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| In Focus: Supply and Demand, the RN Workforce of the Future |
By: HealthBond - Anne Marie Talbott, MA, MBA
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Supply and Demand: the RN Workforce of the Future
Recent articles in "In Focus" have looked at the reported shortage in nurses in today's medical fields. This article continues to examine the trend, and looks at what the experts predict for the short-term future. The RNs of today face challenges that many in other work areas don't; how can we help RNs deal with longer hours, varying rates of pay, and shifts in demand for their services?
As American society ages, the demand for long-term nursing personnel rises. The population of America is continuing to increase at about one percent a year; it is aging rapidly, and those aging Americans are living longer due to technological innovations and advances. Chronic conditions are becoming more prevalent in these older Americans, and the result of all this is that older Americans are now demanding more and longer health care than ever before.
One author notes that on the "...other end of the age continuum, a large wave of young people are entering their teenage years. The behavior that may characterize a portion of this group--such as driving fast cars, using alcohol and drugs, and engaging in crime and risky acts--also suggests that demand for health care services will grow in the future." (Buerhaus, Nursing Outlook, May/June 1998, p.103).
Organizations today that deliver health care to the population of the United States face economic challenges that are becoming a major force in the nursing shortage problem. The health care delivery industry has certain fundamental focus areas: constant striving to become the most efficient delivery system to be price competitive and to lower costs; shifting from acute care settings to ambulatory care and long term care settings; and an increased amount of attention to quality improvement across the board. Particularly in hospitals, especially in acute or critical care settings, these forces shape the future of RNs in the workplace. How well do RNs understand these business forces, and how involved are they in making decisions that affect these issues?
"Already, numerous shortages of experienced and specialty RNs--those working in cardiac care units, operating rooms, intensive care units, and emergency rooms--and difficulty in recruiting such nurses are reported across the United States," notes Peter Buerhaus in his article on the nursing shortage (Nursing Outlook, May/June 1998, p.104). Organizations are emphasizing competency and quality when recruiting for these specialty areas for RNs, and that fuels the demand for them. But these forces vary across regions and markets, leaving some areas in severe RN shortage mode, while other parts of the country have more than enough RNs from which to choose.
The shift from long-term hospital stays to more home-care and ambulatory care treatments is also affecting the demand for RNs today. Different skill sets are needed for these alternatives to critical care settings, and nurses as well as other health care providers have to adjust to this new trend in health care delivery. RNs have made significant advances in home health care nursing, and that field continues to grow as the market grows.
This shift is noticeably stronger in states that have strong HMOs. All these changes raise questions for the RN: how much of the demand for RN employment will be in home health care settings? How much will remain in specialty areas, like operating rooms and critical care settings? Will the growth of home health care absorb the RNs who are victims of downsizing corporate hospitals? Should RNs specialize in a particular area while in school, or focus on more generalist studies, to be more employable?
Not only is America aging--the RN population is aging, too. The "...average age of RNs began to increase dramatically after 1985, rising at a rate of one third of a year each year...(there has been a) rapid decline in the proportion of RNs younger than 30 years of age ...in fact, between 1984 and 1994, the proportion of RNs older than age 35 years increased far more rapidly than did the proportion of workers older than age 35 years in all other occupations," Buehaus notes (Nursing Outlook, May/June 1998, p.105).
There are serious worries that the rapidly aging RN workforce will present serious challenges to management and health care delivery systems. Reported declines in BA/BS level educational programs for RNs fuels that fire, as well. If the population of RNs in this country is aging rapidly, and enrollment in schools for RNs is decreasing, what does that tell you?
Colleen Conway-Welch, dean of nursing at Vanderbilt University in Nashville, Tennessee agrees that there is definitely a shortage problem: "Yes, especially in critical care areas...(there is a) current cycle. Also, in good economic times, full-time nurses go part-time; plus, (the) average age (of RNs) is 48." Various forces at play influence the nursing shortage, and Conway-Welch notes that change is in the air. "We need many more nurses with higher education. (We) only have 7% of nurses with (a) MSN and less than 1% with earned doctorates."
Political activity, new to the nursing field, is on the rise, although Conway-Welch doesn't think that striking is the best way to deal with workplace frustrations. She noted in an email interview with this author that Congressional funding is necessary to deal with the whole issue, and more detailed research is also very important. In saying this, she echoes many in the field who believe more research can help solve the growing RN shortage problem, as well as design more efficient, effective training programs for tomorrow's RNs.
