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Falling Short in the Nursing Shortage: A Look into the Crisis

By

Amber D. Fierro



English102, Section 5232

Dr. Barstack

July 11, 2007

Issue Analysis/APA Format


Do not indent the abstract.

Abstract


The nursing shortage is nothing new to the United States of America. In this issue analysis essay, the causes that are compounding the nursing shortage are examined as well as the actions taken to prevent the shortage from becoming worse. Past nursing shortage causes and the current causes are studied. Most importantly, patient safety is at risk resulting in medical errors that otherwise would never happen. Nurses are also feeling dissatisfaction within their careers and many nurses across the country do not think positively about their field. It is important that the nursing shortage be taken control of [be controlled] before the negative impacts of the deficiency are too great in damage. Together, hospitals, nursing programs, and the government must all work as a team in order to overcome the nursing shortage.
Falling Short in the Nursing Shortage: A Look into the Crisis

Thesis: The United States is in a severe nursing shortage with no relief in sight due to many factors compounding the problem and resulting in compromised patient care and nurse burnout. Good outline; however, to maintain parallelism you need to either use all sentences or all phrases in divisions of equal value. For instance, if “I” is a sentence, then “II” should be a sentence.



  1. A look at past nursing shortages in history may assist researchers by examining the sources and strategies used to overcome past shortages to help facilitate solutions to the crisis today.

    1. During World War I and World war II, needed nurses overseas and in America

  1. During WWI, 23,000 served in hospitals, 10,000 served overseas.

  2. 260 died in the line of duty or from the influenza pandemic.

    1. The depression during the 1930’s

  1. Families could not afford to pay nurses.

  2. Nurses in hospitals were paid by picking up leftover food from kitchen.

    1. By 1940, the government provides funds to create nursing programs.

        1. Congress authorizes one million dollars for assistance in training courses.

        2. within two years, three million

        3. Creation of the United States Cadet Nurse Corps from the Nurse Training Act passed by congress in 1943.

  1. Hospitals and healthcare organizations have experienced shortages in the past, but the current shortage seems to be the most long lasting because there are many factors compounding the problem. .

    1. New appealing jobs in technology with computers

      1. Less stress

      2. Better pay

    2. Baby boomers are retiring.

      1. Leaving without being replaced

      2. Shortage is expected to increase dramatically.

    3. Nursing Schools

      1. Limited faculty

      2. Limited seats, and clinical sites

      3. Qualified applicants are turned away or have to wait.

    4. Job dissatisfaction

      1. Dangerous with high nurse to patient ratios

      2. Working extra shifts and long hours to compensate

      3. Feel underappreciated

  2. Patient safety is compromised with the nursing shortage leaving hospitals a dangerous place to be as a patient..

    1. High patient to nurse ratio

      1. Hospitals have policies for nurse to patient ratio safety, but becoming more difficult

      2. Harder to complete doctor’s orders on time

    2. Less time spent with patients

      1. Teaching time with patient is less.

      2. Critical assessments and prevention are missed.

      3. Communication with patients and families are is decreased.

      4. model to practicing holism is incomplete, RO ethics are at risk.

  3. Nursing schools, hospitals and the governments are all working together to help ease the nursing shortage crisis and change the image of nursing from negative to a positive and respectful profession..

    1. Offer nursing school grants for faculty

      1. Nursing schools have a difficult time recruiting faculty because they cannot compete with hospital pay.

      2. More faculty will equal more seats that are available for qualified applicants.

    2. Hospital incentives

      1. Incentive pay and short training for nurses whom no longer practice, but want to return to the profession

      2. Sign-on bonuses and student extern programs

      3. Tuition reimbursement programs

    3. Government assistance

      1. The Nurse Reinvestment Act

      2. Grants to nursing schools

      3. Scholarships for nursing students

      4. Army Nursing Corps

Falling Short in the Nursing Shortage: A Look into the Crisis

The nursing shortage most likely does not mean a great deal to people until they are in the care of a nurse. The United States is in a severe nursing shortage with no relief in sight due to many factors compounding the problem and resulting in compromised patient care and nurse burnout. Nursing shortages have been experienced in the past by the United States and have been overcome them with team effort. [parallelism] However, the current shortage is proving to be the most complex and great strides are being made to defeat the crisis before it becomes too difficult to change. Researchers anticipate that by 2010, the United States is projected to will need almost one million more registered nurses than will be available (Cherry & Jacob, 2005, p. 30).

