Regulatory and Policy Issues

A number of regulatory and policy issues may also be exacerbating the shortage. These include state and federal law, regulation by accreditation/certification organizations, licensure and nursing practice acts, and requirements from reimbursement organizations, private organizations and the government. Some issues are factors in causing nurses to leave the profession and others may be barriers for recruiting nurses. Specifically, in this section the authors look at: the complexity of documentation resulting from regulatory agencies; federal and state funding support to nursing programs; employment of foreign nurses; and the role of state Boards of Nursing.

There is a clear need for an aggressive review of the federal and state support to nursing programs to increase the enrollment of students. Given the federal budget surplus, it is timely to expect increased support for schools of nursing and special scholarships to recruit students for basic and advanced nursing education.

As nursing organizations such as the American Nurses Association lobby for increased federal funding, individual nurses need to respond to the request for communication with their elected officials. Every nurse must become a vocal proponent of increased funding for nursing and educate their representatives that nursing is the necessary glue in health care..

Solution: As nursing organizations such as the American Nurses Association lobby for increased federal funding, individual nurses need to respond to the request for communication with their elected officials. Every nurse must become a vocal proponent of increased funding for nursing and educate their representatives that nursing is the necessary glue in health care. Grassroots lobbying efforts, such as those by the AIDS and breast cancer coalitions, have proven to be effective in increasing government support. Solution: Buerhaus (2000b) has suggested that the federal government create a commission to address the issue and attach funding to the recommendations. Solution: State level workgroups are underway in several states and some state legislatures have committed resources as noted above. More state level groups that unite nursing practice and education with state government will be needed. The state nurses' association can take a lead in initiating this work in states where it has not begun. Even if the state does not have a critical need today for more nurses, in the next few years, all states will have this need.

A recruitment strategy that has been successful in the past and is being used again is the employment of foreign nurses. Hoping that this may be a solution, many are raising the question about reviewing federal policy regarding visas for foreign nurses. Currently, the federal policy is a barrier for recruitment of nurses from other countries. However, many countries, Canada for one, are also experiencing a shortage of nurses and this strategy may not help. In fact, many are predicting that there is an emerging global shortage of nurses.

State Boards of Nursing also have an important contribution to make during this uncertain time regarding both the recruitment of nurses and retention of nurses. No doubt, there will be pressure to lower licensure standards to increase the number of graduate nurses. This would be a mistake as the Boards are responsible for protecting the public from unsafe, illegal or unethical practice. During times of shortage and stress, the potential for unsafe practice may be heightened. However, Boards need to review also their policies and procedures to determine whether those policies and procedures are contemporary or out of date and contributing to the nursing shortage. Another topic of great discussion is that of assistive personnel. As hospitals have increased their use of assistive personnel, many registered nurses have not been willing to remain on staff and supervise care of other providers. The Boards of Nursing define the scope of nursing practice and what can be delegated to others and should be helping to educate nurses about this issue. Also, rather than viewing delegation as promoting fragmentation of care, definition needs to be given as to how care can be enhanced by using the full capabilities of registered nurses. The American Nurses Association's position statement on maintaining professional and legal standards during shortages is useful to read in this regard (ANA Board of Directors, 1992 ).