Thursday, March 10, 2016

Sick & Getting Sicker: the Perils of Nursing

By B. Lana Guggenheim, Staff Writer

The recession might be over officially, but many professions are still feeling the squeeze. Healthcare demands are rising as the Boomer generation ages, but even though they are mostly protected from the worst of the volatile job market by virtue of being unionized, nurses are starting to feel the pain of job insecurity.

First in the 90s and again recently, there have been severe budget cuts impacting the health sector as government attempts to minimize budget deficits. Then and now, the results have been mostly negative across the board.  One of the biggest threats to nurses’ jobs are hospital restructurings - which are results of these budget cuts, and are significant changes that nurses often have no voice in. They also have no way to predict or prepare for the nature of those changes either.

Downsizing can make work intolerable: between budget cuts, hiring freezes, overtime restrictions, and wage freezes, nurses reported they had an increasing desire to quit, citing burnout and decreased life satisfaction in addition to job insecurity. In short, hospital restructures often lead to fewer nurses on staff, thus increasing the workload of those who remain, sometimes dangerously so.

Insufficient staffing raises the stress level of the nurses remaining on staff, but it also leads to dangerous levels of insufficient care for patients. Stressed nurses are driven to the breaking point, and many choose to leave their profession as a result. And high nurse turnover and vacancy rates cause avoidable patient deaths. Similar nursing cuts in Canada have led to nurses speaking out about the dangerously sub-optimal care patients now receive as a result.

The increasing instability of nursing jobs might lead one to think that the job market for nurses is over-saturated, but the opposite is true. An aging Baby Boomer population means there is more demand for nurses than ever before. And the aging nurse population means that there are ever increasing numbers of vacancies to be filled as well. The American nursing shortage is projected to grow to 260,000 RNs by 2025 - a shortage not experienced since the mid-1960s, the worst of which is projected to manifest in the South and West. Yet, nursing schools across the country are struggling to expand the capacity to meet this rising demand. Part of the problem is that these schools simply do not have the faculty necessary to expand their programs. According to the AACN’s enrollment data from 2012-2013, American nursing schools turned away nearly 80,000 qualified applicants from bachelor’s and graduate nursing programs due to the insufficient number of faculty, clinical sites, classrooms, and budget.

There is no magic solution to this problem, no easy quick-fix. But there are strategies that can be employed to ameliorate some of the worst effects of this nurse shortage. Hiring retired nurses, or giving incentives to retirement-age nurses to stay on is one way to slow the shortage. This can be done via financial incentives and job enrichment opportunities, such as leadership positions or taking on special assignments. This can also include mentorship programs, which help train newly hired nurses at the start of their careers under a senior nurse with a lot of experience. And it is cheaper than hiring and training a new nurse to take their place. New technology, along with process improvements, can relieve nurses of onerous and redundant administrative tasks, freeing up more time for them to get back to actual nursing. Finally, allowing for flexible scheduling gives nurses a measure of control over their lives. When allowed to dictate their own hours, nurses reported greater job satisfaction, and turnover rates were significantly lowered.

None of the above strategies will resolve the ultimate cause of this nursing shortage in the first place: budget cuts, both at universities and at hospitals and health care centers. However, addressing budget shortfalls is probably out of the reach of most individual nurses, or even most hospitals. These strategies, once implemented, should help stave off some of the worst effects until we ride this crisis out.


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