As healthcare providers look to increase the efficiency and quality of medical care, one of the worst shortages of nurses in recent times is affecting revenues, coordination of care, patient outcomes and countless other areas of healthcare delivery.
Heightening the effects of the shortage are factors such as an aging population set to live longer, a lack of nurse education programs, fewer young nurses entering the field and a large group of nurses leaving or preparing to leave the profession.
“(We have) an increased demand, a flat growth of supply and a huge outgoing group of nurses,” said Linda Burnes Bolton, RN, president of the American Academy of Nursing and vice president of nursing at Cedars-Sinai Medical Center in Los Angeles.
Burnes Bolton said this is one of many nursing shortages the nation has endured since 1945.
“The difference this time around is that 40 percent of the workforce is eligible to retire in the next 15 years,” she said. The shortage, she added, is not just in acute care hospitals, but across all types of organizations in which nurses practice.
To address the shortage, hospitals, outpatient centers and education programs are looking at ways to improve recruitment and retention. Many organizations rely on “traveling nurses” – those managed by agencies or pools who temporarily relocate to work on a short-term basis for premium rates – and foreign nurses, coming from such areas such as Europe and Asia.
Both of these approaches for filling vacancies have significant drawbacks, including the high price of traveling nurses and the moral concerns raised by the hiring of foreign professionals, which essentially removes skilled healthcare providers from other nations.
While temporary nurses can bail out institutions that have immediate staffing needs, the process of repeatedly familiarizing such nurses with a hospital is an additional drain on finances and siphons offs work time and efficiency.
Advocacy groups and institutions have launched extensive efforts to attract people who want a long-term career in nursing and have succeeded in many areas. But an education gap impedes the training of many would-be nurses. For a variety of reasons, Burnes Bolton said, the nation has not been able to increase the number of nurses holding masters and doctorate degrees, the pool from which nurse educators are drawn.
“While we’ve increased interest in the profession, we’ve just turned away 145,000 qualified applicants,” she said. “They all met the prerequisites, but couldn’t get in (schools), and that’s because of a huge faculty shortage.”
Burnes Bolton noted that 70 percent of all nurses coming into the field are at the associate or bachelor’s level, and they typically need assistance before they acclimate themselves to working in a healthcare setting. As a result, overall efficiency takes a hit.
“We have a lot of nurses out there that aren’t handling a full patient load because they’re training new nurses,” said Ellen Whalen, chief nursing officer at the University of Southern California’s University Hospital residency program. There’s a need for more training programs and programs with low residency turnover rates to assist in on-site nurse training.
Whalen hopes to improve retention and attract nurses to her program with the help of Versant RN, a residency design system touted for its effectiveness in reducing turnover rates for new graduate RNs.
“We have 17 RNs now,” she said. “Ideally, we’d have 24 in the program.”
With Versant RN, USC’s grads will be learning from a lot of different preceptors who are teaching in the same standardized way – which will result in better efficiency and patient outcomes, Whalen says. “It really helps the new graduate nurse to be able to organize his or her day, and that makes everything more efficient,” she said.
A major barrier to making nursing an attractive career is the amount of time nurses have to spend on work that doesn’t involve seeing patients, Burnes Bolton said. “Merely increasing the number of nurses doesn’t improve outcomes. It’s the time they spend with patients (that matters),” she said.
Robert Kane, MD, co-director of the University of Minnesota Clinical Outcomes Research Center, conducted a study that looked at 20 years of literature on nursing. He found that a better ratio of RNs to patients measured in hours, rather than number of nurses, tends to improve care and efficiency across the board.
“What we have found is that there is a generally consistent but not completely consistent modest relationship between having more RNs on staff and fewer adverse events,” he said. This is mostly seen in surgical wards and ICUs, the most expensive areas of the hospital in which patients receive treatment, he noted.
How can providers get nurses to spend more time with patients? “Remove the non-value work of nurses,” said Burnes Bolton. “I don’t want to spend 30 percent of my time on paperwork and another 15 percent of my time hunting and gathering.”
Increasing retention and generating interest in nursing is tantamount to ensuring that it’s a career that people will want to enter. Whalen said USC’s residency provides nurses with mentors and social workers to whome they can turn when things get tough.
“When (nurses) are learning to care for patients, it can be very stressful,” she said. “It helps them to know that they are doing a good job.”
“We’ve got to find a way to meet the demand and keep nurses in an environment where they can provide safe care and feel good about the work they’re doing,” Burnes Bolton said.