NBNA BRIEFING PAPER ON NURSING SHORTAGE

REQUEST
The Congressional nursing community’s champions have consistently advocated for funding at $175 million for Title VIII, nurse education and training programs.  The Congress approved $151.2 million for Title VIII funding for nursing education and training for FY 2006.  The conference agreement between the House and Senate also called for a one percent across the board cut for all discretionary programs.

RATIONALE

The nursing shortage is REAL.  It is estimated that there are 2.6 million registered nurses in the United States.  According to the National Sample Survey of Registered Nurses 2000, 58.5 percent of RNs are working full time, (this is only one-half percent increase over the 1996 Sample Survey); 23.2 percent work part-time; and 18.3 percent reported not being employed in nursing.  59.1 percent of all RNs are employed in the hospital; 18.3 percent in public/community health; 9.5 percent in ambulatory care including physician-based practices, nurse based practices and HMOs; 6.9 percent in nursing homes and extended care facilities; 2.1 percent in nursing education and 3.6 percent in other settings such as federal administrative agencies, state boards of nursing or health association, health planning agencies, prisons/jails or insurance companies.  While African Americans make up 12 percent of the population, only 4.9 percent of RNs are African Americans.

This is an aging nursing work force.  The average age of RNs working in nursing is 43 years.  In 1980, 26 percent of RNs were under the age of 30; today less than 10 percent of RNs are under the age of 30.

Why is there a nursing shortage?

• Aging nurses, with the average age of 43
• Retiring nurses
• High turnover rate
• Nurses’ working conditions, contributing to medical errors
• Mandatory overtime
• Inflexible schedules
• Increasing workload, more patients
• More paper work and more non-clinical work
• Reduced role in decision making
• Stagnant salaries, clinical and teaching
• A good number of the newer nurses are spending less than 10 years in the profession. 
• Alternate job opportunities, with better benefits and the chance of career development
• Nursing faculty shortage, resulting in fewer students being educated
• Retiring nurse faculty over the next 15 years

Making the case, employing public policy strategies

The nursing short is REAL.  Our Nation needs to educate and train more nurses.

There is good indication of wide interest in persons attending nursing schools.  However, nursing schools are turning away qualified applicants because they do not have the capacity to meet the demand.   According to the American Association of Colleges of Nursing, enrollment in baccalaureate nursing programs nationwide increased by 13 percent between 2004 and 2005.  AACN reported that nursing colleges and universities turned away 32,617 qualified applicants, largely due to a shortage of nurse educators.

The National League for Nursing reported that 147,465 qualified applicants were rejected for admission, which includes hospital and community college nursing programs.

It is estimated that enrollment in nursing programs would have to increase by at least 40 percent annually to replace those nurse expected to retire.

• There are not enough faculty members to educate the students.  The number of full time faculty needed to fill the nursing gap may be as high as 40,000.  Currently there are less than 20,000 full time faculty in the system.  The average age of nursing professors is 52; for associate professors the average age is 49.  Nearly 1800 full time faculty members leave their positions each year.
  
• There is not enough classroom space.
  
• There are not enough clinical sites with adequate staff to provide training for the nursing students.
  
• Student nurses need financial support to attend nursing school.  The Title VIII funding supported only 81 nursing scholarships.

A business and societal case around the nursing shortage may spur the need for public policy strategies.  A study published January 10, 2006 in the journal Health Affairs provides new evidence that if hospitals invest in appropriate registered nurse (RN) staffing, thousands of lives and millions of dollars could be saved each year. Specifically, the study shows that if hospitals increased RN staffing and hours of nursing care per patient, more than 6,700 patient deaths and four million days of care in hospitals could be avoided each year.  While the business and societal case reported in Health Affairs makes an excellent case to reduce adverse outcomes, we still need more nurses.  Student nurses need funds to attend nursing school. 

Another business case may fuel public policy.  The pharmaceutical industry must conduct clinical trials to bring important drugs into the market place. There is a need for more nurses to be trained to help design and implement clinical trials.  Nurses are an integral part of the research team, recruiting patients, implementing protocols, educating patients, helping to keep them compliant and on their medical regimes, providing follow-up and consultative services.  And, yet, we need more nursing students in the pipeline to become licensed providers who may become interested in conducting clinical trials.

A societal case related to demand for nursing services may spark the public policy debate.  With the demand for more nursing services expected when baby boomers begin to retire in greater numbers in 2020, it is critical that our Nation designs strategies to eliminate the nursing shortage.   As the Sample Survey showed, less than 3 percent of nurses are employed in nursing homes or related facilities.  Demand for care will increase as seniors choose to age in their homes, (age in place); move to assisted living facilities; move to senior housing communities. There will be a need for more nurses trained in geriatric nursing to serve the ever growing senior population.

Moreover, the baby boomers who are used to having a certain level of health care services will expect the same level of health care and nursing services as seniors.  With the smaller increase in nurses employed in the hospital setting, there may not be enough nurses to provide nursing services when the seniors need it, this includes surgery.

