Research Korner: Nursing Issues

Contemporary Issue in Professional Practice     How to combat the shortage of Registered Nurses?   Introduction The topic about combating the shortage of registered nurses is chosen to be the focus of essay discussion by the researcher due to the fact that she is amiably aware of the importance of nurses’ role as well as functions in health care, chosen to address possible needed factors in combating nursing shortage and keep command to effective nursing profession within the nursing care milieu, as these kind of shortage is present Shortage of registered nurses (RNs) assumes a contemporary issue into the nursing care practice as it poses real situation into health care setting hitting almost all related domains like, the hospital care team since, the shortage of nurses will be felt due to lack of proper management handling and other factors affecting the nurses’ workplace environment. Buchan (1999); Duffied and O’Brien-Pallas (2002) and O’Brien-Pallas et al. (2003) indicated a well documented to evidence of nursing shortage as  now happening  hitting almost being exacerbated by the aging nursing workforce in combination with an aging general population and increasing acuity of institutional clients (O’Brien-Pallas et al., 2003) The need to combat shortage of registered nurses is one ideal process to think, act and decide.  According to Zurn et al. (2005 p. 608), there can be certain ways to address concerns as core strategies to combat nursing shortage, as indicated below -          Increasing new recruits to the profession -          Retaining Registered Nurses (RNs) currently employed in nursing -          Attracting RNs who have left the profession back into nursing employment   Literature Zurn et al. (2005), noted that “such health human resource shortages have been described as symptomatic of inadequate recruitment and retention strategies” which are important in combating the shortage reality of the issue known as the shortage do occur into cyclical phenomenon (Buchan and Calman, 2005). However, “even if recruitment initiatives attract sufficient new nurses to the system, there is currently a shortage of nurse educators to assist them through the required nursing education programs”, (Buchan, 1999). Furthermore, Waldman et al., (2004) reported that some of the turnover costs does affect the growing shortage of nurses and how to better combat the situation several nurses are hired due to the demand of the nursing care profession  (Waldman et al., 2004). Thus, some RN demographics suggest that retirements will make up an increasingly larger component of turnover. Retirement turnover results in a greater loss of nursing capital i.e. the acquired knowledge, skills and abilities of retiring RNs. The loss of productivity, which occurs while new recruits move toward job competence and mastery, is an often unrecognized cost of staff replacement. Furthermore, Aiken et al. (2001) mentioned that, “each individual who enters the profession of nursing should be capable of adaptive behaviors with a goal of achieving optimal health. It is obvious that the nursing profession is in grave danger. Some of the students have no intention of practicing nursing but are using nursing schools to receive a degree to move on to other fields such as law and medicine. The fact speaks volumes about nursing schools, their student admission, the curriculum and faculty which are reason for the such nursing shortage”. The burden of nursing is another reason for the nursing shortage. Many people who are entering or have entered schools of nursing may be working on a second profession or forced into the profession because of loss of jobs in the past, looking for never-ending employment and perhaps nursing was a lifelong desired career but was unable to pursue it because of other obligations as nurses strike for more wages that are compatible with their education and work status and a more humane working conditions. (AACN, 2001) There are many issues that must be resolved before nursing crisis be avoided. It is important that all nurses continue to advance their knowledge base. It is important that nursing school administrators obtain qualified faculty members who are truly practice nurse-oriented. (Steefel, 2004) The retention rate in the schools of nursing would increase if schools of nursing included as a mission to help students know and believe in themselves, take advantage of resources and opportunities, set and achieve their goals, learn throughout their lives use the nursing profession to build fruitful and satisfying relationships with others. (Steefel, 2004; Healthcare Financial Management, 2002; Goodwin, 2002)      Combating the Shortage The initiative to get most federal workforce as addressing complaints about working conditions and concerns over quality of care, California took the lead on setting minimum nurse to patient ratios in 1999. (Kimball and O'Neil, 2002) The legislation established minimum staffing levels for registered nurses and licensed vocational nurses working in hospitals and also limited the tasks performed by unlicensed personnel. (Kimball and O'Neil, 2002) The joint commission developed staffing standards that do not mandate specific staffing levels or ratios, but instead require organizations to determine their own ratios based on factors such as nurse competency and level of patient needs. Oregon enacted legislation in 2001 that requires hospitals to develop nurse staffing plans. (Oregon Nursing Shortage, 2001) Nursing authorities have joined forces with health care providers, business and other stakeholders and these regional projects is now in over twenty states bring people together to implement permanent systems of nursing workforce planning. (Peterson, 2002) There are a lot of people out there with