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Nicole Kittle

"How Nurses can help Fix the Nursing Shortage"
College Writing 2, Dr. Jordan Canzonetta

The nursing shortage in the United States is far from a new problem. It has been an ongoing issue for many, many years. Recently the shortage has become a crisis in some areas due to the COVID-19 pandemic. As the nation struggles to adapt to a post pandemic society, so does nursing. I feel that not enough is being done to keep nurses at the bedside and more and more are leaving the profession altogether or finding jobs in areas that are not in acute areas such as documentation specialists, etc. The area that suffers most from the nursing shortage is the acute care areas such as hospitals and this is where the focus needs to be. The reason for this is that although all areas of nursing are extremely important to healthcare, acute care areas like the hospital care for the most ill patients and require an extensive amount of care. When the hospital does not have an adequate staff of nurses, there are not enough nurses available to care for the patients, yet hospitals continue to admit patients despite this fact. Since this is becoming more and more frequent in hospitals across the United States there needs to be a change! Many companies are extremely focused on attracting new nurses and hiring, but do very little to keep them happy with their employment; thus they leave for greener pastures. Many nurses feel disrespected by the lack of support and resources they are given, yet they are at the bedsides of patients in hospitals 24/7!

I would love for more people to become aware of the damaging effects of the nursing shortage and how hospital administrators should instead focus their efforts on retaining their current staff instead of constantly losing them and just trying to replace them. I believe this is obtainable if nurses are given proper working conditions like safe staffing, support from upper level management, increased wages, and better scheduling.

Image source: According to the U.S. Census Bureau (2021) the US population is 332,649,507. According to the American Association of Colleges of Nursing (2019) there are about 3.8 million registered nurses in the US and about 84.5% are currently employed; which means about 3.2 million working nurses. So rounding down the numbers it appears there are about 3 million nurses for 300 million Americans. Do those numbers seem adequate to you? How would you feel if your loved one fell down and suffered a major head injury and had to be rushed to the hospital.. only to find out when they got
there, the emergency department was short staffed with nurses and there were 2 patients actively dying and the majority of the ER was working to resuscitate those patients. Due to these circumstances, your loved one was left alone for quite some time without close monitoring. When a nurse was finally able to check on them they were found on the floor because they had become confused due to the head injury. Now on top of their head injury they acquired a broken hip. That sounds absolutely terrible doesn’t it? Sadly, that is happening all over this country in hospitals because of inadequate staffing. When a hospital is short staffed with nurses proper care is not able to be provided to patients. This leads to so many negative outcomes for the patient as it also negatively impacts the nurses as well as all other hospital staff.

So why do we have a shortage of nurses? It truly is a multifactorial problem. As stated by Dr. Crissy Hunter (2021), a clinical nursing faculty member of Southern New Hampshire University, some of the reasons for the shortage can be attributed to a large number of aging/retiring nurses, nurses becoming burnt out and leaving the profession, an aging baby boomer population and not enough nurses to take care of them, and a lack of nursing educators to train new nurses. I myself am a current registered nurse and have been working in critical care for the past 2 years. I have witnessed all of the above as being reasons for the nursing shortage, and I feel that hospital administrators mainly focus on trying to replace the nurses who left, but do very little to keep them employed there for a long time. The video listed below gives a little bit more insight to the problem.

So again, as being a current working nurse dealing with the shortage I feel that if hospital administrators focused their efforts on retaining staff instead of just continually trying to attract and hire new staff to replace those leaving, the nursing shortage would significantly decrease.

My views as a working nurse may not be in agreement with hospital administrators though. One reason for not agreeing with my proposed solution is budgets and cost. From a budget standpoint it may be cheaper for the hospital to keep hiring brand new nurses who get paid the least amount of money instead of keeping nurses who have been employed 20 years and would be highest paid on the wage scale or increasing compensation for current nurses to encourage them to stay employed. To this argument I would have to say that in the long run it actually costs the hospital more money to keep hiring new nurses rather than keeping current staff and providing them with higher wages. If the hospital budget allowed for higher pay for current staff it would encourage them to stay, less nurses would leave, and there would be less of a need to hire new nurses thus lessening the shortage. This would decrease the amount of healthcare complications experienced by patients by having more experienced/knowledgeable staff available. This would increase the hospital's payments from Medicare and insurance companies, as well as contribute to higher patient satisfaction and more patients choosing to go to that facility knowing that they will be well cared for. Other than budgets, I could not find another opposing view as to why hospitals should focus their efforts on retaining staff to help with the nursing shortage.

So since we have discussed some of the reasons for the shortage, how it affects patients, and who would possibly be opposed to correcting the nursing shortage by retaining staff.. Let’s dive into how we can actually retain those nurses to fix the shortage!

