How the Nursing Shortage Can Affect You: One RN's Observations

You may have heard mention of the nursing shortage in the news in recent years, but have you given any thought to the impact that this could have on you as a recipient of health care services?

As the population ages, there will be an influx of elderly patients into the health care system. Already, hospitals are full and ER wait times usually exceed 3 hours. It has been projected that by the year 2025, there will be a shortage of 500,000 - 1,000,000 nurses. Nurses work in a variety of settings from physicians offices, to hospitals and outpatient surgical clinics. They are the backbone of the health care system.

While in the hospital, you may not notice or care that the nurse providing care to you or your loved one is an LPN or an RN and if the RN has an Associates degree versus an RN with a Baccalaureate degree. It takes both LPN's and RN's to provide the care currently needed. Physician's offices primarily utilize LPN's in their practice because the job duties they perform are limited and the cost is lower. Hospitals utilize both RN's and LPN's to provide direct patient care. LPN's, however, are limited in the scope of care that they are able to provide. For example, if you have an LPN providing your care while hospitalized, they can assess you and administer most of your medications but certain medications such as IV drips, and blood infusions require an RN for administration. RN's receive, at a minimum, a 2 year college education to earn an Associates degree in Nursing whereas Baccalaureate prepared RN's have a 4 year college education.

Typically, an RN or an LPN in the hospital will be assigned a team of 5-6 patients, and at times, this may be as high as 7-8 patients each. The ideal nurse to patient ratio is 4-5 patients per nurse. In addition, there should be an RN charge nurse available to float and assist as needed. With the current nursing shortage, nurse to patient ratio's are increasing and this can directly affect the care that you or your family member receives.

According to the Department of Health and Human Services, approximately 1/4 of all unexpected events leading to patient death, injury or permanent loss
of function were the result of inadequate staffing. If the nurse to patient ratio is 8 instead of 4, the risk of death while hospitalized could increase by up to 31% or 20,000 deaths per year. In addition, increased staffing of RN's, has been shown to reduce the incidence of pneumonia, urinary tract infection, cardiac arrest, and shock. As you can see, the risks associated with a nursing shortage are great, especially if it consists of RN's.

The nursing profession is not glamorous and it is hard work. Nurses have to be devoted to providing the best care possible. With the current level of nursing shortage, nurses are having to work mandatory overtime, often working 12 hour shifts without a meal break. There are risks of needle sticks and blood and body fluid contamination which increase a nurses risk of acquiring a chronic, life threatening disease. So, how do we recruit, educate, and retain nurses that are dedicated to such a profession.

In order to recruit and educate nurses, there has to be an adequate supply of Masters and Doctorally prepared nurses to provide the education and training. Nurse educators must be recruited. Universities need to provide adequate pay and compensation packages for these educators. Currently, class sizes are limited and there are limited classes due to a shortage of faculty. RN's should be able to further their education by obtaining a Masters or Doctoral degree with a reciprocal increase in salary for a higher level of education.

Individuals must be able to see that they can earn a competitive income in return for the 2-4 years of education that they will be required to have to become licensed as an RN. In addition, hospitals and health care facilities must offer compensation packages with retirement benefits that are at least equivalent to those offered to other workers.

To retain nurses, job satisfaction is a must. Nurses must feel that the work they do is appreciated by hospital administration, physicians and patients. Nurse to patient ratios must be manageable and allow the nurse to provide the best possible care and hospitals should be mandated to establish and enforce these ratios even if this means turning patients away and routing them to another facility. Nursing has become like an assembly line. Get them in and get them out. Nurses are in the business of nursing because they enjoy caring for others. Allow them the time to provide the care that the patient needs without having to sacrifice the quality of care.

Flexible shifts should be available for nurses who have families and benefits should increase yearly instead of decreasing. In the 15 years that I have practiced nursing, I have seen the elimination of sick time accrual and yearly raises have declined from 5% per year to 4% and now to 3%. Insurance benefits have declined. At one time, we only had a co-pay for physician office visits. Now we must first meet a $500 deductible before being eligible to pay only the co-pay.

Eliminate mandatory overtime and ensure that nurses receive a 30 minute uninterrupted meal break. That may sound strange, but a 30 minute uninterrupted meal break is rare in nursing. There are physician's lounges with elaborate resting areas and buffets available to them at no cost. Nurses have a small, cramped break room and if they are lucky enough to get a 30 minute uninterrupted meal break, they have to spend 15 minutes of it going to the cafeteria to get their food and then rushing to eat it in the remaining 15 minutes.

With the recent shortage of teachers, the government has established loan forgiveness programs. For each year of teaching, a predetermined amount of student loans are forgiven. This should be established for nursing as well and should not only include new nurses, but nurses that are currently working. There are a tremendous number of nurses still struggling to pay off student loans that they have accrued in the past 10 - 15 years.

These may seem like trivial things, but the majority of nurses will tell you that these are the things that matter to them. Without nurses having a positive outlook on their jobs and the work that they do, it will be hard to entice younger individuals into the field of nursing.

While these are only generic ideas to help ease the nursing shortage, they are a starting place. It will require state and federal government programs to resolve but it can't be put off any longer. The process must start now in order to ensure the future health care needs of all US citizens.