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 The
Nursing Shortage continuation
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Titled “Health Care at the Crossroads: Strategies for
Addressing the Evolving Nursing Crisis”, the report
makes the case that “There are, of course, other compelling
shortages of health care personnel-pharmacists, lab technicians
and respiratory therapists…But the nursing shortage
is, in many respects, the most extreme of these problems” since
nurses are “a primary source of care for many people
at the most vulnerable points in their lives.”
The study presents evidence that “90 percent of long-term
care organizations lack sufficient nursing staffing to provide
even the most basic of care, (some) home health agencies
are being forced to refuse new admissions and there are 126,000
nursing positions currently unfilled in hospitals across
the country.”
It also argues that that things are likely to get worse before
they get better, with the aging of the 78 million baby boomers
who will need and demand skilled health care for the rest
of their lives. “Given this anticipated demand for
health care services, it is estimated that by 2020, there
will be at least 400,000 fewer nurses available to provide
care than will be needed.”
To compound the crisis, all of this is happening in an environment
where public institutions of higher education are receiving
fewer tax dollars and cannot afford to hire enough qualified
nursing faculty. According to the report, “nursing
schools turned away 5,000 qualified baccalaureate program
applicants in 2001. In the Southeast, 18 percent of nursing
faculty members are due to retire between 2002 and 2006.”
The study also documents that nurses themselves are aging,
with the average age of working nurses reaching 43.3 by the
year 2000 and continuing to accelerate. The “average
age (for working nurses) is increasing at a rate more than
twice of all other workforces in this country. Only 12 percent
of registered nurses in the workforce are under the age of
30, a decline of 41 percent compared to a one percent decline
for all other occupations since 1983.” In six years,
the average age of working registered nurses is expected
to exceed 50.
Sounding an alarm, the report claims that “Higher acuity
patients plus fewer nurses to care for them is a prescription
for danger.” JCAHO data shows that “staffing
levels have been a factor in 24 percent of the 1609 sentinel
events (unanticipated events that result in death, injury
or permanent loss of function) that have been reported to
JCAHO as of March, 2002. Other identifying contributing factors,
such as patient assessment, caregiver orientation and training,
communication and staff competency implicate nursing problems
as well.
Conversely,…positive impacts on quality,
costs and health outcomes (happen) when nursing staffing
levels are optimized-fewer complications, fewer adverse events,
shorter lengths of stay, lower mortality.”
Local health care has not escaped the impact of the critical
nursing shortage. The help wanted pages in the daily newspapers
are filled with want ads for nurses, local higher educational
institutions are scrambling for dollars and trained faculty
to expand their nursing training programs and, as we reported
last month, local hospitals are coming forward with contributions
to nursing training institutions like Manatee Community College
to help fund the expansions.
The Nursing Shortage: Why Should We Care and
What Should We Do About It?
By Jeffrey Orenstein, Ph.D. Executive Editor
Part Two of Three
Editor’s Note: Last month, we introduced the dimensions
of the nursing crisis. This month, we look at why we should
care and what the Joint Commission on the Accreditation of
Health Care Organizations recommends that we do about it.
Next month, we will take a close look at what local training
institutions are doing.
The Shortage Could Kill You
Should you be concerned about the national nursing shortage
if you are not a hospital administrator or a nurse? Does
it matter that “According to the American Hospital
Association, 126,000 nurses are needed to fill vacancies
at all of the hospitals in the United States. By 2020, there
will be a shortage of more than 400,000 registered nurses.”
The title of a recent Ivanhoe Broadcast report puts it starkly: “Fewer
Nurses Equals More Deaths.” The story reports that “The
ratio of nurses to patients can mean the difference between
life and death.” Sharina Person, Ph.D., a biostatistician
at University of Alabama in Birmingham, says, "Patients
who attended hospitals that had more nurses, specifically
RNs per patient, were less likely to die in the hospital."
Her study found many hospitals are cutting registered nurses
or moving them to management and filling their positions
with less-trained nurses who may not be able to recognize
complications or know when physician evaluation is needed.
She said, "Before …those types of changes are
made across the board, people really need to…take
a look at studies like this.”
She recommends that patients should seek a nurse-patient
ratio of one nurse for no more than four to six patients
when deciding where to have elective surgeries in surgical
or acute-care settings.
Ivanhoe reported on another study that shows for every patient
added to a nurse's care, the risk of death increases 7 percent
for that patient.
