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NURSES: 7 Myths About The Nursing Shortage

November 8th, 2006

Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000. I set out to debunk a number of popular myths surrounding the current nurse shortage at a recent meeting convened in Washington, D.C. on the future of nursing. The September 20-21 meeting was sponsored by Health Affairs, the Robert Wood Johnson Foundation, and the John A. Hartford Foundation.

Myth: We can continue to “muddle through” present and future nurse shortages without serious consequences. The lack of nurses has substantial impacts on emergency preparedness, quality of care, patient safety [2-week free access], access to needed health care services (especially for vulnerable populations), and economic growth.

Myth: Not enough Americans want to be nurses. Tens of thousands of qualified nursing school applicants were turned away last year because U.S. nursing schools lacked educational capacity, particularly with respect to faculty.

Myth: The U.S. nurse shortage can be solved by opening our borders to nurses from other countries. The U.S. long-term nurse shortage is too large to be solved through immigration [2-week free access]. The nurse shortage isn’t confined to the U.S. — it’s global. Extracting nurses from other countries would simply bankrupt the international supply of nurses, affecting global health.

Myth: The U.S. nurse shortage can be solved by substituting unskilled labor. Research shows that substituting licensed practical nurses or aides for registered nurses in hospitals results in much higher mortality rates and worse patient outcomes.

Myth: Expanding roles and demands for nurses will be constrained by opposition from practicing physicians. Because of factors such as the changing demography of the physician workforce, regulation of hours, and increasing demand for services, doctors need nurses to be able to “work upstream” in the medical division of labor.

Myth: Care will increasingly shift to out-of-hospital settings, reducing the demand for nurses. Although inpatient days have fallen dramatically in the past 20 years, inpatient acuity has increased — meaning that more intensive services are needed within a shorter hospital stay. In addition, demand for nurses in nonhospital settings is growing rapidly because of the rising burden of chronic illnesses.

Myth: We don’t know how to solve the nurse shortage. The solutions are out there. More and smarter federal investment in nurse education is needed. Hospitals and other nurse employers also need to support the education of new nurses. In addition, they need to increase nurse efficiency, so that nurses are actually doing nursing, and take steps to reduce high levels of burnout among nurses. The education community needs to create more innovative and efficient educational pathways to BSN and graduate nursing education, and needs to provide more incentives for faculty recruitment. Finally, payers need to recognize the impact of nursing care on ensuring health care quality and safety — and pay for it.

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8 Responses to “NURSES: 7 Myths About The Nursing Shortage”

  1. OutspokenRN Says:

    None of these ideas are going to address the nursing shortage.

    The reason for the shortage is because of the stress of un-manageable assignments, poor management, vicious behavior of staff that drives off staff and reduces retention, abuse from poor management who either never worked as a floor nurse or couldn’t cut it as a floor nurse, not having good team support, techs that won’t do their jobs, dealing with dissatisfaction of patients and families that is the fault of the hospital and administrators but the blame falls on the nurses…..and more. That is the real reason for the shortage. It is not a glamorous job. It is a job that offers no appreciation except for what you tell yourself when you have to try to convince yourself that you did a good job when you are just plain lucky to get through the day without being the cause of some fatal error or a death due to unsafe conditions. Every nurse complains about the same thing but none of this is addressed when it comes to talking about shortages. There are over 500,000 inactive nurses. Ask them why they are inactive. Ask them why they chose to give up their careers and most of what you will hear is that the stress wasn’t worth it.

    In the field of nursing, we are supposed to be practicing self care and health but most nurses are suffering physical damage from the job as well as health problems from the stress. Try working 12 hours without being able to drink enough water, go to the bathroom or get a break. Try lifting and moving heavy adults all day and every day. See how it feels to be rushing around for 8 – 10 or 12 hours and not being able to stay on top of things. With all the dissatisfaction of the patients these days, the hospitals are throwing more demands on the nurses to do more to address safety concerns and patient dissatisfaction. The real reason is because of the nurse patient ratio and JCAHO and the hospitals keep throwing more tasks at the nurses without addressing the ratio or the ability to get the work done. To be a nurse a person must be able to intensely mutitask under extreme pressure working side-by-side with other people who are either doing the same or not pulling their weight. All of these bandaids to increase funding and media coverage to recruit is not going to help the real problem. The real problem is ignored and it comes from not being able to do the job right or safely while being punished and abused from the administration of the facilities.

