Essay/500-words or less: Shortage Y's

  1. In 500 words or less:

    (a) If you agree there is a shortage of bedside nurses, list the reasons why.

    (b)Or refute the need, citing reasons.

    (c) Sum up by projecting future bedside nursing needs and whether you believe that the goal is achievable or even desirable.
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  2. 13 Comments

  3. by   Sleepyeyes
    OK, I'll go first:

    I believe there is a shortage of bedside nurses, and I believe we've always had a shortage of (licensed) bedside nurses.
    The current shortage was artificially created when diploma schools closed and nursing students were no longer used for bedside care.
    Hospitals and healthcare became big-business. HMO's took over the system, redefining the nurse's role in the hospital setting. We didn't put up a fuss; we too wanted what was "best for the patient." We martyred ourselves to the nobler cause--and lost important professional headway. Big mistake.

    Other career options opened and women traded up the ladder for more money, better perks, and more prestige without the inconvenience of un-family-friendly shift work, exposure to dangerous diseases and patients, low pay, no retirement, few perks, and exhausting physical labor.

    I see the shortage as a continuing crisis because I remember back in the '60's when there was a similar crisis-- the "teacher shortage." Yes, there was. But school districts didn't expand the budget nor hire teachers to reduce classroom size. Teachers still don't get paid much for what they do, though unlike nurses, they have a strong union, and I predict the same will happen to nurses.
  4. by   VivaLasViejas
    I can summarize why there is a nursing shortage in only 2 words:
    MANAGED CARE.

    'Nuff said.
  5. by   spineCNOR
    Sleepeyes,

    I can't improve on what you said--good summation of the problem!
  6. by   James Huffman
    While it's easy to blame a shortage on one factor, that doesn't explain the problem.

    The shortage began around 1930, and has continued since. There have been ups and downs, but the shortage has never gone away. Managed care may indeed contribute to the problem, but the shortage was here long before that factor came on the scene.

    Jim Huffman, RN

    www.NetworkforNurses.com
  7. by   DelGR
    Working conditions -- basically forcing nurses to leave hospitals for better working conditions elsewhere.
    Pay doesn't equate to the responsibility and knowledge needed for the professional nurse.
    Attitudes of the hospital associations and insurers -- nurses continue to be the highest cost area of hospitals. Insurers will only pay for so much. If hospitals want to keep costs down, they will continue to keep staffing levels low. Nurses are more expensive then ULPs and LPNs.
    Then we are back to my first statement----working conditions.
    I don't think it will ever get better.
  8. by   rstewart
    The American Organization of Nurse Executives' position is that a nursing shortage presently exists; This is reason enough for me to state that there is no true nursing shortage.

    Others have studied the situation and when traditional indicators for defining professional shortages are used, their conclusions are that no overall nurse shortage exists at this time.

    There are more licensed nurses now than ever before....but the number of hospital beds has been been decreasing. Does that sound like a true shortage?

    Or consider this common scenerio: Hospital X wishes to take care of 32 patients each day in their critical care unit. They have dozens of staff nurse FTEs which they are unable to fill, yet they are able to take care of 32 patients each day. How? They use Traveling nurses, Agency Nurses, Contract Agency Nurses, Float pool Nurses and Per Diem Nurses----all receive significantly more money than what regular staff nurses are offered. All the beds are filled and the unit is fully staffed. The hospital spokespersons say there is nursing shortage at their hospital pointing to the unfilled FTEs---but is there?

    Much has been written about what should be done to retain recruit and retain nurses. Sign on bonuses are fairly common. But what of retention bonuses, improved ergonomics, significantly improved benefit packages, childcare, retirement, etc.? How common are they in your area? In many areas of the country typical annual age increases remain at 2-3%--- This after a decade of flat income when adjusted for inflation. Does the above suggest an industry doing everything they can to keep nurses at the bedside?

    And of course then there are the staffing issues. In your area are the facilities improving staffing in order to increase professional satisfaction and improve patient care? Or do they try to fill as many beds with patients as possible regardless of how many nurses there are to take care of them? In short, are they doing everything they can to allow bedside the nurses to succeed in their mission (and stay at the bedside)?

    I could go on. Certainly there are areas and specialities where there may be acute shortages. How could this not be so? Massachusetts, for example has twice the nurses per capita when compared to California, for example. But over all....Nope, I'm unconvinced that there is a true shortage, but rather an unwillingness to work at the bedside as regular staff because of working conditions and pay. A final example: More than one hospital in this area will not offer an applicant more than the midpoint of their pay range for staff nurses. The midpoint is typically reached in 7-9 years. That means that any nurse with more than nine years experience will receive no compensation for it on an already pitifully low pay scale. Again, does that sound like a true nursing shortage exists? The local papers all say it does and I'll bet yours does too.

