Tuesday, June 4, 2019
Nursing Shortage in the United States
breast feeding Shortage in the United StatesNURSING LABOUR FORCE IN THE U.S. HEALTH CARE form AbstractThe well- pass judgment demographic change attributed to the ageing of the baby boomer population in the USA pull up stakes led to a signifi bathroomt demand on the wellnessc ar industry in the unyielding run. Important resources such as the nurse work on force out will be required to provide gauge health c atomic consider 18 services to the population. This research paper will provide a brief description and statistics of the nurse labor force in the USA, the commandal requirement inquireed to be a nurse, the ch altogetherenges face by the nurses in the health cautiousness governing body. The last part of the paper identifies the treat deficit and the solutions for the short and vast run, the recommendations and finally, the conclusion.LABOR FORCE IN THE U.S. HEALTHCARE SYSTEMThehealth electric charge corpse in America is a complex and unique linguistic context comp aring to the opposite 34 countries in the memorial tablet for Economic Co-Operation andDevelopment (OECD). In 2016, The United States spent $3.3 trillion on healthc are benefits, or 10,348 per person annually, which represents17.9 % of the hail GDP and rebrinyed at top of all OECD countries for the healthcareexpenditures. About 30% of the cost was spent on hospital care, 20% onphysician and clinical services, 10% on prescription drugs and 5% on breast feedingcare. However, the life expectancy is 78.6 eld which ranked 22ndof the OECD countries (Medicare & Services, 2015).Meanwhile, bothers such as growing population, senescence and shortfall ofphysicians and nurses are causing the increasing demand for healthcare benefits(Levit & Patlak, 2009).In 2016, there were 5,534 registered hospitals including 4,840 lodgehospitals in the U.S, more or less of the healthcare facilities are owned by privatecompanies and 60% of the community hospitals are non-for-profit organizations,20% are for-profit and 20% are owned by brass. In U.S, the most value ofhealthcare system in America is the health professional, also con human facered ashealth providers (AHA, 2018). THE NURSING WORKFORCEAccordingto U.S dominance of Labor (2018), the total labor force was round 160 million. obliges are playing an important lineament in the healthcare system. Nursingdemographic consists of1.5 million certified treat suspensor (CNA), which represents about 1% of the U.S labor force who are responsible supporting patients daily activities such as taking vital signs, dispensing prescribed medications, bathing and transporting patients. Certified nursing assistant is consulted as nursing assistant as general or patient care assistant. CNA is like medical examination assistants that both assist physicians, nurses and such healthcare providers. Usually, CNAs are assigned in an inpatient hospital and residential facilities such as nursing home and day care centers. Till 2016, the mean(a) hire for CNA was $26,590 while VA hospitals might offer better recompense, around $37,450. Alaska make ups the highest average salary which was $17.81/hour while it was $11.6/ hour in West Virginia. In fact, the market judge the demand for CNAs would append about 11% during 2014 to 2024. 738,000 licensed practical nurse (LPN), which represents about 0.5% of U.S labor force, who are responsible for granting injections, surgical preparation and communication betwixt patients and physicians. LPNs also do assistant works such as recording and maintaining communication with patients, registered nurses and physicians. LPNs are directly assigned to take care of patients that keep patients comfortable. Sometime, LPNs are assigned to take blood pressure, insert catheters and such activities. LPNs usually work in hospitals, nursing homes, doctors offices and any healthcare facilities. In fact, LPNs are the direct contact between patients and physician that they are responsible for keep patients knowledge about intercession and procedures. The average salary for an LPN was $44,000 and the number is evaluate to increase. Connecticut severalise pays the highest average salary which was 24.30/ hour, comparing to the lowest paying state West Virginia with $14.25/ hour or $29,640 per year. 3 million registered nurse (RN), which represents the largest sort of all types of nurse and 1.9% of U.S labor force, who are qualified with license to make nursing diagnoses and work as a supervisor of CNAs and LPNs. RNs work with physician and healthcare teams to improve healthcare pure t unmatched and treatment quality. RNs also educate patients for their health conditions and support patients and their family members on further living. Since it is the largest concourse, the competition is fierce. Depending on the specialty, education and down, the average salary was around $70,000 in 2015. Some hospitals might offer better payment to $100,000. California owns the largest n umber of RNs, which was around 300,000 and it pays the highest salary in America, which was $98,400 on average. The market expect a 16% increase of RNs from 2014 to 2024.151,000 advanced registered nurse practitioner (ARNP), who standard additional education with masters degree or post ammonia alum degree and additional medical experience. ARNPs work as clinical nurse specialist and nurse anesthetists that they are certified to diagnose, prescribe medication and therapy, provide treatment and counsel to patients. ARNPs are specify into multiple types such as acute care, nursing