Introduction
Is this nursing shortage going to be The Big One? Is it The One for which all forerunners have been mere warm-ups? If so, should members of the nursing profession respond with worry and fear, or glee and gratification?
Were it not for the legitimate needs of current and future patients, I might react to the question with a baldly impolitic response - that is, a smug, we-told-you-so glee. But I - or one of my family, or a friend, or a student, or you, dear reader -- might be one of those future patients. And more than most members of American society, we understand how important a good nurse can be to a person‘s recovery. Nope, this is a serious situation about which we need to be concerned.
The seasoned nurse reading these articles on the nursing shortage will be struck by a sense of déjà vu. We‘ve been here before, we‘ve discussed it at length, and, yes, we know what‘s necessary to get us out of it. Unlike previous shortages, however, this one has additional permutations -- an aging workforce, a newly-constrained health care industry, and a booming economy that lures workers into a variety of other pursuits -- but it can still respond favorably to changes we have known were needed for a long time.
Within the past 10 years, the Strengthening Hospital Nursing Program (SHNP), a $25 million national initiative of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, formulated some of the most comprehensive and innovative plans ever envisioned for improving workplace opportunities for nurses. Had those plans been fully implemented across the U.S., it is unlikely we would be facing a nursing shortage of the current magnitude. So why weren‘t they?
In essence, the changes in hospital nursing proposed through the SHNP were overwhelmed at their implementation by the forces of cost containment, managed care, and competition. Therein lies a tale'¦but also therein lies the story of what has often happened to big plans for nursing: Something weighty in the health care environment changes, and there is a shift of priorities. Short-term solutions are implemented, and long-term nursing measures go to the back burner.
The real challenge of this shortage is to use the fear that this may be The Big One for the long-term gain and development of the discipline.
We must expect and be ready for the predictable barriers, large or small, that will move in to block our path forward. And by the way, the primary barrier to action is not money. If money were the fundamental problem, we wouldn‘t be seeing so many large salaries and raises going to members of other health care disciplines, or luxurious new buildings being constructed, or multi-million-dollar marketing and public relations campaigns. As one of our authors has eloquently indicated, the real barrier to action is --and has been -- the failure of institutions to recognize the value of nurses and to invest in them as critical, irreplaceable resources. Until there is true recognition and investment, short-term solutions will continue to generate, at best, mediocre short-term results.
Please join us in exploring the emerging nursing shortage through the following thought-provoking articles:
The article by Cheryl Peterson notes that the nursing shortage will strongly affect health care organizations within the next decade. After 2010, there will be a dramatic widening between the supply of registered nurses (RNs) and the demand for their services. Some states already report difficulty in hiring experienced and specialty nurses, and recruiting time is lengthening. Peterson places the fundamental blame of the emerging shortage on the current nursing environment of care. As a result of multiple factors during the consolidating, care-managing, cost-constraining, acuity-increasing decade of the 90s, the environment of care has both driven practicing nurses out of acute care settings and discouraged new entrants into the profession. The availability of numerous alternative career opportunities has heightened the effect. Unless issues related to the nursing environment of care are addressed, any strategies to increase the overall supply of nurses are unlikely to yield success. Continuing contributory causes to the deselection of nursing are the influences of wage compression and limited career progression over the lifetime of the nurse, and insufficient orientation and mentoring of new nurses. Peterson insightfully notes that recent changes in the health care system have gone unevaluated and without oversight by regulatory agencies--a situation not in the best interests of patients or nurses. She proposes a number of both consensually-supported and creative approaches to addressing the nursing shortage.
Sarah Keating and Karen Sechrist talk about the nursing shortage in California, likely a preview of what will happen soon in other states. California ranks 50th in the U.S. in number of RNs per 100,000 population, with a projected shortfall of 25,000 nurses in the next 5 years. Both absolute numbers of nurses and those with the needed levels of education--baccalaureate and masters preparation--are insufficient to meet demand. This shortage was anticipated, yet there was a marked failure by the public sector and hospitals to take preventative measures. Keating and Secrist describe how a group of nurse leaders founded the California Strategic Planning Committee for Nursing (CSPCN) in 1992, a multi-party collaborative initiative, to develop a master plan for education and practice to ensure an adequate nursing workforce to meet the health care needs of Californians. It maintains reliable nursing workforce data to use in a model forecasting nursing work force needs. Forecasts have enabled CSPCN to conduct strategic planning to ensure a supply of nurses, and elements of their planning have been implemented. The work of CSPCN can serve as a model for other states or regions.
The third article, by Ada Sue Hinshaw addresses the shortage of optimally educationally-prepared faculty and how the shortages of nurses and nursing faculty are linked: each intensifies the other. Schools and colleges of nursing are already reporting difficulties filling vacant faculty lines. She projects that numbers of both masters- and doctorally-prepared faculty will fall short of future need, with the latter further impacting nursing education at the baccalaureate, masters, and PhD levels--preparation levels most needed for future practicing nurses and educators. Further exacerbating faculty shortages is the typically brief post-PhD career span doctorally-prepared faculty have to master the tripartite demands of academic work. Major consequences of the nursing faculty shortage include: limitations on the number of students who can be educated when the shortage of nurses is becoming severe; curtailment of the development of nursing‘s scientific knowledge base; and reductions in the profession‘s leadership influence at organizational, local, state, and national levels. Sadly, these consequences threaten significant advancements made by the discipline in the last 50 years. Hinshaw proposes sound strategies to address both the nursing and nursing faculty shortages, including retention of productive senior faculty, earlier recruitment of new faculty, and placement of the nursing shortages crisis on the national health policy agenda.
Finally, the last article focuses on solutions to the nursing shortage. A potent assertion of these authors is that the public and employing organizations must revise how nurses are valued. Authors Brenda Nevidjon and Jeannette Ives Erickson urge that the profession use the shortage as a catalyst to create a strong foundation for the future. They join other authors in noting that this nursing shortage, driven from the supply side, has some differences from all previous ones: It will be more severe, longer, not responsive to traditional and short-term solutions, and is likely to be global. The article describes trends in society and in the workplace reflecting personal choices people make about their work lives. Proposed ways of addressing the shortage include changes in the workplace, nursing education, adoption of new models of care, and alterations in policies and regulations.
Is this The Big One? You decide. We hope you will find ideas in these articles that mix the familiar and the novel. Please share your reflections, comments, and ideas by writing to OJIN. We will select responses and post them on this issue‘s site in the very near future.
