Nursing Shortages: what is the real problem?
In recent years, the nursing shortage has attracted both local and national attention. It also has and generated scores of studies. Unfortunately, in my opinion, many of these studies focus on solutions that, while popular, have no real hope of solving the problem at hand.
Many of these studies were sponsored by managements and were geared to improving recruitment and retention without spending a lot of money. The proposals always touted were to expand the students in nursing schools, improving the image of nursing and instituting superficial workplace reforms aimed at generating team spirit. None of the most common proposals ever really look at changing the underlying reality of stress in the workplace.
In 2001, more than 25 state laws were enacted to address the nursing shortage. Two-thirds of these were designed to encourage more students to go into nursing programs. In September 2001, Secretary of Health and Human Services Tommy Thompson announced a program to give $27.4 million worth of grants and contracts to institutions of higher education to increase the number of future RNs. He commented; “it's absolutely critical that we encourage more of our nation's students to choose careers in nursing.” He went on to say “he wants students to realize that nursing is an exciting and satisfying career that makes a difference in people's lives." These are very altruistic statements, but throwing money at the problem in this manner won’t fix the real underlying problem.
These were probably well-intentioned ideas. But they were misguided. The nursing shortage can most quickly be solved not by expanding the number of students in nursing programs but by improving working conditions so that existing but currently non-working RNs will choose to return to the profession. There are thousands of good, quality nurses who have left the profession. Producing more graduates of nursing schools will do little good if these nurses become disillusioned and drop out after a few years of hospital work like the ones have done thus far. This, in fact, is exactly what the evidence suggests. Recently graduated RNs are no more satisfied with their jobs than are older nurses. The Nursing Executive Center reports that 31 percent of nurses under age 24 changed hospitals within the past two years, as did 20 percent of nurses older. All were looking for something they can’t find.
If the conditions on the job are not improved, the turnover rate will continue to be a huge problem. It will be like pouring water into a bucket with holes and wondering why it never fills up. Hoping that student nurses won't discover the downside of their profession until it's too late is not a wise approach. Inevitably, even beginning nurses will start thinking about leaving once they realize the realities of their chosen occupation.
To solve the workforce crisis, individual hospitals need to recruit new employees into the organization and then make appropriate changes to retain them. Retention is more important then recruitment.
Management in most hospitals address the nursing shortage by offering recommendations aimed at superficial improvements in the workplace atmosphere without significant change in the basic parameters of the job. Organization like the American Hospital Association has advocated hospitals to "increase the time caregivers can spend in the actual care of patients." But their recommendation for achieving this goal has nothing to do with staffing levels. Instead, they encourage hospitals to "introduce new technologies that reduce paper records and the repetitive entry of information." This so-called technology sounds good when you’re not the ones trying to implement it. If there were no learning curve and everything worked precisely as envisioned, it might be easier. But in reality, nurses spend more time doing paper and computer work and even less time with patients. If computerization and technological advances are not implemented together with staffing improvements, they will prove futile.
The problems that are driving nurses out of the industry are global rather than individual or idiosyncratic. Changes to improve retention such as weekly staff brainstorming sessions, a nurse-manager open door policy, suggestion boxes, physician-nurse communication programs, unit equipment audits, a personal nurse-manager skills improvement plans, thank you grams or CARE awards all constitute worthwhile initiatives; but won’t fix the problem.
Patients are sicker and require faster, more tests and procedures in a shorter period of time. Nurses are relational and want hands-on patient care. None of the above strategies will work long-term without increased staffing at the bedside.
Cost is always brought up as the reason staffing levels are maintained at these levels. But in the long run, we cannot afford to continue along this path. To keep nurses in their fields, we need to allow them to do what they do best; take care of patients. This requires more staffing.
Many of these studies were sponsored by managements and were geared to improving recruitment and retention without spending a lot of money. The proposals always touted were to expand the students in nursing schools, improving the image of nursing and instituting superficial workplace reforms aimed at generating team spirit. None of the most common proposals ever really look at changing the underlying reality of stress in the workplace.
In 2001, more than 25 state laws were enacted to address the nursing shortage. Two-thirds of these were designed to encourage more students to go into nursing programs. In September 2001, Secretary of Health and Human Services Tommy Thompson announced a program to give $27.4 million worth of grants and contracts to institutions of higher education to increase the number of future RNs. He commented; “it's absolutely critical that we encourage more of our nation's students to choose careers in nursing.” He went on to say “he wants students to realize that nursing is an exciting and satisfying career that makes a difference in people's lives." These are very altruistic statements, but throwing money at the problem in this manner won’t fix the real underlying problem.
These were probably well-intentioned ideas. But they were misguided. The nursing shortage can most quickly be solved not by expanding the number of students in nursing programs but by improving working conditions so that existing but currently non-working RNs will choose to return to the profession. There are thousands of good, quality nurses who have left the profession. Producing more graduates of nursing schools will do little good if these nurses become disillusioned and drop out after a few years of hospital work like the ones have done thus far. This, in fact, is exactly what the evidence suggests. Recently graduated RNs are no more satisfied with their jobs than are older nurses. The Nursing Executive Center reports that 31 percent of nurses under age 24 changed hospitals within the past two years, as did 20 percent of nurses older. All were looking for something they can’t find.
If the conditions on the job are not improved, the turnover rate will continue to be a huge problem. It will be like pouring water into a bucket with holes and wondering why it never fills up. Hoping that student nurses won't discover the downside of their profession until it's too late is not a wise approach. Inevitably, even beginning nurses will start thinking about leaving once they realize the realities of their chosen occupation.
To solve the workforce crisis, individual hospitals need to recruit new employees into the organization and then make appropriate changes to retain them. Retention is more important then recruitment.
Management in most hospitals address the nursing shortage by offering recommendations aimed at superficial improvements in the workplace atmosphere without significant change in the basic parameters of the job. Organization like the American Hospital Association has advocated hospitals to "increase the time caregivers can spend in the actual care of patients." But their recommendation for achieving this goal has nothing to do with staffing levels. Instead, they encourage hospitals to "introduce new technologies that reduce paper records and the repetitive entry of information." This so-called technology sounds good when you’re not the ones trying to implement it. If there were no learning curve and everything worked precisely as envisioned, it might be easier. But in reality, nurses spend more time doing paper and computer work and even less time with patients. If computerization and technological advances are not implemented together with staffing improvements, they will prove futile.
The problems that are driving nurses out of the industry are global rather than individual or idiosyncratic. Changes to improve retention such as weekly staff brainstorming sessions, a nurse-manager open door policy, suggestion boxes, physician-nurse communication programs, unit equipment audits, a personal nurse-manager skills improvement plans, thank you grams or CARE awards all constitute worthwhile initiatives; but won’t fix the problem.
Patients are sicker and require faster, more tests and procedures in a shorter period of time. Nurses are relational and want hands-on patient care. None of the above strategies will work long-term without increased staffing at the bedside.
Cost is always brought up as the reason staffing levels are maintained at these levels. But in the long run, we cannot afford to continue along this path. To keep nurses in their fields, we need to allow them to do what they do best; take care of patients. This requires more staffing.
posted by Anonymous at 5:49 AM
1 Comments:
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