Occupations with the Largest Job Growth, 2002-2012.” Monthly Labor Review Online.
February 2004: table 4. Accessed
Appendix I:
Annotated Bibliography for No Program
Space Amidst a Nursing Shortage?
Albaugh, Jeffrey A. “Resolving the Nursing
Shortage: Legislative Issues.” Urological
Nursing 24.3 (2004) : 214-215. Healthsource:
Nursing/Academic Edition. ESBCOhost. Accessed
Chaska, Norma, ed.
The Nursing Profession: Tomorrow and
Beyond.
Conan, Neal. “Analysis: Shortage of
Registered Nurses in the
“Faculty
Shortages in Baccalaureate and Graduate Nursing Programs:
Scope of the Problem and Strategies for Expanding the Supply.” AACN – Publications –
White Papers [American Association of Colleges of Nursing] Web Site.
May 2003. Accessed
Hansen, Brian. "Nursing
Shortage." The
CQ Researcher Online 12.32 (2002). Accessed
Hinshaw,
“Iowa Schools Turning
Nursing Students Away.” Community College Week.
Kohn, Carol, and Henderson, C. W. “With Too
Few Faculty, Nursing Schools Turning Away Students.” Managed Care Weekly Digest
Lawton, Wendy. “Nurses
Urge Education Shakeup.” The
Oregonian
“Nurses for a Healthier Tomorrow Launches
Campaign to Increase Number of Nurse Educators.” Nurses for a Healthier Tomorrow Web Site. Accessed
“Nursing Faculty Shortage
Fact Sheet.” AACN – Media Relations [American
Association of Colleges of Nursing] Web Site. Updated