Since its early history, nursing as a profession has always been seen as a calling of dedication, sacrifice, and commitment; indeed, nurses are among the few noble professionals today. Despite the fact that nursing practice has come a long way in terms of expansion of knowledge and improvement of techniques, it still faces major challenges that threaten to severely cripple service delivery in healthcare setups around the world. Alarmingly, some of these challenges have a predilection to affect developed nations; which have a relatively better organized and comprehensive healthcare sector than their less-developed counterparts; a good example of this is the shortage of nurses in the United States. This however does not eliminate the fact that there’s also a need to address the delivery of healthcare and nursing practices to the remote and less developed human habitations on the planet.
On the other hand, nurses in the US and around the world have continued to show a remarkable ability to adapt to a rapidly changing medical practice field and dynamic demographic outlooks; and to venture out into new fields of medical services delivery; however, their ability to sufficiently adapt to meet future needs is sufficiently in doubt if some form of concerted and deliberate effort is put in place to mitigate some of the situations that are affecting the proper functioning of nurses.
Among the more nascent problems that have faced the nursing profession is the nursing shortage; this is particularly prevalent in developed countries especially the United States. This, however, has to be distinguished from the absolute lack of healthcare services on all levels commonly witnessed in less developed countries. In the West, the shortage is precipitated by demand for nursing services that far outstrip the supply available. The prevailing shortage is predicted to get worse; as the US government predicts that by the year 2020, there will be a shortage of one million nurses in the country (Buerhaus, 2008).
Several aspects have been incriminated for this shortage; these include the loss of acute care nurses to specialized nurse practitioners; retirement of large numbers of registered nurses as the workforce ages; reduced number of young people choosing nursing as a profession; the reduced ability of nursing as a profession to retain qualified staff; and a difficult work environment (Buerhaus, 2008; Australian Nursing Journal, 2003). All, these factors have resulted in difficulties in replacing the numbers exiting the profession either through natural attrition or through voluntary departure.
Poor working environment
Even without additional difficulties, nursing is a challenging calling; which requires absolute dedication and fortitude. The ability to handle human suffering on a day-to-day basis; and to dedicate oneself to alleviate their agony and sorrow can be taxing even to the best of workers. Unfortunately, nurses are also commonly burdened with a poor working environment that does not seek to augment their efforts in providing proper care.
Nurses are among the most overloaded workers in any industry; they are required to multitask; either by handling more than one task at a time or many patients at the same time. This is not mitigated by the long working hours; physical exhaustion from challenging patient-handling tasks; poor working relations with other players in the industry; and allocation of extra administrative duties to be taken concurrently with nursing ones.
In this light, nursing has continued to receive bad publicity as a difficult and stressful profession; making it unattractive to potential recruits seeking a career in medical practice. Unfortunately, some of this publicity originates from the nurses themselves; thus effectively denying themselves the much-needed fresh blood in the industry. Indeed, it is prudent to admit that a nurse faces challenge levels that are seldom reached by workers in other industries; however, much can be done to improve its public image for the benefit of attracting young recruits to replace the fast-aging crop of nurses (Black, 2001).
Shortage of nursing school faculty
For a profession that requires enforcement of strict qualification guidelines, it is imperative that there be adequate faculty staff to train the required new crop of recruits into the industry. Unfortunately, there has been a severe shortage of qualified doctoral and master’s level staff to populate nursing school faculties. Consequently, many qualified applicants are turned away by nursing schools every year due to a lack of capacity (Buerhaus, 2008; Nurse Educator, 1995). For example, according to the AACN’s report on 2003-2004 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, a total of 15,994 qualified applicants were declined positions in American nursing schools in 2003 alone. Many of these institutions incriminated the lack of faculty as the major contributing factor in the rejection of these applicants.
This situation suggests a lack of preparedness on the part of policymakers in the healthcare delivery sector in the country; since the demand for healthcare would have been anticipated to increase in the future with the population growth, how did these parties plan to cater for the increased demand for nurses if the school did not deliberately increase their respective capacities?
Changing demographic outlooks
There has been a documented change in the demographic constitution of many developed countries; of particular concern is an aging population increases the demand for nurses to care for them. The improved healthcare provision of the 20th century and the concurrent improvement of living standards have resulted in more people living longer than in any other period in the history of man; as such, the life expectancy of developed countries is much higher; and the demand for nursing is indeed expected to increase as the baby-boomers attain the age of 60 years.