information, nurse administrator, travel nursing, family nursing, psychiatric nurse, neonatal nurse and pediatric nurse. The average wages for ARNPs was $95,000 or $46.40/ hour. During the first decade of 21st century, the job opportunities in the healthcare segment of United States grew with a pace of 20% while, in all other segments of the industries nationwide, the same growth was merely 3%. The growth r ate has boomed in the US healthcare market, demanding for more and more registered nurses and nursing professionals in the real decade as well. These opportunities energize created mixed job profiles so far in the evolving hospital settings. New hospitals and home care- found jobs are also emerging rapidly. It is anticipated that the rate of employment in the health care sector will grow tumultuouser than the rate of employment in all other sectors between 2014 and 2024, with projected increases of nearly 22% and 5%, respectively. Other service sectors are projected to grow by about 8% during the same time design .(Martiniano, Chorost, & Moore, 2017).Currentlythere are more than six million of the staff available across states in thehealthcare settings for RNs and NPs working in different administrative positionsin United States. The growth rate is also having imperative rays of hopes interms of having future job employments because of the fact that between 2014 to2024, it is estimated that the home care based jobs are expected to increase by60% while jobs in the offices of the healthcare practitioners are also said tohave the increase of 25% because as of now, there are more than 4 million ofjobs that are available in the same positionthe job positions are subjected tobe va earth-closett and modify at the same time, depending on the conditions of thenurses who are employed and leave their jobs due to unforeseen conditions (Martiniano et al., 2017). Researchesshowed that there would be a 1 million shortage of RN in 2020 because of thedropping economic situation in America. In fact, the shortage has been ongoingsince 1998 that it has been always a lose of supply. The supply was high thanthe increase of demand. in that location were several reasons behind the shortage. Ageingof nurses might be the most concerned issue in recent that galore(postnominal) nursingpractitioners are getting older. Since 2012, the 50-60 year-age grouprepresented the largest group on RNs and these group is expected to retirebefore 2025 but they are the ones who are the most experienced for taking careof patients (Levit & Patlak, 2009). TheU.S government also supports foreign-born nurses in wander to remove the gapbetween supply and demand. In 2008, international nurses represented 15% of thenursing workforce. One concern was the communication that international nursesmight have chores on communicating with patients and doctors even thoughtthey had passed the English language test such as TOEFL and IELTS. In fact,foreign-born nurses on average cost less than American born nurses and theycontribute extra value on international patients (Levit & Patlak, 2009).NURSINGPROFESSIONS efficiencyWith the expansion of the ACA, allowing more slew access to health care and insurance coverage, and the aging of thepopulation, which increases the nationwide rate of terminal illnesses such asheart ill luck and malignant neoplastic disease, the demand for care is h igher than ever and thereprompts the big question of whether the matchd health care workforce canadequately meet that demand. To fill the obvious gap that will occur,non-physician providers will be needed. Potential candidates for the positionsare no other than advanced trained nurse. In the1990s, funding for nursingeducation drew the attention of policymakers as people realized there would besubstantial shortfalls of nurses in the next decades. Efforts to increasefunding for nursing education have been intermingled with advocacy forincreased emphasis on baccalaureate entry-level education. In the past, moreRNS were educated in hospital-based diploma programs, but most of theseprograms has been converted to associate or bachelors degree programs. Theshift in nursing education from hospitals to universities marked the importanceof the body of knowledge that the nursing profession should possesses. muchessentially, it be nursing as any(prenominal)thing much more than assistant t o thephysician. As an effort to alleviate a looming cycle of nursing shortage, communitycolleges and technical schools started offering nursing program in the 1970s. Sincethen, the nursing education has greatly evolved to better prepare theirstudents for the ever-changing and challenging world of health care system.The two most frequent modes for people pursuinga nursing degree is either obtaining a 2-year associate degree (AND) or a4-year baccalaureate program (BSN). Many community and technical colleges offerADN programs and they are more attractive to prospective nurses because oftheir afford ability and a shorter time period to finish. Graduates from theprograms are qualified to sit for the National Council Licensure Examinationfor Registered Nurse (NCLEX-RN). This type of program provides a solidfoundation for entry-level nursing positions at a wide array of health-relatedestablishments, including hospitals, primary care clinics, and nursing homes. Inaddition, nurses can later register for the RN-to-BSN bridge programs to obtaintheir BSN. The 4-year BSN, while more time consuming, opens up moreopportunities for nursing students upon their graduation. BSN candidatesreceive intensifier