National Healthcare Crisis: The Implications Research Proposal

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¶ … National Healthcare Crisis: The Implications of the Nursing Shortage on the Profession and the Quality of Healthcare Services in the United States

Today, the United States faces a nursing shortage of unprecedented proportions, and the impact of this dearth of professional healthcare providers will have some profound effects on the quality of healthcare services delivered in the coming years. This is an especially important issue today because more Americans are joining the ranks of the elderly as Baby Boomers retire and experience a wide range of age-related maladies that will demand timely and effective healthcare services. Unfortunately, all signs indicate that despite a growing awareness of the problem among policymakers and healthcare providers alike, there are an insufficient number of new nurses entering the profession today to make a substantive difference in the future. To determine what can be done, this paper provides a review of the relevant literature to identify salient cultural, legal and ethical issues involved, the implications for nursing and the quality of patient care, as well as a personal response to the literature reviewed. A summary of the research and important findings are presented in the conclusion.

Review and Discussion

Cultural, Legal and Ethical Factors

Being a professional nurse in the United States today is a tough job for a number of reasons besides the hard work involved. For instance, by any measure, the United States is becoming an increasingly multicultural society where the traditional "melting pot" has been replaced with a "salad bowl" configuration wherein immigrants to this country are tending to hold on to their cultural roots and languages, even while they otherwise assimilate into mainstream society. In this environment, it is important for healthcare professionals to recognize cross-cultural issues that can affect the provision of healthcare services. For example, some cultural segments of the U.S. may not seek out healthcare as frequently as others for reasons aside from pure economics, while others may respond differently to the healthcare protocols from others. For example, Glover and Blankenship (2007) report that, "Culture is believed to influence the perception of a disability, the manner in which a disability is defined, and the manner in which it is assigned meaning. Culture is also felt to affect the manner in which an individual and their family accepts, reacts to, and adapts to a disability" (p. 41). Furthermore, the United States is also becoming an increasingly litigious society and even though many healthcare professionals are provided with malpractice insurance, it is not uncommon for a malpractice lawsuits to ruin an otherwise promising healthcare professional's career (O'Connell & Bryan, 2000). Moreover, healthcare professionals routinely encounter ethical dilemmas where there may not be a black and white solution, only varying shades of gray and many nurses may be reluctant to report medical errors they make or which are made by their peers or physicians (O'Connell & Bryan, 2000). It is not all that surprising, then, that even during a period of economic recession where growing numbers of Americans are desperately searching for meaningful employment, there remains a shortage of qualified nurses today and all signs point to a worsening shortage in the future. It is also apparent that a severe shortage of qualified nurses will have some profound implications for those who are currently employed in the field and these issues are discussed further below.

Implications for Nursing

A recent report from Rosseter (2009) makes it clear that the road ahead is going to be uphill for nursing college recruiters seeking to satisfy the demand for qualified nursing staff in the future. In this regard, Rosseter cites survey data from February 2009 released by the American Association of Colleges of Nursing (AACN) that showed fewer than 50% of all qualified applicants to entry-level baccalaureate nursing programs were enrolled in 2008 in spite of the well publicized need for more qualified registered nurses in the United States. According to Rosseter, "Though interest in nursing careers is high, the latest data show that almost 50,000 qualified applications to professional nursing programs were turned away in 2008, including nearly 6,000 applicants to master's and doctoral degree programs" (2009, p. 2). Even more alarming is the nature of the current shortage of qualified nurses across the country. As noted above, the United States has experienced a dramatic shift in demographic composition in recent years that appears to have contributed to the current nursing shortage. In this regard, Stanton (2004) emphasizes that, "Periods of high vacancy rates for RNs in hospitals have come and gone, but the current shortage is different. The nursing shortage reflects fundamental changes in population demographics, career expectations, work attitudes and worker dissatisfaction. In fact, the present situation may well continue over the next two decades" (p. 2).

Further, although there appears to a shortage of qualified personnel in all nursing disciplines, the shortage is particularly acute in psychiatric nursing. In this regard, Halter (2002) emphasizes that, "The current nursing shortage promises to be more fundamental and intractable than previous shortfalls in supply and demand, and will have an impact on psychiatric nursing as demand for our services increases abut our numbers dwindle. The numbers of psychiatric nurses need to triple by 2005, yet numbers of nursing students choosing psychiatric nursing declined by 2% in the late 20th century" (p. 23). According to Rosseter, in spite of a favorable trend during the period 2001 through 2003, during the 2007-2008 academic year, entry-level baccalaureate nursing programs received 190,483 completed applications with just 122,001 satisfying admission criteria; of these, only 80,616 applications accepted which represents an acceptance rate of 42.3%. The percentage change in the number of applications received and accepted for entry-level baccalaureate nursing programs for the period 1994 through 2008 is shown in Figure 1 below.

Figure 1. Percentage Change in Enrollments in Entry-Level Baccalaureate Nursing Programs: 1994-2008

Source: Based on bar graph from American Association of Colleges of Nursing, Research and Data Center, 1994-2008 at http://www.aacn.nche.edu/Media/pdf/EnrollChanges.pdf

According to the report by Rosseter, the main reasons cited by nursing schools for not accepting all of the applicants who are qualified into their entry-level baccalaureate nursing programs are as follows:

1. A lack of faculty (62.5%);

2. Insufficient clinical teaching sites (53.8%);

3. Limited classroom space (42.3%);

4. Insufficient preceptors (25.4%); and,

5. Budget cuts (14.8%).

Because resources are by definition scarce, the above reasons make it clear that more money is going to have to be invested in personnel and infrastructure in order to reverse the ugly trends that have affected the field in recent years, but this investment does not appear to be forthcoming in any meaningful way. The only logical response to the growing shortage of nurses in America, then, would be to allocate more resources now and in the future for pay, infrastructure and improved working conditions. As Anderson points out, simply throwing money at the problem is not an end-all solution: "Wage increases alone are unlikely to solve the nursing shortage. Even with substantial increases in salaries and nurse graduation rates, the nursing gap is likely to persist for another decade, analysts note. Financial considerations are likely to constrain wage growth, while capacity issues bedevil nursing schools" (p. 2).

Moreover, Elgie (2007) points out that 40 years' of government subsidies to help nurses attend school and attain a degree have been counterproductive in terms of creating a level playing field for wage levels today. In this regard, Elgie suggests that, "Politics and policies meant to correct the nursing shortage should focus less on how to reduce the cost of producing nurses, and more on how to afford to compensate nurses with wages and benefits that achieve market equilibrium" (p. 1). There are some other options available as well, though. For instance, Anderson (2007) advises, "For policymakers it is best to focus on the two most practical solutions to alleviate the impact of the nursing shortage on U.S. patients: 1) Increasing nursing faculty and school infrastructure and 2) Raising immigration quotas to facilitate the entry of foreign nurses" (p. 1).

The implications for nurses are significant, of course, as fewer nurses mean a higher patient-to-staff ratio and less time available for quality care with a concomitant increase in burnout and job dissatisfaction. In this regard, Anderson emphasizes that, "The odds of patient mortality increase 7% for every additional patient in the average nurse's workload in the hospital. Increasing a nurse's workload from 4 to 8 patients would be accompanied by a 31% increase in patient mortality" (2007, p. 1). Therefore, the implications for patients, too, are significant. According to a report by Stanton (2004), "Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections" (pp. 2, 1). While the nursing shortage is severe across the board, Anderson (2007) also points out that it is particular acute in rural areas… [END OF PREVIEW] . . . READ MORE

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