Downgraded Medicine: The Shortage of Nurses

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In a desperate economy, no industry is safe from workforce downsizing, overworked team members, and budget constraints. This is a fact of life for most companies – downsize the workforce or risk losing the business altogether. While most industries have adjusted to the supply and demand inconsistencies, the nursing sector still needs improvement. Nurses are in high demand but much shorter supply. Some current nurses are getting older and will soon retire. Doctors don’t want to replace a nurse with more than 30 years of experience with a recent graduate. Not to mention, the shortage is affecting nursing school faculty numbers. Colleges much turn away students because they can’t find enough qualified nurses to teach the curriculum. Will this disaster cause a serious health risk to the public? Is it too late to fix? Are we seeing signs of an emergency? 

The Problem: America Faces a Nursing Shortage

As early as 2014, the American Association of Colleges of Nursing (AACN) predicted the United States (U.S.) would face a serious shortage of Registered Nurses (RN) (“Nursing Shortage.”). While the AACN didn’t cover the likely shortage of other nursing professionals (i.e. Licensed Practical Nurses (LPN), Nurse Practitioners (APRN), and Nurse Assistants (NA)), the shortage seems to include all nursing levels (“Nursing Shortage.”). But the prediction doesn’t take into account one simple truth – America has faced this shortage for decades (Grant). It was recent years that saw the biggest decline in nurses (Grant). 

The nation has more than three million nurses, representing the largest workforce in the healthcare industry (Grant). Even though the U.S. Bureau of Labor Statistics (BLS) report the nursing industry is one of the fastest growing sectors in the country, demand for qualified nurses far outweigh the supply (Grant). The BLS predicts there will be more than one million nursing vacancies between 2014 and 2022 (Grant). According to a report by The Atlantic, a team of Vanderbilt University nursing researchers determined “by 2025, the shortfall is expected to be ‘more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s’” (Grant).

The Cause: Several Factors to Consider

While the shortage of nurses is primarily caused by less graduates, there are several factors to consider. The increasing population of aging Baby Boomers has caused medical needs to skyrocket (Grant). The majority of older patients, about 80 percent, face at least one chronic disease (i.e. diseases that are long-term) (Grant). And more than half the Baby Boomers in America have at least two chronic illnesses (Grant). 

‘The aging population and chronic disease are creating the perfect storm driving demand for nurses. People with chronic diseases clearly use more health-care services, and people who are older have more chronic disease,’ said Julie Sochalski, an associate professor at the University of Pennsylvania School of Nursing. ‘The aging population and chronic disease are creating the perfect storm driving demand for nurses.’ (Grant)

The increased demand has subsequently overpowered the supply of qualified nurses. The increased medical needs of Americans over age 50 aren’t the only factors limiting the number of nurses. The age of nurses, benefits, and college admittance also play a large role in limiting supply (Grant).

As with the Baby Boomers they treat, nurses also are aging at a rapid pace (Grant). The National Council of State Boards of Nursing (NCSBN) and The Forum of State Nursing (FSN) conducted an analysis on aging nurses and the effect on nursing shortage in 2013 (“Nursing Shortage.”). More than half the nursing workforce is above age 50, and “the Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years” (“Nursing Shortage.”). Pam Cipriano, president of the American Nurses Association (ANA), said the aging nurse population was caused by limited access to women (“Nursing Shortage.”). “The biggest cohort of registered nurses joined the workforce before the 1970s, when career choices for women were more limited” (“Nursing Shortage.”). 

The Education also has issues keeping up with the demand for highly-trained nursing students, adding to the shortage (“Nursing Faculty Shortage.”).  Even though nursing applications are exceeding a nine-year high, colleges have a difficult time finding faculty members to teach new students – also a cause of the shortage (“Nursing Faculty Shortage.”). Since there are not enough nurses to fill medical jobs, colleges cannot find nurses to teach. 

Faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for nurses continues to grow. Budget constraints, an aging faculty, and increasing job competition from clinical sites have contributed to this emerging crisis. (“Nursing Faculty Shortage.”)

AACN reported that during the 2014-2015 academic year, nursing schools rejected 68,938 qualified applicants because the program lacked enough faculty, clinical sites, classroom space, clinical preceptors, and funding to accommodate the students (“Nursing Faculty Shortage.”). The shortage of faculty teachers and increased student applications caused a surge in nursing school admission costs (“Nursing Faculty Shortage.”). “Though interest in nursing careers remains strong, many individuals seeking to enter the profession cannot be accommodated in nursing programs due to faculty and resource constraints” (“Student Enrollment Expands at U.S. Nursing Colleges and Universities for the 9th Year Despite Financial Challenges and Capacity Restraints.”). 

The Effect: Nursing Shortage Hurts Patients

While the shortage of nurses hurt colleges, doctor officers, and hospitals, there is still one, more important element to consider. The lack of nurses could cause a dangerous domino effect on patient health. Dr. Christopher Friese, MD and his colleagues told researchers a nurse’s education significantly impacted patient results (American Association of Colleges of Nursing (AACN)). In fact, patient mortality and failure-to-rescue rates are lower with nurses who receive at least a bachelor’s degree in nursing (BSN) (AACN). Dr. Friese and his team stated “moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients” (AACN). Dr. Linda Aiken, MD and her colleagues conducted a study published May 2008 in the Journal of Nursing Administration that reasserted claims she made five years previous (AACN). She reported a 10 percent increase BSN-trained nurses accompanied a four percent decrease in patient death (AACN). 

Nurse shortage also has an impact on the 30-day mortality for patients diagnosed with serious acute diseases and medical conditions (AACN). The Journal of Advanced Nursing reported in January 2007 that a new study reaffirms Dr. Aiken’s claims that nurses with BSNs decrease mortality rates in acute patients (AACN). One research team University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada followed nearly 50,000 patients admitted to hospital and diagnosed with either a heart attack, stroke, pneumonia, or blood poisoning (AACN). The research team reported:

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10 percent increase in the proportion of baccalaureate prepared nurses was associated with nine fewer deaths for every 1,000 discharged patients. (AACN)

The facts show highly-trained nurses are a benefit to the medical field. Removing more nurses will only hurt those numbers.

On the other hand, the Nursing Economic$ magazine reported in early 2005 that a survey conducted by Dr. Peter Buerhaus, MD and his colleagues determined more than 75 percent of the nursing workforce “the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients” (AACN). This morality program causes nurses to make mistakes, and tired, overworked nurses are more prone to accidents and misinterpreting medical orders (AACN).

Works Cited

American Association of Colleges of Nursing (AACN). “Impact of the Nursing Shortage on 

Patient Care.” American Association of Colleges of Nursing (AACN). N.d. Web. 11 Aug. 2016. http://www.aacn.nche.edu/media-relations/nursing-shortage-resources/impact.

Grant, Rebecca. “The U.S. Is Running Out of Nurses.” The Atlantic. 3 Feb. Web. 11 Aug. 2016. 

http://www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/.

Rosseter, Robert. “Nursing Faculty Shortage.” American Association of Colleges of Nursing 

(AACN). 16 March 2016. Web. 11 Aug. 2016 http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage.

– “Nursing Shortage.” American Association of Colleges of Nursing (AACN). 

24 April 2014. Web. 11 Aug. 2016. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage.

– “Student Enrollment Expands at U.S. Nursing Colleges and Universities for the 9th Year 

Despite Financial Challenges and Capacity Restraints.” American Association of Colleges of Nursing (AACN). 2 Dec. 2009. Web. 11 Aug. 2016. http://www.aacn.nche.edu/news/articles/2009/09enrolldata.