really good ideas and these collaborative efforts are on the right track of solving what is a "very local issue’’ and to fill gaps, hospitals have looked to temporary nurses and unlicensed personnel to cover their immediate needs. (AACN, 2002) Thus, nursing care institutions can possibly offer good nurses’ incentives like performance bonuses as well as higher salaries in addition to other things geared to improving nursing working conditions into recognition and health care programs to possibly not be in shortage situation thus, assuming better ways to improve the image of nursing care and practice notion. (AACN, 2002) The need for enough number of registered nurses to partake in health care services to serve rightly, some nurses are retiring or leaving the profession before retirement. (Sochalski, 2002), and few people are entering nursing because other professions are doing a better job of attracting a new generation of workers, men and women alike as there argues that the primary factor leading to this nursing shortage is declining interest in nursing among women, who now have many more career options than in the past. (Sochalski, 2002) The need to avoid workplace dissatisfaction in the nursing care (Aiken, 2001) and here some key findings of research that, only 34 percent of surveyed nurses reported enough RNs to provide high-quality care in the facility where they work, that 29 percent reported that nursing care agency should listen and respond to registered nurses' concerns to spare off any shortage, as nurses who are dissatisfied are the ones likely to experience pressure and too much issues in the workplace than seeing worthwhile compensations and salary systems. Thus, having nurse shortage applies to the usual solutions such as hiring bonuses and education reimbursement may help in the short run but won't solve the underlying issues. Fest (2004) asserted the “core retention issues will also address the key recruitment issues that keep candidates from entering the profession. Nurses need work environments with strong professional practice models that value their work and recognize their impact on patient outcomes”. There should be a crucial look at a health care system under stress and the declining quality of medical treatment in the country from registered nurse's point of view. It should serve as better wake up call for health care providers concerned about the quality of health care. (Steefel, 2004) One thing has not changed that is the dedication and care nurses provide to patients and nurses' continuing desire to make a difference in patients' lives. Now, when the mean age of inpatients is older, there are fewer resources at nurses' disposal to assist in the care of those patients. (Steefel, 2004; AACN, 2001) The problems associated with the nursing shortage and the quality of healthcare delivery to the customer in lieu to the issues perceived in the health care system today that must be address for providers interested in broadening their knowledge base about needed reformation of the health care system and how to take more proactive role in the reformation and is used to stimulate discussion in nurse leadership groups in health care facilities for the patients and customers. (CNN News, 2001) In addition, to combat the shortage of registered nurses, the following good points have to be realized and applied into the nursing care process and actual professional practice The consultation and communication – there will be the need for an expressed desire for improved consultation with nurses regarding changes to the health care system, combined with improved communication regarding such changes. There was a sense that, in their experience, only superficial dialogue had been undertaken, and that advice offered from front-line nurses was not incorporated into change plans. Recognition – RNs described a strong yearning to receive recognition for their efforts from those higher in the organization. While they felt appreciated by clients and their families for their work efforts, there was the perception of a corresponding lack of gratitude from their employer. Given their descriptions of heavier workloads and other indicators of a worsening work environment over the past decade, this lack of recognition was keenly felt. Adequate staffing levels – some participants reflected on the personal impact of this heavier workload at a time when they themselves are beginning to feel the affects of aging. There was strong sentiment that staffing levels would have to be improved in order to keep older nurses in the system: The changes would make people stay is to somehow give them the time to practice nursing the way they see they need to practice, to not just be so run off your feet that you cannot even think about what you've done. You need time to process; you need time to make a human connection. Supportive management – nurses spoke of the need for support from management. Because participants had worked as a nurse for at least a decade, they were able to compare the current situation to that prior to the health care restructuring as expressed ideal desire to return nursing effective structure which included front-line nurses as being empowered to make unit level adjustments as required to better meet the needs of patients needing care: Flexible work schedules – work-life balance was raised as an issue by many of the nurses who were trying to manage their home and professional lives. There was a common desire for work schedules that are more responsive to their need to balance these competing demands and to adjust to the physical changes of advancing maturity: More flexibility working hours for nurses, that's very important through better scheduling. and realize there's a lot of job to finish. Support for new nurses – these long-term nurses