    Talk to any nurse about what makes the job hard and you will hear why there is a shortage. Most people do not want to be abused. Try taking care of obese people who don’t take care of themselves and tearing your back apart on them day in and day out. Try spending 12 hours on a job with dry mouth and not being able to hydrate yourself or go to the bathroom. Try walking around whiping feces off of people and digging it out of fingernails because they dig their hands into it. Try taking care of someone withdrawing from alcohol that won’t stay in their bed and is unsafe but you have a full assignment with other patients that you can’t tend to. Try taking care of people with dementia that keep climbing out of bed and falling but you can’t restrain them because of lawsuits and you still have a full assignment. Try managing 5 or more heavy patients with 3 or 4 of your co-workers sitting at the desk socializing and ignoring lights. I know a lot of nurses that hate the field they are in and blame the administrators for it. You won’t see too many managers out there helping get patient care done. As a matter of fact, you won’t see many managers on the floor and available at all. They hide, they rarely come in to work and they have rarely worked as a floor nurse at all.

    None of these efforts are going to address the shortage. Sure, people will take advantage of free schooling and other things to get in but will they be able to handle the job? Will they stay? How will they feel? Most young adults that come in to the job are totally turned off by cleaning feces and taking care of bed-bound people who won’t do anything for themselves. The nurses that are dedicated and willing to work hard are not appreciated. Nurses are abused by administration and their concerns are ignored. Safety is the biggest complaint – the fact that you can’t safely manage your assignments. Physical abuse comes second. A real nurse prefers to have a safe environment over her own self care. But that goes unappreciated.

    When people start addressing the real reason for the shortage, then maybe something will be done. Nursing has turned out to be a very disappointing field with little rewards and many people chose not to live under so much stress and get out. Especially hospital and floor nursing.

    Ask those nurses with licenses who are not working. Ask the nurses who are working. This bandaid won’t stick. Free schooling won’t address the problem. Job satisfaction is the problem. There are already good nurses out there that won’t work because of the abuse and unsafe atmosphere.

    Want to address the shortage? Protect the nurses from administration abuse and change the nurse to patient ratio. Until that is done, there is always going to be a problem in nursing. Administration is the number one problem! Yes, management. Poor management and abuse is the main reason for dissatisfaction. Listen to the nurses. Until you do, this won’t change. I have watched many new nurses come into this field and get turned off by the stress of not being able to manage your assignments.

  2. kcurna Says:

    Writing a standard and implementing a measurable standard are two entirely different things. Neither of which always reaches the desired results. I could in the course of my 12 hours meet all the standards and give excellent care if those standards did not have to be measured or documented. This accounts for job complexity, oppression, job dissatisfaction and yes the Nursing Shortage. I would not acquiesce to the current system. Mentally pursuing the problems allowed by to be engaged while never helpless. My peers (Nurses at the bedside) see no hope of changing the system partly because the problem appears too insurmountable with no clearly defined enemy.
    Nurses although go home after a long day, physically, mentally, and spiritually exhausted. All that effort would be worth it if we could go home with the knowledge of a job well done. This was the catalyst to my efforts; why couldn’t I give the care I wanted to? It is a combination of feeling guilty and yet victimized which leads to dissonance. So I began to break down and analyze everything I do. The ultimate realization was I was a slave to the system. When asked why do we do it this way? The answer 99% of the time pointed to the accreditating bodies or cost reduction efforts. I soon realized the system is also enslaved to the process of accreditation because hospital must get their Medicare funding to survive. The belief has been it is only a few extra minutes to implement this new checklist or charting. Since 1965 how many minutes have been added to fulfill the overseeing eye of another. The system honors those who chart appropriately and those who actually try to implement care are left weary. Hence apathy follows because no one can see how this current system can be changed. This state of helplessness has lead to many dysfunctional behaviors and dysfunctional environments, although just the symptoms of a much bigger problem, are the root causes of the Nursing Shortage.

  3. Petryu Pestela Says:

    The only thing that will change the nursing shortage is higher salaries. 85-90k as a floor nurse seems a lot higher than the national average. Nurses in many parts of the country make 35-40k.
    Why are people content to pay the person who cares for their dying mother less than they pay the guy who fixes their car? It is because people have no idea what nurses actually do.

