This document discusses the nursing shortage crisis in the United States. It summarizes surveys that found nurses are overburdened, dissatisfied with their work, and concerned about patient safety due to inadequate staffing levels. It also cites research showing decreased nurse staffing correlates with increased medical errors. The document proposes several solutions to address the shortage including improving nurse compensation and work conditions, increasing nursing school enrollments, regulating nurse-to-patient ratios, and making hospitals more "nursing-driven" organizations.

1. The New Nursing Shortage
Why It Is
What We Can Do About It
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2. What is happening?
 The burden of care for nurses, patients and
families has demonstrably increased since
1990
 Nurses and families are very concerned about
the erosion of care and fearful about hospital
safety
 Nurses report increasing dissatisfaction with
their work in hospitals that have cut staff, that
require frequent overtime, and have replaced
nurses with assistive personnel
 Research has shown that these phenomena are
related to adverse nurse and patient outcomes
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3. ANA Survey of 7300 nurses
 75% feel the quality of nursing care
at the facility in which they work has
declined over the last 2 years
 40% would not feel comfortable
having a family member cared for in
the facility in which they work
 54% would not recommend their
profession to their children or friends
 50% feel exhausted and discouraged
when they leave work
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4. ANA Survey of 7300 nurses
 44% are discouraged and saddened by
what they couldn’t provide for their
patients
 40% feel powerless to effect change
necessary for safe, quality patient care
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5. Tightening Supply
 Aging of the nursing workforce
 Nurses leaving bedside care roles
 Decline in student enrollments
 Shortage of nursing faculty
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6. Safety Issues
 AHA/ Picker Institute Survey – 1997: The
perceived “thinness” of hospital nurse
staffing was reflected in a universally
mentioned experience: “If I hadn’t stayed in
the hospital room with my mother (or child or
spouse), they never would have gotten the
correct medication or care on time”
 Dr. Don Berwick – Institute for Healthcare
Quality Improvement: “so many of my
colleagues and friends have told me they
were afraid to leave their loved one in the
hospital for fear that something bad would
happen” Brought to you by

7. Safety Issues
 Decreased RN staffing is correlated with
increased medication errors
 Nurses who had only an associate degree were
more than nine times as likely as those with a
bachelor of science to be charged with
violations
 Broadening nursing assistants’ responsibilities
to include seemingly routine tasks has a
negative effect on the quality of the information
available to physicians and nurses and also
leads to medication errors (Preuss 1998)
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8. Safety Issues
 Both nurses and physicians
reported that heavy
workloads caused nurses
to postpone or miss tasks
 Nurses described a
troubling erosion of their
capacity for empathy
because of the difficulty
they had finding time for
even basic physical care
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9. Pay Issues
 Stagnant for last 5 years
 Not competitive with
other options for women
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10. Regulation and Licensing
 Establish standards for safe patient care, while
acknowledging the extraordinary difficulty of
doing so
 Establish training standards and competency
(certification) exams for previously licensed
personnel, through both national and hospital-
based strategies
 Find new ways to regulate the sites in which
nurses practice (for example, closing beds
when RN staff is reduced below a particular
level and adding clinical nurse specialists to
units) Brought to you by

11. Regulation and Licensing
 Require that clinical assignments be given only
to persons qualified to perform them
 Require that all staff performing clinical tasks
be properly identified
 Prohibit the use of mandatory overtime
 Encourage state legislatures to establish
commissions on nursing
 Establish licensing requirements that reflect the
different capabilities of nurses with different
educational credentials Brought to you by

12. Financing
 There is an absence of effective
reimbursement incentives for
quality care in general and nursing
care in particular
 There is a lack of funding for clinical
training costs of nursing education
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13. Role of Governing Boards
 Become more systematically
involved in overseeing the quality of
care.
 Request that the senior nurse
executive attend all board and
executive committee meetings.
 Elect more nurses to hospital
boards
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14. Recruiting and Educating Nurses
 Improve work conditions, compensation,
and benefit packages
 Recruit among high school students
 Tie repayment and forgiveness of
educational loans and grants to the
recipient remaining in nursing, in
hospitals and other health care agencies,
for periods of time related to the extent of
support granted
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15. Recruiting and Educating
Nurses
 Make nursing education more efficient by
reducing the number of nursing schools
in community colleges and increasing
capacity in baccalaureate and graduate
degree programs
 Increase faculty capacity to educate
nurses through the use of distance
learning
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16. Organization of Nursing
Services in Hospitals
 Have a strong chief nurse executive with the
formal power to act as an advocate for both
patients and nurses
 Adopt the ANA Principles of Nurse Staffing,
either as an industry standard or by regulation
 Require hospitals to report nurse-to-patient
ratios publicly on a regular schedule
 Establish protocols to prevent the
circumvention of technologies designed to
prevent medical errors Brought to you by

17. Organization of Nursing
Services in Hospitals
 Establish a more effective standard hierarchy of
expertise in nursing service
 Provide opportunities for education and career
progression for all hospital positions
 Require hospitals to collect and report better
data related to the quality of nursing care and
patient outcomes
 Encourage hospitals to improve working
conditions in order to be eligible for Magnet
Hospital Recognition Brought to you by

18. 10 Nursing-Sensitive Quality
Indicators for Acute Care
Settings
 Mix of RNs, LPNs, and Unlicensed Staff Caring
for Patients
 Total Nursing Care Hours per Patient Day
 Pressure Ulcers
 Patient Falls
 Patient Satisfaction with Pain Management
 Patient Satisfaction with Education Information
 Patient Satisfaction with Overall Care
 Patient Satisfaction with Nursing Care
 Nosocomial Infection Rate
 Nurse Staff Satisfaction
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19. An Interesting Idea
 Many hospitals will boost nursing pay scales
and upgrade information systems to improve
patient monitoring and record keeping. That is
the conventional wisdom. But unconventional
wisdom will be to get in line with the core values
of the primary caregivers in every health care
organization – nurses. Hospitals have thrived by
catering to physicians. That was important, and
still is. But there are three times as many
practicing nurses as active physicians.
Becoming a nursing-driven organization would
change some fundamental processes at many
hospitals and health systems. Brought to you by

20.  Healthcare executives must join
their caregivers in putting patients
first, and then figuring out how to
make money. In any industry, the
organization that provides
customers with the highest value is
the winner. – Russ Coile’s Health
Care Forecast
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