March 3, 2008 The Pump Handle 7Comment

The Health Affairs Blog has put up links to its top 10 most-read blog posts of 2007, which gave me a chance to read one I’d missed when it was first posted: Linda Aiken’s myth-busting about the nursing shortage. She starts with the grim statistics:

Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000.

This isn’t because we don’t have enough Americans wanting to be nurses, Aiken explains; there are actually plenty of nursing-school applicants, but not nearly enough nursing-school slots for them. It does seem to me that this problem is recognized, and that efforts are underway to address it – for instance, the Robert Wood Johnson Foundation’s Building Human Capital program makes grants in this area, and their news digests regularly highlight stories about nursing-school expansions. Although it remains to be seen whether current efforts will be able to add enough nursing-school capacity to meet our needs, I’m more worried about another mistaken belief that Aiken highlights, which may be harder to correct.

One of the challenges in fixing our broken healthcare system is that many people don’t realize the toll of the cuts and squeezes that have been accumulating over the past several years. Declining reimbursement rates and soaring uncompensated care expenses have forced hospitals and other providers to change the way they provide care, often by shortening the amount of time that individual health professionals spend with patients. (See my post on hospitals and high rates of uninsurance for more on this.) Nurses in West Virginia and Kentucky have been advocating for “safe staffing” levels to ensure that units have enough nurses on duty at all times to provide the care that patients need. California is the one state with a law mandating nurse-to-patient ratios in certain wards; it first first took effect in 2004 and is now in the final implementation phase.

Aiken’s post shows that it’s an uphill struggle, though, because many people believe that the current shortage of nurses isn’t a severe problem:

• Myth: We can continue to “muddle through” present and future nurse shortages without serious consequences. The lack of nurses has substantial impacts on emergency preparedness, quality of care, patient safety [2-week free access], access to needed health care services (especially for vulnerable populations), and economic growth. …

• Myth: The U.S. nurse shortage can be solved by substituting unskilled labor. Research shows that substituting licensed practical nurses or aides for registered nurses in hospitals results in much higher mortality rates and worse patient outcomes. …

• Myth: Care will increasingly shift to out-of-hospital settings, reducing the demand for nurses. Although inpatient days have fallen dramatically in the past 20 years, inpatient acuity has increased — meaning that more intensive services are needed within a shorter hospital stay. In addition, demand for nurses in nonhospital settings is growing rapidly because of the rising burden of chronic illnesses.

Until people realize that there’s no shortcut around the shortage of nurses, and that leaving the problem unsolved has serious consequences for patient outcomes, it will be hard to mobilize the resources needed to solve it.

7 thoughts on “Unseen Costs and the Nursing Shortage

  1. I would add to your statement: “Myth: The U.S. nurse shortage can be solved by substituting unskilled labor” OR students who do not have the qualifications or capabilities to survive the training program. I taught Anatomy and Physiology at the junior college level and I was not impressed with the students unwillingness to work and the I”just want to pass” attitude!!! They weren’t interested in learning and many of them could not pass my exams!! Deplorable.

  2. I’ve read that here in California that both two- and four-year colleges have cut nursing programs back due their higher cost (in faculty and in course materials). Seems like an institutional problem that can and should be fixed.

  3. From an essay on the Philippines that I wrote a couple monts ago:

    The Philippines is the leading primary source country for nurses internationally by design and with the support of the government. The 2001-2004 Medium Term Philippines Development plan views overseas employment as a key source of economic growth. Filipino nurses are in great demand because they are primarily educated in college-degree programs and communicate well in English, and because governments have deemed the Philippines to be an ethical source of nurses. … There has been recent debate that the growing global demand for Filipino nurses is so great that emigration of nurses could be threatening the country’s health care quality. It is estimated there are more than 30,000 unfilled nursing positions in the Philippines. In 2001 the United Kingdom, Saudi Arabia, Ireland, Singapore, and United States were the most common destinations for Filipino nurses.

    If the Philippines can educate so many nurses, certainly the US can.

  4. What Aiken fails to address is that there are over 300,000 RNs in the United States today who aren’t at the age of retirement and are not employed as Registered Nurses! Aiken never addresses retention of nurses in the work place. Many RNs site management, pay, increasing paperwork and higher patient acuity as reasons for leaving the profession. Why isn’t anyone working to recruit RNs back into the profession?

  5. There have been several studies in both the US and Canada that shows mortality rates go up at hospitals that employ nurses without a BSN.

    I’m appalled to know that nurses who are highly skilled and willing to work here are being limited by the state department. It is ashame.

  6. The problem could be related to the ad atop this article:
    Unseen Costs and the Nursing Shortage:

    Ads by Google
    Medi-Cal Nursing Homes
    Middle Class Families can Qualify
    for Medi-Cal. Get our DVD Today!

    Quality care with Medi-Cal under-reimbursement for 70% of the census? An oxymoron!

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