The term “nursing shortage” is not new to America. In fact, the United States has

past experiences with such shortages. It is important to recognize past nursing shortages because the events will assist researchers in examining the sources and strategies used to overcome the nursing deficit and facilitate a solution to the current crisis.



During World War I and World War II, America called upon thousands of women to become nurses for their country to help in hospitals and overseas units. America’s calling was considered a success and by the end of World War I, 23,000 nurses served in Army and Navy cantonments and hospitals, 10,000 served overseas, and 260 either died in the line of duty or from the influenza pandemic (“Nursing Reflections”, 2000, p. 18). In the early 1930s, nurses experienced the devastation of the depression. Families were very poor and unable to feed themselves let alone pay for a nursing visit. This caused many nurses to seek work elsewhere. Nurses who were lucky to be employees in hospitals during this time were given compensation with leftovers from the kitchen at the end of the day. America continued to grow stronger and become financially stable. The surge of stability and strength led to many jobs such as nursing to flourish. Awkward wording By 1940, the government was providing funds to help create accredited nursing programs. Congress approved one million dollars towards creation of nursing programs. These new programs showed impressive success and the funds expanded to three million within two years. In 1943, the Nurse Training Act passed in legislation that led to the creation of the United States Cadet Nurse Corps (p. 47). What source? This attracted many women to nursing because it provided 36 months of free education, student stipends, room and board, and a promising career. Figure A shows one of many famous advertising posters used to attract women to train for a nursing career. America continued to prosper; hospitals were working along side nursing programs and the government to bring a positive image to the nursing field. Nursing was on its way to finally being recognized as an imperative and honorable role in healing by women and men.



Figure A


United States Cadet Nurse Corps Advertisement poster.

Note. From the Rochester General Hospital Website. (June 2007). Retrieved July 4, 2007 from http://www.viahealth.org/body_rochester.cfm?id=512 [not listed in Works Cited]
Hospitals and healthcare organizations have experienced shortages in the past, but the current shortage seems to be the most long lasting because there are several factors compounding the problem (Zerwekh & Claborn, 2006, p.343). The current shortage began around the mid-nineties when computers and technology began to soar in numbers. Careers in these areas drew many potential nurses into these fields because of the shorter education time, the stress of having another person’s life in your hands was gone, the pay was competitive, and the hours were not demanding. Nursing began to feel the effects of the shortage a few years later when large numbers of baby-boomer nurses began to retire without anyone to replace them. The future demand for nurses is expected to increase dramatically as the baby boomers reach their sixties and beyond (Rosseter, 2007).[difficult to find in your Works Cited because you do not have it listed by author; you must identify your sources so they may be easily found] The best source to replace nurses is with new graduate nurses. New graduate nurses are young, eager to learn, and have a desire to help others. The only problem is that there are not enough graduate nurses to fill in the empty vacancies. The nursing shortage is not only in the hospitals, but also within nursing school faculties. “Shortages in nursing instructors and spaces for clinical instruction prevent nursing programs from adding students quickly enough to satisfy the demand for nurses” (Kelly, 2007, p. B3). This limits the available seats for qualified applicants and places a backlog on the waiting time for potential nursing students. Many potential students do not wait and therefore begin to pursue other careers. Nursing programs also have a difficult time attracting nurses to become instructors because they have to compete with hospitals that give bonuses and incentives and make it more desirable to work within a hospital. Nursing faculty are leaving nursing programs and returning to practice in a hospital because the incentives that a hospital can provide offset the incentives of being a nursing instructor. Nurses are also leaving hospitals because of job dissatisfaction from feeling underappreciated and stressed. To help compensate for the shortage many nurses are putting in extra hours on scheduled days off and working over schedule on regular workdays. With little recognition for their extra time put in, nurses begin to feel frustration and resentment toward their superiors creating a difficult working environment and dissatisfaction. Nurses are already in a high stress career and many are deciding to leave because it is not worth the stress or the risk of losing their nursing license to practice. Nurses follow a code of ethics. Element nine of the Code for Nurses (American Nurses Association, 1985) states, "the nurse participates in the profession's efforts to establish and maintain conditions of employment conducive to high quality nursing care." The statements further add the "responsibility for conditions of employment" and "maintaining conditions for high quality nursing care." Nurses are placing their ethics on the line when they are faced with working conditions that are not safe. Placing patients in this danger is unfair and these practices must change in the healthcare system. Figure B represents the perceptions nurses have upon their work environment and how they are affected by the negative impacts from the nursing shortage. The information gathered from a random national survey in 2000 reveal that nurses are feeling dissatisfied and are not confident within their careers.