    What nursing really needs is a marketing rep. We are the most trusted group of professionals in America, yet no one knows what we really do.
    I am the one district nurse for the 8 schools and over 3000 students in a school district.
    A district with some seriously chronically ill children. Everyone thinks all I do is put on bandaids and pick lice. They have no idea!
    There was a school nurse in every school when I was a child….Most people believe that is still true. Most people think that PAs have more training than Nurse Practitioners!

    People really don’t know what they are missing because of the shortage.

    We live in a world where everything and everyone is turned into a commodity. If we want to get our heads above water, we need to take our position seriously and begin marketing ourselves.
    I think that would make much more of a difference than the any legislative changes the nursing organizations are concentrating our money and their time on.

    If we want to play with the big boys, we need to step up and get into the game.

  4. TLloyd Says:

    I agree with Linda’s comments on the nursing shortage. When it comes to advertising about nursing as a profession one of the mistakes made is no one ever talks about the flexibility of the work hours. This is a major plus to me and my collegues who continue to go to school. I work 2 days a week and can pick up a third day for overtime. 3 days a week is considered full time status. This type of schedule also works well for my friends who have kids. This consept is completely ignored when advertising for nurses.

    The reason for the nursing faculty shortage comes from the fact that nurisng is one of the only professions I know of where earnging higher degrees does not increase your pay! The only reason to pursue a bachelors or masters degree in nursing is to be a manager or teacher. And neither of these jobs pay decent wages. I can work as a floor nurse and make in excess of $85,000-$90,000 + per year in CA. Why would I want to work as nursing instructor after going through all of the schooling required and make $65,000 per year?

    Perhaps one solution to the nursing faculty problem is to let nurses teach who, like myself, have obtained degrees in subjects other than nursing. Having a bachelors or masters degree in nursing does not make one a good teacher. Teaching is a talent that requires among other things good communication skills – not everyone can do this and certainly a degree does not inspire someone to be a good communicator.

  5. Joe Bunda Says:

    Is it me or am I just mis-informed?…

    Medicare and commercial insurers look daily to curb reimbursements – so if that’s the case – who is going to pay for the additional nurses? Should the hospitals and other employers of RN’s just pay out of their pockets and eat the expense generated by employing nurses?

    C’mon… The current nursing shortage is a man made shortage. (period) (In other words – it could be fixed…)

  6. Mary-Louise White Says:

    The situation in public mental health is alarming as well. Attempts to recruit and retain nurses into public mental health is frought with challenges. Not only is the new graduate nurse not interested in this area of nursing, the inequities in reimbursement patterns and access to quality care make this area of nursing even less attractive to them. Furthermore salaries and compensation packages are comparatively much less attractive at all levels and across disciplines. These are among some of the factors which create additional levels of complexity and grim to the existing shortage of nursing for mental health.

  7. LFBaltrucki Says:

    The situation in the clinical laboratory is no less acute.

    Due to the combined effects of retirement, retention, recruitment, and reimbursement, there is a looming crisis in the field of medical technology and it is happening on “our watch”.

    A “technician” can no more replace a “technologist” than an LPN or nurse assistant can replace a Registered Nurse.

    The problem goes well beyond mere manpower needs. The profession of medical technology needs to be redefined, both in terms of the value that medical technologists bring to the delivery system and in terms of their professional activites, their scope of practice and how they are connected to pathologists and to other health care professionals, (including nurses).

  8. Neil Gardner Says:

    The health manpower issue, my favorite subject! I do believe you could substitute primary care physicians and dentists into this above story and get pretty much the same future picture!

    One has to wonder just who is watching the store when in an era of supposed attempts to increase access to care for all, the number and scope of providers is not being watched and updated by any significant social body or social effort that I am aware of. BTW, just who does determine the number of training slots for these various health professions, AND who REALLY has the main clout in determining not just numbers, but the types of providers allowed and their scope of practice? Is it the mission of the health care system to restrict practice to a few providers who get into the club while providing these with great incomes and maybe provide some care as well to some lucky people, OR is it the mission of the healthcare system to provide documented quality care to all who need it while providing decent jobs to a myriad of folks providing the care? Is there any national plan concerning adequate future health provider manpower issues?

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