## Nursing Shortage

  
  
"Nurses are a critical part of healthcare and make up the largest section of the health profession." (Haddad) With more than more than 3.1 million registered nurses practicing nationwide, nursing is amongst the nation's largest healthcare profession. According to the American Nurses Association (2018), there is said to be more nursing positions available through 2022 than any other profession in the United States. The US Bureau of Labor Statistics projects 1.1 million additional nurses will be needed to address the nursing shortage.  
  
Nursing shortage: the inadequate number of qualified nurses to meet the project demand for nursing care within healthcare settings, where the demand for nurses is greater than supply. (American Association of Colleges of Nursing)  
  
The reports of nursing shortages began surfacing the United States in the twentieth century. "It was one of the first in a series of nurse shortages that plagued the U.S. health-care system." ("Where Did All The Nurses Go?") Illustrating ways by which nursing shortages have developed and the solutions used to address them, each nursing shortage has been unique, particularly in the context in which it occurred. In the 20th century, nurses were trained basic healthcare skills as well as hospital etiquette, such as how to address patients, how to dress, and treat patients as if they were guests in their home. The health care setting at this time was exclusive to in home visits or on the battlefield. Medical skills were acquired from other women in the same profession, not seen by others as a respectable trade. Hospital visits were reserved for those who were extremely ill, badly injured or nearing death. During World War II, nurses had begun to shy away from the profession as a result of being seen as unprofessional, enduring the demanding schedules, and having financial instability. As a result, the nursing shortage of this time lead to unfavorable nurse to patient ratios. The nursing profession has changed drastically since then. The medical settings for nurses now are: hospitals, doctor's offices, home health services, assisted living facilities, insurance companies, military, etc. Nurses take on greater responsibility than they had done so before and are known to be respectable medical professionals because of their extensive schooling and real world application of skill. The advancements in technology have helped saves lives, made jobs easier, and created better experiences for patient care. The advancements over time, have transformed the nursing profession from being one that isn't reversed but one that now deserves respect.  
  
In 2016, The Bureau of Labor and Statistics released their findings for projected employment growth between 2016 and 2026. It shows that the expected need for registered nurses will rise from 2,955,200 to 3,393,200, which is an increase of 15%. (Bureau of Labor Statistics) This increase in the need for RNs can be attributed to the follow contributions: rise in the baby-boomer population, faculty shortage, and job dissatisfaction.  
  
Registered Nurses (RNs) are the largest group of health professionals in the United States. The baby boomer generation, those born in the years immediately following World War II have reached adulthood, contributed to advancements in the medical field and are nearing retirement. The birth rates of Americans had skyrocketed during that time. "By 1990, baby-boomer registered nurses (RNs) numbered nearly one million and comprised about two-thirds of the RN workforce" (Buerhaus, et al) The seniority cohort has accumulated substantial knowledge and clinical experience over time. Many of those retiring have accumulated decades of knowledge and skill. The retirement wave of baby boomers will create a drain on clinical expertise and institutional knowledge. An average of 10,000 baby boomer nurses will reach age 65 every day, which is historically known to be the retirement phase of life. As a result, an abundance amount of baby boomer nurses will retire, collect social security and receive Medicare coverage. Baby boomer nurses are leaving the hospital at a time when the aging population is expanding and more care is required as a result.  
  
In effort to solutionize this factor, hospital facilities should identify which nursing units, departments, and patient populations will be directly affected. It is crucial that this information be uncovered that way preventative measures can be taken, in anticipation that nurses will retire at some point. The hospital can anticipate that they will need to recruit or hire additional nurses to fill their positions. In addition, hospital leadership should prioritize engagement with soon to be retiring RNs to learn what can be done to delay their retirement. For example, offering fewer shifts, modifying responsibilities and offering bonus incentives. By postponing retirement, baby boomer nurses can anticipate higher benefits and savings as well in aspects of social security, pension and health insurance. Offering incentives to employees to stay with their facility longer bridges the staffing gaps. Allowing baby boomer to have flexibility within their jobs keeps them invested and willing to stay longer. By offering these incentives, baby boomer nurses can optimally receive higher wages to fill gaps in scheduling, have priority over preferred holiday they want to work so that the hospital is able to retain and leverage the existing staff they currently have. In addition, train future RN leaders with soon-to-be retiring RN in management positions providing assurance knowing that they are well-prepared to assume the management of clinical or administrative operations.  
  