saw real need to pass on their acquired wisdom and knowledge to new nurses and expressed a willingness to assist new graduates adapt to their chosen profession as due to their current heavy workloads, there was inadequate time to provide the level of orientation and support that new nurses require. They sought a systematic solution to this problem and praised a new mentoring program being initiated in their health region: Professional development – Educational opportunities as being valued amongst the registered nurses as they lamented the lack of profession development available and suggested that more resources need to be directed toward continuing nursing education. Again with the issue known, length of working years have remain to drive in the professional development opportunities as available into nurses’ career formation thus, enabling nurses to find better means to be in command into the work environment.   Implications for Practice For implications in practice, good and bad side will be in explaining mode. For the good side of the shortage of RN is that, there will be much more positive change, options towards better nursing care set up, the need for much effective nursing care allowing nurses to keep track of their career avenue and performance recognition and assessment , there maybe reality that these registered nurses will imply and utilize several useful vibes towards great workmanship, efficient driven values formation and better services given upon actual care. Meanwhile, the bad side can be about the presence of such competing pressures of RNs work environment being felt that are gradually taking toll, by which if not being combated at the same time addressed constantly, will impose a quick negativism and outcome into such adverse impact on registered nurses shortage rates as compared with retention rates of the nurses. The underlying outcome might involve a crippling effect of such known ability of nursing care systems to provide good and innovative level of nursing research and care patterns as it would be essential that nursing shortage have to be in parallel with some of the pressing issues into the nursing care practices from within it would be wise for the health care policy makers to ideally listen to there vocation calling than any other factors affecting good stance of nursing services from with aspects of actual experience without too much expectations on rewards, incentives and other motivation materials at hand. Furthermore, definite case clears the issue as there can be dedication providing support for nurse leaders that make decisions related to patient care assignments, such as the North Carolina Organization for Nurse Leaders supports staffing patterns that promote safe patient care. The nursing profession has gradually accepted responsibility to assure that safe and accessible healthcare is available to the public even in times of nursing shortages. The profession continues to accept better responsibility and identifies strategies to promote the best possible patient care and do recognize in several healthcare institutions, the traditional skill mix involving registered nurses, licensed practical nurses and certified nurses assistants has evolved into teams of professionals, which include interdisciplinary approaches to care. Registered nurses are at the forefront of leading these teams and collaborating with the patient's plan of care In an effort to effectively manage patient care and the nursing shortage, healthcare settings expanded the role of the nursing assistant; however, the registered nurse has increased accountability for ensuring standards of patient care. With this expanded role of the nurse assistant, healthcare settings should make every effort to provide ongoing training and competency validation as per accreditation and regulatory standards. Although nursing shortage is not unlike previous shortages, concern arises when the average age of the bedside nurse is taken to account as well as the decreasing enrollments noted at colleges and universities of nursing students. In addition, we are seeing experienced nurses leave traditional acute care settings for less stressful yet more lucrative position outside of acute care. Combating strategies will be realized for one, means of increasing nursing school enrollment and promoting effective advancement of nursing practice will assist in the long-term retention of nurses. Nursing care background should be managed well and duly evaluated  into the nursing practice upon ensuring workplace provision for achieving quality health care for patients. As some of the hospitals do continue to place ample "human experience" into a more tangible nursing reality. The nurse shortage have to be avoided as much as possible that the registered nurses should emphasize active involvement into the nursing care as well as nursing issues that will trigger nurses’ performance to go down opening doors for the shortage.     Conclusion The combating of nursing shortage have had provided effective ways to fight the phenomenon and keep the number of registered nurses stable along with potential approach from having better stance into the nursing care research and profession thus, allowing registered nurses to maintain a strong goal and vision into the health care service without anything in mind as it can be within organization of ideas combating any shortage presence. Therefore, the need to motivate the nursing care units are one of better consideration keeping up nursing shortage less and that to combat the shortage of nurses, support for needs and professional development can place a vital factor avoiding shortage, the need to imply satisfaction and good domains of nursing practice to execute good working benefits and awards as placed within ample context and perspective of the registered nurses. There sharing of not just ideas but with ideal nurses’ attitudes and emotions for ethical process that can be behind several reasons why there is nursing shortage in today’s medical society. To combat shortage, proper nursing research planning and implementation of various approaches are required for application purposes, the need to understand several expenditure points as well as valuable resources from spontaneous ideas and profile of the nursing workforce  such as those developed in Malaysia and that, nursing retention policies should be attend to and be developed quickly before some of the registered nurses choose to lessen their work loads as premature as it is into the personal careers dominance.     