The Nursing Shortage: Insights and Perceptions
Lee, Sharon A., Frontiers of Health Services Management
THE "NURSING SHORTAGE " is one of the most widely published and read topics in professional and trade journals and publications. In fact, entire books are written on the topic. It is the subject of innumerable workshops and seminars; it is talked about in professional gatherings of nurses, physicians, and administrators; and it regularly appears in the lay press with advice to patients on how they should assess their healthcare facilities for the adequate supply and skill of nurses, suggesting that their care may be compromised.
I, too, have been an avid reader of any publication I can get my hands on related to the nursing shortage. I have attended seminars and workshops on the topic. I have even given presentations on the subject to others who are eager to solve the problem. I accepted the invitation to write a commentary on the article written by Janet Quinn with the intention of learning more about this significant societal issue and perhaps developing greater insight into how this problem can be solved over the long term as part of everyday living and as a way of doing business.
THE NATURE OF THE SHORTAGE
The nursing shortage is complex and serious. This is a fact. While some-hopefully not many-believe that this is just another cyclical event like the shortages of the past, this belief is a myth. Although the current one seems to mirror such shortages, it is but a precursor to the long-term shortage that is not only predicted, but will become real unless society collaborates with healthcare for a long-term solution.
Quinn states that the nursing shortage is a result of "dis-ease" in a healthcare system that has cut nursing positions and substituted unlicensed assistive personnel in their place. She states that this has resulted in an untenable work environment, leading nurses to exit the profession. Quinn's analogy relating the disappearance of nurses from hospitals to the mutation and disappearance of frogs on the planet is intriguing. Her solution revolves around changing the practice setting to a "healing environment" that returns meaning to the practice of nursing. Although I agree that a supportive and positive practice environment is critical to nurse satisfaction, ensuring that it is conducive to quality practice will not be the total solution to the nursing shortage. If that were the case, we could embrace a new model for care with appropriate staffing ratios (perhaps the Nightingale unit) and ensure that physicians, nurses, and other members of the team relate properly, with the result that nurses would flock to the hospitals to seek jobs. I wish that the solution was that simple.
The nursing shortage we have today will require a multipronged approach. We must involve legislators, regulators, nursing educators, hospitals, physicians, managed care companies, the Joint Commission on Accreditation of Heathcare Organizations, hospitals and healthcare associations, corporations that pay for healthcare, and others who make decisions about how and where healthcare is financed and delivered. A diverse cross-section of society as a whole should be included to represent the consumer perspective. Of course, nurses themselves must be involved in finding the solution to this problem, for who is better prepared to identify the factors that will not only retain nurses but stimulate young men and women to choose nursing as a profession? It is difficult to look beyond today, and the problems we face in finding the appropriate number of experienced nurses to care for patients in our facilities need attention right now. However, looking beyond the short term is an absolute must.
WHY IS THE PROBLEM SO COMPLEX?
Nursing is a wonderful educational opportunity and an even greater profession. This is, to some extent, a blessing and a problem. With the exception of a few brief periods of time, a competent nurse could always expect to find a job of his or her choosing. …