Faculty shortage has applied to the inability to produce more nurses due to limitation in capacity with accredited nursing professionals. Qualified students are turned away because of the faculty shortage. Prospective nursing students feel the impact of this as the competition for admission increases, with wait lists as long as 5 years. "Budget constraints, aging instructors, and increasing job competition from clinical sites have all contributed to a shortage of faculty at nursing schools across the country." ("Nursing Faculty Shortage") Nursing professors are required at minimum to have a masters degree in nursing and several years of practical nursing experience. According to the U.S. Bureau of Labor Statistics, the median annual salary for nursing instructors and teachers is $69,130. The lack of faculty to teach aspiring nursing students contributes to the nursing shortage. Twenty seven thousand nurse educators are expected to retire by 2023. Theoretically speaking, those that pursue nursing want to typically practice in the field. If they earn a master or doctorate degree, they can earn more money than they would as nurse educators. In effort to minimize the impact of faculty shortages on the nation's nursing shortage, the American Association of Colleges of Nurses is leveraging its resources to secure federal funding to generate more nursing professionals.  
  
Academic administrators and faculty must explore and examine new strategies for retaining the expertise of their productive senior faculty as they enter the retirement phase of their career. The shortage of faculty is a result of faculty age, salary differentials, and faculty workload and role expectation. Similar to the aging nurses retiring, faculty members should be offered incentives as well for the purpose of facilitating satisfaction and productivity in their position by decreasing full time faculty and increasing part time faculty. Incentives offer creative approaches that will which encourage baby boomer nurses to continue teaching. This can be achieved by creating opportunities to develop new programs, lower teaching hours, and project focus on research. In effort to strategize this, facilities can attract younger nurses to faculty positions. By obtaining federal funding for younger facility, this could offer advancement in career. In addition, financial incentive programs could offer scholarships, loan repayment or loan forgiveness in exchange for teaching commitment.  
  
Nurses work under increasingly difficult circumstances. The strain of treating difficult and increasingly ill patients lead to stress and job attrition. Research shows that hospitals with better nursing staff and work environments have greater nurse outcomes where less burnout, job dissatisfaction and intention of leaving the job are present. Nurse burnout is a result of chronic overwork and sustained lack of job fulfillment and support; in long run, leads to job dissatisfaction and affects patient outcomes. Job dissatisfaction can be a result of: staff levels, work environment, benefits and work hours. In addition, nurse burnout affects patient satisfaction levels. Patient happiness and nurses who acquire adequate support and relationship with staff over time are likely to have greater satisfaction with their profession. Nurses leave the nursing profession out of concern for themselves. This can result if profession does not pay enough to support their family or the benefits aren't to their expectations. In addition, it can be a result of being in an unfriendly workplace. As a new RN, one can anticipate that nurses that they work with have been in the profession for a while therefore they will act better than you for they have been there longer than you. At the end of the day, everybody is human and one can only handle so much.  
  
Leadership is the vision of a transformed healthcare system. While a nurse may not begin their career with thoughts of becoming a leader, leadership skills and competencies are acquired over time. Leadership in the nursing profession should involve working with others in a context of respect and collaboration, which in turn contributes to patient safety and quality of care. Recognizing an employee for their accomplishments speaks volumes. While workspace is shared in the nursing profession, personalized presentations, certifications and recognition build teamwork by showcasing one's extraordinary performance. Career advancements create new opportunities for nurses, which in turn bring increased salary and additional responsibilities.  
  
In spite of these proposed solutions, with demanding currently exceeding supply, the nursing shortage will likely not diminish in the near term. The nationwide demand for RNs is projected to grow and will result in a surplus in excess of RNs by 2025. There is hope in the near future.  
  
Due to the shortage, the lack of inadequate nurses has an inevitable impact on the quality of care received by patients. The delivery of care for patients in the hospital is complex and requires efforts from many health professionals. An insufficient supply of essential personnel, is a stressor, a red flag, for the facility. In situations like such, nurses need to cross train or pick up additional shifts to fill the demand for what is needed. Cross training develops professional and interpersonal skills such as: increased knowledge, improved efficiency, greater understanding & empathy and greater flexibility and adaptability.  
  
Shifting focus of this paper to first person, I have personally encountered this shortage. As a newborn hearing screener, my job is centered around communication with nurses and their patients. The past couple of shifts nurses have had to cross train and work on various floors for the shortage has impacted those who needed medical attention. In addition, the amount of registered nursing positions available on any hospital career page site, it is pages long.  
  
The nursing shortage not only impacts the patient but also the facility and the other nurses in the workforce. Hospital facilities need patients to make money and stay in business. If they have to turn away patients because they can't accommodate the demand, they are losing business. Constant and prolonged understanding undermines the long term health and success. Those nurses that remain in the workforce can find themselves in high demand at significant costs. Unmanageable workloads are physically, mentally and emotionally exhausting with no relief in site, where job dissatisfaction rises.  
  
In conclusion, the nursing shortage has been a persistent issue since the turn of the century. There is no single measure of what has caused this nursing shortage specifically but rather abundant resources to support what the contributions to the issue have been: baby-boomer population retiring, faculty shortage, and job dissatisfaction. Nurse researchers, educators, clinicians and administrators need to work together to actively deal with the issue of nursing shortage. All healthcare professionals should collaboratively work together in a way so that nurses feel more satisfied and committed to their profession. Nurses will get past this nursing shortage.