Essay: Healthcare Policy Issue and Nursing Strategies

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Nursing

Policy Issue Analysis: The National Nursing Shortage

The healthcare industry is afflicted by a wide array of internal problems, policy issues and systemic flaws. Included among them are the prohibitively high costs of medical treatment, the inaccessibility of healthcare coverage for many system users and the frequency of preventable occurrences like medical error or health system negligence. One of the root problems in the healthcare system, a mounting crisis which impacts all of these and other areas of the industry, is the shortage of registered nurses and of healthcare workers in general.

Problem Identification:

In the face of rising demands for healthcare providers, the industry is experiencing records gaps in its ability to treat patients in the system. And projection suggest that this condition will only worsen, with ratios of nurses to patients becoming less and less optimal all the time. This is particularly problematic given the population trends that threaten to throw our economy into even further chaos in the coming years. As the population of retirees grows to include the enormous Baby Boomer generation, the nation's productivity and, by consequence, its healthcare system, will be fully reliant on the far smaller succeeding Generations X and Y. This means that gaps between healthcare providers and the patient population are likely to grow without some significant shift in the current trends in the field. According to the text by Cullen et al. (2010), "in 2008, American Health Care Association's report of vacancies in long-term facilities and American Hospital Association's report of hospital vacancies combined relayed an even larger shortage of 8.1%. By 2025, the shortage in RNs is projected to grow to an estimated 260,000 FTEs, twice as high as any U.S. nursing shortage since the 1960's." (Cullen et al. 2010) This alarming trend provides a rationale for the present research, which concerns the way that these ratios impact such matters as job performance for healthcare professionals, health outcomes for patients and efficiency for healthcare facilities on the whole.

These national figures are bolstered by similar patterns at the state and local level. In Texas, we are currently experiencing a staffing shortage that, according to Roberson (2010), is likely to reaching a shortfall on 71,000 nurses by 2020. At present, Roberson reports, rates of 5% vacancy have shrunk to 2% thanks to the recession and efforts at recruiting new nursing school students. However, this, the text reports, is a temporary improvement in trends that will rise by the projected date above. Accordingly, similar patterns have been seen in the locality of Houston. Here, according to Perin (2008), "the area is already struggling with an ongoing nursing shortage of 4,000 to 5,000 full-time RNs, and the HWS study shows that the vast majority of the RN pipeline locally will be inexperienced new graduates, indicating hospitals will have a growing problem hiring experienced nurses." (Perin 2008)

Background:

Social Factors:

At the root of the nursing shortage is a number of convergent sociological trends, including those relating to immigration, demographic shifts and population aging patterns. Accordingly, Cullen et al. indicate that myriad social factors may be identified as having in some aspect contributed to the initiation of the shortage and to what projections state will be a resurgence and far greater severity of gaps in staffing in the next decade. Cullen et al. report that "research suggests that the current shortage is the product of several trends including: steep population growth in several states, a diminishing pipeline of new students to nursing, a decline in RN earnings relative to other career options, an aging nursing workforce, and an aging population that will require intense health care services." (Cullen et al. 2010) These all point to a strong imperative for policy action and identify several areas where regulatory oversight might prevent projected trends. Critical among such trends, Cullen indicates that a survey conducted in 2006 projected that 55% of nurses surveyed intended to retire between the years of 2011 and 2015, with job dissatisfaction frequently cited as a major cause for this anticipated decision.

Economic Factors:

The text by Leavitt et al. (2012), underscores the economic correlation to nurse-to-patient ratios, indicating the direct correlation between fewer nurses and less desirable health outcomes is accompanied by a number of peripheral economic costs. Leavitt et al. note, "for example, inadequate nurse staffing could be linked to increases in rates of infection, morbidity, and morality -- outcomes that can increase institutional costs and jeopardize an institution's reputation and future business." (Leavitt et al. 2012) Another often overlooked cost is the lost productivity of a labor force with lesser healthcare outcomes and, as a result, greater susceptibility to illness, sustained ailment or mistreated injury. Lost work time and lower productivity are the results.

And importantly, the low level of worker morale and the high level of consequent turnover in nursing cost the system a significant sum in training, position vacancies and payment of overtime for compensatory work by retained nurses. According to the Texas Center for Nursing Workforce Studies (TCNWS)(2006), "in 2004, the New York State Education Department calculated that the statewide cost of RN turnover per year would be over $1 billion when the annual turnover rate is 15%.6 Nationally, the total cost of turnover, at a nurse turnover rate of 20% in U.S. hospitals, is estimated to be $12.3 billion." (TCNWS 2006)

Ethical Factors:

Berkowitz posits the argument that in addition to the practical demands that are incumbent upon the healthcare industry in terms of addressing staffing shortage issues, there are substantial ethical imperatives at play too. Because of the limited accessibility of healthcare treatment opportunities for many portions of the population, staffing shortages which carry implications to the availability of healthcare providers carry ethical overtones. According to Berkowitz, "fairness and equity are important aspects of policy development. Fawcett and Russell (2001) consider the equity of a policy as the extent to which it allows the benefits and burdens of nursing practice to be equally distributed to all; in particular equal access to health services." (Berkowitz 2012)

This suggests that there is a tangible ethical dimension to the research problem identified here. The degree to which staffing shortages result in disruptions in equal distribution of healthcare access is the degree to which there is an ethical responsibility vested in healthcare providers and the industry as a whole to fill gaps in effective staffing. According to the text by Berkowitz, it is for this reason that policy action is, in addition to being of critical practical importance, also pointedly necessary for the achievement of an ethical stasis in the distribution of healthcare services. And given our current level of knowledge on the impending threats to nurse-to-patient ratios, there is an additional ethical imperative to act preemptively to prevent the increasing severity of this staffing crisis.

Political and Legal Factors:

Among critical issues of political and legal importance are the global ranking of the U.S. Healthcare system and the implications of socioeconomic disparity to this ranking. According to the text by Greis & Duda (2010), "The nursing shortage has broad implications for the future ability of the U.S. health care system to provide quality patient care. Meanwhile, the U.S. health care system has received a number of recent notorious distinctions. For example, in 2000, the World Health Organization ranked the U.S. health care system thirty-seventh in overall performance. Similarly, others have criticized the U.S. health care system for having significant disparities between high-income and low-income adults in the quality and quantity of care provided." (Greis & Duda 2010) This denotes that there is cause to bring significant public pressure to bear on public representatives and office-holders to the end of bridging gaps both in the socioeconomic disparity of the healthcare system and gaps between the U.S. And other industrialized nations with more adequate and equitable systems.

Issue Statement:

The primary issue identified here is two-fold; namely, there are critical nursing and healthcare staffing shortages through the American healthcare system and in spite of considerable empirical evidence that this leads to less desirable healthcare outcomes, greater rates of preventable death and higher incidences of medical error, it remains a top challenge for hospitals to find way to overcome staffing issues.

Stakeholders:

The key stakeholder in this policy discussion is the public at large. Users of the healthcare system at every level, and especially those in impoverished communities or otherwise compromised healthcare locations, are the likeliest victims of understaffed facilities. This group represents the most important stakeholder in the discussion.

Equally as important and frequently as mistreated are professional healthcare providers, nurses and prospective nurse managers. Their stake is particularly vested in the improvement of wages, working conditions, training and recruitment efforts. This is also true of nurse educators, who have a central role in addressing the present shortage. As Allen (2008) reports, "the lack of faculty to educate the growing demand for baccalaureate-prepared RNs directly impacts the nursing shortage. The nursing shortage thus directly impacts safe patient care. The main reasons for the lack of faculty to meet… [END OF PREVIEW]

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