Uncertainty in the marketplace, the beginnings of a political consciousness, and shifts in the health care delivery system as a whole, combined with demographic changes both in the national population as well as within the RN population all combine to deliver a nursing shortage the likes of which this country has never experienced. How we respond to this as a health care community is critical. Patients will not want to go to a hospital that has shortages of RNs, any more than they want to enroll in a HMO staffed by low-quality physicians. The marketplace will drive hospitals and other health care delivery systems to deal with the RN shortage, but between now and then, the ride's going to be a bumpy one.
How hospitals look at the problem decides how they will solve the problem. If hospitals and other health care delivery systems look at the RN shortage as a long-term issue, and treat it as such, they can most probably weather the shortage and continue to provide quality care. If they react with only short-term goals in sight, the result will be uneven staffing, a lot of turnover, and patient dissatisfaction with the nursing care they receive (or fail to receive) while in the facility.
"In the mid-1990s, according to Deloras Jones, hospitals stopped their in-house training, figuring there was a nurse surplus and that the nursing schools were providing adequate preparation. Now, Kaiser has started that program back up, placing 2,000 of their incoming crop of nurses in training programs lasting three months, or, in the case of operating room nurses, considerably longer." (J. Lawrence, Physicians Financial News, 17 (7): 23. 1999).
"Caregivers' and consumers' concerns have risen dramatically as many institutions have decreased the numbers of registered nurses (RNs) caring for an increasingly acutely ill population, cutting corners by substituting unlicensed assistive personnel for RNs. 'Too often, managed care has meant managed cost,' says Beverly Malone, president of the American Nurses Association (ANA). 'If the health care industry continues to dig in its heels and fight for false economies on the backs of patients and RNs, we can expect to see more and more bills on the floors of state legislatures, calling for mandated minimum nurse-to-patient ratios." (M. Stewart and D. Marks, www.nursingworld.org, January 24, 2000).
If hospitals don't regulate the nurse-to-patient ratio, the government will. Does any hospital want more red tape? How efficient is that? Again, it's a question of looking at long-term goals and short-term goals, and being wise enough to know the difference, as a manager.
How educational groups deal with the RN shortage is also critical. More research, as Conway-Welch noted in her interview, is needed to help craft the educational experience of a RN in training to better match what's needed in the workplace. "The push is also on in the California legislature to direct more funding toward state nursing schools. 'They have waiting lists if they can fund the spots,' Ms. Jones explains." (J. Lawrence, Physicians Financial News, 17 (7): 23. 1999).
More hands-on experience is needed; more problem-solving and management classes would be helpful. Encouraging nurses to go on for higher educational degrees, to mentor other nurses, and to increase their management skills--all of these are suggestions being heard around the country for nursing programs to incorporate in their training syllabi. "...now is the time to bolster enrollment in entry level nursing programs; now is the time to find new ways to increase the attractiveness of nursing as a career for women; now is the time to concentrate on recruiting more men and minorities, and now is the time for organizations that employ RNs to carefully examine the short-term and long-term implications of their wage policies," says Peter Buerhaus, concluding his article in Nursing Outlook (May/June 1998, p. 107).
How can we make a difference? As managers, remember to look at things in a long-term view, even if the pressure is there to deal with things quickly. As nurses, it's important to realize that you have a say in all this, and getting involved with the ANA or other organizations is a good way to start your journey. As health care providers, we all need to remember who comes first in this--the patient. If the nursing shortage (and short-term, misguided efforts to fix it) negatively affects patients, we have only ourselves to blame.
A coalition of managers, physicians, nurses, educators, and patient representatives can accomplish far more for the field than any legislation can, and with a lot less red tape. Solutions are out there--we just have to look for them, and implement them with an eye for the long-term goals of the health care industry. Any ideas?
Discussion
June 2000 - In Focus: Nursing Shortage Previous Articles
June 12-16, 2000, What Do the Numbers Say?
June 5-9, 2000, Nursing Shortage: Mirage or Menace?
Anne Marie Talbott - atalbott@healthbond.com
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Member Opinions:
By: Ingolfsson on 6/19/00
Does it take a crisis to promote change? Or can we manage things before they reach a crisis? Any ideas?
By: Terin on 6/21/00
The entire healthcare system tends to be crisis driven. It's our nature. Healthcare has always treated the sick and managed diseases. However, its only been recently that we started exploring healthcare's role in prevention and healthy living. Healthcare traditionally has not been proactive but reactive. And it's going to take a while to change our paradigm.
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