The New Nursing Shortage Why It Is What We Can Do About It.

The New Nursing Shortage

Why It IsWhat We Can Do About It

Connecticut Nurses’ Association

What is happening? The burden of care for nurses, patients and

families has demonstrably increased since 1990 Nurses and families are very concerned about the

erosion of care and fearful about hospital safety Nurses report increasing dissatisfaction with their

work in hospitals that have cut staff, that require frequent overtime, and have replaced nurses with assistive personnel

Research has shown that these phenomena are related to adverse nurse and patient outcomes


ANA Survey of 7300 nurses 75% feel the quality of nursing care

at the facility in which they work has declined over the last 2 years

40% would not feel comfortable having a family member cared for in the facility in which they work

54% would not recommend their profession to their children or friends

50% feel exhausted and discouraged when they leave work


ANA Survey of 7300 nurses 44% are discouraged and saddened

by what they couldn’t provide for their patients

40% feel powerless to effect change necessary for safe, quality patient care


Tightening Supply Aging of the nursing workforce Nurses leaving bedside care roles Decline in student enrollments Shortage of nursing faculty


Safety Issues AHA/ Picker Institute Survey – 1997: The

perceived “thinness” of hospital nurse staffing was reflected in a universally mentioned experience: “If I hadn’t stayed in the hospital room with my mother (or child or spouse), they never would have gotten the correct medication or care on time”

Dr. Don Berwick – Institute for Healthcare Quality Improvement: “so many of my colleagues and friends have told me they were afraid to leave their loved one in the hospital for fear that something bad would happen”


Safety Issues Decreased RN staffing is correlated with

increased medication errors Nurses who had only an associate degree

were more than nine times as likely as those with a bachelor of science to be charged with violations

Broadening nursing assistants’ responsibilities to include seemingly routine tasks has a negative effect on the quality of the information available to physicians and nurses and also leads to medication errors (Preuss 1998)


Safety Issues Both nurses and

physicians reported that heavy workloads caused nurses to postpone or miss tasks

Nurses described a troubling erosion of their capacity for empathy because of the difficulty they had finding time for even basic physical care


Pay Issues Stagnant for last 5 years Not competitive with

other options for women


Regulation and Licensing Establish standards for safe patient care,

while acknowledging the extraordinary difficulty of doing so

Establish training standards and competency (certification) exams for previously licensed personnel, through both national and hospital-based strategies

Find new ways to regulate the sites in which nurses practice (for example, closing beds when RN staff is reduced below a particular level and adding clinical nurse specialists to units)


Regulation and Licensing Require that clinical assignments be given

only to persons qualified to perform them Require that all staff performing clinical tasks

be properly identified Prohibit the use of mandatory overtime Encourage state legislatures to establish

commissions on nursing Establish licensing requirements that reflect

the different capabilities of nurses with different educational credentials


Financing There is an absence of effective

reimbursement incentives for quality care in general and nursing care in particular

There is a lack of funding for clinical training costs of nursing education


Role of Governing Boards Become more systematically

involved in overseeing the quality of care.

Request that the senior nurse executive attend all board and executive committee meetings.

Elect more nurses to hospital boards


Recruiting and Educating Nurses

Improve work conditions, compensation, and benefit packages

Recruit among high school students Tie repayment and forgiveness of

educational loans and grants to the recipient remaining in nursing, in hospitals and other health care agencies, for periods of time related to the extent of support granted


Recruiting and Educating Nurses Make nursing education more efficient

by reducing the number of nursing schools in community colleges and increasing capacity in baccalaureate and graduate degree programs

Increase faculty capacity to educate nurses through the use of distance learning


Organization of Nursing Services in Hospitals Have a strong chief nurse executive with the

formal power to act as an advocate for both patients and nurses

Adopt the ANA Principles of Nurse Staffing, either as an industry standard or by regulation

Require hospitals to report nurse-to-patient ratios publicly on a regular schedule

Establish protocols to prevent the circumvention of technologies designed to prevent medical errors


Organization of Nursing Services in Hospitals

Establish a more effective standard hierarchy of expertise in nursing service

Provide opportunities for education and career progression for all hospital positions

Require hospitals to collect and report better data related to the quality of nursing care and patient outcomes

Encourage hospitals to improve working conditions in order to be eligible for Magnet Hospital Recognition


10 Nursing-Sensitive Quality Indicators for Acute Care Settings Mix of RNs, LPNs, and Unlicensed Staff Caring

for Patients Total Nursing Care Hours per Patient Day Pressure Ulcers Patient Falls Patient Satisfaction with Pain Management Patient Satisfaction with Education Information Patient Satisfaction with Overall Care Patient Satisfaction with Nursing Care Nosocomial Infection Rate Nurse Staff Satisfaction


An Interesting Idea Many hospitals will boost nursing pay scales

and upgrade information systems to improve patient monitoring and record keeping. That is the conventional wisdom. But unconventional wisdom will be to get in line with the core values of the primary caregivers in every health care organization – nurses. Hospitals have thrived by catering to physicians. That was important, and still is. But there are three times as many practicing nurses as active physicians. Becoming a nursing-driven organization would change some fundamental processes at many hospitals and health systems.


Healthcare executives must join their caregivers in putting patients first, and then figuring out how to make money. In any industry, the organization that provides customers with the highest value is the winner. – Russ Coile’s Health Care Forecast


References Arkansas Nurses’ Association Town Hall Forums When Care Becomes a Burden: Diminishing

Access to adequate Nursing by Claire Fagin, PhD, RN, FAAN sponsored by Milbank Memorial Fund

Russ Coile’s Health Care Forecast Special report. Aspen Publishers, Inc. 2001

ANA’s Safety & Quality Initiative & ANA’s Staffing Survey @ www.ana.org/readroom/fssafe99.htm

The New Nursing Shortage Why It Is What We Can Do About It.

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