The Nursing Shortage
Karin Mogren-Kuzma
Learning Objectives
• The student will be able to describe the current and
projected nursing shortage.
• The student will understand contributing factors
impacting the nursing shortage.
• The student will be able to acknowledge the impact of
nursing shortage on patient care.
• The student will recognize strategies to address the
nursing shortage.
Introduction
• The nursing shortage affects every aspect of
health care delivery in the United States.
• The problem of the global nursing shortage is
cyclic in nature. Thus, it seems certain that
shortages of nurses will continue to reoccur with a
certain degree of regularity.
• The National Center for Health Workforce
Analysis suggested that by 2020, approximately
36% of nursing positions would not be filled.
Shortage History
• The nursing shortage has commonly been referred
to in terms of supply and demand. Since the
World War II, the United States has gone through
cyclic shortages of nurses. In the 1990’s hospitals
reduced their numbers of employed RNs to
contain costs.
• A few years later, a nursing shortage was
emphasized when the hospitals experienced an
increased demand for nurses.
Shortage History
• In the presence of good economy, many nurses
moved away from traditional positions to new
emerging roles in healthcare, creating vacancies
in hospitals.
• In the recent recession, many nurses were forced
to reenter the workforce to supplement or support
their families economically. As the economy
recovers, many RNs are likely to retire.
Where are we today?
• Demand by 2020 will exceed supply by 29%36%.
• Increased demand due to aging Baby Boom
population (people born between 1947 and 1962)
and nursing workforce retiring.
Demand and Supply
National supply and demand projections for RNs: 2000-2020
Shortages by state
States with Shortages in 2000
Shortages by state
States with projected shortages in 2020
Today’s Shortage
• The present shortage has been described as being
different in many ways from prior shortages.
• Several factors have been identified as
contributing to the shortage:
– Aging workforce
– Educational bottlenecking
– Changing work climate
Aging Workforce
• Retiring Nurses
- Average age of employed RNs is 45.5 years.
- 45% of the nursing workforce is older than 50
years of age.
- majority of nurses intend on retiring between
2011-2020.
• Aging of Baby Boomers
- More health care services needed.
Aging Workforce
Age Distribution of RNs: 1980, 2000 and 2020 Projected
Educational Bottlenecking
• Nursing school enrollment is not growing
fast enough to meet the projected demand
of nurses.
• Faculty shortage
- Low compensation
- Insufficient number of clinical sites
- Budget constraints
Changing Work Climate
• Stressful working conditions leads to
dissatisfaction, high turnover, and low
retention.
-
Short staffing
High nurse-patient-ratio
Mandatory overtime
Low compensation
Abusive environment
Root Cause Analysis
The Nursing Shortage
•Aging workforce
•Declining enrollment to
nursing schools
•Changing work
environment causing low
retention, high turnover,
burnout, and change of
profession
Inferences and Implications
• The nursing shortage adversely affects patient
outcomes and satisfaction.
• Shortage of registered nurses, in combination
with an increased workload, poses a potential
threat to the quality of care.
-
High nurse- patient ratio is associated with increased patient
mortality.
RN shortage negatively impacts patient care and undermining
the quality of care goals set by the Institute of Medicine and
the National Quality Forum.
Inferences and Implications
• The nursing shortage causing insufficient staffing
is raising the stress level of nurses, impacting job
satisfaction, and driving many nurses to leave the
profession.
• The change in work environment is also causing a
high turnover rate of RNs.
Inferences and Implications
Licensed Registered Nurses not employed in nursing
Nursing Theory
Benner’s Stages of Nursing Proficiency
• Process of five stages of nursing practice
-
Novice
Advanced Beginner
Competent Practitioner
Proficient Practitioner
Expert Practitioner
Nursing Theory
Benner’s Stages of Nursing Proficiency
Novice
No expertise
Limited practical skills
Relies on rules and
expectations of others for
direction
Advanced Beginner
Marginally competent
skills
Difficulty establishing
priorities
Competent Practitioner
Feels competent and
organized
Plans and sets goals
Proficient Practitioner
Views patients
holistically focuses on
long term goals
Expert Practitioner
Performs fluidly
Expertise comes
naturally
Social Theory
• Theory of Reasoned Action (TRA) developed by
Fishbein in 1967.