Figure B


Note. American Nurses Association provided graph to the Office of the Professions (April 2001). Retrieved July 4, 2007 from http://www.op.nysed.gov/nurseshortage.htm
The nursing shortage is creating a risk for patient safety and making hospitals a dangerous and unsatisfactory place to be a patient. A leading factor in risking patient safety is to have a high nurse-to-patient ratio. Hospitals must have policies and guidelines for nurse-to-patient ratios, but the policies are constantly changing to compensate for the shortage. As Clark, Leddy, Drain, and Kaldenberg (2007) report in “State Nursing Shortages and Patient Satisfaction,” complications specifically connected to nurse-to-patient ratios include postoperative respiratory and cardiac complications, increased risk for pulmonary failure, reintubation, and infection complications leading to 39 percent increased length of stay and 32 percent increased resource usage among intensive care units. The increased patient assignments for nurses result in more doctor’s orders to complete, more assessments, and less time with patients. The risk of not completing a doctor’s order is high and therefore, completed later and resulting in longer hospital time for the patient. Assessments and time spent with patients are shorter and nurses are missing critical changes that lead to poor outcomes for the patients. Surveys show that 93 percent of hospital nurses report major problems with having enough time to maintain patient safety, detect complications early, and collaborate with other team members (Rosseter, 2007). Patients begin to feel less satisfaction with their care and nurse. Units with high nurse-to-patient ratios have lower rated quality of care (Clark et al., 2007). Hospitals rate their quality of care based on patients’ satisfaction surveys, RO this is a key indicator that a hospital is in need of nurses. An important role of any nurse is to educate patients about their health. Nurses are cutting this precious communication with their patients far too short. Many patients risk going home under prepared and they soon return to the emergency room for something that is preventable but not fully aware on how to prevent complications. Holism is the nursing model of care. If communication is at a minimum, then understanding the full picture of the patient is lost and holism care in incomplete.

