Nursing shortages have been on the rise throughout the country, a problem which has doubled up due to an aging baby-Boomer population, increasing the need to determining the root cause of the shortage. This is essential for health care providers as health costs are on a continuous increase.
Registered Nursing (RN) is listed among the top careers in terms of job growth. There is a need for 649,100 auxiliary nurses in the labor force bringing the total number of job openings for nurses due to development and replacements to 1.09 million by 2024.
A shortage of registered nurses is likely to spread across the country between 2009 and 2030.
In October 2010, the Institute of Medicine called for the need to increase the number of baccalaureate-prepared nurses in the labor force to 80% while doubling the population of nurses with doctoral degrees.
In July 2010, the Tri-Council for Nursing released a joint statement which warned shareholders about announcing an end to the nursing shortage.
The aging baby-Boomer population causes increased Turnover through the United States. This rise in the baby-boomer population has increased the need for RN’s in the state.
In 2012, The Bureau of Labor and Statistics released findings on the estimated employment growth between 2010 and 2020. It stated that the expected need for Registered Nurses (RN’s) would rise from 2,737,400 to 3,449,300, which is an increase of 26% (Bureau of Labor Statistics , 2012a).
With the recent gush of citizens of “baby-boomers” turning 65 at a rate of almost 10,000 people a day which total 79 million people or 26% of the total population, the need for ore nurses is urgent as it is necessary (Barry,2011).
In 2008, it was deduced that 110,000 direct-care staff positions were vacant which was at the time one in six of registered nursing positions but qualified skilled candidates were not available to fulfill the required need (AHCA, 2008). It was also reported that the need to fill these positions would be on the rise and the amount of vacancies present will also continue to increase which by 2025, the shortage of RN’s
The shortage is to be most intense in the South and West of America.
The current nursing labor force falls short of these approvals with only 55% of registered nurses prepared at the baccalaureate or graduate degree level.
The most analysts believe the depression in the economy that has led to an easing of the shortage in many parts of the country to be temporary. In the joint statement, the Tri-Council rises grave fears about slowing the production of RNs given the high demand for nursing services, particularly after healthcare reform.
Causes of the Shortage of Nurses
The average age for nursing staff is growing at an increased rate. Higher percentages of nurse professionals who are ageing primarily those over the age of 50 work in nursing homes, academic education programs, and the home health setting.
Several issues that arise with an aging labor force is the increase the retirement of these well skilled nurses. Major stressors have also been identified and they include; Chronic pain, tiredness and exhaustion. This costs health care organizations a lot.
Reports show that 55% of the RN workforce is age 50 or older. The Health Resources and Services Administration projects that more than 1 million registered nurses would be within the retirement age within the next 10 to 15 years. (Cox, Willis, & Coustasse, 2014)
In 2004 the average age was 46.8 years old and grew to 47 years of age in 2008 (Buerhaus, Staiger & Auerbach, 2008).
The RNs over the age of 50 make up 44.7% of the total healthcare staff population in 2008 which has risen from just 33% in the year 2000 and take shifts of an average of almost 43.7 hours of work per week (U.S. DHHS, 2010)
These RNs are more likely to stay with their same employer from year to year as compared to the younger generation of nurses who are more likely to move to different settings as their providers age (U.S. DHHS, 2010).
These members of staff have been dealing with increasing pressure due to high work demands and nursing shortages. (Gabrielle, Jackson, & Mannix, 2007).
In 2009, the cost of losing nurses especially those from the ageing population with their experience in the field cost the healthcare organizations between 1.2 and 1.3 times the annual yearly salary or about or 5% of the total Budget of healthcare providers (Palumbo, et al., 2009).
The combination of these stress factors and increase in aging suggest the increased need for managerial recognition and change in the delivery service to fit the health needs of its aging nursing population (Gabrielle, et al., 2007).
As the population of the U.S. And the baby-boomers generation reaches 60 years and older, the ratio of nurses to the elderly population is decreasing by an average of 40% between 2010 and 2020 due to the increased age of the U.S. Population and the nursing population decreased due to high rates of turnover.
With the changing population, and a majority of the population turning 60 by 2020 changes will have to occur in order to affectively aid and help the new demographic in the U.S.
The recent recession affecting America over the past five years has briefly slowed down retirement by nursing professionals. The current national healthcare reform known as the Affordable Care Act or ‘Obama care’ created better access to health care services from the aging population and those over the age of 60.
The Older Population in the United States found that by 2050, the number of US residents age 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases and comorbidities (Ortman, Velkoff, & Hogan, 2014).