The effect of the increased average age of the population has been exacerbated by the rise of chronic diseases as a leading of morbidity and mortality among Americans. Diseases such as obesity, diabetes mellitus, and heart disease that commonly occur as co-morbidities and that require long-term and specialized care are increasingly taking up precious supplies of nursing services. More alarming is the fact that these conditions are increasingly affecting younger people with cases of type II diabetes being seen in children due to an increased prevalence of obesity. Such will only serve to make the shortage worse now and in the future.
As we have already mentioned, nursing as a profession suffers the disadvantage of being perceived as difficult thus attracting fewer recruits relative to other sectors; as such, the average age of practicing nurses has continued to increase; and is estimated to reach 50 years by the year 2010 according to the government report titled Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944). To add to this, nursing has been experiencing a high turnover rate of nurses in hospitals.
Job dissatisfaction and burnout have been incriminated as the leading causes of nursing opting for another profession. This has been caused both by the physical and emotional overload experienced in many institutions. The irony of the matter is that the situation is operating on an appositive feedback system; whereby the sustained exit of nurses from their stations is making the lives of those left behind more difficult due to the shortage and increased workload, thus setting the stage for more exits.
The high turnover of nurses from emergency care can also be attributed in part to the increased diversification of the nursing profession and in particular the rise of nursing practice as a viable alternative for nurses. Many who have the ability to further their professional training are opting to specialize into nurse practitioner often seen as having better working conditions particularly in regards to workload; offering more autonomy, and being more financially lucrative (Duffield et al., 2004).
For a field that operates at the cutting edge of science and technology, medical service delivery has been plagued by a failure to adapt to the ever-changing social, political, and economic landscape of the country. As such, the policies guiding the delivery of health services on a population level have remained virtually unchanged for the last 20 years; and the need for major reforms in this sector has been the bone of contention on many nations. As such, the drive for healthcare delivery has been geared mainly towards the reduction of costs and the allocation of limited resources to cater to a large and increasing population; unfortunately, this means the exploitation of individual nurses to their human limit with no proper guidelines for the amount of workload which an individual of a team can be allocated.
While it may be convenient to point an accusing finger at the government and other regulatory bodies for this mess, it would be naïve not to apportion some of the blame at the nurses themselves; and in particular their advocacy groups. Vital decisions affecting the welfare of nurses (as individuals and as groups) should not have been made without first consulting such representative groups and without these parties raising their concerns regarding the welfare of their members.
This has resulted in a situation whereby many nurses have become disillusioned with the status quo; opting to abandon it altogether; or even worse, advise potential replacements from choosing the profession. Such can be witnessed by the low number of nurses’ children who choose the career of their parents.
The Impact of the Nursing Shortage
Nurses play a key role in the continuum of care to a patient as they form the key linkages between diagnosis, treatment, and recovery. As such, the activities which a nurse undertakes within the time which a patient is under his/her care are crucial in determining whether the patient fully recovers within a short period. It would therefore be prudent to assume that any breaks in nursing care would inevitably result in reduced efficiency of the treatment and recovery process. In a situation whereby a hospital is understaffed with nurses resulting in overloading of the inadequate staff, it, therefore, would only be safe to assume that the safety of the patient is grossly jeopardized; and that some mortalities and complications can be directly attributed to inadequate nursing care; and that they were completely preventable.
Indeed, many studies have linked the shortage of nurses with poor patient outcomes; increased risk of patient mortality; increased incidence of medical errors; and increased incidence of preventable complications and co-morbidities. This scenario increases the cost of healthcare services as more money is spent to care for preventable conditions. Additionally, the situation also exacerbates the shortage since more human resources are allocated to the management of acute conditions that have become chronic due to poor medical outcomes.
The supply and demand of nursing services
The healthcare industry is a labor market affected by the forces of supply and demand as any other. As mentioned before, various factors have led to the imbalance between supply and demand of nurses in the market; with the demand far outstripping supply. As such, an increase in demand results in a shortage; which in turn triggers efforts to recruit more staff and increased compensation for the nurse. What follows is an oversupply of nurses with opposite effects.
