Nurse Shortage: Retention is Key

Within any healthcare organization, there are many systems that work interdependently to provide the optimal quality of care for all patients who enter through their doors. While all of these systems are essential to these institutions, the nurse organization is one of the systems that is the most obviously necessary, and regrettably one that is currently depleting. Nurses are at the forefront of the delivery of care to patients, often being the ones who have the most contact with the patients thus influencing their opinion of the hospital. Because nurses provide mostly one on one care, it is vital that these organizations maintain the adequate number of qualified nurses to fulfill their patients’ needs. Unfortunately, we are currently facing a nurse shortage that seems to only have the potential to increase in the next ten years. Issues such as understaffing, low morale and high turnover are just some of the things affecting the nurse organization. In order to combat this shortage, healthcare organizations must put emphasis in nurse retention and education programs, so that they can continue to provide excellent quality of care with a sufficient amount of nurse aid.

An example of the dissatisfaction of the nursing organization can be seen in the upcoming ten-day strike, held by the nurses of Sutter Hospitals in San Francisco. According to the Mercury News, a local newspaper in the Silicon Valley, nurses from eleven different hospitals in the area reported that they will be on strike for ten days beginning March 21st. Some of the hospitals that will be affected are: Mills Peninsula, Sutter Delta and Eden Medical Center. Not only will these private hospitals have strikes, but the nurses at Contra Costa Regional Medical Center, along with nurses in county health clinics and jails, will also be holding a three day walkout beginning March 21. As demonstrated by the picture on the right, this is not the first time these nurses have united under one cause. In nine days, these women will rally up once more to fight the county official's decision to "freeze the county contribution for health benefits for current employees and retirees, thus causing the nurses to pay an increase in premiums beginning in 2009." Once this is put into place, new employees will receive a set amount of money for health insurance and will not receive health benefits upon their retirement. According to the county, the reason behind this cutback is the outstanding liability of $2.6 billion for retiree health benefits which was unfunded. Although nurses are aware of the lack of money, they are upset that they are the only county employees who are being cut back on benefits; all other non-union employees and managers are not being asked to take the same cut. Along with the request for better retirement health benefits, nurses are also asking for better meal and break relief , as well as safer lifting procedures.

While ten days may not seem like a long strike, this length of time without nurses is actually very costly to hospitals. According to Dr. Jeffrey Smith, and executive director for one of the affected hospitals, hiring registry nurses can cost around $1.5 million dollars per week. Not only do registry nurses cost more, but they also pose a higher threat to the patients. These traveling nurses are usually not familiar with any cases and they are not acquainted with the protocols, processes and mission of the institution. This makes them more of a liability that regular employee nurses. Instead of having to use all of that money to pay registry nurses, hospitals should reconsider what they proposed plan of action is, and negotiate with the California Nurses Association so that they can reach an agreement which will stop the nurses from going on strike. Hospitals need to realize that with the current nurse shortage problem, nurse retention is really what is going to help them meet California's New Nurse to Patient Law which requires one nurse per five patients in general floors, and much smaller ratios in more specialized floors.
According to the recent research of the American Association of Colleges of Nursing, there are approximately 116,000 registered nurse vacancies across the United States. This is equivalent to a vacancy rate of 8.1%. While this might not seem like a large number, this actual translates as approximately 800,000 vacant RN positions. If we were to look at the number of states that will have predicted shortages by the year 2020, all but five can be accounted for (US Department of Labor). California is by far one of the most affected states, with less than 600 registered nurses for every 100,000 people and its only projected to get worse. With such an increasing demand of nurses and a decrease in the supply, the quality of care is bound to decrease because of the lack of provider services. Many studies show that there is an increase in the hospital related mortality rate, in the failure to rescue rate, and in the length stay with lower numbers of nursing staff. Moreover, being overburden because of overstaffing does not allow the nurses to achieve the quality of care goals, such as patient centered care, decreased waste and anticipation of patient needs, established by the Institute of Medicine.

Though these figures are quite staggering, it is important to look at the underlying causes of the problem. One of the reasons for why we are noticing such a decline in the supply of nurses is because of the low enrollment rates in nursing schools. While there are a great deal of interested candidates every year, there are just not enough spots for all of the applicants. According to a recent study done by the U.S. Department of Health and Human Services, there are on average about 30 to 40 percent of qualified applicants who get turned away from nursing programs. The American Association of Colleges of Nursing equates that percentage to about 40, 285 applicants a year. This is a result of “insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints”. Because there are fewer new nurses entering the workforce, the average age of the nurse is increasing. Currently, only 9.1 percent of nurses are less than 30 years of age, The AACN reports that in a current survey done of the nursing workforce, 55% of them said that they were planning on retiring between the years 2011 and 2020. As can be seen in the line graph on the right, not only are healthcare organizations going to lose their current nursing workforce, but demand is also going to increase because of the rise of the aging population. The baby boomer generation is going to be entering their sixties soon, and they are going to require an increased amount of care in the near future.

While the lack of a new nurse workforce is a great concern for all, a more pressing issue lies in the high turnover rate of nurses found within healthcare organizations. This high turnover rate is fueled by understaffing, giving too much responsibility too soon to new RNs, weak orientation programs, decision making by supervisors without input by those most familiar, and nurses not receiving positive feedback from supervisors. These types of issues should not be arising in a time in which nurse retention is really key in maintaining a steady nurse workforce. Considering one of the key ways for retention is worker satisfaction, hospitals such as the Sutter hospitals should reevaluate their treatment of their nurses, because clearly there is no worker satisfaction if they are driven to go on strike. They should really internalize the idea that nurses are one of the most valuable resources they have, and without them, they will not function.