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In Focus: Nursing Shortage: Mirage or Menace?
Nursing Shortage: Mirage or Menace? Discussion

Recently, discussion has been focused on the nursing shortage. Nurses are turning from their field, specializing or getting out of healthcare altogether. Many nurses, especially RNs, are complaining that they're working longer and harder hours now than ever before. Work satisfaction and morale have taken hits over the long hours and lowered benefits, and some see a serious shortage developing in the numbers of nurses available to the United States healthcare consumer in the near future.

Is there really a shortage, or is it merely a matter of selective distribution? If there is a shortage, what are some of the reasons for it? How can we, as a healthcare community, deal with it in a positive manner, and meanwhile avoid the pitfalls of over- and under-reaction? If we over-react, then the numbers of nursing students will balloon, leading in the long run to a surplus in the nurse labor market. If we under-react, then we'll be facing a shortage for a long time, as America grays. Can we afford this?

Some of the shortage has been offset to some degree by the movement in healthcare to transfer patients as soon as possible to healthcare facilities outside the hospital setting. Some people in the nursing profession welcome this change, notes Peter Buerhaus and Douglas Staiger, in their article, "Trouble in the Nurse Labor Market? Recent Trends and Future Outlook", (Health Affairs, 1999, vol. 18, n.1). The explosion in growth of the non-acute care settings for patients has also led some of these people to look for a similar expansion in the employment opportunities for nurses. Nurses who are leaving hospitals for other settings are leaving for a multitude of reasons, though.

Downsizing, budget cutbacks, layoffs, career changes, the shift of patient care to non-acute settings... all of these are reasons nurses are leaving their traditional labor market; nursing schools are trying to redo their curriculum to reflect the changing labor market for their graduates. But are we facing a shortage? The numbers are still out there...

Buerhaus and Staiger, analyzing employment data, think that the growth of managed care has slowed down the nursing labor market dramatically. Emerging trends included leaving the nursing field for management and leaving acute care for home healthcare nursing. "Despite these emerging trends, the national impact on nurse employment and earnings was slight. Since 1994, there has been a surge in the growth of managed care, and it is likely that the national impact on the nurse workforce has grown." (Health Affairs, 1999, vol. 18, n.1).

The authors analyzed recent employment data, and found that between 1983 and 1994, growth in the nursing employment field averaged between 3 and 4 percent a year. This was dramatically slowed down in the mid-1990s, slowing down to just under 2 percent per year since 1994. Buerhaus and Staiger believe that the recent slowdown in nursing is "largely the result of lack of employment growth in hospitals, a sector that until recently employed more than 2/3rds of RNs... In contrast, hospital employment of LPNs and aides, which declined sharply throughout the 1980s and early 1990s, declined less (and even increased for aides) after 1994." (Health Affairs, 1999, vol. 18, n.1). They feel that hospitals are hiring less skilled workers and replacing RNs with them.

A decrease in earnings has accompanied the decrease in employment for RNs. "RNs experienced strong yearly growth in inflation-adjusted hourly wages through 1990...but wage growth leveled off between 1990 and 1994 and then fell 1.5 percent annually over the next three years." (Health Affairs, 1999, vol. 18, n.1) This would indicate the market has been saturated with RNs, and is adjusting itself; managed care, with its emphasis on cost reduction and smaller hospitals, certainly has lent a hand here, too. The authors found this shift especially noticeable in states that had high HMO enrollment, a likely indicator of the role managed care is playing in this trend. Buerhaus and Staiger note that what happens in the states with high HMO enrollment is likely to happen in the rest of the country, too, over time; the high enrollment states serving as trend-setters.

What does the future look like for RNs, according to the authors? Declines in hospital staffing, a slowdown in the home healthcare market, and a decline in overall RN earning power are the portents they see. Why, then, are nursing schools increasing their recruitment efforts? Why would anyone go into a high-stress, highly technical field, knowing that their chances of employment in the traditional sector--hospitals and acute care settings--are lower now than ever before? Knowing that the home healthcare system is slowing down markedly, reducing employment there, too? Knowing that wages are decreasing?

Or are they? In the next few articles this month's In Focus has scheduled, we'll look at the picture from other viewpoints, including interviewing people working in the field, as well as teaching nursing students now. We'll look at what the government forecasts for the nursing labor market, and see if these numbers jive with Buerhaus and Staiger's research. Information is power, in any field, and nursing is no exception to the rule. We'll see if there's a nursing shortage, or if it's a perception problem, and what people working in the field today think about the future of nursing tomorrow. Stay tuned, and as always, if you have comments to make, please do so! Your input is welcome!

Discussion

Anne Marie Talbott, atalbott@healthbond.com

May's In Focus looks at Consumers in Healthcare



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Member Opinions:
By: Tommy on 6/5/00
The question is asked:
Q-Why would recruiters increase efforts to recruit
A-Could be because there is a demand for one or all of the nursing classifications. On the other hand,it could be they want to keep their jobs too.
Q-Why would students choose high stress ,technical jobs along with decreases in employment and wages.
A-I dont believe most people going into this field as RN,LVN,CNA,Aid etc think realistically about thiese issues. If theyve never experienced these issues in nursing,theyre not going to really grasp the problems theyre facing.Wages:chances are they are making less than what nursing would pay.Their present job probably is perceived as less glamerous than nursing is.They also perceive the working environment better than what they have presently.
There are alot of other factors in regard to why anyone goes into nursing that arent addressed here. The shortage as Ive seen it is greatly influenced by the resistance of hospitals to staff more nurses or other staff in order to improve the bottom line.
Tommy Gunn

By: tammy on 6/5/00
I agree with much of what Tommy says. I think whatever shortage is happening. We have created it ourselves. If nursing is seen as an unattractive career, then the healthcare industry created that culture. The question is how does healthcare improve this culture and incorporate nursing into its core team. I think if nursing was viewed as an integral part of the team with valued input, the culture would be different.

By: TRyndes on 6/5/00
In a companion article on today's Healthbond ("Nurses Rally..."), the US Dept of Labor Statistics is quoted, predicting we will need 450,000 additional RN's and 136,000 LPN's by 2008. I assume that this is based on nurse to population ratio's that may not reflect trends identified above, but correcting the ratio determinants will not get us out of a shortage. In the national network that I work within, there are definitely regional nursing shortages now. I'm not sure I'd just look at hospital and home health employment trends to suggest that the need is a mirage. I'd be more inclined to look at patient projections.

The Congressional Budget Office,in 1997, projected that the over 65 population (highest users of health care resources) will be growing over 70% between 2010 and 2030. Where will these people be getting care as they confront their acute and chronic illnesses? Telemedicine will surely help ease some of the labor issues, but will also create a specialized nursing(?) labor need. What possibly can lead us to a positive labor scenario here?

I too think Tommy is raising some good points, but believe that hospitals are increasingly over a barrel when it comes to preserving the bottom line, so I tend not to denigrate administrators for doing what they are being paid to do: protect the financial security of the institution for the community. How that is accomplished many vary from hospital to hospital, but generally only a few high impact things can be done when you have to drop your expenses fast in order to protect your future. Sadly, cutting staff is one of those things. What may often be lacking is a way to do this in a dignified, rather than ruthless or uncaring, way. That I am very critical of.




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