How to fix the nursing shortage?

elkpark · Apr 10, 2008

Many of us don't buy the whole "nursing shortage" baloney; there is no nursing shortage, there is just a shortage of nurses willing to put up with the lousy working conditions so many hospitals expect us to. Right now, there are hundreds of thousands of licensed RNs in the US who are simply not working as nurses; more than enough to fill every single vacancy in the country. As long as experienced, seasoned RNs are continuing to leave the field in droves, turning out every larger and larger numbers of minimally-prepared new grads every year is not going to help the problem.

Also, I've been in nursing education in NC for a long time, and I don't know (and am not asking -- I don't want to know :chuckle) what school you're at, but IMHO there are quite a few technical/community college programs in the state that not only shouldn't be expanded, they should be closed down, because they are doing a poor job of educating and preparing the students they have now.

I realize that's not helpful for your paper, but you said you were curious about our thoughts on the idea, and those are my thoughts. Best wishes for your paper and your studies, though! :)

gonzo1, ASN, RN · Apr 12, 2008

Elkpark is right. There is no shortage. I know several nurses who have left nursing because they are not willing to work under the current conditions. Turning out more new nurses is not going to help in the long run.

Nurses graduating today won't stay at the bedside for long. They have been raised to expect more and will burn out sooner.

I also know several new grads who only stayed bedside for a year or two and then left to do other/relating jobs.

The great thing about nursing is you can parlay your education, knowledge and experience into many other jobs.

Mijourney · Apr 12, 2008

Yes, there is a shortage of nurses at the bedside only because like the previous posters wrote, the existing nurses are not willing to deal with the mess in the working environment. You have bullying and sniping going on; overly demanding physician and staff, patients and families; over assignment of complex patients with resulting medical errors on occasion; overtime; insufficient wages based on the expectations of the nurses and so on. What needs to happen is that the onus of care needs to fall on the patient and family. I know it won't happen overnight, but patient and families need to be thoroughly instructed by physician and other practitioners of their responsibilities in taking care of themselves. More time needs to be spent in education then treatment. Reduce the dependence of physicians, families, and patients on the institution. Oops, I forgot. we tend to be co-dependent on the health care system. Oh well, the thought was good.

llg, PhD, RN · Apr 12, 2008

My feelings about the nursing shortage have evolved significantly over the past few years. While I think there is (or will soon be) an underlying problem with the numbers because of the aging baby boomers ... I do NOT believe the "answers" lie in pumping more nursing students into the system.

Simply making more new grads is not the answer to our problems. We need to focus on working conditions and other retention strategies. We also need to UPGRADE nursing education to better prepare students for successful practice in the real world. The "quickie" programs that are expanding now are doing more harm than good. They gobble up resources and produce too many new grads who will struggle in the workplace and consume more resources before too many of the leave the profession. That's not the answer.

I find myself becoming increasingly radical in my views as I study the situation more and more. We need to close down the ineffective nursing schools and consolidate our limited resources (instructors, money for learning labs, classrooms, clinical rotation slots, etc.) so that they can be used more efficienctly. We don't need a mediocre nursing school on every street corner.

In addition to consolidating and upgrading nursing education ... we need to focus on retention by addressing working conditions and the sensible utilization of nursing resources. As the problems are addreesed in the workplace, the jobs will become more attractive and people will be interested in filling those jobs.

I too, have come to believe that the fundamental problem is not a shortage of people who like to do nursing work ... it is a problem of the nursing jobs that exist being unattractive. We need to stop wasting resources on bad nursing programs and focus on making those jobs attractive.

llg, RN, PhD

elkpark · Apr 12, 2008

As usual (:chuckle), I completely agree with llg. Nursing in the US needs to abandon this "quantity, not quality" mentality and focus limited, precious resources on schools that can do a good job of turning out smaller numbers of well-prepared graduates who will actually stay in nursing (in addition to the other side of the equation, which is making it more attractive for experienced nurses to stay in the field).

I've been in and out of nursing education for many years now, and believe that US nursing education in general has seriously "gone off the rails" and needs some major reworking. We used to do a much better job of educating nurses in this country (and not that long ago!!), and while, obviously, the answer is not simply to return to "the old ways," I do think we need to honestly examine to what extent we've thrown the baby out with the bathwater ... But it's like the tale of the emperor's new clothes -- too many people in the field have too great a stake in the status quo, and no one wants to rock the boat.

However, I'm even more "radical" on the subject than llg, and my views are definitely outside the nursing education mainstream. (But I notice that, as time goes on, more and more people are starting to agree with me ... :))

SillyStudent, ASN, RN · Apr 12, 2008

As usual (:chuckle), I completely agree with llg. Nursing in the US needs to abandon this "quantity, not quality" mentality and focus limited, precious resources on schools that can do a good job of turning out smaller numbers of well-prepared graduates who will actually stay in nursing (in addition to the other side of the equation, which is making it more attractive for experienced nurses to stay in the field).

Warning: The new grad perspective

I think part of the problem is the lack of incentive for GOOD nurse educators to teach in nursing programs. In a lot of cases, Colleges do not pay our educators as much as they can make as staff nurses. These folks have an lot on their shoulders; 'creating' nurses to take care of patients is no joke, and they should be compensated commeasurate with responsibility.