American history of nursing is characterized by swings between shortages and oversupply of nurses; this can be attributed to a number of factors including expanding professional options for American women; cycles in hospital and health funding; and changes in the public’s perception of nursing as a profession (Peterson, 1999). Today, the American market faces a shortage of nurses; in the near future, the dynamics of demand for nurses will be influenced by two major factors. The first one is the aging of the nursing faculty; while the other is the aging of the entire nursing population (Peterson, 1999). All parameters indicate that both of these groups are generally getting older; thus the supply of nurses may not be very sufficient in the future (Black, 2001).
On the other hand, various factors are seen to affect the demand of nurses in the United States; some of these include the healthcare policies; advances in medical technology; the average age of the population; restructuring of the healthcare sector; and economic aspects. All these factors point to the possibility of increased demand for nurses in the future; this is especially for those with baccalaureate or master’s qualifications (Peterson, 1999).
Many efforts are already in place trying to mitigate the current and projected shortage; high salaries are attracting a good number of hopefuls to the profession with the shortage of nursing faculty being a major impediment to mass recruitment of nurses; indeed many nursing schools have required the applicant to apply for vacancies first and turning away unsuccessful ones. With time, it is only obvious to predict a time when there will be an oversupply of nurses in the market.
The dramatic swings between supply and demand have been postulated to have negative effects on the quality of care that the patients receive; and have been blamed for destabilizing the nursing profession. Additionally, wastage in the system results in losses of a huge amount of money and invaluable human resources (Peterson, 1999). Better planning and proper consultation with the active participation of nurses would see a reduction in these fluctuations of demand and supply.
As mentioned before, the increased demand for nurses has seen a trend of increase in salaries offered as many healthcare facilities seek to attract and retain nurses. In general, there has been an increase in the salaries of nurses; however, various factors influence the amount of increase seen; these include the level of education, specialization, level of experience, certification, and geographic location of the healthcare facility (Robinson & Mee, 2003). On average, the salary increase for the year 2003 for nurses at all levels of care was 3.21%; additionally, 15% of respondents to the 2003 survey reported annual incomes of $65,000 or more. This is an increase compared to 8% and 4%, respectively, in the previous 2 survey years.
As mentioned before, increasing salaries have the effect of increasing the number of people interested in a particular career path; this has been seen as the inability of nursing schools to absorb all of the applicants. Additionally, high wages have attracted foreign-trained nurses who immigrate to the United States through special arrangements aimed at reducing the prevailing shortage. A continued influx of nurses in the market can only precipitate a future reduction in wage increase thus triggering a mass exodus.
Cultural sensitivity in nursing
The issue of nursing shortage has been shown to have a direct effect on patient outcomes, and by the extent to the health of the population. While changes in the age parameters of the American population have significantly affected the supply and demand of nurses, changes in other parameters have also contributed to the challenges facing the average nurse in a healthcare setup. Of particular concern is the increased ethnic and cultural diversity of the American population.
Cultural insensitivity can be a severe impediment to the delivery of efficient services by a nurse (Souers, 2009); therefore creating a bottleneck that further worsens the prevailing shortage. While many institutions of learning and practice have tried to incorporate aspects of cultural sensitivity into academic and professional training, these efforts remain disjointed and reactive to challenging situations on the ground. Indeed, a more concerted and institutionalized effort is needed to bring the nursing population to full cultural sensitivity; thereby improving the efficiency of service delivery (Souers, 2009).
Possible Solutions to the Nursing Crisis
As mentioned before, various efforts are already underway to reduce the current and projected shortage of nurses in the United States. Among the more controversial is the recruitment of foreign nurses; on one hand, recruiting a foreign nurse would save considerable time and money in training undertaken in a different country. Additionally, this would be an immediate solution to the problem. On the other hand, the practice of changing immigration laws to favor foreign recruitment would mean that the systems that should ideally be developed to handle the challenge would remain ineffective thus putting the country at major risk should this alternative prove unviable in the future. Additionally, such practice would only deny the source-country their trained professionals, thus leaving them equally at risk.
Another effort has been aimed at increasing the number of young people choosing nursing as their preferred profession. Such efforts include hosting high school students in educational camps to allow them to discover their affinity for nursing (Daumer & Britson, 2004). These types of efforts should, however, be also accompanied by an increased capacity of nursing faculty (Nurse Educator, 1995). Additionally, recruitment drives should be aimed at underrepresented population groups such as men and ethnic minorities (Buerhaus, 2008). Such would function not only to bring diversity to the profession but also to inject much-needed new lines of thinking.
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