The combination of advancements in medical science and general improvement of quality of living is helping Americans live longer as compared to the past. This trend is evident from the fact that the proportion of Americans aged 65+ to the total population has risen from 12.4 percent in 2000 to 14.9 percent in 2016. This number is expected to rise further, and by 2050, 22 out of every 100 Americans will be aged above 65 years.
Of course, living longer does not mean Americans will be leading a healthier life. As of 2016, eight out of every 10 Americans suffer from more than one chronic health condition. Common ailments include hypertension, high cholesterol, allergies, diabetes, etc., which either require or invariably lead to prolonged medical and nursing care.
This reason is why a shortage of nurses, despite nursing being one of the fastest-growing occupations in the U.S., is a very significant issue.
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Demand for nurses is expected to rise to close to 3.2 million in 2024 as compared to around 2.75 million registered nurses (RNs) in the country in 2016. Apart from growing demand for nurses due to people living longer and suffering from ailments, another factor contributing to the shortage is the high turnover seen in the nursing industry.
Data indicates that 16.5 percent of all nurses employed in hospitals quit their jobs within the first year. Further, recruiting a replacement nurse is a time consuming affair with average recruitment time ranging between two and three months per nurse, depending on the specialty. With an average turnover cost of around $45,000–$63,000, hospitals are losing $4–$6 million per year simply because there are very few nurses and that the rate at which they shift from one job to another is very high.
Impact on Health Care
Apart from the financial costs, lack of adequate nurses has an inevitable negative impact on the quality of care received by the patients.
There is a direct correlation between patient mortality (i.e., risk of death) and shortage of nurses. An increase of one full-time RN per 1,000 inpatient days contributes to a 4.3 percent decline in death of patients. Conversely, hospitals with fewer nurses witnessed a 2–7 percent increase in mortality.
Secondly, lack of nurses is one of the biggest reasons behind the problem of overcrowding of emergency rooms. Ninety-two percent of all emergency departments have reported the problem of overcrowding, which can lead to an increase in the duration of hospitalization, performance of additional procedures, permanent disability or even death.
Overcrowding also increases the risk of physicians committing more errors. Lack of nurses is leading to issues like patients waiting for hours for the first consultation with the doctor in the emergency room. In fact, three out of every four hospitals reported instances when10 patients had to wait more than three hours for the consultation.
Thirdly, shortage of nurses leads to an increase in the workload of the existing workforce, which results in a predictable increase in medication errors. Close to half of all nurses employed have admitted to committing a medication error in the past year. Errors may range from infusing medicines at the wrong rate (most common) to giving the wrong medicine or mixing up medicines between patients, which easily can result in fatal consequences.
Worryingly, inadequate education and training is the most common reason for medication errors while fatigue is the second-most common reason. This issue is indicative of a more serious problem of inadequate infrastructure and lack of qualified educators for training RNs.
Resolving the Problem of Shortage of Nurses
Considering the fact that demand for RNs is high with limited supply, it is surprising that just half of RNs have indicated being satisfied with their salaries. Simply paying more and offering bonuses to those individuals who sign on to become nurses can go a long way in rectifying the problem.
Another strategy would be to expand beyond conventional target groups and seek out people from underrepresented backgrounds. Apart from attracting top talent and alleviating the shortage, this approach will help create diversity within the profession.
Thirdly, providing better training and education will help create more opportunities for those individuals already in the existing pool of RNs seeking better growth in their field. This professional development can create a sense of loyalty, which can go a long way in tackling the problem of high turnover of nurses in hospitals.
Finally, hospitals could opt for seasonal hiring of temporary nurses during surges in hospital admissions. People don’t fall ill at the same rate throughout the year, which may create a situation when there seems to be a dearth of nurses when simply hiring more people for a short period of time may reduce patient care delays and resolve the issue.
Strategic Steps to Address the Problem
Adding more RNs to the workforce will require a more strategic approach that goes beyond higher pay and seasonal demand-supply tweaks. A very important step would be to focus on the pay of nurse educators. One-third of facilities that educate nurses described their salaries as uncompetitive. It will be impossible for quality nurses to be educated in high numbers unless top talent is attracted to field of nurse education, as well. Higher salaries and additional incentives, monetary as well as non-monetary, can help retain existing talent and attract better teachers into the profession.
Another way to make nursing financially attractive would be to facilitate faster and easier payment of nursing student loans. One in every four RNs owes a student loan, which can be a contributing factor to the industry’s high turnover.
Finally, nurse education can become easier and more convenient if students had the option of choosing distance and online learning programs. This alternative can allow individuals who otherwise would have rejected the profession to consider the same. Distance and online learning also can help attract members of other professions to obtain nursing qualifications. The option also can be attractive for those nurses who may not be comfortable with the conventional teaching methods currently used by nurse educators.
It is evident that the nursing shortage will impact the quality of care patients receive in hospitals and emergency departments. Only a comprehensive strategy consisting of immediate and long-term measures can ensure Americans don’t continue to suffer due to lack of adequate RNs.
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