How Can a Nursing Shortage Be Prevented?
by Richard A. Sherer| Geriatric Times |  |
July/August 2001 | |
Vol. II | |
Issue 4 |
Kathleen Sanford, R.N., said, in an interview with Geriatric Times, "A friend of mine met a legislator from Texas at a conference. After they had talked for a while, the legislator asked her what she did [for a living]. When she told him she was a nurse, he said, 'What a waste!' How do you think that made her feel?"
That story goes a long way toward explaining, at least in part, why the current nursing shortage may be much more serious than the ups and downs that have plagued the profession for decades.
"If people don't think that bright, articulate people go into nursing, how are we possibly going to attract them?" asked Sanford, vice president for nursing and administrator at Harrison Memorial Hospital in Bremerton, Wash.
The nursing shortage is real, and it has become the main topic of discussion throughout the industry. The American Hospital Association has named a blue-ribbon commission to find solutions to the problem. The U.S. Congress is considering legislation to create a National Nurse Service Corps to help recruit nursing students and provide scholarships. Some hospitals are aggressively recruiting graduates from developing nations to fill their staffing gaps.
The U.S. Bureau of Labor Statistics predicts the nation will need 450,000 additional registered nurses by 2008. But enrollments in nursing schools are declining; fewer people are entering the profession; and a survey released in April by the Federation of Nurses and Health Professionals reported that 20% of currently employed nurses plan to leave the profession within the next five years.
Increasing numbers of nurses will be reaching retirement age in the next decade -- a group that includes many whose services will be needed by the graying population. Sen. Barbara Mikulski (D-Md.) told attendees at a hearing regarding the nursing shortage, "Fifty percent of all working nurses will reach retirement age in 15 years." By one estimate, the nursing workforce will fall 20% below required levels by 2020. "We're going to find ourselves in a catastrophic situation," said Joani Ketter, an official with the American Federation of Nurses, while talking with GT. "Only the acutely ill will have access to a qualified health care professional. Unless you are very, very sick, you will not have access to health care."
Staffing issues have become a leading cause of dissatisfaction among nurses. The May/June 2001 issue of Health Affairs published a survey that looked at nurse job dissatisfaction and uneven quality of hospital care in the United States, Canada, England, Scotland and Germany. The researchers found that only about a third of the nurses who responded agreed with the two statements: "There are enough registered nurses to provide high-quality care," and "There are enough staff to get the work done." The survey also found that 41% of U.S. nurses were dissatisfied with their jobs, and 33% of those under age 30 were planning to leave their present jobs in the next year.
"It's a chicken-and-egg situation," Dolores A. Bower, R.N., Ph.D., dean of the College of Nursing at Niagra University, told GT. "The workforce is aging. The average age of nurses in hospitals and related areas is in the mid-40s. These people will be retiring soon. Because of shortages of staff, the prediction is that those people will leave even sooner -- people who are older and being pressed with mandatory overtime and a strenuous work environment. [These factors] threaten even that small supply."
The average age of the registered nurse population in March 2000 was estimated to be 45.2 years, according to the February 2001 preliminary findings of the National Sample Survey of Registered Nurses. Only 18.3% of nurses were under 35 in 2000, compared with 40.5% in 1980. The nurse population under age 30 dropped from 25.1% in 1980 to 9.1% 20 years later.
"In current nursing employment, the baby boomer generation is the largest generation," commented James Bentley, senior vice president for strategic policy planning at the American Hospital Association, in an interview with GT. "Each generation behind them is smaller, and the baby boomer generation is now 55 years of age at its leading edge. You think about early retirement, certainly retirement. The smaller population cohorts behind the baby boomer generation aren't going to be large enough to fill the gap."
Not everyone is convinced that nurses will retire on any kind of a schedule, however. Christine Kovner, Ph.D., professor at New York University's Division of Nursing, explained her perspective to GT. "Nurses may retire sooner because the work is so grueling, or later, which is what's happening in other industries because somebody who's 65 is not very old," she said. "In our grandparents' era, you retired at 60 or 65 because you knew you only had a couple more years left. Now people think they can delay [retirement] because 65 is young. I don't know how that's going to play out in nursing."
The impact of the nursing shortage is particularly acute in the care of the elderly. In an interview with GT, Charlene Harrington, Ph.D., R.N., a professor at University of California in San Francisco, said nurses and nursing assistants are being recruited from long-term care facilities by the promise of higher wages. "Some hospital nurses can make $85,000 a year," she claimed. "The typical nursing home nurse is trying to make $33,000 a year." Nursing homes in 1998 were providing 3.4 hours of staff nursing time per patient day, compared with hospitals, where the average was 5.9 hours, according to the On-Line Survey, Certification and Reporting System sponsored by the Centers for Medicare & Medicaid Services (formerly Health Care Financing Administration).
Mathy Mezey, Ed.D., R.N., FAAN, director of the John A. Hartford Foundation Institute for Geriatric Nursing, agreed. "If there's a nursing shortage in hospitals, home care and nursing homes will suffer first," she told GT. "Hospitals are preferred sites, especially in relation to nursing homes. Some of us are trying to work with states to think about loan forgiveness and other incentives for nursing home nurses. There's a lot of turmoil and activity trying to at least ensure that they don't suffer to a degree that's going to cripple them. They are very worried."
While money remains a major issue for nurses -- real wages adjusted for inflation increased by less than $17 a month between 1992 and 2000 -- societal changes also are making nursing less attractive to students planning their careers. "In a service economy, health care is seen as low tech," explained Bentley. "Hands-on care doesn't give people the idea of high tech."
Increased opportunities for women also have played a role. "Seventy percent to 85% of the health care workforce in hospitals is female," Bentley stated. "In the past 30 years, we've opened a huge array of career opportunities for women. Thirty years ago, the choices for women typically were limited to five occupations: homemaker, nurse, librarian, secretary or teacher. That's no longer true. Women today have much broader choices, and hospitals have not successfully increased the number of men in nursing."
Sanford believes the solutions to attracting more nurses will involve a radical change in the system. "Nurses are not poorly paid," she said. "But, if you compare what they have to do and the hours they have to work, then it's hard to compete" with other professions.
"We're competing with jobs that have better work environments," she added. "Nurses have to work 24 hours a day, seven days a week, holidays, weekends, nights, evenings. Nursing salaries are in the middle of the road. They're not bad. But when you compare them with people who can make that much working a job Monday through Friday on the day shift, then they look bad."
Sanford would increase shift differentials to make night and evening work more attractive and change working hours to allow nurses more time with their families. "Because shift work and holiday work is never going to go away, and we have to work nights and weekends because people need nurses, the money needs to be spent in a way that makes those shifts better for human beings' lifestyles."
Bentley agreed and went even further, "We need to [be innovative] with things like onsite day care, onsite adult care because many of us have aging parents, and new educational arrangements between schools and hospitals. We need to make kids aware of health care opportunities. Most kids today are unaware of the types of careers we have. The only time they see a nurse is in a physician's office. There are a huge number of career opportunities in the hospital field that young people don't see. We need to sponsor Explorer Scout programs, Girl Scout programs and look at how we use Candystripers.
"We also need to create career ladders. We need to tell people about the opportunities for career progression. And we're also working with nurses to restore or build respect, so we don't have people leaving the institution every day telling their friends, 'I wouldn't do this again.'"