Therefore, RNs do perform the most important duties during a patient’s stay at the hospital, from monitoring vital signs to administering necessary medications but during the past years, there was rampant shortage of nurses in healthcare industry and that this shortage is expected to increase in the years to come. Furthermore, as hospitals and clinics struggle to recruit nurses, some nurses are seeking other avenues of job or other options to work happily. The presence of creative staffing may not fill the void of nurses that remains, there are other ways in which people are working to salvage the nursing profession in a country. The most important way in which the nursing shortage can be addressed is through this avenue. In order for the shortage to begin to be alleviated, the lack of funding and space in these nursing programs needs to be evaluated because of constraining factors, not enough applicants can be accepted and nursing shortage continues to grow. Aside, in order to meet the rising demand for registered nurses, nursing care institution must be able to operate to their fullest capacity and the budget changes should reflect that. The other ways the shortage are to be addressed are by means of recruiting programs as there is responsible for rounding up qualified applicants for vacant positions into such demanding job options attracting more RNs and that, hospitals may continue to suffer from the shortage reality until some budgetary issues are resolved respectively.   References 1.    Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R., Clarke, H., Giobannetti, P., Hung, J., Rafferty, A.M., Shamian, J. (2001), "Nurses' reports on hospital care in five countries", Health Affairs, Vol. 20 No.3, pp.43-53. 2.    American Association of Colleges of Nursing. (2001). AACN's Nursing Shortage Fact Sheet, Washington, D.C American Association of Colleges of Nursing: AACN's 2001 Annual Report 3.    American Association of Colleges of Nursing. (2002). Enrollments Are Rising at U.S. Nursing Colleges and Universities, Ending a Six-Year Period of Decline, Washington, D.C. 4.    Buchan, J. (1999), "The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice", Journal of Advanced Nursing, Vol. 30 No.4, pp.818-26. 5.    Buchan, J., Calman, L. (2005), "Summary: the global shortage of registered nurses", The Global Nursing Review Initiative, available at: www.icn.ch/global/summary.pdf, . 6.    CNN News. (January 12, 2001).  Some worry nursing shortage could put patients at risk http://archives.cnn.com/2001/HEALTH/01/12/nursing.shortage/ 7.    Duffield, C., O'Brien-Pallas, L. (2002), "The nursing workforce in Canada and Australia: two sides of the same coin", Australian Health Review, Vol. 25 No.2, pp.136-44. 8.    Fest. G. (2004). Federal funds to ease shortage falling short Administrators forced to turn away most applicants who have applied to two popular nursing programs http://www.nurseweek.com/news/features/04-08/funds.asp 9.    Goodwin, K. (2002). States Tackle the Nursing Shortage: The Lack of Qualified Nurses Is Reaching Epidemic Proportions. States, Universities and Hospitals All Are Trying to Do Something about It Magazine Title: State Legislatures. Volume: 28. Issue: 9 National Conference of State Legislatures Gale Group 10. Healthcare Financial Management. (2002). Congress passes legislation to ease nursing shortage Updata - Nurse Reinvestment Act 11. Kimball, B. and O'Neil, E. (2002). Health Care Human Crisis: The American Nursing Shortage. The Robert Wood Johnson Foundation, Princeton, NJ 12. O'Brien-Pallas, L., Baumann, A., Villeneuve, M. (1994), "The quality of nursing worklife", in Hibberd, J., Kyle, M. (Eds),Nursing Management in Canada, W.B. Saunders, Toronto, pp.391-409. 13. O'Brien-Pallas, L., Alksnis, C., Wang, S., Birch, S., Tomblin Murphy, G., Roy, F.A., Sajan, P. (2003), "Early retirement among RNs: estimating the size of the problem in Canada", Longswoods Review, Vol. 1 No.4, pp.2-9. 14. Oregon Nursing Shortage. (2001). A Public Health Crisis in the Making. Issue Brief No. 1, Northwest Health Foundation 15. Peterson, C. (2002). In Short Supply around the World, the Need for Nurses Grows, Nevada RNformation 16. Sochalski, J. (2002). Nursing Shortage Redux: Turning the Corner on an Enduring Problem, Health Affair 17. Steefel. L. (2004). Bridges or Barriers Will new certification rules for foreign nurses protect patients or intensify staff shortages? http://www.nurseweek.com/news/features/04-07/visa.asp 18. Waldman, J.D., Kelly, F., Arora, S., Smith, H.L. (2004), "The shocking cost of turnover in health care", Health Care Management Review, Vol. 29 No.1, pp.2-7. 19. Zurn, P., Dolea, C., Stilwell, B. (2005), "Issue paper 4 – nurse retention and recruitment: developing a motivated workforce", The Global Nursing Review Initiative, available at: www.icn.ch/global/Issue4Retention.pdf, .

Contemporary Issue in Professional Practice: How to combat the shortage of Registered Nurses?

Contemporary Issue in Professional Practice How to combat the shortage of Registered Nurses? Introduction The topic abou...