Hannah Charleston

Period 7
Outline

1) Purpose​: To investigate the causes of the nursing shortage, even though it is one of the
fastest growing careers, discuss the impacts of the shortage on patients and nurses, and
what can be done to fit it.
2) Thesis​: Without recognizing the causes of the impending nursing shortage, the impacts of
this on both patients and nurses, and finding effective ways to solve the issue, the crisis
will become a reality.

3) Causes of the Shortage

a) Implications of the Aging Population
i) Baby boomers are reaching retirement age
(1) “It is estimated that between 2010 and 2030, the senior citizen
population will increase from 75 percent to 69 million, and by
2050, it is predicted that 88.5 million people in the U.S. will be
aged 65 and older” (Grant, 2016).
(2) The elderly population is predicted to “double by 2050, while the
working aged class in predicted to decrease” (Snavely, 2006).
(3) “About 80 percent of older adults have at least one chronic
condition, and 68 percent have at least two,” according to the
National Council on Aging (Grant, 2016).
(4) “The National Council of State Boards of Nursing reports 55% of
the RN workforce is age 50 or older; the Flealth Resources and
Services Administration projects that 1 million nurses are eligible
for retirement in 10-15 years (AACN, 2013)” (Snavely, 2006).
(5) “With the retirement of aging baby boomers, who comprise 40%
of the current health care workforce, there will be a dramatic
reduction in RN supply” (Juraschek, 2012).
Connection to Thesis​: This argument connects to thesis as it describes the major cause of the
shortage.
b) Nursing Schools
i) Nursing schools are suffering due to aging population
(1) “At the beginning of the 2014-2015 academic year, over half of all
U.S. nursing schools reported a cumulative total of 1,236 full-time
faculty vacancies” (Snavely, 2006).
(2) According to an American Association of Colleges of Nursing
report, “U.S. nursing schools turned away 79,659 qualified
 applicants from baccalaureate and graduate nursing programs in
2012 due to insufficient number of faculty, clinical sites, classroom
space, clinical preceptors, and budget constraints.” (Grant, 2016).
(3) “According to the AACN, U.S. nursing schools turned away nearly
80,000 qualified applicants to baccalaureate and graduate programs
in 2012” (Snavely, 2006).
Connection to Thesis​: Nursing schools are the places educating the new wave of nurses, and just
like the profession itself, it is also being impacted by the aging population, making it a key part
of the cause of the shortage.