Pictured to the right are some of the statistics from a small survey I collected from current registered nurses. The survey was offered online to two different nursing Facebook groups; one for Alumni of Joliet Junior College’s Nursing program and the second was a group only available to current working nurses in an intensive care unit at the hospital I work for. All of the responses were completely voluntary and the participants were informed of this as well as all of their identities would remain anonymous. 27 participants answered a 10 question short answer survey about their current working conditions. On average the number of years of
nursing experience by the respondents is 8.6 years and on average worked 2.6 different nursing jobs. The average age of the respondents is 36. One of the survey questions asked “Do you ever feel overwhelmed or burnt out from your work? If so, can you provide an example of what contributes to you feeling this way?
One nurse answered:

“Every shift. We never have enough staff and are overloaded with patients that just keep having higher and higher acuity. No lunches or breaks and leaving at least an hour late. Being asked the constantly do more more more with no help in sight.”

Source:

Even though this survey was small and was limited to a small population of nurses, the results were very clear that current nurses feel burnt out and many are looking for new employment due to unfavorable working conditions.

We briefly discussed one way to help retain nurses is to increase compensation. A research study was conducted by 2 nursing professors at a University to discover factors that contribute to the nursing shortage and one of the biggest factors they found was indeed compensation. They found that within their study “27% of the respondents reported that they would prefer not to work (Lynn & Redman, 2005, p. 269)”. The author interprets this as the only reason they are currently working is for the money which is not good for the profession of nursing, meaning if they had other financial means they would leave nursing. They also found that many nurses reported high job dissatisfaction and only stay because they are the breadwinner of the family (Lynn & Redman, 2005). Although this is a sad fact to report, it does show that if nurses were better compensated more nurses would be encouraged to stay with their positions when the conditions are less than favorable. So we can increase pay, but how do we make the conditions better?

Higher pay is a great incentive but it will do little to keep nurses if this is the only change taking place within an organization. There needs to be multiple areas addressed in order to keep current staff satisfied with their positions and less likely to leave or retire early. One interesting piece of evidence I found was that hospitals with magnet designation had higher staff retention rates and attracted more nurses to apply (Graystone, 2018). Not all hospitals are magnet hospitals. Magnet hospitals have to be awarded this status by the American Nurses Credentialing Center. To do this the hospital must meet rigorous standards set forth that showcase the use of evidence based practice and encourage nurses to attain higher education levels as magnet designated hospitals must have a certain number of nurses with a bachelor's degree or higher. This sets forth a standard for nurses to continue their education which in turn leads to the potential for career and personal growth (Graystone, 2018). This then promotes a healthy working environment for nurses and better patient outcomes; therefore helping nurses to stay satisfied with their working conditions and less likely to leave for another organization. So facilities who currently are not magnet certified could set a goal to become magnet certified to help achieve this top notch environment for nurses.

Another area that contributes to the nursing shortage is not having enough support for new nurses. Many nurses actually leave altogether within the first couple years of the profession due to lack of support and feeling overwhelmed. An online news article I had found written by a reporter who had interviewed
nursing staff and faculty had looked into a nursing residency program at an ambulatory healthcare center and it reported that “ 97% of nurses at UW health ambulatory nursing residency program have stayed (Reese, 2021)”. So in order to help retain staff they must be given proper support. When nurses feel like they have been improperly trained and have no available resources to help them in their first few years as a practicing new graduate nurse it can lead to alarmingly high levels of stress and burn out. If hospital administrators implemented longer residency programs and provided additional support such as extra mentors and having more experienced staff available for assistance, this could help to create less anxiety for new nurses helping them to stay at their current positions.

Another giant problem in the nursing shortage has been the recent COVID-19 pandemic. It placed a huge burden on healthcare and all healthcare workers. Many nurses suffered severe emotional and physical damage from it and have left the profession altogether according to Darrell Spurlock, a professor at a University who holds his masters degree in nursing as well as PhD in psychology (2020). Darrell states that “nurses leaving the workforce—and perhaps the profession— earlier than planned due to psychological trauma and even physical disability will only exacerbate the nursing shortage further (Spurlock, 2020, p. 303)''. There is obviously an inadequate amount of resources dedicated to the well being of nurses. They are often expected to work in not good conditions caring for extremely ill patients for over 12 hours a day and have to come back the next day to do it all over again. If hospitals could provide mental health resources and promote self care for nurses like making sure nurses actually are being provided with adequate breaks during the shift and are able to discuss concerns with their managers, maybe they would feel a little less stressed out and overwhelmed and would not experience burn out as frequently.