    While there may be some argument as to whether or not a shortage exists, there is agreement that we will have a shortage in a few years if significant changes are not made. I am not optimistic we will succeed in attracting and retaining adequate numbers of nurses at the bedside. Only time will tell. But do not be misled by the small increases in BSN programs you may have read about. I precept these bright young folks and I can see particularly in the past couple years that they have set their sights beyond bedside nursing even before they take care of their first patient. CRNA, CNS, Nurse Practitioner, Administrator/Executive etc. is what they want......it's all about getting enough bedside experience to move on with them and the sooner the better. As things stand, can anyone blame them?
  9. by   Sleepyeyes
    Excellent posts, all! Thanks for the thoughtful responses.
  10. by   FTell001
    a shortage of nurses? or..a shortage of nurses UNWILLING to work in the present enviroment? I know plenty of nurses...that are staying home..or working in other professions ..so I don't think "schooling more nurses" is the answer. I do believe that if the working conditions were improved, more nurses would consider returning to the bedside.
    Safer nurse/patient ratios would help the problem. But do hospital administration really WANT that many nurses on a shift? Isn't it cheaper to claim "nurse shortage" rather then adequatly staff a unit?
    (shaking my head here)
  11. by   llg
    I agree with a lot of what has been said on this thread, but I will add a few more thoughts.

    I think the situation is a lot more complicated that some people seem to think it is. Yes there is a shortage of RN's in the active workforce, but there probably would not be a shortage if every RN were actually working full time in nursing. However, I don't think that simply raising the pay would completely solve the situation -- though I would be happy to receive a raise, myself.

    I think a lot of it has to do with the fact that certain aspects of nursing (even under decent conditions) are not appealing to a lot of people. Hospitals need to stay open on nights, weekends, and holidays -- and most people simply don't want to work at those hours. Also, nursing involves dealing with things that smell bad, etc. and with people who are under stress, etc. Then, on top of all of that is all the financial mess of HMO's, managed care, etc. that others have mentioned.

    Finally, there are the sociological issues. Most nurses are women -- women with families who would rather NOT work full time if they had the choice. Most young nurses do NOT really intend to work full time as a bedside nurse until they retire at age 68 -- and most older nurses never intended to do that either.

    The truth is, most people enter the profession with the underlying expectation that they will do it for a few years, then either move on to some other job in health care OR switch to part time after they have children OR stop working after marriage and live off their husband's salary. The number who really intend to work at the bedside full time for 40+ years is small. As pay increases, it simply allows nurses to satisfy their financial needs with fewer hours of work. Not that I blame them ... If I suddenly won the lottery -- or had a husband with a health paycheck, I would not be working full time, either.

    Also, as the acuity rises and the needs for highly educated nurses with advanced skills grows, we need more nurses per patient. One RN, with the help of an LPN and an aid, used to be able to provide safe care for 20 patients on a general med-surg unit. No one would think that was safe with today's level of acuity.

    So ... the need for nurses grows; the stress increases because of higher acuity and a more restrictive financial environment; women have other, more attractive career options than they had in the past; and most women NOT to work full time or unattractive shifts if they don't have to. When you add all of that up, it's not surprising that we have a shortage -- and there is no easy solution.

    llg
  12. by   llg
    A question:

    If pay were increased to the point at which a nurse working 1 shift/week earned $100,000 per year and 2 shifts/week earned you $200,000 per year etc. How many of you would work more shifts/week than you currently do? How many of you would drop your hours and work less?

    llg
  13. by   Sleepyeyes
    Gosh, llg, you're talking to a workaholic here....
    I'd probably do my 40 hours and a couple of extra classes, as usual.... :chuckle

    I only know that because we discussed that ever-popular "would you keep working if you hit the Lottery" question. I would, but I'd have to buy more insurance, I guess. And I'd do more volunteer nursing stuff.
  14. by   OC_An Khe
    To over simply a complex problem. Most Americans don't see or recognize the true economic value of the Nursing Profession. They still for the most part consider us servants.
    A lot of todays problems can be traced to the 1930's. Thats when Nurses became predominately employees of hospitals instead of independent practicioners. Nursing then became a cost center to be controlled as opposed a center of economic value. This view has be ingrained in hospital administrators thought processes for generations.
    In the Depression Nurses traded employment and current income for the Indepence of the profession and as a result ultimately control of the profession passed away from nurses. Hospitals at one time employed/ controlled over 80% of all nursing employment in the country. This trend has been reversed, it's now less than 60%, and hospitals now have to compete with many areas for Nursing talent. Including a growing return to independent practicioners and Nursing regaining more control of its own profession.
    They will fight to keep Nursing from controlling its own profession. It is why UAP, med techs, institutional liscencing, anti-union positions, etc. are continually being pushed by hospitals and insurers.
    The perception of economic value, and who controls this value will ultimately determine the Nursing Professions fate.

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