Tri-Council for Nursing

Transcription

1 Tri-Cuncil fr Nursing January 2001 Strategies t Reverse the New Nursing Shrtage A plicy statement frm Tri-Cuncil members fr Nursing: American Assciatin f Clleges f Nursing (AACN) American Nurses Assciatin (ANA) American Organizatin f Nurse Executives (AONE) Natinal League fr Nursing (NLN) There is n simple descriptin f the status f the nursing wrkfrce shrtage - present and future. Discussin surrunding this issue is cmplex and interrelated. It is nt pssible t islate single factrs r slutins. Rather, a systems perspective review gives the greatest depth and understanding f the relatinships between multiple variables. It is critical t include the systematic issues in educatin, health delivery systems and the wrk envirnment. Further, the impact f reimbursement, legislatin, regulatin and technlgical advances must als be cnsidered. Failure t cnsider the relatinships amng these aspects limits the full appreciatin f the nursing wrkfrce shrtage cmplexity. The Tri-Cuncil is an alliance f fur autnmus nursing rganizatins each fcused n leadership fr educatin, practice and research. While each rganizatin has its wn cnstituent membership and unique missin, they are united by cmmn values and cnvene regularly fr the purpse f dialgue and cnsensus building. The Tri-Cuncil's diverse interests encmpass the nursing wrk envirnment, health care legislatin and plicy, quality f health care, nursing educatin, practice, research and leadership acrss all segments f the health care delivery system. Member rganizatins believe the alliance captures the cllectivity f nursing's scial, plitical, prfessinal and mral authrity natinally and internatinally t influence and prvide stewardship within the prfessin f nursing. These rganizatins represent nurses in practice, nurse executives and nursing educatrs. The New Nursing Shrtage Tday's nursing shrtage is very real and very different frm any experienced in the past. The new nursing shrtage is evidenced by fewer nurses entering the wrkfrce; acute nursing shrtages in certain gegraphic areas; and a shrtage f nurses adequately prepared t meet certain areas f patient need in a changing health care envirnment. As a result, there is a grwing realizatin that the supply f apprpriately prepared nurses is inadequate t meet the needs f a diverse ppulatin - and that this shrtfall will grw mre serius ver the next 20 years. The actual size f the nursing shrtage is difficult t quantify. Registered nurses currently cmprise the largest number f health care prfessinals in the United States. Statistics frm

2 the U.S. Department f Labr and frm studies within the nursing prfessin indicate there has been a steady increase in nurses entering the prfessin that wuld appear t be sufficient t fill nursing jbs. Indeed, accrding t U.S. Bureau f Labr statistics, grwth in actual jb demand fr nurses drpped during the years 1992 t 1997 t an annual average f 2.7 percent. This cmpares with a 3.6 percent annual average jb grwth rate fr the previus six years. During rughly the same time perid ( ) surveys within the nursing prfessin shw that the number f registered nurses emplyed in nursing practice rse annually by an average f 3.4 percent culminating in an emplyment rate f nearly 83 percent f the registered nurse ppulatin in Numbers are Deceptive Traditinal emplyment statistics are deceptive and inadequate t measure the scpe f what is actually taking place in health care. Research indicates that the standard dynamics f supply, demand and need with regard t nursing have been altered by variatins in health delivery systems, Medicare and Medicaid reimbursement and even by reginal and lcal custms and culture. Hw care is delivered, where it is delivered and hw it is paid fr are issues that directly impact the need fr nursing services. Mrever, the increasing age f the general ppulatin and the grwing need fr management f chrnic disease cnditins suggest that the verall requirement fr nursing services will increase. The current, aging nursing ppulatin and the declining number f nursing prfessinals in the academic pipeline indicate that the nursing shrtage will nly grw mre serius as time ensues. The Natinal Cuncil f State Bards f Nursing (NCSBN) reprts that the number f individuals taking the NCLEX exam each year has declined cnsistently since The American Organizatin f Nurse Executives (AONE) reprts that in areas where the mst acute shrtages seem t exist, sme hspitals are clsing units, diverting patients, and canceling surgeries because there are nt adequate numbers f prfessinal nursing persnnel. Disturbing Future Trends One f the mst critical prblems facing nursing and the nursing wrkfrce is the aging f nurses and nursing faculty. The present average age f emplyed registered nurses is 43.3 years, with registered nurses wh are less than 30 years ld representing nly 10 percent f the ttal wrking nurse ppulatin. Accrding t the American Assciatin f Clleges f Nursing (AACN), nursing schl assciate prfessrs and assistant prfessrs are an average age f 52 and 49 years. These figures track with the average age f medical schl prfessrs, 45 percent f whm were age 50 t 59, and with pharmacy prfessrs, 46 percent f whm were age 50 t 59 at the time f the survey. Hwever, this cmparisn des nt hld true with regard t new dctral recipients within the health sciences and ther fields. In 1996, the average age f new dctral recipients within nursing was 45 years. Accrding t the Natinal Research Cuncil and the Natinal Opinin Research Center, the average age f new dctral recipients was 34 in all fields, 39 in the health sciences, and 44 fr educatin majrs. The aging f nursing faculty will impact the capacity f nursing schls t educate sufficient numbers f registered nurses t meet future demand.

