by Michael Stewart, MA
The last nursing shortage occurred between 1985 and mid-1991. Suddenly, there's talk of another one. But the differences between the health care delivery system of the mid-1980s and that of the late 1990s are staggering. This nursing shortage will not be simply a replay of the last one.
Emerging trends appear to indicate that, this time around, the shortage has complex causes — some driven by real limitations and some by artificially created constraints. For example, under managed care, many registered nurses have been displaced by unlicensed assistive personnel (UAP). The new shortage raises other questions. Are there not enough nurses, bottom line, or not enough of certain kinds of nurses where they're needed? Are there too few slots for available RNs under managed care?
As it did in the late 1980s, the media is beginning to notice and report on this shortage. For example, Californians were warned in a January Los Angeles Times front-section article, "State's Hospitals Suffer Critical Nursing Shortage." In it, Doloras L. Jones, MS, RN, a divisional director of nursing for Kaiser Permanente, California's largest HMO, stated, "The problem now is one of maldistribution — an unmet need for nurses with specific skills such as those required in the operating room, the emergency room and the ICUs." Jones is a member of ANA\California (ANA\C).
ANA\C executive director Catherine Dodd, RN, agrees: "The situation is urgent. As an example, California is one of several states that waived licensure requirements during the last flu epidemic in January of this year." In addition, California Governor Pete Wilson declared an "emergency care crisis," prohibiting acute care and emergency room closures and any further downsizing. Calling the current shortage "the tip of the iceberg," Jones believes that hospitals in California and elsewhere increasingly will face a shortage of RNs of all kinds.
While the new crop of nurses shrinks, the demand for them is increasing as the general population ages. People over 85 years old are the fastest growing population in the United States. The aging of America also is at the crux of the latest nursing shortage because, as the general population ages, so do nurses. The average age of RNs is 44. Approximately 50 percent of nurses are entering their 50s, and many will leave the workforce within the next 10 years. As of 1996, only 9 percent of nurses were under the age of 30.
odd cites this statistic as a crucial impetus for the nursing profession to work harder at recruiting the up-and-coming generation. (See article on mentoring, page 12.) "We must continue to advocate for quality patient care and good working conditions so that we don't alienate the next generation of potential nursing students," she says. "Our other challenge is going to be to fund nursing education to meet the demands of a new and changing health care system, which — because of technology and because of the complexity of the system — requires more education," she continues.
Pamela F. Cipriano, PhD, RN, FAAN, chair, ANA Congress on Nursing Economics, says that, in terms of addressing an emerging nursing shortage, "the Congress on Nursing Economics is concerned that RNs are less mobile and more are already working full-time." Cipriano notes that traditional remedies for regional shortages were to relocate nurses and to offer part-time nurses full-time employment. However, nurses now are aging, and more are married than in earlier years, both factors that influence mobility. The older nurses may be concerned about the portability of their own health coverage should they move, while married nurses also must consider their spouses' job prospects.
In addition, since more nurses today already are working full-time, increasing their hours isn't feasible. Thus, Cipriano says, "The traditional ‘fixes' may not work to correct growing regional shortages of experienced hospital nurses. We are stepping up efforts to analyze the current dynamics of the RN labor supply and demand."
According to a February 1998 AACN issue bulletin on the shortage, "[W]hat's needed today isn't simply more RNs, but more RNs in the right educational mix to handle the more complex demands of the current health care environment." The bulletin states a specific and urgent need for nurses with bachelor of science in nursing (BSN) degrees and graduate preparation in areas such as neonatal intensive care, pediatric cancer care, community health, cardiovascular care, and neurological nursing. Geographic shortages reflect demographic patterns. For instance, Florida needs more gerontological nurse practitioners.
"The hospital industry should do a 180 degree turn and put patients ahead of profits," says ANA President Beverly Malone, PhD, RN, FAAN. "Rather than cutting their nursing staffs to save money, thus creating a nursing shortage, they should look at maintaining adequate nursing staffing to assure quality care, as well as rationing capital and technology expenditures."
Much of the nursing shortage can be attributed to increased consumer awareness and subsequent demand. "I think we're going to see a resurgence in the demand for nurses," said noted economist Stuart Altman, PhD, professor of national health policy at Brandeis University, at ANA's workplace advocacy and economic leadership conference February 4.
"It's just like in corporate America, where businesses saw decreased service and decreased quality," when they downsized," he continued. According to Altman, Americans were initially supportive of efforts to cut costs with regard to health care. "But now, Americans perceive that they're getting poor quality of care in hospitals, so my prediction is we'll see an increased demand for nurses."
Watch upcoming issues of The American Nurse for ongoing coverage of this issue.
Michael Stewart is the senior public relations specialist in ANA's communications department.