Saturday, July 19, 2008

The Nursing Shortage: A Global Crisis, Close to Home

(Note: This is my inaugural post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

The nursing shortage is here to stay. At least that's where the signs all seem to be pointing. From reports of teachers doing the work of school nurses to a profound lack of nursing faculty, the shortage---predicted for years by many in the know---is an inescapable phenomenon with far-reaching repercussions.

For instance, the Joint Commission (which is responsible for accrediting American hospitals and other healthcare facilities) has stated flatly that up to 100,000 preventable hospital deaths per year in the United States can be attributed to the nursing shortage. Additionally, the Department of Health and Human Services' Agency for Healthcare Research and Quality estimates that adding one patient per nurse per shift in U.S. hospitals increases the risk of hospital-based complications by as much as 17%. But how, pray tell, can hospitals decrease nurse-patient ratios in the face of such massive shortages of personnel?

As individual states consider passing legislation to decrease nurse-patient ratios, some state legislatures---like the Massachusetts Senate---seem deaf to the cries of nurses and patient advocates for mandated nurse-patient ratios that will serve to protect both nurses and patients from unnecessary injury. And in the midst of such a shortage, over-working nurses to the point of attrition from the profession is wholly counter-productive.

When it comes to educating new nurses, the American Association of Colleges of Nursing (AACN) predicts a shortage of up to 500,000 nurses by 2025, exacerbated by a severe shortage of nursing faculty across the United States. With 40,000 qualified applicants turned away from nursing schools in 2007, how will the shortage ever truly be addressed as nurses (and nursing faculty) of the Baby Boom generation begin to retire in droves? This AACN fact sheet apparently says it all, and the picture that's painted is anything but pretty.

As the average age of nurses climbs towards 47; as schools of nursing turn away students in record numbers; as Baby Boomers retire and nursing faculty follow suit---how are we to stem the tide? Faculty salaries cannot keep up with inflation, nurses are recruited heavily from region to region, and overworked nurses burn out as they care for too many patients.

From Canada to Prague to South Africa, more nurses are needed than schools can produce as nurses retire faster than they can be replaced. The story appears to be the same around the world, and governments, facilities and organizations seem to be scrambling for a multitude of solutions.

This writer does not purport to know the answers, and as I read the news, talk with nurses, and read what nurses throughout the blogosphere have to say, the nursing shortage is having a far-reaching ripple effect that touches on every aspect of medicine, health, healthcare, and community.

Nurses are essential to the health of myriad communities. Visiting nurses keep patients safe when they come home from the hospital with acute medical and nursing needs. Hospice nurses provide support for patients and their families as they navigate the dying process. Medical-surgical nurses keep hospital units running smoothly, safely, and efficiently. School nurses dispense medications and tend to the (often complex) medical needs of our children. Office-based nurses serve as the backbone of many private and group medical practices, and advanced practice nurses provide specialized medical care in settings where a doctor is neither available nor necessarily essential to good patient outcomes.

In the coming months, it will be interesting to see how the two major political candidates address---or fail to address---the nursing shortage. Barack Obama may have shadowed a nurse for ninety minutes, but a few hours in scrubs does not a policy make. And when it comes to national healthcare for the masses, if there are no nurses to deliver that care, then the plan is moot from the start. As far as this writer is concerned, any national healthcare policy debate that does not take into consideration the very real shortage of nurses in this country is a debate lacking an essential ingredient.

Yes, the nursing shortage is apparently here to stay---at least for the foreseeable future---and the resolution of this crisis is a goal in which every citizen has a serious stake.
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