3 These numbers d nt address the skills, capabilities and educatinal mix that are required t meet health care needs tday and fr the freseeable future. Enrllments in all basic RN preparatin prgrams have declined each year fr the last five cnsecutive years. Accrding t the Natinal League fr Nursing (NLN), between 1995 and 1999, the number f prgrams f mst types has increased in the United States. Despite this verall grwth in the ttal number f nursing prgrams (frm 3,137 t 3,220 r 2.6 percent), the number f students enrlled in and graduating frm nursing prgrams has declined with the exceptin f a 4 percent increase in dctral prgrams. Cnsistent with enrllment declines, an verall decline in graduatins frm all types f prgrams was 13.6 percent between 1995 and The clear trend is tward an increase in the number f prgrams ccurring simultaneusly with a decrease in the number f enrllments and graduatins frm thse prgrams. The Natinal Advisry Cuncil n Nurse Educatin and Practice (NACNEP) has recmmended that by 2010 at least tw-thirds f all registered nurses hld baccalaureate r higher degrees. Presently, nly 32 percent f registered nurses are prepared at the baccalaureate level and an additinal 10 percent educated at the master's level r abve. NACNEP prjects that nly 36 percent f the ttal registered nurse ppulatin in 2010 and 37 percent in 2020 will have a baccalaureate degree as their highest level f preparatin. Based n these and ther statistics frm the Natinal Sample Survey f Registered Nurses, the Divisin f Nursing within the Bureau f Health Prfessins predicts that demand fr fulltime equivalent RNs will begin t exceed supply by The gap is expected t grw wider in ensuing years - particularly if nthing is dne t prmte the retentin f lder and mre experienced nurses. Fcus n the Wrkplace Cnstant change in the health system challenges the ntin that ne nurse can be all things t all peple. Nurses with varied educatin and practice cmpetencies bring different skills t patient care, and they must be able t practice t the fullest ptential f these capabilities. T cmpete as attractive prfessinal destinatins, practice envirnments must recgnize and reward these differences by defining nurses' rles, and by utilizing and cmpensating nurses accrding t their different educatinal preparatin and cmpetencies. The nature f the care envirnment in which they practice is anther significant cntributing factr t the difficulty in recruiting and retaining registered nurses. Althugh lw pay rates cntinue t be cited by nurses as a prfessinal drawback, surveys indicate that the leading factrs given fr turnver in the nursing prfessin are wrkplace issues. A 1999 study by William Mercer, Inc. fund the primary reasn fr nurse turnver is "increased market demand" exacerbated by underlying causes such as "dissatisfactin with the jb, the supervisr r career prspects." The secnd mst cited reasn fr turnver in the nursing prfessin accrding t Mercer was "wrklad and staffing." These are fundamental prblems that stand separate frm the issues related t the supply and demand fr nursing services. Unless issues related t the care envirnment are addressed, strategies t increase the verall supply f nurses will nt be successful.