What Should We Do About It?
Given the convincing evidence above that there is indeed
a crisis that impacts all of us, what needs to be done? While
opinions vary, the Joint Commission on the Accreditation
of Healthcare Organizations (JCAHO) proposes that the nursing
crisis can only solved over the long haul. In a substantial
study titled Health Care at the Crossroads, the widely-respected
organization proposed a series of reforms and made very specific
recommendations for transforming the nursing workplace, aligning
nursing education with real-world clinical experience and
providing federal financial incentives for health care organizations
to invest in high quality nursing care.
To transform the nursing work environment, JCAHO recommends
adopting the characteristics of “Magnet” hospitals
that have staffing levels based on staff competency and patient
mix, that empower and respect the nursing staff, that provide
management training and support to nursing executives and
that create a diverse and high-standard working environment
with support for excellence and no tolerance for abusive
behaviors by health care practitioners.
To bolster the nursing education structure, JCAHO wants public
and private sources to increasing funding for nursing education.
It also advocates establishing a standardized post-graduate
residency program, improving training via use of teams and
creating better nursing career ladders.
For hospitals, JCAHO recommends federal help. Specifically,
the organization advocates that more federal money be provided
for health care organizations to invest in nursing services
(based on their attainment of evidence-based goals) and an
alignment of private payer and federal reimbursement incentives
to reward effective nursing staffing since “there are
no incentives or even expectations built into the payment
system-public or private-that encourage an optimal number
of nurses or even safe care.”
The Nursing Shortage: Why Should
We Care and What Should We do About It? By
Jeffrey Orenstein, Ph.D. Executive Editor
Part Three of Three
Editor’s Note: This
article concludes our three part series. In April, we introduced
the dimensions of the nursing crisis. In May, we looked
at why we should care and what the Joint Commission on
the Accreditation of Health Care Organizations recommends
that we do about it. Now, we are spotlighting what local
nurse training institutions are doing to help resolve the
crisis here.
We know that working nurses in the Sarasota and Manatee
area are aging and rapidly approaching retirement age at
the same time that our hospitals, health care needs and
population are expanding. What this means is simple yet
stark: we need many more nurses here and failure to get
them will result in a serious drop in the quality of medical
care.
Since we cannot depend on attracting enough of the few available
working nurses from other areas to fill our growing shortage,
we need to train tomorrow’s nurses locally. Fortunately,
our educational institutions and their supporters are responding
to the degree that resources permit.
Nursing Training In Paradise
A variety of local institutions are already graduating well-qualified
nurses. Without leaving the Tampa Bay area (and in most
cases, without leaving Sarasota or Manatee Counties), a
local student can earn a masters degree and become a Nurse
Practitioner, a baccalaureate-degreed Registered Nurse
(RN), an associate-degreed RN, a Licensed Practical Nurse
(LPN) or a Certified Nursing Assistant (CAN) and get fully-accredited
high quality training and have a fairly good shot at financial
aid.
Most of our local nursing training institutions have expanded
existing programs and are hoping to do even more in the future.
Unfortunately, the need keeps growing and nobody knows if
local institutions can keep up. They each face their own
facility limitations and need more money to hire a sufficient
number of qualified nursing faculty.
Also, though most institutions report that they have extensive
affiliation agreements with all or most of area hospitals
and nursing facilities so students can get clinical training
as part of their educational experience, all indicated they
could use more. The new Lakewood Ranch Medical Center will
be a clinical training site and will take up some but by
no means all of the need.
Here is a brief survey of nursing training in this area.
The newest nursing program (and the only private college
in the group) in our area is the associate degree program
that will produce RN’s at the Sarasota Campus of Keiser
College in Lakewood Ranch. The program matriculated its first
class in January, 2004. It expects to graduate 21 RN-candidate
nurses with an associate degree in August, 2005.
Keiser plans on accepting 24 in each January and July class.
Eileen Perciful, R..N., D.N.Sc., Nursing Program Director,
said, “We did our homework and realized there’s
a severe shortage in the community-it’s (our) job to
respond to marketplace needs.”
At Manatee Technical Institute’s East Campus, also
in Lakewood Ranch, Sharon Herman, Health Program Operations
Manager, reports “We increased our class sizes and
added evening and weekend programs to appeal to people who
need flexible hours about two and a half years ago. We just
graduated our first class of 22 LPN’s who are already
working in area long-term care facilities and hospitals.”
