Action proposals

Arizona Nurse,  Sep 2001  

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SUBJECT: Nursing Workforce

INTRODUCED BY: AzNA Board of Directors

REFERRED TO: Professional Issues Hearing

BACKGROUND

A growing shortage of nurses is a public health and public policy issue. Hospitals report difficulties in filling nursing vacancies in all departments, emergency rooms are increasingly on diversion, and elective admissions are delayed due to lack of nursing personnel to provide patient care.

The nursing shortage underscores the fact that having a sufficient number of qualified nurses is critical to the health care system. Research consistently shows that adequate numbers of qualified nurses are associated with patient safety and quality of care, including lower mortality rates, shorter hospital lengths of stay, lower health care costs, and fewer complications. (Kovner & Gergen, 1998; Needleman et al, 2001; Preuss, 1998; Sovie, 1999)

Over the past ten years, hospitals have been reducing their nursing workforce in response to managed care pressures. Nursing salaries have also been affected by changes in the healthcare delivery system. A recent national survey found that, when adjusted for inflation, nursing salaries have remained flat since 1992 (HRSA Division of Nursing, 2001). Not only has this situation impacted patient care, it has negatively impacted the work environment for nurses and the perception of nursing as a career. When coupled with increasing opportunities for women, the result is fewer people entering the nursing profession. Enrollment in RN preparation programs has consistently declined in each of the last six years.

As a result, the existing nursing profession finds itself both overworked and aging. Studies show that older nurses tend to work fewer hours per year than younger nurses. The average age of working registered nurses was 43.3 years in March 2000, one year older than in 1996 when the average age was 42.3. This trend is partially due to the fact that the average age of a nurse at graduation is estimated to be 30.5 years. In addition, men and minorities are still underrepresented in the nursing profession. The percent of men employed in nursing is less than 6% and only 12.3% of nurses reported being in an ethnic minority group (compared to 28.2% of the population).

Compounding the shortage is a growing dissatisfaction among practicing nurses. A study by the ANA (2001) found that 75% of nurses surveyed felt the quality of nursing care has declined in their work setting in the past two years. According to the nurses, the reasons for this decline were inadequate staffing, decreased nurse satisfaction and a delay in providing basic care.

The nursing shortage and nurse dissatisfaction in Arizona seems particularly dramatic. State to state comparisons demonstrate that Arizona and surrounding southwestern states have fewer nurses per capita than the national average. Arizona has only 628 registered nurses per 100,000 population, compared to the national average of 782 (HRSA Division of Nursing, 2001). Since 1997, Arizona's health care organizations report an increase in vacancy rates for nursing personnel. The use of registry and travel nursing staff has more than tripled over the past four years (AzHHA, 2001). In a study by William M. Mercer (1999) nurse turnover in hospitals was 15% annually. In the same study, nurse turnover in Arizona was 26%. The cost of this turnover is enormous. According to the Healthcare Advisory Board (1999) the cost to replace a RN is $42,000. Thus, the expense to the Arizona healthcare system of RN turnover is over $190 million per year.

RECOMMENDATIONS:

That the Arizona Nurses Association:

1. Identify and implement strategies intended to maintain quality patient care and a professional nursing work environment.

2. Identify and implement strategies that contribute to an environment that retains experienced nurses within the practice setting.

3. Continue to collaborate with other organizations and projects to identify and implement strategies to recruit individuals into the profession of nursing.

4. Enhance the attractiveness of the profession to youth, men, and minorities.

5. Continue to collaborate with the Student Nurses Association of Arizona and other organizations to identify and implement strategies to assist in the transition from the role of new graduate to the role of professional nurse.

6. Propose and support government funding to increase resources for education of nurses at all levels.

7. Disseminate research on the relationship between registered nurses staffing and patient care outcomes.

SUBJECT: Affirmation of Professional Advocacy

INTRODUCED BY: AzNA Board of Directors

REFERRED TO: Professional Issues Hearing

BACKGROUND

In 1996, the Board of Directors appointed a task force to frame an AzNA workplace advocacy program. This was a result of the Board's recognition of several elements of AzNA's history and the changing employment environment. Nurses were finding that working conditions were increasingly difficult. They felt powerless to influence the health care environment and improve the quality of patient care.