Hospitals are forced to join the public debate relative to the nursing shortage as much-needed operating rooms close because they lack enough experienced nurses to assist the surgeons.  The closures will exacerbate the hospital’s backlog of surgical cases.  Lack of experienced nurses will force more hospitals to seriously reduce beds in every area of the hospital.

The nursing shortage is REAL.

The role of the federal government is to provide additional funding for education and training of registered nurses; funding for training of nurse scientist researchers; provide loans and loan forgiveness programs for secondary education through the Department of Education; and provide funding for workforce programs through the Department of Labor to encourage persons to become nurses.

January 16, 2004
Sacramento Business Journal

Agency bogs down as nurses rush to register
By Kathy Robertson, Staff Writer

With hospitals across the state scrambling to find enough workers to meet new nurse-to-patient ratios, a record 220 nurses showed up at the Bureau of Registered Nursing in the first week of January to get state approval.

The wait time for that has grown to six weeks or more. Budget cuts at the state agency that licenses registered nurses reduced staff by 15 percent last year, creating a backlog of work at a time when demand for its services is at an all-time high.

January 6, 2004
Nursing Shortage Forces Hospitals to Cope Creatively
By LAURIE TARKAN

With mechanical help, flexible shifts and online auctions of shifts, hospitals are surpassing the creative in dealing with the nursing shortage that experts predict will worsen in a decade or two.

The pressure on hospitals to attract and retain nurses continues to grow, largely because of a mounting body of evidence that being short staffed compounds the rate of medical errors and deaths.

January 25, 2005
NBC - San Diego

Local University Has Plan To End Nursing Shortage
Local Hospitals Have 1,000 Vacant Nursing Positions
 
SAN DIEGO -- A San Diego university hopes to alleviate California's nursing shortage by offering an accelerated training program for entry-level nurses.
 
National University's program in its School of Health and Human Services will allow new nurses to receive their associate's degree in 18 months. The university plans to eventually enroll 200 students in the program.
 
Other colleges and universities in the area typically turn away applicants due to limited space in nursing programs.
 
San Diego State University, for example, has about 630 students in bachelor's and master's degree nursing programs, but last year, it turned away 100 qualified applicants. Point Loma Nazarene has about 190 students in its nursing program and turns away about 1,000 qualified students a year.
 
There is a two-year waiting list for San Diego Community College District's City College, which has room for about 130 students.
 
San Diego's hospitals, meanwhile, have about 1,000 vacant nursing positions, said Steve Escoboza of the Hospital Association of San Diego and Imperial Counties. Statewide, the shortage is estimated at 14,000 nurses.

January 24, 2005
TV 2 - WESH
 
State Experiencing Serious Nursing Shortage
Nursing Board Rules Limit Class Sizes
 
ORLANDO, Fla. -- Florida is in the grips of a serious nursing shortage.
 
Thousands of extra nurses are needed, but they're just not coming out of nursing school quickly enough, WESH NewsChannel 2 reported.
 
Jennifer Dolcater had to wait one year to get a spot in Florida Hospital's nursing program.
 
"We were encouraged to take the prerequisites, take the other courses and continue to study and be determined. And that's what I did," she said.
 
Now, she's one of the lucky ones. This year alone, nursing programs turned away more than 1,000 students.
 
That troubles instructors like Erica Hoyt at the University of Central Florida.
 
"I've had a number of them express to me they were not gained entrance into the program and they are devastated and very upset," Hoyt said.
 
Nursing schools told NewsChannel 2 that they're facing three big problems. One is a lack of funding. Two is finding qualified instructors. But the biggest problem is they don't have room.
 
"We have rules from the Board of Nursing that we cannot have more than a ratio of one to 12 within our clinical sites. We try to keep one to 10 because many of our local agencies do not want more than one to 10," said UCF's Dr. May Lour Sole.
 
The nursing program at Florida Hospital has actually added an additional enrollment that's allowing 70 more students this year than last year to be in the program.
 
"By being able to accept more students, it definitely impacts Central Florida community by graduating qualified healthcare professional for the area," said Dawn McLendon, of the Florida Hospital College.
 
Eventually, that means more students like Dolcater, who are passionate enough to take on the challenge, will graduate.
 
"You can't let it discourage you because if that's really what you want to do you've got to persevere," Dolcater said.

Program-Inclusive Numbers Raise Nursing and Nursing Faculty Shortages to Crisis Level
December 15, 2004—New York, NY— Calling it a red flag, the National League for Nursing today released a preliminary report that shows that thousands of qualified applicants, represented by an estimated 125,000 applications, are turned away from nursing programs at all levels. According to Dr. Ruth Corcoran, chief executive officer of the NLN, “despite what seems a healthy increase in the number of graduations, admissions, and enrollments in all nursing programs for the academic year 2003-2004, the supply will fall well short of the demand and the gap will continue to grow unless we address the critical shortage of faculty.”