Herman reports that MTI is considering alternative clinical
hours as well, so the health training facility can do rotations
in the evening hours, providing more clinical spaces and
flexibility.
For now, MTI East is at maximum size and will continue to
operate at capacity. Herman pointed out that “Clinical
facilities determine our class size-we can only do 12 students
per group.”
She also said, “The nursing shortage extends to the
nursing assistant level, too, especially with the new patient-caregiver
ratio recently enacted by the Florida Legislature. MTI is
preparing more of them too. We have 14 nursing assistants
in a class and currently have two classes and a potential
of four additional classes that include some specialized
training.”
MTI’s Sarasota County counterpart is Sarasota County
Technical Institute (SCTI), located on Proctor Rd. Both technical
institutions are funded by their county boards of education
under Florida law.
Harlean Satin, Department Chair for Health Science told
DHJ “This year we expect to graduate 50 p.n’s
They graduate as practical nurses and become LPN’s
when they pass the state boards-we have a 100% pass rate.”
SCTI has two full-time day training programs with up to
40 students. A part-time evening program was launched in
2002 in response to the nursing shortage. The school has
also started a high school practical nursing program. Students
enrolled in any Sarasota County high school are eligible
to attend SCTI a half day and spend the other half at their
home school. The school district provides transportation
and students can complete at least 50% of nursing program
at no cost to them while still in high school. Seven graduated
in May and then enrolled as adult students to complete the
program with an additional four months’ training.
SCIT reports that the program is at maximum capacity now
and will be very difficult to expand without further resources.
Manatee Community College’s Dr. Bonnie Hesselberg,
Dean of Nursing and Health Professions, told DHJ that MCC
graduated 62 nurses in May, 2004. They all earned an associate
degree and are preparing to take their RN licensing exam
during the summer. Most are planning to work locally, especially
at area hospitals.
Hesselberg said, “We expanded the basic program in
Spring, 2004 by an additional 24 students. We expanded again
in the summer of 2004 using the scholarship money donated
by the Hospital Corporation of America.”
“In addition, we are taking about 20 already-working
LPN’s and re-training them to become RN’s in
one year at the Venice Campus starting this fall. We will
give them the last year of the associate degree curriculum
and qualify them to sit for the RN exam.
We also have articulation agreements with all of the state
universities for students to complete their baccalaureate
degree in nursing. A lot of them go on to The University
of South Florida (USF) and we are pleased to announce that
USF is bringing their baccalaureate program on the Bradenton
Campus starting this fall. They currently offer the RN
Completion Program via distance learning.
USF Sarasota-Manatee also offers advanced courses for MCC
and other associate-degreed RN’s to work toward their
baccalaureate degrees in nursing. The local campus offer
core courses for all concentrations and some concentration
(nursing major) courses for the Adult, Child and Family
Nurse Practitioner programs on a part-time basis, though
some courses have to be taken at USF Tampa.
USF’s local campus also offers a Masters of Science
in Nursing. The degree qualifies students to take the examination
for certification as an Advanced Registered Nurse Practitioner
to (ARNP) and other specialty certifications.
Keeping Nurses Locally
Once the region educational institutions provide a sufficient,
steady supply of newly-trained and retrained nurses, the
continuing challenge to filling the local nursing shortage
is for area employers to provide working conditions and
incentives that will keep our nurses here for their entire
careers.
Fortunately, our local climate and increasing community
growth and amenities are working for us to keep nurses
here. They will not be sufficient by themselves however.
As the Joint Commission on the Accreditation of Health
Care Organizations pointed out, employers need to provide
better staffing levels so existing nurses are not overworked
to the point of being unable to do their jobs effectively,
provide better pay, good working conditions, a satisfying
career ladder and excellent continuing education incentives.
Every indication is that local hospitals and other training
institutions are doing what they can now and are making
it a priority to do more.
Important:
Because all information in Doctors Health Journal print, online
and on the radio and TV is for general knowledge only and
is not intended to be a substitute for medical advice or treatment,
Doctors Health Journal does not answer questions about your
specific medical conditions.
We strongly recommend that you contact your personal physician
about these medical questions.
If you don’t have a physician, call the Manatee Medical
Society at 755-3411 or the Sarasota Medical Society at (941)
966-3134 or one of the area hospitals for a referral.
If You Are In Crisis and Need Immediate Help, Call 911.
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