ANA Continuing Education | The Nursing Shortage: Solutions for the Short and Long Term

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The Nursing Shortage: Solutions for the Short and Long Term

Every article, speech and interview about the nursing shortage notes that it is a different type of shortage than in the past. Some contributing factors remain the same, such as women having more choices for a career. Key differentiators from the previous two shortages are the aging of nurses, the general workforce shortages in ancillary professions and support labor, and the global nature of this shortage. In addition, the fundamental changes in how patients are cared for in a managed care environment is compounding the shortage. With decreased length of hospital stays and more acute care in the ambulatory and home settings, the need for experienced, highly skilled nurses is unmet. A numerical analysis may indicate enough current numbers, but the level of expertise may be the cause of the problem.

From an economic perspective, this shortage is being driven more by the supply side of the supply/demand equation than the demand side. Thus, this is a more complex shortage, which promises to worsen during the next decade as more nurses retire. Past economic solutions such as sign-on bonuses, relocation coverage, or new premium packages will have limited and temporary effect because they simply redistribute the supply of nurses, not increase it.

Past economic solutions such as sign-on bonuses, relocation coverage, or new premium packages will have limited and temporary effect because they simply redistribute the supply of nurses, not increase it.
However, these solutions are already gaining in popularity again as evidenced by ads in local newspapers. The solutions to create a sustained improvement to the nursing shortage will need to be more radical than past shortages and must address many long-term issues.

In addition to the worsening nurse shortage is the shortage of other staff including various allied health professionals, secretaries, and support staff. The shortages of other staff are adversely impacting nurses who have the most continuous and closest relationship with patients and their families. In the early 90's, for cost cutting reasons, there was an increased use of unlicensed assistive personnel. However, these models have failed due to increasing patient acuities, the concerns over medical errors, and the declining numbers of ancillary personnel.

Approximately one third of the nursing workforce is over 50 years of age and the average age of full time nursing faculty is 49 years. A study published in the July, 2000, issue of JAMA predicts that 40% of nurses by 2010 will be 50 years old or older (Buerhaus, 2000a). The challenge is for redesign of patient care delivery models that are built to support the practice of an older workforce. Nursing, a physically demanding profession, must address this challenge by initializing new technology into practice. Hospitals must support the aging nurse by offering flexibility in scheduling, increased time off, and sabbaticals.

In a Lexis/Nexis review of 6 months of news articles throughout the United States about the nursing shortage, every story noted the need for creative strategies. Disappointingly, few described any new interventions. The purpose of this article is to review several factors contributing to the shortage and present possible strategies to address them. The authors have chosen to review: trends in the general work environment, image of nursing, recruitment of students, retention of current nurses, and regulatory and policy issues. Solutions, some already underway in the U.S. are highlighted. Primary nursing and Patient Focused Care are discussed and a preferred model of care is described. They hope that this article will create a rapid communication of ideas to colleagues and stimulate others to build upon these ideas.

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