The change in demographics will have more long-term conditions that ever before. The long term conditions such as dementia care, requires specialized training and has been often left out of general nursing education, which requires the need for frequent practice which after nurses receive it, is difficult for healthcare providers to keep such trained employees due to the salary requirements (Kinnair, 2012).
In 2010 it was expected that 14.2% of nurses were planning to retire (Healthcare Association of New York State, 2010).
This will cause increased need for nurses to provide more treatment to this population of patients (Healthcare Association of New York State, 2010).
Due to the decreased staffing of nurses, because of high turnover of nurses and retirement, it is becoming more difficult for current active nurses to affectively provide quality patient care to their patients.
With a drop in disease control caused by insufficient staffing within hospitals, the inability for patients to receive proper treatment has become difficult as exposure to these infectious diseases has risen from 50% to approximately 200% due to possible needle stick injuries and near-misses.
As a result of low staffing and an increased patient ratio , for each patient that is added to the nurses current high workload, nursing burnout rose by 23% and job dissatisfaction rose by 15% for each nurse on staff which led to increased turnover of nursing staff..
If nurses are required to service more patients due to a lack of staffed nurses it has been shown to increase infection rates in hospitals (Cimiotti, Aiken, Sloane, & Wu, 2012).
In addition, 88% of nurses have reported safety concerns with 75% observing A decrease in patient care due to work stress, overworking, and concerns about health with over 60% fearing back injuries, and 45% fearing HIV or hepatitis due to needle sticks. Also it has been found that workgroup learning was lower with hospitals where turnover rates were between 3.3% and 4.5% compared to hospitals with 0% turnover as an organization (Bae, Mark, & Fried, 2009).
This is due to an increased amount of time spent with an increased patient load because of the high turnover and retirement of ageing nurses. The nurses surveyed about the increasing shortage of nurses available to serve patients 98% stated an increased stress on their nursing career, 93% an impending lowering of quality care towards patients, and 93% mentioned it as a reason to leave the profession (Buerhaus, et al., 2007).
These near-misses occur an estimated 400,000 to 600,000 times annually nationwide, due to amplified fatigue because of an increased patient load.
Lack Of Experience
While many nurses positions are open the inability for healthcare providers to hire qualified nurses has become a growing issue.
Due to the recession, healthcare organizations are seeking nurses with higher qualifications since there are fewer nurses who have the years of experience required by the healthcare organizations.
In 2011, 36% of the new nurses who had graduated were still unemployed for months after they graduated.
The major job requirement that has withheld many potential applicants to apply for open nurses positions are the words, “no new graduates” (Kurtz, 2013).
This is because these organizations do not want to spend extra funds on training of new nurses (Staiger, Auerbach, & Buerhaus, 2012)
80% of healthcare organizations hired nurses with experience instead of new graduates. This problem was more felt in California as 47% of all new nursing degree graduates within the state remained unemployed, while 51% of the part-time nurses were working were absorbed into full-time positions (Jannetti, 2011)
It has been reported that by 2020, 3.4 million nurses will be required from the current Level of 2.7 million in 2010; almost 764,000 of these positions will be Certified nurse assistants (CNA).
With over 32 million Americans gaining access to healthcare due to the ‘Obama care’ provisions, an increase of 5.1% in the enrollment of entry-level nursing school programs in 2011, was not sufficient to meet the upcoming demands that are facing the healthcare industry.
The goals established by the institute of Medicine in 2011, has called for over 80% of the nursing workforce to hold baccalaureate level degrees by 2020. The main factor causing the shortage of nurses was also the inability for nursing schools to admit qualified high school graduates into nursing school with over 78,587 applicants turned away from nursing schools in 2011.
This high number of CNAs could be a direct result of the lack of graduate nursing programs, with qualified institutes turning away 37,412 qualified applicants in 2004 (Siela, Twibell, & Keller, 2008).
With over 50,000 new graduates leaving nursing school, only 24% of those graduating had received job offers upon the time of graduation (Jannetti, 2011).
However, this would not be achieved due to the driving need for specialized care of the new patient demographics. The inability to give these willing students a chance may also be due to insufficient faculty and budget restrictions (American Association Of Colleges Of Nursing, 2011).
In the 1980’s and early 1990’s the wages paid to nurses rose on an average of 3% each year but experienced a drop of 17% from1997. Basic nurse salaries averaged $60,700 with the lowest tenth percentile averaging $40,000 and the highest tenth percentile averaging $83,400.
Since 2000, providers working for unionized hospitals were able to negotiate a 3%-5% increase in wages. However in 2002, it was found in the state of New York 45% of nurses interviewed stated the primary reason for dissatisfaction in their careers was salaries and compensation. However, most of the providers who are compensated in the higher tenth percentile are in management positions (IOM Future of Nursing Report, 2010).