4 Strategies fr the Future The Tri-Cuncil recgnizes that thers have viced cncerns abut the nursing shrtage and that many rganizatins have identified gaps, made recmmendatins and implemented strategies t address nursing wrkfrce issues. Many f these recmmendatins are relevant tday. Hwever, in rder t encurage the develpment and deplyment f nursing persnnel with skills apprpriate t the health care system, the public, plicy makers and the prfessin must engage in nging lng-term wrkfrce planning, regardless f the perceived r real pressures related t the shrt-term demand fr nursing services. Withut measures t reverse the trends discussed abve, the natin is in danger f experiencing serius breakdwns in the health care system. Strategies t recruit and retain are cstly and must be dne with sme assurance that these effrts will be accmpanied by specific strategies t vercme wrkfrce issues that discurage lng-term cmmitment t a career in nursing. Therefre, the fllwing recmmendatins are made t address a number f cncerns. Educatin Develp career prgressin initiatives t: Mve nursing graduates thrugh graduate studies mre rapidly; Identify the range f ptins available beynd the entry-level rle such as faculty, researcher and administratr. Institute an educatin and practice system t prmte mre equitable cmpensatin in the health care cmmunity based n a better understanding f the educatinal preparatin required fr different health care rles. Supprt health care emplyers t create and sustain staff develpment prgrams and lifelng learning fr cntinued cmpetence. Reach ut t yuth (ages 12 t 18) thrugh cunselrs, yuth rganizatins, schls and ther utlets t prmte recruitment f a yunger, mre diverse ppulatin f nursing students. Wrk Envirnment Implement specific strategies t retain experienced nurses in the prvisin f direct patient care, such as: Intrducing greater flexibility int wrk envirnment structure and scheduling prgrams; Rewarding experienced nurses fr serving as mentrs and/r preceptrs fr

5 new registered nurses; Implementing apprpriate salary and benefit prgrams. Create a partnership envirnment that advances the practice f nursing by: Establishing apprpriate management structures within the health care system; Ensuring adequate nurse staffing; and Prviding nurses with sufficient autnmy ver their practice in all settings. Redesign wrk t enable an aging wrkfrce t remain active in direct care rles. Legislatin and Regulatin Advcate fr increased nursing educatin funding under Title VIII f the Public Health Service Act and ther publicly funded initiatives t imprve the capacity and resurces fr educatin f an apprpriate nursing wrkfrce. Advcate fr better identificatin f registered nursing services within Medicare, Medicaid and ther reimbursement systems. Technlgy, Research and Data Cllectin Investigate the ptential fr using technlgical advances t enhance the capacity f a reduced nursing wrkfrce. Supprt wrkfrce planning by the Divisin f Nursing and ther public r private rganizatins t develp mdels fr health wrkfrce planning that cnsider bth the need and demand fr nursing services. Prmte cnsistent data cllectin at the natinal, state and lcal level t accunt fr variatins at each level t enable apprpriate wrkfrce planning fr registered nurses. REFERENCES American Assciatin f Clleges f Nursing. (1998). "As Registered Nurses Age, Nursing Schls Seek T Expand the Pl f Yunger Faculty." Issue Bulletin. Washingtn, DC: Authr. American Assciatin f Clleges f Nursing. (1999). "Faculty Shrtages Intensify Natin's Nursing Deficit." Issue Bulletin. Washingtn, DC: Authr. American Organizatin f Nurse Executives. (2000). "Perspectives n the Nursing Shrtage:

6 A Blueprint fr Actin". Mngraph Series. Washingtn, DC. Mses, E. (1998). "The Registered Nurse Ppulatin: Findings Frm the Natinal Sample Survey f Registered Nurses 1996." Health Resurces and Services Administratin, Department f Health and Human Services. Washingtn, DC. Natinal Advisry Cuncil n Nurse Educatin and Practice. (1996). "Reprt t the Secretary f the Department f Health and Human Services n the Basic Registered Nurse Wrkfrce." Health Resurces and Services Administratin, Bureau f Health Prfessins, Divisin f Nursing, Rckville, MD: Authr. Natinal Cuncil f State Bards f Nursing, Inc. (1994, 1995, 1996, 1997, 1998, 1999). "Licensure and Examinatin Statistics." Chicag, IL: Authr. Natinal League fr Nursing. (2000). Unpublished Data. New Yrk, NY. Natinal Opinin Research Data. (1996). Chicag, IL: Authr. Natinal Research Cuncil. (1996). "Survey f Earned Dctrates." Washingtn, DC: Authr. William M. Mercer Inc. (1999) "Attracting and Retaining Registered Nurses - Survey Results." Chicag, IL. American Assciatin f Clleges f Nursing American Nurses AssciatinAmerican Organizatin f Nurse Executives Natinal League fr Nursing One Dupnt Circle, NW 8515 Gergia Avenue 325 Seventh Street, NW 61 Bradway Suite 530 Suite 400 Washingtn, DC rd Flr Washingtn, DC Silver Spring, MD New Yrk, NY Fax Fax Fax Fax