As amazing as it would be to be overstaffed everyday, this would waste tons of money that could be used elsewhere such as having higher wages for staff to retain them instead of losing them to other companies/areas where they could receive higher wages. I was able to find an interesting statistical study written by 2 managers of operations and management for a University where they focused on how scheduling and effective budgeting could help with the shortage. So the authors developed a model that shows how hospital managers could coordinate scheduling with the use of float pool nurses and agency nurses to decrease mandatory overtime and offer their own staff more attractive scheduling options (Wright). Float pools are a hospital's team of nurses that do not have a designated unit and float to multiple areas such as when nurses call in sick and they need extra staffing, the float pool helps fill the staffing gap. Agency nurses are nurses that do not work for the hospital but for an outside agency and they agree to a contract with the hospital to work there temporarily for a set amount of weeks and for a set amount of pay. This will help current staff to be more apt to stay if they have good scheduling options and will experience less burn out from being overworked, as well as save money on labor costs due to decreases in overtime (Wright & Bretthauer, 2010). This is a win for hospital management as well as staff!

The last piece of information I would like to discuss is a little more personal and doesn’t so much come from a scholarly article, but from a team of nurses and the like who have focused on changing the image of nursing to help provide nurses with better funding, resources, and respect which all helps to decrease the nursing shortage (Summers & Summers, 2015). The above video gives a brief overview about the organization, but I found my information from a book written by the organization's founder Sandy Summers who has a masters degree in nursing and has spent many years working in emergency departments and intensive care units. The authors state how nurses are often portrayed in the media as “sexy, naughty nurses” and wear cute little outfits and strictly follow physician's orders and that is all (Summers, 2015). It does not portray how nurses are educated healthcare practitioners who have autonomy in their practice and play a vital role in taking care of and saving patient’s lives. This is all often attributed 100% to physicians in the media and does not give any credit to nurses and the vital role they play (Summers, 2015). Summers also claims, “a key element underlying many of the immediate causes of the shortage is poor public understanding of what nurses really do. That ignorance undermines nurses' claims to adequate staffing, nursing faculty, and other resources in our era of ruthless cost cutting (2015, p. 14)”. One way healthcare organizations can diminish this is by acknowledging all that nurses do for their healthcare company and provide them with opportunities and funding for advancing their education, dedicating more of the hospitals resources to nurse staffing and less to highly paid executives of the companies, and providing the units with more nursing educators so that staff can become even more knowledgeable in their skills and abilities to practice as healthcare agents.

To summarize, the nursing shortage is an extremely important area that needs to be given much more attention and resources. The area that suffers the most from the shortage is acute care areas such as hospitals and there needs to be a change in the way administrators deal with this. Nurses keep leaving and at minimum hospital administrators keep replacing them, only to have many of them leave again in a few years, creating a vicious short staffing cycle. This is only worsened by the high number of nurses retiring, less nurses joining the profession altogether due to a lack of educators being able to train new nurses, and the COVID-19 pandemic! If hospitals focused on retaining their current staff this would greatly impact the nursing shortage. Hospital administrators may argue that it is cheaper to hire newer, less paid staff than keeping higher paid nurses with more years of experience, but this only worsens the shortage and the hospital loses more money by not being reimbursed from insurance companies due to hospital acquired complications from subpar care due to inexperienced staff and short staffing. If hospitals could give their nurses the respect that they deserve by providing proper funding for their continued education and staffing, providing them with higher compensation, using float pools and agencies to help reduce the workload and minimize overtime as well as favorable scheduling options for nurses, and altogether just providing them with more support such as just being able to actually take their meal breaks instead of working through them to keep up with the workload.. This would all increase employee satisfaction and reduce burnout encouraging nurses to stay within their current positions. This would lessen the shortage and more nurses would then be available to become educators and more nurses would be available for employment. Nurses have shown that they are dedicated, hard working professionals for a long time and especially during the pandemic.. It is time they are given respect for all that they contribute to healthcare!
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References

Kittle, N. (2021, August 11). Retaining current staff in regard to the nursing shortage. [Online forum post]. SurveyMonkey.

U.S. Census Bureau. (2021). U.S. and World Population Clock.
https://

American Association of Colleges of Nursing. (2019). Nursing Fact Sheet [Fact sheet]. https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet#:~:text=Nu
.

Hunter, C. H. (2021, February 26). Nursing Shortage: Why There’s a Continued
Demand for Nurses. Southern New Hampshire University.

Graystone, R. (2018). How magnet® designation helps hospitals tackle the nursing shortage. The Journal of Nursing Administration, 48(9), 415–416.

Lynn, M. R., & Redman, R. W. (2005). Faces of the nursing shortage: Influences on staff nursesʼ intentions to leave their positions or nursing. The Journal of Nursing
Administration, 35(5), 264–270. .

Reese, M. (2021, July 6). Distinctive nurse residency program to address nursing shortage, burn out. WJFW Newswatch 12.

Spurlock, D. (2020). The nursing shortage and the future of nursing education is in our hands. The Journal of Nursing Education, 59(6), 303–304.
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Wright, P. D., & Bretthauer, K. M. (2010). Strategies for addressing the nursing shortage: Coordinated decision making and workforce flexibility. Decision Sciences, 41(2), 373–401. .

Summers, S., & Summers, H. (2015). Saving lives: Why the media’s portrayal of nursing puts us all at risk (2nd ed.). Oxford University Press.