The nursing shortage demands action now—state and federal legislation passed - Healthy Policy Issues

AORN Journal, Nov, 2001 by Candace Romig

There are three problems causing the current nursing shortage, according to Georges C. Benjamin, MD, secretary of the Maryland Department of Health and Mental Hygiene--nurses are not entering the profession, they are not staying in the profession; and they are not happy when they are there. (1) Dr Benjamin gave this testimony before the US Senate Health, Education, Labor, and Pensions Subcommittee on Aging, which was charged with investigating the nursing shortage and its effect on the US health care delivery system, in February 2001. At the same meeting, Sen Hillary Rodham Clinton (D-NY) noted the direct link between nursing care and patient outcomes. Sen Clinton urged Congress to address nurse staffing, whistle blower protections for nurses who register complaints about inadequate patient care, stagnant wage growth, and mandatory overtime. (2) Similar hearings were held before the Senate Health, Education, Labor, and Pensions Committee to investigate staffing changes in the last decade and before the Senate Veterans Affairs Committee to investigate the effect of the nursing shortage on the Department of Veterans Affairs.

UNDERSTANDING THE SHORTAGE

Two federal reports shed light on the nursing shortage issue. One report, issued by the Congressional Research Service (CRS), states that the nurse staffing crisis may be attributed to a maidistribution of labor rather than an actual shortage of RNs. The report implies that the shortage may be the result of recent poor personnel decisions. The report also states that more significant nursing shortages will be evident by 2010 unless corrective actions are taken now to increase the supply of RNs. (3)

The second report was issued by the General Accounting Office (GAO) after Rep Nancy Johnson (R-Conn), chair of the House Ways and Means Subcommittee on Health, requested the GAO study the challenges facing nurses today. The GAO concluded that data are not available currently to assess the nursing shortage adequately. Like the CRS report, however, the GAO report concludes that demographic pressures on supply and demand for RNs will result in a further shortage if steps are not taken immediately to correct the problem. (4) The report indicates that job satisfaction plays a key role in retention of RNs who are employed currently. The report states that the following factors are responsible for growing dissatisfaction in the nursing profession:

* inadequate staffing,

* heavy workloads,

* increased use of overtime,

* lack of sufficient support staff members, and

* inadequate wages. (5)

AORN JOINS THE DISCUSSION

AORN has joined approximately 30 other nursing organizations in a consensus statement that identifies factors contributing to the nursing crisis. Titled Assuring Quality Health Care for the United States: Supporting Nurse Education and Training, Building an Adequate Supply of Nurses, this statement addresses the need for increased capacity in the following areas. (6)

* Increase funding for programs of the Health Professions Education Partnership Act of 1998. A minimum $25 million increase in general appropriations funding over fiscal year (FY) 2001 is requested for FY 2002.

* Increase funding for the Nursing Education Loan Repayment Program. At least $10 million in appropriations is requested for FY 2002.

* Provide authority for and appropriations of at least $10 million in FY 2002 for the Nursing Student Loan Program. This program has operated on a $2 million revolving account funded through loan repayments, and new funding has not been authorized since the 1980s.

* Expand the Health Professions Education Partnerships Act of 1998 to ensure an adequate, highly trained nurse workforce. This expansion includes minority nurse initiatives, internship residency programs, scholarships, faculty member development (eg, a fast-track nursing faculty scholarship and loan program), a National Nurse Corps, and tax incentives.

* Promote quality patient care through initiatives in the Department of Labor and the Office of Minority Health that recognize the nursing shortage as a national issue that needs recruitment and retention strategies for minorities and through grants to support information systems that enhance the clinical education of nurses in all fields.

* Encourage community-based solutions, including the development of community-nurse outreach grants; expansion of Area Health Education Centers (AHECs), especially in rural areas; expansion of AHEC nurse-mentoring programs; and expansion of the Public Health Service to allow federal recognition of nurse-managed health centers.

* Incorporate research by the Agency for Healthcare Research and Quality on nurse staffing and education preparation, the National Institute of Nursing Research on the cost-effectiveness of different nursing practices on patient outcomes, and the Health Resources and Services Administration (HRSA) on increasing the timeliness and frequency of data collection to develop a national nursing workforce model. Data collection efforts and state and regional workforce planning efforts should be coordinated through HRSA.