Across this site, there are 400 plus posts spanning more than a decade. Sprinkled throughout, are posts on staffing and the need for labor, especially nurses. In other words, the U.S. health system, all provider segments, needs nurses and the pandemic exacerbated this need. The need is most critical at the bed side, direct care. https://rhislop3.com/2023/07/17/jobs-data-and-staffing-status-update/
Over the weekend, in my typical pile of stuff to review (generally electronic), came a piece via my wife. My wife is a nurse and a co-owner and partner in our firm, H2 Healthcare, LLC. The story is about a program at the University of New England School of Nursing (Maine) that has created a fast-track RN program that takes one year to complete. Students must have an existing bachelor’s degree, not necessarily in healthcare or related to healthcare. Each student must complete eight prerequisites. The program details imply that nothing will be cut from a typical RN education program, including clinical hours. Students will essentially receive a second major or second bachelor’s degree, this time in nursing. To work officially as an RN, each student will be required to pass a national board exam. https://www.fox6now.com/news/12-month-nursing-schools-fast-track-registered-nurse-shortage?utm_campaign=trueAnthem%3A%20Trending%20Content&utm_medium=trueanthem&utm_source=facebook&fbclid=IwAR30R8CIq61KdTabsc7kFHzyshpclvjrwDgE6qaFIi5WMV5Qs4LB46Dns9Y
For this year, projections from the National Center for Workforce Analysis indicate a shortage of 78,000 Registered Nurses. Rural areas are the hardest hit by shortages today. Among the top three reasons for rural hospital closures, availability and cost of staff is typically one or two. By 2026, the demand for nurses, driven principally by an aging population in need of more care services, will grow by 26%. This growing need is concerning because just as the need for nursing increases, the industry faces consistent, ongoing serious personnel shortages.
The nursing shortage is due to several factors including, but not limited to, the growing demand for healthcare services in general, fueled in part by an aging population with increasing lifestyle and chronic disease issues. Not only is the healthcare industry experiencing high turnover rates, but the demand for healthcare staff (all disciplines) has surpassed the supply of qualified, educated candidates. Among the many challenges in recruitment of new students is the growing perception that the career of a bedside nurse is unfulfilling and stressful.
I have written and spoken, too many times now to recall, about the need to develop a multi-prong approach to address staffing problems, particularly focused on bed side care or direct care. To me, retention and job satisfaction improvement is the most critical component to making headway in fixing the staffing problem. It is nonsensical to believe that recruitment alone will make a dramatic dent, particularly if demand continues to grow but so does turnover. Recognize, even at a one for one pace (one new nurse for every one nurse leaving direct care), the system falls behind at a ten to twenty percent clip as demand is increasing not stable or decreasing.
A report titled the PRC National Nursing Engagement Report (fall of 2023) provides exceptional insight as to what causes turnover and burnout for nurses. The report is essentially an analysis of extensive survey results of nurses. PRC-NurseReport-Final-031819-Secure From the report,
The financial impacts of this shortage are significant, considering the
costs of termination and reduced team productivity, recruiting, and
training. During periods of turnover, diminished morale and disrupted job
duties become the norm. Further, retaining a nurse who is incompatible
with the team or unable or unwilling to perform to the standards of
excellence makes the achievement of “Always” nearly impossible. PRC
found that 50% of nurses reporting burnout have no plans to leave
their organization. They are physically “clocking in,” but are emotionally
“clocked out,” displaying a lack of confidence in their work and an inability
to be present. These nurses have lost touch with their patients and those
behaviors are reflected in how patients perceive their quality of care.
The top three drivers of engagement (work satisfaction) per the nurses surveyed were, 1) Autonomy, 2) RN to RN teamwork and collaboration, and 3) Leadership access and responsiveness.
From my perspective, nearly forty years in healthcare, a fast-track program sounds like a quick fix but the underlying issues of nurse turnover, if not addressed, will not change the present shortage paradigm. I also question how successful nurses in a one-year program can be in terms of managing patient assignments in multiple venues. Great nurses (I know many) are technically sound but their management of wholistic patient care issues is where they shine along with their ability to manage more than one patient. Shorter programs may provide a decent technical basis, but nothing replaces clinic time, especially with good preceptors and clinical instructors – another element sorely missing and in short supply.
A large-scale analysis and debate around attracting students to nursing, how to build more programs of nursing with instructors (many programs can’t take more applicants because of instructor shortages), regulatory reform that reduces documentation burdens, improved clinical staff management via proper management/leadership training, and increased post-graduate programs on managing the social constructs of current patient care needs (age, lifestyle, family dysfunction, etc.), is required.