c) Lack of Benefits / Poor Working Conditions

i) Experience Gap
(1) A nurse with over 40 years of experience leaves and then has to be
replaced with a nurse that may have only 5 years of experience,
which causes nervousness, but employers needs to see the big
picture and understand that they have a responsibility to maintain a
strong health-care system and that can’t be done without nurses
(Grant, 2016).
(2) Linda Aiken, director of the Center for Health Outcomes and
Policy Research at the University of Pennsylvania, has discovered
that “hospital administrators are reluctant to hire more nurses
because it is not seen as cost-effective.”
ii) Lack of Benefits / Poor Working Environments are making nurses leave
the profession.
(1) “[Nurses] are leaving because of the lack of access to continuing
education, the lack of professional development, the stress, the
workplace environment, the bullying and the harassment, and as
nurses in Ghana have said, because of a lack of feeling valued”
(Oulton, 2006).
(2) “Misuse and misdistribution show up as reduced quality of care,
poorer patient outcomes, reduced job satisfaction, high staff
turnover rates, and increased care costs” (Oulton, 2006).
(3) Zimbabwe has enough money to hire approximately 2,000 nurses,
if more nurses were willing to work there. Additionally, Malawi
there are 30 nurses per every 1,000 hospital beds and in Uganda
there are 1 to 2 for every 100 patients (Oulton, 2006).
Connection the Thesis​: When nurses don’t feel like the work they do is valued or they don’t have
opportunities or the right resources to expand their knowledge/ use their skills, they leave the
profession and choose not to go to areas that need the most help, making the shortage worse.
4) Impacts of the Shortage
a) Impacts on Nurse-to-Patient Relationships
i) “When staffing levels fall below certain nurse-to-patient ratios, the
patients are more likely to suffer or even die” (Jacobson, 2015).
ii) Bonnie Castillo, the director of the Registered Nurses Response Network
at National Nurses United, stated that “If you have several patients, and
one is having a sudden hemorrhage and one is having chest pain and the
other is having a stroke or is choking, you have to have enough nurses that
can deal with each of those instances and not place one above the other”
(Jacobson, 2015).
iii) “...overworking leads to fatigue and burnout, which threatens the quality
of care and increases the incidence of error” (Grant, 2016).
iv) The Lancet​ in 2014 found that an increase in a nurse’s workload by one
patient increased the likelihood of a patient in that hospital dying by 7
percent (Jacobson, 2015).
v) “One study reported hospitals with inadequate staffing are positively
correlated with higher readmission rates” that costs the Center for
Medicare and Medicaid Service approximately $26 billion” per year
(Snavely, 2006).
vi) High nurse-to-patient ratio is directly “associated with increased urinary
tract and surgical site infections” (Snavely, 2006). More infections that
have a positive correlation with nurse-to-patient ratio include
“ventilator-associated pneumonia, centralline-associated bloodstream
infection, and Clostridium difficile infection” (Snavely, 2006).
vii) “lower registered nurse-to-patient ratios are shown to reduce mortality rate
by more than 50%” (Martin, 2015).
b) Turn-over rates
i) “An estimated 30%-50% of all new RNs either change jobs within nursing
or leave the profession altogether within the first 3 years of clinical
practice” (Snavely, 2006).
ii) “41% of hospital nurses were dissatisfied with their jobs and 22% planned
to leave them in less than 1 year. Among nurses younger than 30, this
figure was 33%” (Oulton, 2006).
iii) “the average cost of turnover for a bedside RN ranges from $36,900 to
$57,300 resulting in the average hospital losing $4.9M-$7.6M” (Snavely,
2006).
c) Case Studies
i) Stephen Juraschek and his team of researchers ​created a grading scale for
states and their projected nursing shortage by 2030.
 (1) Based on the difference between the demand and supply of RN
jobs per 100,000 people each state was given a letter grade based
on the difference between the national mean and each state’s ratio,
so using SD as the framework, A and F grades were (+-)2 SD, B
and D grades were (+-)1 SD, and C+ and C- grades were (+-)0.5
SD (Juraschek, 2012).
(2) “Using a numeric grading scale with A = 4, B = 3, C+ = 2.33, C =
2, C− = 1.67, D = 1, and F = 0, the average national grade is 2.21
in 2009 and 1.13 in 2030” (Juraschek, 2012).
(3) The 12 “F” states are Florida, Georgia, Texas, Virginia, Alaska,
Arizona, California, Hawaii, Idaho, Montana, Nevada, and New
Mexico (Juraschek, 2012).
(4) “In 2030, states with the largest shortages (ie, the largest number
of RN jobs) will be California (193,100 jobs), Florida (128,364
jobs), and Texas (109,779 jobs)” (Juraschek, 2012).
(5) “The models used incorporate workforce dynamics to forecast
future nursing supply and demand and project that there will be a
national shortage of 300, 000 to 1 million RN jobs in 2020”
(Juraschek, 2012).
Connection to Thesis​: Because the shortage feels so distant, this case study shows how real the
problem actually is, especially in our very own state. This study supplements all of the
information previously presented and highlights how every state will be individually impacted by
the shortage.

5) Possible Solutions
a) All of the solutions in place now, are temporary fixes to a deeply complex
problem, so in order to make a true solution, an effective combination of the
solutions needs to be put in place.
i) Any effective solutions will be a combination of the five following
priority areas: policy intervention, macroeconomics and health sector
funding, workforce planning and policy, positive practice environments,
and retention and recruitment (Oulton, 2006).
ii) One possible solution to the nursing crisis is to create a national licensure,
rather than state licensure because every state has different guidelines for
what nurses are allowed to do, as some states may be more limiting and
restrictive than others (Grant, 2016).
iii) Another potential solution is to “open up the paths to a degree” (Grant,
2016).
 iv) Hospitals are getting so desperate to recruit nurses that they are offering
“five-figure signing bonuses, free housing, college tuition for employees
and their children” (CNN Wire, 2018).
v) “Because the nonprofit health system can’t find all the nurses it needs
locally, it has been seeking out candidates from other states — and
sometimes other countries” (CNN Wire, 2018).
vi) “To entice these new recruits, it has offered relocation allowances and
signing bonuses of up to $10,000, said Kathy Howell, chief nursing
executive for UCHealth. It provides nurses with up to $4,000 a year to
invest in continuing education. And it offers the Traveler RN program,
which allows nurses to do a 13-week rotation at different UCHealth
facilities” (CNN Wire, 2018).
vii) Inova Health System, specifically, is offering “candidates who have at
least two years of critical care experience and live more than 50 miles
from one of its six Washington-area hospitals a $20,000 sign-on bonus and
up to $20,000 in reimbursable relocation costs” (CNN Wire, 2018).
viii) West Virginia’s WVU Medicine “will start offering tuition reimbursement
for employees and their children” (CNN Wire, 2018).
ix) “A better approach would be to invest in improving the work environment
for nurses and offering better pay, career development and hours to help
make sure they don’t burn out, she said” (CNN Wire, 2018).
Connection to Thesis​: Finding a solution that will actually be successful is a huge part of this
paper. This section presents ways that hospitals are trying to combat it now, but these solutions
are just covering up the root cause of the problem. Taking the ideas above, a solution that
combines aspects of all of them will ultimately be more effective.