Studies examine RN shortage, nursing department productivity

AAACN Viewpoint, Mar/Apr 2002 by Russell, Sally

National Office: (800) AMB-NURS * Web Site: www.aaacn.org aaacn Viewpoint

Research Analysis

The following is a review of two studies conducted by E.C. Murphy, LLC, a consulting and research firm based in Charlotte, NC.

Murphy, E.C. (2001, July). Key performance indicators and turnover. Case Studies on Nursing Shortage. Research Insight Series, Volume 1. [On-line]. Available: www.ecmdev.com/kpi.pff

Ambulatory care nurses experience the changes of the health care profession in varying degrees. Because of the variety of settings in which these nurses practice, finding studies that discuss the impact of the nursing shortage specifically on the ambulatory care nursing venue is very difficult.

The author of this study spent time searching for information on the nursing shortage and how it was affecting specific nursing groups. This type of search is difficult, as those doing the studies seem to include all nurses in all study reports. There are allusions to different groups but no overt discussion. However, because of the places that ambulatory care nurses work - hospitals, clinics, walk-in centers, and any other permutation imaginable - it is possible to obtain information in a roundabout way that is pertinent to the specialty.

A Hot Issue

The current nursing shortage, predicted by some to become the worst in history, is being studied and addressed by many people and organizations. Numerous theories as to the cause, even more theories about the possible cure, and few true studies about what actually works, are being found in the literature. There are, however, studies surfacing now which at least point to factors involved in causing this latest round of shortages.

This study, which was contracted for by the American Hospital Association, the Association of American Medical Colleges, the Federation of American Hospitals and the National Association of Public Hospitals and Health Systems, surveyed hospitals and clinics across the country to look at the shortage in health care professions. Data from this study can be found on the Internet at www.ecmdev.com/kpi.pdf.

The Murphy study did not focus exclusively on the nursing shortage, but looked at shortages being experienced in all health care fields, especially in hospitals and clinics.

Registered nursing was consistently found to be the second highest health care position needing to be filled, with imaging technicians being reported as the position that had the highest vacancy rate in the reporting institutions.

As for the RN shortage, it has become an extreme shortage from critical care to all of the areas serviced by those RNs. Traditionally, the critical care areas have been the biggest concern, as those patients require the most time-- consuming per patient care. With this shortage having lasted several years in those areas, the "rules" about not hiring new graduates are being relaxed. The unfortunate ripple effect has been to create a shortage in the areas that traditionally hire new graduates.

The projection that was gleaned from this study was that RN vacancy rates will be greater than 15% by 2003. Note: this is assuming that the demand for RNs will not increase over what it is today. The 15% vacancy rate is probably a low one since demand has been rising steadily over the last several years due to the increasing age of the population and number of baby boomer nurses who are preparing to retire. Unfortunately, not only are RNs retiring, but trends indicate that nurses are staying in nursing for less time than in past years. All of these trends will increase the severity of the shortage if no relief is experienced.

The effects on the institutions experiencing the nursing shortage are subtle, but the ever-present bottom line is increasingly being affected. The effort to recruit RNs is up 82% in the institutions participating in this survey, a greater percentage than that being expended on any of the other shortage areas. Many hospitals are using agency nurses, which increases the daily cost of the nursing department. Overtime, which in some departments is being used as a daily method to get through the workload, increases the budget line for the nursing department as well.

In an effort to recruit, institutions are hiking base salaries and overtime pay, paying bonuses for new hires, and sweetening benefit packages. A rise in the number of recruiters has occurred as well, with many of those coming from the nursing department. This in turn decreases the numbers of nurses at the patients bedside.

Other effects being felt in institutions with a shortage of RNs are an increase in patient complaints or statements of decreased satisfaction in the quality of care. Obviously public relations are a great concern to institutions, since without repeat business in today's world, their bottom line will suffer.

E.C. Murphy. (2001, July). Nursing role makes other departments look productive. Research Insight Series, Volume 1. [On-line]. Available: www.ecmdev.com/prodnurse.pdf

This study examined benchmarks used to determine which departments were the best at cost savings and productivity. Researchers determined that departments rated as "the best" when compared to similar departments in other hospitals may have achieved that rating at the cost of other clinical departments, or by using other departments' resources.