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Nursing Shortage and the Need for ChangeSarah C. RousseauFerris State UniversityAbstractMany have heard of the growing nursing shortage that plagues the United States (US) and its projection to continue (American Association of Colleges of Nursing (AACN), 2012). Nurses are working longer, harder and growing more tired. The median age for practicing nurses is 45 (Marshall, 2011). The population across the US is living longer and there is a growing number being diagnosed with chronic diseases, all which requires more comprehensive nursing care (Marshall, 2011). Without an increase in the quantity of practicing nurses, the aging population will be unable to receive the care they need or desire. The nursing shortage is often leading to longer working hours, mandatory overtime, and an increase in work related stress (AACN, 2012). These conditions can lead to unsafe practices for the nurses and compromised care for patients. The nursing shortage will have lasting effects on the healthcare system, and must be marked for change. The following will examine causes related to the nursing shortage and the need for change.Nursing Shortage and the Need for ChangeThere is a shortage of nurses affecting the US. As the population begins to live longer, there becomes an increase in the need for nursing care. Without a corresponding increase in the number of nurses, many will be unable to receive the care that is needed. Anna Oritgara (2000) said “We are on the brink of a health care disaster. With millions of Baby Boomers marching their way toward Alzheimer’s disease, our nation will see a major long term care workforce shortage and a dramatic drop in the care quality unless we address this problem immediately” (para. 1). Not only is Alzheimer’s disease a concern, but there is a growing number of chronic diseases affecting the aging population. Nursing leaders are currently studying this issue in order to gain a better understanding of the impact on healthcare and the nursing profession, now and in the future. Understanding the issue at hand is a key to facilitating change. This paper will address related causes of the nursing shortage and why change is necessary.ChallengeThere are many challenges facing the leaders of the nursing profession, the current shortage is one that is affecting the profession and patient care alike. Most areas of the healthcare industry lack enough personnel to work and leaders to lead (Marshall, 2011). Experts are reporting that the current shortage is more serious than those that have come before (Marshall, 2011). There have been nursing shortages in the past which have been quickly rectified, because the cause was simple. For example, the population boom in the US after the end of World War II caused an increased need for licensed nurses. Through the 1970’s and 1980’s the shortage was caused by workplace dissatisfaction (Alspach, 2000). The cause for the current shortage is not so easily identifiable; some of the past issues have contributed but the current shortage is caused by many factors including: an aging nurse population, changes in responsibility, a changing environment, lack of nursing educators, and nursing school enrollment (Janiszewski Goodwin, 2003).Nurse PopulationThe largest group of healthcare professionals in the US is Registered Nurses (RN) (United Healthcare, 2013). The previous shortages caused a short term influx of nurses into the profession. Since that time, those that entered the profession have begun to reach the age of retirement. At an aging workforce global summit participants reported that by the year 2050 there will be three times as many people over the age of 60 that there are today (AACN, 2012). The average age of practicing nurses is 45 years, it is estimated that nurses in their 50’s make up a quarter of the RN workforce (Marshall, 2011). The number of new graduate nurses entering the workforce is not corresponding with the increasing number reaching retirement age. With the loss of the aging nurse population, younger nurses and patients alike are losing the experience and knowledge the older generation will take with them. Hatcher, Bleich, Connolly, Davis, O'Neill Hewlett & Stokley Hill (2006) recommend preserving knowledge held by experienced workers through working relationships with the newer employees. The experienced worker then plays an important role in sharing past experience to help guide the newer worker. Utilizing the aging staff in different ways to capitalize on their experience is a valuable asset to the new generation of nurses.Nursing EducatorsThere are not only not enough nurses to provide care, but a lack of nursing educators to provide the needed education for the next generation of nurses. Increasing age is affecting nurse educators as well. The age of potential students is also increasing, and nursing is becoming a second career for many, thus increasing the number of applicants to nursing programs across the country. From 2008-2009 the AACN (2009) reported 39,423 applications were turned away from baccalaureate and graduate programs. The AACN (2009) received data from 318 schools reveling that the principal cause for turning away applicants was a lack of faculty. The increasing age of nursing educators is leaving programs without the faculty to educate the incoming students. A large portion of new graduate nurses are foregoing continued education to join the workforce. Without an increase in the number of nurses that continue their education, the number of nurse educators decreases. In turn without the proper number of educators schools are forced to decrease enrollment in nursing programs, which negatively impacts the nursing shortage. Changing EnvironmentThe responsibility of nurses has increased exponentially over the last few decades. Sheila Bentley (2010) wrote “in a nursing shortage that’s expected to reach the thousands in the next 5 to 10 years, we as nurse leaders must act now to prevent burnout and create an environment in which nurses experience only occasional stress” (p. 19). With a shortage in RN staff, those practicing are working longer hours, and taking on more patients and more responsibility in the care of those patients. The increased responsibility and change in working environments is leading to increased stress, and burnout. Maslach and Leiter (1997) describe professionals as emotionally, physically and spiritually exhausted. The longer hours and increased stress are contributing to patient safety errors. A study by Rogers, Hwang, Scott, Aiken & Dinges (2004) found that longer hours for hospital nurses could have negative effects for the patients in their care. Buerhaus, Donelan, Ulrich, Norman, & Dittus (2006) wrote a six part series that analyzed the nursing shortage in the US and what affect the shortage has had on patient care. They found that the shortage frequently affected timeliness of care; effectiveness and efficiency of patient care; and two thirds of registered nurses interviewed said that the shortage had affected both the safety and quality of care they give to patients. Patients rely on the nursing staff to help ensure their safety, but with the changing nursing environment and a growing shortage, patient safety is at risk.Nursing School EnrollmentStudies have shown that there is a direct link between the level of education and the care a nurse is able to provide. Haverkamp and Ball (2013) reviewed published literature on the association between nursing education and patient care, and found that baccalaureate and higher educated nurses are associated with improved patient care. They also found that these nurses demonstrate three important skills in today’s nursing environment: knowledge of role, ability to problem solve, and improved communication skill. With the decreasing number of practicing nurses, the number of baccalaureate-prepared nurses is decreasing as well.Elaine Marshall (2011) said “nurses are now virtually the only ‘professionals’ among healthcare practitioners who have significant responsibility for critical care in illness and injury, health maintenance and health promotion for whom college graduation is not a prerequisite” (p. 144). There is a growing need for more college educated nursing professionals in the healthcare industry. Need for ChangeThe shortage of nurses is a topic that is unable to be ignored. Patients see it and feel it when their care suffers. Nurse’s notice when workloads increase and demands are higher. Nursing leaders are affected when turnover increases due to burnout and stress. Nurses, the healthcare industry, and the government alike are making every attempt to bring this topic to the forefront (Janiszewski Goodwin, 2003). Past attempts to positively affect the shortage have been short lived. There needs to be a long-term solution which will have lasting effects. Aiken, Clarke, Sloane, Sochalski & Silber (2002) found that an increase in the registered nurse staff substantially decreases patient mortality rates, when all other factors are equal. The increase in staffing can only increase if changes are made and implemented. Change TheoryKurt Lewins Change Theory can be used as a guide for implementing positive change. Lewin’s theory is a three stage model. Kritsonis (2005) explains that the first stage of Lewin’s change theory is to “unfreeze” the status quo (2005). Identifying ways to “unfreeze “the status quo is part of step one. Researchers have found potential solutions including increasing recruitment, reaching out to unemployed or retired nurses, encouraging continued education, and an increase in job satisfaction (Janiszewski Goodwin, 2003). The second step in Lewin’s theory is movement (Kritsonis, 2005). The second step involves getting nursing leaders, nurses and the healthcare industry to agree that the status quo is not working and make a move for change, then finding ways to implement the change that researchers have found as viable solutions. The last step of Lewin’s model is refreezing (Kritsonis, 2005). This requires that change is made and implemented; it must be then refrozen for it to be sustained over time. ConclusionIn conclusion, the nursing shortage in the US is a topic that many are aware of. Practicing nurses are working harder, longer hours than ever before. The population as a whole is aging and there are an increasing number of chronic diseases that require more care. A large portion of nurses are reaching retirement age and there is an unequal amount of new graduates to replace them. The current shortage is affected by the aging nurse, the changing environment in which they work, a decreased number of nursing faculty, and a decrease in the number of nurses pursuing higher education. Nursing leaders and researchers are studying this issue to gain a better understanding of the underlying causes contributing to the shortage. A true understanding of the issue and its causes will guide leaders to facilitate a change. Without change the shortage will only get worse and affect the generations to come.References BIBLIOGRAPHY \l 1033 Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002, October). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288(16), 1987-1993.Alspach, G. (2000) Editorial: another nursing shortage wake-up call?Critical Care Nurse 20, 8–12.American Association of Colleges of Nursing. (2009). Student enrollment expands at U.S. nursing colleges and universities for the 9th year despite financial challenges and capacity restraints. Retrieved from Association of Colleges of Nursing. (2012). Nursing shortage [Fact sheet]. Retrieved from American Association of Colleges of Nursing: , S. M. (2010). Nursing retention through addressing burnout. Nursing Management, 41(12), 19-21. Buerhaus, P.I. Donelan, K.I., Ulrich, B., Norman, L., & Dittus, R. (2006). State of the registered nurse workforce in the United States. Nursing Economic$, 24, 6-12.Hatcher, B. J., Bleich, M. R., Connolly, C., Davis, K., O'Neill Hewlett, P., & Stokley Hill, K. (2006). Wisdom at work: the importance of the older and experienced nurse in the workplace. Princeton, New Jersey: Robert Wood Johnson Foundation. Retrieved from , J. J., & Ball, K. (2013, August). BSN in 10: what is your opinion? AORN Journal, 98(2), 144-152.Janiszewski Goodwin, H. (2003). The nursing shortage in the United States of America: an itegrative review of the literature. Journal of Advanced Nursing, 43(4), 335-343.Kritsonis, A. (2005, November). Comparison of change theories. International Journal of Management, Business, and Administration, 8(1), 1-7.Maslach, C., & Leiter, M. P. (1997). The truth about burnout. San Francisco, California: Jossey-Bass Inc.Marshal, E. (2011). Transformational leadership in nursing: from expert clinician to influential leader. New York, NY: Springer Publishing Company, LLC.Oritarga, A. (2000). Long term care workforce crisis is looming: Millions with Alzheimer’s disease at risk. Retrieved October 7, 2013, from , A. E., Hwang, W.-T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004, July/August). The working hours of hospital staff nurses and patient safety. Health Affairs, 202-212. doi:10.1377/hlthaff.23.4.202Rosseter, R. J. (2012, August 6). Nursing shortage fact sheet. Retrieved 2013, from American Association of Colleges of Nursing: Healthcare. (2013). Center for nursing advancement. Retrieved from: ................
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