I am a new grad, and the difference between solid, concerned nursing faculty and the 'other' kind is measurable in what I learned. For example, I am reasonably confident about the education I received in many areas, but I know for a fact that my pediatric unit was extremely bad. My clinical instructor was great, and stretched our brains. The lecture component was godawful. I did well on the test (because it was ridiculously easy), and managed to pass NCLEX, but I did a lot of extra studying and reading about pediatric problems after I graduated, to bring myself up to par. The rest of my nursing school experience seems to be adequate. My measuring stick is: the theory I learned keeps coming up in my practice, and I know what I am supposed to do in a lot of situations.

I also believe that good, solid nursing programs should be given more spots for students if they have enough faculty to handle them.

My biggest problem with nursing education is the NCLEX. I believe that 'teaching to the boards' is ridiculous. We have to be more concerned with 'teaching to nursing practice'. I also do not believe that the NCLEX is an accurate measuring stick of basic nursing knowledge. 75 questions is simply not enough. I am actually afraid of what they did NOT ask me.

Experienced nurses that leave the field are a seperate problem. I have no idea how to even begin to solve it. The hospitals are not going to volunteer more base pay or better conditions on their own, and as far as I can tell, nurses tend to not unionize. We have no collective bargaining power in any hospital in my area. (except one, but they have serious union problems) Hospitals offer more money for shifts when they are desperately short of staffing, but that is not solving the problem.

llg, PhD, RN · Apr 12, 2008

Nice post, SillyStudent. Welcome to the profession of nursing. Seriously. We need more people like you who can think clearly about such things and express them so well.

I wish you great success.

SillyStudent, ASN, RN · Apr 12, 2008

There are usually hundreds (600-800) or more people applying for 80 spots. It's also been shown that out of those applying many more than the acceptance number are qualified, but there isn't enough space/availability.

I wanted to address this seperately. :)

'Qualified' candidates for nursing school in my program had at least a 2.5 GPA, and could have repeated core classes multiple times. I understand that if you received a 'D' in A&P2, then took it again and got a B, your grade was changed to a C. This does not reflect the D on your transcripts.

My nursing school was at a community college. There was no candidate interview, no competition based on GPA, essay, or interview....no competition except whether you turned in your application on Monday or Friday.

Candidates for medical school are screened much more thoroughly than nursing school candidates. We have heard debate on the field of Nursing and whether it should be considered a 'job' or a 'profession'. If we want to BE a profession, we should consider more carefully what qualities we want in our nursing school candidates.

Many nursing programs start with 100 students each semester and end with 50. I am glad that we do not generally let anyone slide through school. but I wonder if our current nursing school spaces could be utilized more effectively if we made entry into our programs more competitive. I am talking about the Community College level here; I know that BSN candidates sometimes have more competition.

There will be people who disagree with me on this one. I know that perfectly good 'C' students get through nursing school and become great nurses. A Nurse Manager on a floor where I had clinicals said, "I would rather have a C student with common sense than an A student with great transcipts and no clue."

I would rather have an "A" or "B" student with common sense .

Lots of people go on to a different profession while they are on a 3 year waiting list for a spot in nursing school. Let's make nursing school more accessible to the people who can learn the material and apply it.

madwife2002, BSN, RN · Apr 12, 2008

I aggree with all that has been said above. We need to focus on retention rather than recruitment. Also focusing on Quality rather than quantity.

I work with some fantastic nurses who are worn out and fed up.

It is ok saying well you only work 3 days per week but you are exhausted at the end of the day if you are doing your job correctly.

We need to suppress the urge to be writing people up thus lowering moral and focus on educating when things have gone wrong.

nurseygirl79 · Apr 12, 2008

It doesnt matter how many hundreds of thousands of nurses there are out of the hospital and LTCF, if they're not in them....it's a shortage. and what's the very next thing on the list.........teachers!!! sorry girlfriend, if we don't wanna inject ativan in the looney ward, we don't wanna get shot up in the inner city either. teachers get paid poorly, no matter what they teach, even if they're nurses. too bad they can't find some incentive program for teachers at the nursing schools...good luck!

CraigB-RN, MSN, RN · Apr 13, 2008

Just to play the Devils advocate a little bit.

I do agree with ltos of the things said. But I want to keep it in perspective. 33 years ago, I worked on a med surg floor. 45 patients and night shift consisted of a single RN, a single LPN and a single aide. FOr the most part things are much better now, even without mandated patient loads. The difference is, that the acuity of the few patients per nurse has gone way up. 33 years ago, I only had a half a dozen meds to worry about and only 2-3 different IV meds. My pay is meeting my needs, I'll never turn down more money, but in reality I get payed enough.

Now with the acception of more drugs to memorize, and careplans and nusing diagnosis, the core nursing education is still the same. Add to that the fact that the attitude in the nuses station hasn't changed, and it's no wonder that nurses are leaving. I've posted in other places, that as long as we expect other people to start the change for us, nothing is going to change. We have to start it ourselves. We can't tolerate bad behavior from out fellow nurses, it's not supporting those new grads, and helping them along. It's taking control of our proffesion.

If we band together, and support each other, and quit fighting these counter productive battles, we're never going to get anywere.