New report shows lack of nurses, predicts future shortage

For years, nurse advocacy groups, including the AFT Healthcare, have been sounding the alarm about the worsening nurse shortage. Recently, AFT Healthcare did a two-part Healthwire series on the issue and commissioned a Peter Hart poll that examined the reasons nurses are fleeing from the field.

Now hospital management and the research community are also recognizing that nurse numbers are dwindling to a dangerously low level. For example, the American Hospital Association (AHA) released a study this past June revealing that there is, in the words of AHA president Richard Davidson, an "astounding shortfall of workers that hospitals are coping with today." Unfortunately, when looking for strategies to lure nurses back to the profession, policymakers and hospital executives don't always make the essential connection between increasingly difficult nursing conditions and rapidly disappearing nurses.

"When people ask me about the nursing shortage, a lot of the time I'll say that there isn't a shortage of nurses, but of nurses working," said Carol Flynn, immediate past president and executive board member of the Danbury (Conn.) Hospital Professional Nurses' Association. "We may have ample bodies licensed, it's just that they're no longer willing to work in the field. Walk into a hospital and it doesn't take long to see we have one serious problem."

A recently released report from the General Accounting Office has highlighted the very point that Flynn is making. The July 2001 report, prepared by the General Accounting Office for the House Ways and Means Committee, is titled Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors. The report warns that "a serious shortage of nurses is expected in the future" and predicts that by 2020, the supply of RNs will be 20 percent below the number required to meet the projected demand. The report also stresses that "job dissatisfaction [is] a major factor contributing to the current problems of recruiting and retaining nurses."

The report's conclusions echo and confirm an April 2001 Peter Hart opinion poll sponsored by the AFT Healthcare (Healthwire, May/June 2001). The poll of 900 direct-care nurses raised a flurry of national news coverage centered on two particularly disturbing findings: One in five nurses plans to quit the nursing profession within the next five years; also, 54 percent of nurses surveyed have considered leaving the profession in the past two years, either to retire or to enter a different kind of job. The top problems nurses cited as contributing to job dissatisfaction were short staffing, mandatory overtime, and lack of time to spend caring directly for patients.

As the baby boomers age, the demand for nurses is expected "to increase dramatically," the GAO report notes. Nurse shortages will be exacerbated by the fact that by 2010, approximately 40 percent of the nurse workforce will likely be over 50 years of age. Meanwhile, the report points out, the number of younger women entering nursing is declining significantly.

Referring to numerous studies by nurses' organizations--and drawing heavily on the recent AFT Healthcare/Peter Hart poll--the report said that better working conditions will be vital in turning the nursing shortage around: "...Improv[ing] the workplace environment may both reduce the likelihood of nurses leaving the field and encourage more young people to enter the nursing profession."

Areas of the country particularly hard hit are Maryland, with a statewide average RN vacancy rate for hospitals of 14.7 percent; California, with a 2000 vacancy rate of 20 percent; and Florida, with a vacancy rate of nearly 16 percent for 2001.

Hospitals are not the only sector feeling the pinch. The report referenced a 1997 American Health Care Association survey of nursing homes that showed a 51 percent turnover rate for RNs and LPNs, as well as a 2000 national survey of home health care agencies that reported a 21 percent turnover rate for RNs.
 

Changing the workplace climate

While it's vindicating to see such an all-round recognition of the crisis, AFT Healthcare leaders are concerned that some proposed solutions--such as stepping up nurse recruiting programs, enticing new hires with additional fringe benefits, and offering on-site child care--while admirable in themselves, don't address the root of the problem.

"No amount of money or benefits will bribe nurses back into the profession unless working conditions change," said Flynn. "Why would nurses want to return to hospitals where they're given too many patients to care for, patients who are so much sicker than in the past that it's mind-boggling? Why would they want to return to jobs where they're verbally abused, or threatened when they question overtime, or at risk for physical injury almost every moment of the day?"

This spring, the federation came out with recommendations for reinvigorating the nursing profession and renewing its appeal both for currently licensed nurses who might be willing to come back to the bedside and for young people considering a nursing career.

In the report on the nursing profession, AFT president Sandra Feldman called for:

• a legislative ban on mandatory overtime;
• federal standards for health care staffing levels in hospitals and other health care facilities;
• congressional support for the Nurse Reinvestment act of 2001, sponsored by Sens. James Jeffords (I-Vermont) and John Kerry (D- Massachusetts), which would provide loan forgiveness and other incentives to draw people into the nursing profession;
• recruitment efforts targeted at men and minorities; and
• higher nurse salaries and better benefits, particularly pensions.

"There's evidence to suggest that if nursing conditions improve, nurses will return," said Joni Tanaciev, AFT Healthcare senior associate. Tanaciev cited the experience of unionized nurses in the Australian state of Victoria, who last year won a landmark agreement with the state government mandating nurse-patient ratios. Since then, an estimated 2,300 nurses have returned to the profession (see feature story).

"The Victoria experience proves that we can stem the tide of departing nurses but only by fixing the core problems that are causing them to leave in the first place," Tanaciev said.