Nursing schools, hospitals and the government from state to federal levels are all working together to help ease the nursing shortage crisis and change the image of nursing from a negative to a positive and respectful profession. As these three groups collaborate to fight the crisis, the negative impacts of the nursing shortage will begin to disappear. The government is helping nursing schools by providing grants that will supplement faculty pay so that schools do not have to compete with hospitals for qualified nurses. As a result, more nursing faculty will provide an increase of available slots for nursing applicants to begin their nursing program with a shorter waiting period. Applicants will also be less likely to turn away from nursing programs because they will be able to begin their education sooner. Hospitals are offering tuition reimbursement programs, paying for nursing books for current employees whom wish to continue their education, but they have to be willing to sign a contract. Nursing students who have never experienced hospitals are eased into the workforce with bonuses and paid nursing externships. With this program, student nurses are learning and training while overcoming the fears of beginning a career in a foreign area. This helps to maintain nurses and build a stable and constant nursing staff without a high volume of nurse turnover. The increased pay for nurses has grown gradually and hospitals are offering desirable wages. The problem is that once a person decides to become a nurse for the salary and not the hard work of caring, they soon realize that the profession is not for them and they leave the profession and the shortage is back where it started. Luckily, the federal government provided assistance when President George W. Bush signed the Nurse Reinvestment Act P.L. 107-207 into law in August 2002 (Cherry, 2005, p. 31). The 20 million dollars from this act provides funds in areas such as; scholarships, safety announcements to positively promote nursing as a career, supplements geriatric training grants, and nurse retention and safety enhancement grants (p.31). The push for nurses is at work on a local level. For example, governors from Tennessee and Illinois launched campaigns to raise money for nursing scholarships and loan forgiveness programs. In June 2005, the United States Department of Labor awarded more than 12 million dollars in grant funding through the President’s High Growth Job Training Initiative (Rosseter, 2007). Another popular trend is recruiting nurses from other countries to fill in the vacancies. Some of these popular areas of recruitment are the Philippines, England and Mexico. With the increased national security and patient safety issues, these programs have been restricted and less helpful to overcome the shortage. The United States Cadet Nurse Corps is still an effective program today and operated by the Army military branch. The assistance from these three key areas is helpful, but there is still an intense need for nurses.

The key to overcoming the shortage is to train more students in nursing by creating more nursing faculty. These programs are still in the early stages. More legislation at a state level is in need needed to address the severity of the shortage and specifics to individual state situations. Within a few years, a steady increase of graduate nurses entering the workforce will begin to show. The question is will it be enough to keep up with the volume of baby boomers scheduled to retire? Much collaboration and team effort is created to draw potential applicants to the profession of nursing starting on high school campuses and throughout college campuses. Programs are in creation to streamline the time it takes to get through nursing school so that the new graduates can enter hospitals at a faster rate. With so much effort toward overcoming the nursing shortage, one can only hope that it all will work for the sake of nurses and patients within the hospitals and clinics, and once again be a safe and comforting place to be a patient, employee, or both.


References



Where are the annotations for each source?

American Association of Colleges of Nursing (2007, March). Nursing shortage [Fact sheet]. Washington, DC: Rosseter, R. Retrieved June 7, 2007, from http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm

American Nurses Association. (1985). Code for nurses with interpretive statements. Kansas City, MO: American Nurses Association. Retrieved July4, 2007 from http://nursingworld.org/ojin/topic14/tpc14_1.htm

American Nurses Association. [February 6, 2001.] Analysis of American Nurses



Association Staffing Survey. Retrieved July 4, 2007 from http://www.op.nysed.gov/nurseshortage.htm
Cherry, B., Jacob, S. (2005). Contemporary Nursing: Issues, Trends, & Management (pp. 30-31). St. Louis, Missouri: Mosby Inc.
Clark, P., Leddy, K., Drain, M., Kaldenberg, D. (2007). State nursing shortages and patient satisfaction [Electronic Version]. Journal of Nursing Care Quality, 119-127. Glendale Community College Library Media Center Glendale, AZ. 7 June 2007
Kelly, J. (2007, June 10). Nursing programs struggle to expand. The Arizona Republic, p. B3, B7.
Nursing reflections: A century of caring. (2000). Missouri: Mosby Inc. [Is this a book without an author? It is hard to tell what kind of resource this is.]
West, E., Griffith, W., Iphofen, R. (2007, April vol.16/no.2). A historical perspective on the nursing shortage. Professional Issues, 124-130. [I could not find a citation for this in your paper. You may only include sources that were cited in the text.]
Zerwekh, J., Claborn, J. (2006). Nursing today: Transitions and trends (pp. 343-346). St. Louis, Missouri: Mosby Inc.

I enjoyed reading and learning from your research paper. You did a thorough job of reporting your research. A few of your paragraphs are lengthy (more than a page long); it may be more effective to divide these into shorter paragraphs.
It has been a pleasure working with you this summer. I do so appreciate your patience and understanding during the whole process. I wish you all good things in your future, and if I may ever be of assistance, do not hesitate to contact me. Thank you!

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