Nursing Shortages Up Hospital Risks

By Freedman, Stuart I. | Risk Management, July 1989 | Go to article overview

Nursing Shortages Up Hospital Risks

Freedman, Stuart I., Risk Management

Nursing Shortages Up Hospital Risks

Nursing vacancy rates in hospitals and health care organizations throughout the country have hit double digits in 1986 standing at 13.6 percent. According to a survey of the American Organization of Nurse Executives just one year earlier, vacancy rates were only 6.3 percent. What has caused such a dramatic increase from 1980, when 25 percent of all hospitals were reporting no nursing vacancies?

In managing nursing shortages, hospitals argue that new and different factors have contributed to the current situation. Legal theories examine hospital liability through the acts or omissions of its nursing staff.

Factors that have been historically cited as being behind the high nursing vacancy rates are low wages, poor working conditions and a poor public image. Historically, nursing shortages have been cyclical in nature, and the pattern of reaction by the hospital industry has been to wait until a shortage reaches crisis proportions. Interventions have often not begun until shortages have disrupted patient care, burned out nursing staffs, frustrated nursing directors and resulted in cutthroat competition.

In today's health care environment, however, the stakes are higher. The impact of a nursing shortage in the current competitive health care industry could seriously disrupt the quality of patient care and the ability for hospitals to meet health service commitments. Undoubtedly, the risk of hospital liabilities increases when nursing vacancies are at current levels. There are steps that risk managers can take to minimize risks created by today's shortages. Hospitals have previously taken steps to reduce the impact of nursing shortages on hospital operations. Among these are increasing wages (shortages were relieved in 1980-81 when wages increased 13.5 percent); increasing the use of overtime hours; using float pools, nurse registries and crosstraining existing staff; using innovative staffing plans and patient classification systems; using supplemental nursing services/agency services; downsizing health services and closing beds.

These steps have temporarily eased nursing shortages, but few long-term remedies have been taken to improve working conditions for nurses. The fact that nursing in today's fast-paced hospitals is physically grueling, emotionally draining and intellectually taxing has led many nurses to leave the hospital setting or to drop out of the nursing employment market.

The principal reasons cited for the current vacancy rate is that there are simply more career options available to women today. Why should a person go into nursing when he or she can make more money and have better working conditions in business? Another factor contributing to the high vacancy rates in hospitals is that nurses are choosing to work in alternative health care settings such as ambulatory and home care, where improved working conditions and better wages are offered. This latter factor has led to a redistribution of the current supply of nurses away from acute care hospitals to out-patient and home care settings.

The task ahead for hospitals in providing a quality nursing staff will depend on how well hospitals develop, implement and maintain programs of recruitment and retention. At the same time, the nursing profession must deal with the changing clinical and managerial trends in health care. From a clinical perspective, some of the changes already affecting the nursing profession are the movement from general medical/surgical nursing to specialty care nursing, managing an aging patient population, meeting nursing needs in ambulatory and primary care settings, maintaining high quality standards in a more controlled health care environment and teaching families the basic principles of self-care. From a management perspective, nursing must adapt to more decentralized organizations, staffing efficiency requirements, the expanded role of the nursing administrator in planning, marketing and new business development and help management make health care service delivery more economical. …

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