Part 1

Nursing Shortage Factors, Nursing Education Dilemmas, and Relevance

Society is experiencing demographic, epidemiologic, economic and trade, and political changes that have contributed to a crisis in health care delivery.  The healthcare industry shares in the cause by seeking to reduce cost through manipulation of enrollment and retention of health care providers in institutions over the past 20 years.  The problem is now spoken of in “crisis” terms: nursing shortage, health care crisis, access to health care limitations, etc.

There are approximately 3.1 million licensed RNs in the U.S.; 16.8% were not employed in nursing in 2008; some have returned as primary wage earners in the current economic crisis.  Eighty-eight percent are white, non-Hispanic, while 67.9% of the U.S. population is white, non-Hispanic.  56% work in hospital settings; 15% work in community settings, and 6% work in nursing homes.  These are figures from the National Sample Survey of RNs, conducted in 2004.  In the intervening 7 years there has been an increase of applicants, but a modest gain in enrollment because of limited space for classrooms and a declining number of faculty due to retirement.

Changes in society and its health status such as: an exploding population of retirees and aging elders–individuals born after 1945; increase in chronic disease and its consequences  requiring medical and nursing care; an increase of immigrants needing treatment for untreated conditions; uninsured- and underinsured-related illness gone too long without treatment; a rise in incidence in communicable diseases; increase in natural disasters; and extenuated treatment for antibiotic-resistant diseases all indicate the need for nursing intervention.

The demographic profiles in nursing reveal that the average age of the RN population is 46.8 years – 4 years greater than in 1996.  Only 26.6% are under the age of 40.  The largest age group is the 45-49 years group.  The numbers in younger groups continue to decline.  Dr. Peter Buerhaus of Vanderbilt University stated in the Nov. 17, 2004, issue of Health Affairs,  that over the next two decades, a further aging of the RN workforce will continue, with the largest cohorts of RNs between age 50 and 69 years. Within the next 5 years more than 40 percent of the RN workforce is expected to be older than 50 years. By the year 2020, the RN workforce is forecast to be roughly the same size as it is today, falling nearly 20 percent below projected RN workforce requirements.  According to a Government Accounting Office report, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), released in July 2001, 40 percent of all RNs were to be older than age 50 by 2010. (See for details.)

The culture of health care in this environment of high demand and diminishing resources has become challenging. With relatively unsolved hospital work-place issues wearing down dedicated and responsibly loyal nurses, some are leaving the profession, not to return.  Financial concerns have led some hospitals to reduce staff, thus burdening more those who remain. Burnout is widespread and so is low satisfaction level.  Stagnant wages and an environment that diminishes autonomy in patient care add to the problem. In some regions graduating nurses are facing an unwelcoming job market due to budget-cutting strategies by institutions and failure to prepare for future needs.

New graduates, irregardless of their level of maturity or their age, are leaving their current job and even dropping out of nursing altogether because of their stressful experiences in the workplace.  They are prepared for nurse-patient interactions, but surprised and disappointed in toxic lateral work relationships in some settings.  Many are also not prepared for responsibilities required of them without a considerate mentor.

The following points come from the American Association of Colleges of Nursing website:

  • In a joint statement released in July 2010, the Tri-Council for Nursing acknowledged the temporary easing of the nursing shortage in some regions of the U.S., but “raised concerns about slowing the production of RNs given the projected demand for nursing services, particularly in light of healthcare reform.” In this same statement, nursing workforce analyst Peter Buerhaus from Vanderbilt University School of Nursing called for stakeholders to “resist the short-term urge to curtail the production of RNs” since the impending wave of RN retirements and the increasing demand for healthcare services underscores the need to maintain our nation’s nursing education capacity. See

  • In an article published in the July/August 2009 issue of Health Affairs, Dr. Peter Buerhaus and colleagues confirmed that the economic recession has led to a temporary easing of the nursing shortage in some parts of the country, even though the shortfall in the number of nurses needed is expected to grow to 260,000 by the year 2025. In the near-term many hospitals will report an end to the shortage, and new nursing graduates may experience difficulty finding jobs, but these workforce analysts caution that a significant nursing shortage still looms.
  • Changes in the employment patterns of current RNs (e.g. delaying retirement, working longer hours) are not adding nurses into the workforce to fill new positions that are being created for RNs. Analysts with the Bureau of Labor Statistics project that more than 581,000 new RN positions will be created through 2018.

Twenty-five percent of nurses who are not now working in nursing have never worked as a nurse; which means on graduation, they went the other way.  There are various reasons for that, but what we now should determine is how can we escort new graduates into the career?  And how can we attract career-changers and high school graduates into nursing at ever increasing numbers?

What does a recent study of 76,000 nurses reveal about employment factors that satisfy?  Visit here to find out.

In the wake of several major studies and federally commissioned taskforces to measure the scope of the nursing crisis and health care demands, traditional colleges and universities have creatively increased their nursing program capacities to admit more students, even when faculty could not be increased. Technology and distance learning modes are expanding the reach in nursing education. At the same time several for-profit education companies have opened programs (accredited and some lacking accreditation capability).  The marketing strategy many use is to accelerate the student through, even to the Master’s level.  Typically, the student who can do that is mature and may already have another BS degree in another field.  In spite of classroom capacity growth, 40% of applicants have been turned away.

Brevity in nursing program design for convenience, cost savings to the student and the school, and recruitment attraction has the potential to graduate nurses who are not fully prepared to enter a chaotic or rapidly changing health care setting.  Urgent recommendations of recent study groups call for strengthening curriculum to prepare graduates for changing society demographics and behaviors, health care reform, disparity in caregiver-recipient ratios, and advancing disease and growing emergency insults to members of societies.  I refer to Dr. Patricia Benner’s study group report, “Educating Nurses: A Call for Radical Transformation.”

Relevance and Purpose of This Trilogy Course

When a nursing curriculum, already dense with course content of scientific and practice application value, is abbreviated to conform with market forces, the first topics to be lost are those of psychosocial attributes.  Traditionally, nursing programs oriented new students to the cultural behavioral patterns of patient care: attitudes that elicit  cooperation of the patient, therapeutic communication, examination of interaction processes.  Behaviors that reassure, bring comfort to anxiety, and relieve pain naturally were also demonstrated.  Expediency has altered that approach and innovations of “soft” course content are integrated through faculty modeling, independent study, and other means.  Those in distance learning programs under preceptor supervision in the clinical setting may not be assured of that opportunity.  However, if students lack opportunities to practice psychosocial skills, some arrive in the workplace without all the tools for successful relationship-building.

Therefore, this interactive course was conceived to meet that challenge in the 21st century so that nursing schools may assign students to visit and contribute here as independent study and so that you might enjoy learning and experimenting with the fundamental factors of effective and satisfying nursing practice:

  • Knowing why you are a nurse and whether you answered a “call”
  • Learning the characteristics of sincerely caring and bringing comfort
  • Recognizing and operationalizing commitment and engagement in the job, the workplace, and the profession . . . and gaining joy in doing so.

Resolving any doubts or questions about entering the nursing profession through your engagement with this course may be the best action you can take toward contentment with your career.

Visit Conceptual Taxonomies and leave a comment.

The second half of this Introduction module will address concepts and theories which build a framework of understanding.  In these days of urgency to prepare nurses, this may be as close as you get to nursing theories.  I have chosen the most applicable for these topics:

Jean Watson’s Transformational Caring Theory
Myra Levine’s Conservation Model

Proceed to Part 2 of the Introduction

Refer to the course Bibliography

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