Overview•All nations are facing a nursing shortage related to increased demand and decreasing supply, an aging nursing workforce, a shortage of other professional staff, increasing acuity of illness, a poor image of nursing, health sector reform (Mason, Leavitt, & Chaffee, 2012)•Expected number of employed nurses will grow from 2.74 million in 2010 to 3.45 million in 2020, an increase of 712,000 or 26%. Replacements and growth in the nursing workforce brings the total number of job openings for nurses to 1.2 million by 2020 (AACN, 2012)•U.S. Bureau of Labor Statistics confirmed that 296,900 jobs were added to the healthcare sector in 2011, making nursing the top occupation in terms of job growth (AACN, 2012)•Pseudo-shortages exist in countries when there are enough nurses in the country but when post are not funded and /or nurses are not willing to work under conditions available (Mason, Leavitt, & Chaffee, 2012)•Nursing shortages must be addressed in the United States before global funding for health care is allocated to different departments or other health care professionals. Addressing problems on our nations home front needs to take precedence in order to better help global efforts down the road

Risks and Benefits to Stakeholders•Effects of the nursing shortage lead to an increase in patient mortality, higher failure-to-rescue incidents, higher rates of infection, and longer hospital stays for patients•March 2011 study linked insufficient nurse staffing and higher patient mortality rates. 198,000 admitted patients and 177,000 eight-hour nursing shifts across 43 units at large academic health center records were analyzed. Data shows a 6% higher mortality risk of patients who were on units that were understaffed compared to fully staffed units (AACN, 2012)•Research links baccalaureate- prepared nurses to lower mortality and failure- to rescue rates. Future efforts must prepare more baccalaureate- prepared nurses to ensure high quality and safe patient care •Shortage of registered nurses in combination with an increased workload poses a potential threat to the quality of care•An article published in Nursing Economic$ found that the majority of RNs (79%) and Chief Nursing Officers (68%) believe the nursing shortage is affecting quality of patient care. Most hospital RNs (93%) report major problems with having enough time to provide safe patient care, detect early complications, and collaborate with other interdisciplinary team members (AACN, 2012)

Impact/ Severity of Nursing Shortage•Shortage of nursing school faculty is limiting nursing program enrollment

2011-2012 AACN report showed U.S. nursing schools turned away 75,587 qualified applicants from baccalaureate and graduate nursing programs due to insufficient number of faculty (two-thirds percent), clinical site, clinical preceptors, and budget restraints

In a February 2002 study, a combination of faculty vacancies (432) and newly budgeted positions (350) points to a 12% shortfall in the number of nurse educators needed (AACN, 2012)

•Average age of the Registered Nursing is increasingMedian age of nurses is 46. More than 50% of the nursing

workforce is nearing retirement (ANA, 2013)•Changes related to the increasing age of the U.S. population indicates the need for more nurses

Baby boomers reaching 60 years of age and beyondRatio of potential caregivers to the people most likely to

need care (elderly population) will decease by 40% between 2010 and 2013. Access to care and increase in the number of caregivers must occur to decrease this statistic (AACN, 2012)

•Rising level of stress and job dissatisfaction driving many nurses to leave the profession•Turnover and vacancy rate

13% of newly licensed RNs had left profession after one year and 37% reported that they felt ready to change jobs (AACN, 2012)

Bernard Hodes Group released national poll in 2005 with results showing of 138 health care recruiters, the average RN turnover rate was 13.9%, vacancy rate of 16.1%, and the average RN cost-per-hire was $2,821 (AACN, 2012)

•Passage of the Patient Protection and Affordable Care Act in 2010 will lead to more than 32 million Americans soon gaining access to healthcare (DeParle, 2010). This is detrimental in regards to the current nursing shortage•On a positive note, AACN reports a 5.1% increase in enrollment in entry-level baccalaureate programs in 2011. Unfortunately this increase is not sufficient to meet the projected demand for nursing services

Potential Solutions American Association of Colleges of Nurses suggests:

Faculty-•Passing the NEED Act, which would amend Title VIII to authorize Capitation Grants for nursing schools to increase the number of faculty. This act has proven to be successful in 2004 and is planned to be reintroduced in the spring•Many statewide initiatives are underway to address nurse educator shortages. Initiative to start private-sector funding that partnerships to bring in new money to hire more nurse faculty and educate more students•U.S. Department of Labor award $12 million in grant funding to help nursing faculty shortage in June 2005

Students-•Expansion of NursingCAS- service sponsored by the AACN that allows students to use a single online application to apply to multiple nursing programs at participating schools. Making educations readily available is crucial in filling the vacant seats in nursing programs•Recommendations to require all new nurses to complete a BSN program within 10 years of licensure. This helps to achieve better prepared baccalaureate and graduate level nurses which increases the quality of care and maintain patient safety•Nursing schools are forming strategic partnerships and seeking support from local health systems to increase funding to educate more students in return of an employment commitment after graduation

Facilities-

•Partnerships between local nursing schools•Creating healthy and comfortable working environments•Using resources, for example technology, as training tools•Designing more flexible roles for advanced practice nurses allowing more autonomy and independence

Media and the Nursing Image-•Johnson & Johnson (one example) launched a Campaign for Future Nurses- multimedia initiative to promote career and polish image. Campaign included television commercials, a recruitment video, a Web site, and brochures

Implementation

Four Main Recommendations from the IOM report, The Future of Nursing: Leading Change, Advancing Health

(Institute of Medicine, 2013)1. Nurses should practice to the full extent of their education and

training2. Nurses should achieve higher levels of education and training through

an improved education system that promotes seamless academic progression

3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States

4. Effective workforce planning and policy-making require better data collection and information infrastructure

• The listed recommendations address the problem issues related to the United States current health care system. Only after fixing these issues should global health care funding be tackled. How can the U.S. mentor other developing countries when we are struggling ourselves? The nursing profession has the largest workforce in health care. Making positive improvements and retaining more nurses will help the shortage and lead to better patient outcomes that we can then use to educate other countries.

Evaluation •The United States is nursing strong. The above action plan is a start in the right direction to decrease the nursing shortage. Using public and private funding to aid in the expansion of the U.S. nursing workforce must be used first before funding can be delegated to developing countries. Once the nursing shortage begins to decrease and patient outcomes begin to improve, we will then know that our efforts were effective. Modifications can be made along the way for improvements. Once we have a grasp on our health care system, we can then share our knowledge and funding with other nations.

U.S. Funding for Global Health- Nursing Perspective Megan Tingler BSN-SN

NUR 4030

REFERENCES

American Association of Colleges of Nursing. (2012, August 06). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage

American Nurses Association. (2013). Nursing shortage. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/NursingShortage

DeParle, N. (2010 , September 16). The affordable care act helps america’s uninsured. Retrieved from http://www.whitehouse.gov/blog/2010/09/16/affordable-care-act-helps-america-s-uninsured

Institute of Medicine. (2013, October 10). The future of nursing leading change, advancing health. Retrieved from http://www.rwjf.org/en/research-publications/find-rwjf-research/2010/10/the-future-of-nursing.html

Mason, D., Leavitt, J., & Chaffee, M. (2012). Policy and politics in nursing and health care. (6th ed., pp. 711-740). St. Louis, Missouri: Elsevier Saunders.