• An approach to understanding individuals’
complex decision-making processes.
• TRA specifically focuses on the role of personal
intention in determining whether a behavior will
occur.
Social Theory
• A person’s intention is a function of three
basic determinants:
- Attitude
- Subjective norms
- Perceived behavioral control
Social Theory
How it Relates to RN Turnover
Intention: Leaving current position or the
nursing profession
• Attitude: Poor job satisfaction
• Subjective Norms: Cultural variations, social
pressure, career advancement
• Perceived Behavioral Control: Social support,
financial ability to make a change
Social Theory
ANA Standards
• Quality of Practice
• Collaboration
• Professional Practice Evaluation
QSEN Competencies
• Patient safety
• Quality Improvement
• Teamwork and Collaboration
Quality and Safety Improvements
• Solutions to the nursing shortage must be
addressed in ways other than short term
solutions.
• Efforts must be aimed both at recruitment
and retention.
• Increasing nursing school faculty.
• Improving work environments for nurses.
Quality and Safety Improvements
Suggested Strategies
• Improving workplace conditions.
• Encourage nurses who left nursing to reenter the
workforce.
• Enhancing education and professional
development.
• Nurse residency programs for new graduates to
help facilitate confidence, competence, and
decreasing stress levels.
• .
Discussion Questions
• Discuss how the effects of the current nursing shortage
impact your professional practice and your future as a
nurse.
• Describe how quality and safety of patient care could be
affected.
• Censullo (2008) describes several factors contributing to
the nursing shortage. Pick one and explain what you think
could be a potential solution to that particular issue.
• The work environment for nurses is often described as
stressful and abusive. Name things that you can do to
improve the environment for yourself and your coworkers.
References
• American Association of Colleges of Nursing. (2012, August).
Nursing shortage fact sheet (Fact Sheet). Retrieved from
American Association of Colleges of Nursing:
http://www.aacn.nche.edu/media-relations/factsheets/nursing shortage
• American Nurses Association (2010). Nursing: Scope and Standards
of Practice (2nd Ed.). Silver Spring, Maryland: Author
• Censullo, J. L. (2008). The nursing shortage: Breach of ideology as an
unexplored cause. Advances in Nursing Science, 31(4), E11E18. doi: 10.1097/01.ANS.0000341417.88715.2d
• Dotson, M. J., Dave, D. S., & Cazier, J. A. (2012). Addressing the
nursing shortage: A critical health care issue. Health Marketing
Quarterly, 29(4), 311-328. doi: 10.1080/07359683.2012.732861
References
• Egenes, K. J. (2012). The nursing shortage in the U.S.: A historical
perspective. Journal of Illinios Nursing, 10(4), 18-22. Retrieved
from http://0web.ebscohost.com.libcat.ferris.edu/ehost/pdfviewer
• Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S., Hongsoo,
K., & Djukic, M. (2007). Newly licensed RNs’ characteristics,
work attitudes, and intentions to work. American Journal of
Nursing, 107(9), 58-70. doi:
10.1097/01.NAJ.0000287512.31006.66
• Liou, S. (2008). Nurses’ intention to leave: Critically analyze the
theory of reasoned action and organizational commitment
model. Journal of Nursing Management, 17(1), 92-99. doi: 1
0.1111/j.1365-2834.2008.00873.x
References
• MacKusick, C. I., & Minick, P. (2010). Why are nurses leaving?
Findings from an initial qualitative study on nursing attrition.
Medsurge Nursing, 19(6), 335. Retrieved from http://0-g
o.galegroup.com.libcat.ferris.edu/
• Wyte-Lake, T., Tran, K., Bowman, C. C., Needleman, J., & Dobalian,
A. (2013). A systematic review of strategies to address the
clinical nursing faculty shortage. Journal of Nursing Education,
52(5), 245-252. doi: 10.3928/01484834-20130213-02
• Zinn, J. L., Guglielmi, C. L., Davis, P. P., & Moses, C. (2012).
Addressing the nursing shortage: The need for nurse residency
programs. AORN, 93(6), 652–657. Retrieved from http://0www.sciencedirect.com.libcat.ferris.edu/science/article/pii/S000
1209212009581