knowledge non only in the clinical palm, but also inleadership and communication skill. The goal is to provide more professional recrudescement to their students with a broad curriculum that coverssome of the most pressing issues within the profession, such as public health,social sciences, nursing research, and management and leadership. Mostof nursing programs are not recommended to be taken online as they are hands-onprofession. Averagely, nursing program costs $15,000 per academic year(Registered Nursing Degrees, 2018). In the 1990s, nurses once passed their board licensing received the same licenses and oft hired to perform the same jobs. Their background education, whether they had an associate degree (ADN) or a baccalaureate degree in nursing (BSN), did not di fferentiate the task they performed in any health care facility. While the confides and educational differences between ADN and BSN were proven to exist, there was a general but often weak correlation in patient outcomes based on the initial education preparation of the RN providing the care (Kovner & Schore, 1998). A meta-analysis done in 1988 by Joyce Johnson pointed out that BSN RNs attained higher scores in the field of communication, problem solving, and professional role when compared with AND RNs. Contrariwise, these associations decreased when experience was taken into account, and no distinguishing result existed in measuring level of leadership and autonomy between BSN and ADN RNs.Time has changed and so as the complexity of the health care system. The role expectations and educational outcome differences for ADN and BSN has been more clarified. Although the health care system required nurses prepared at both levels of education, the graduates of these programs hold diffe rent competencies and should be valued for those differences (N/A, 1995). A study done in 2003 further proved this notion by showing the connection between higher levels of nursing human capital and improvement in patient outcomes a 10 percent increase in nurses with baccalaureate degree yielded a 5 percent decrease in patient mortality and complications (Kutney-Lee, Sloane, & Aiken, 2013). This clarification in the roles of ADN and BSN nurses are vital to the deli actually of high quality care and require the restructure of their education curriculum as well as validation in the systems in which these graduates are employed. ISSUES IN THE NURSING LABOR FORCELike many an(prenominal) other health care professional, the nursing workforce has many tough areas that need to be resolved. One of the most pressing one is the shortage in labor force. The Patient Protection and Affordable Care Act (ACA) since its delineation in March, 2010, has successfully provided insurance coverage fo r around 19.2 million people and dropped the number of uninsured population from 20.5 percent to 12.2 percent in 2016 (Garrett & Gangopadhyaya, 2016). This influx of modern patients has driven up the demand for nurses with the U.S. Department of health and Human Services projected a shortfall of over one million nurses by 2020 (DHHR, Resources, Workforce, & Analysis, 2017). However, the current state of the workforce is gradually depreciated due to several factors. The aging baby boomer nurses reaching their retirement ages contributes as the first factor in this shortage crisis. This aging workforce has been dealing with increasing pressure due to higher work demand resulted from nursing shortages, and their health suffers tremendously with a significant higher number of senior nurses experiencing chronic pain, tiredness, and exhaustion among the group (Gabrielle, Mannix, & Jackson, 2008). An obvious fix to this problem is to increase the number of qualified nurses in the labor ma rket through and through nursing school recruitment campaign. Unfortunately, the majority of nursing schools nationwide do not have the capacity to accept new candidates due to a lack of faculty, budget constraints and limited clinical sites for students to coiffure. While all schools reported reaching their full capacity and even going over their students limit each year, many applicants got rejected, with 78 percent of ADN applicants and 62 percent of BSN candidates, all of them had qualified credentials, were turned away from nursing school in 2016 (Nursing, 2016). This would directly reduce the chance to engender enough nursing graduates to meet the upcoming demands facing the health care industry. Beside the restricted nursing enrollment rate, health care providers only preferred nurses who already had several years of experience and turned down many potential applicants only because they newly graduated. Another realistic alternative to fill the gap in nursing staff is by h iring foreign-educated nurses. However this solution is poorly received since it stirs up concerns regarding the level of competency of nurses trained outside the U.S. and immigration issues (Williams, 2014).A shortage of nurse will ultimately lead to achange of nurse staffing pattern in care centers, with one nurse tending formore patients. A study by Cummings and Estabrooks (2003) pointed out the negative effects the changein nurse staffing patterns had brought upon the remaining nursing staffshealth and their competency to provide quality care. Other research literaturealso reported imbalance nurse staffing pattern can drive up the rate ofpreventable medical errors and indecent events (e.g. hospital-acquired pressureulcers, wrong blood transfusion) (Cho,Ketefian, Barkauskas, & Smith, 2003). The predominant effects of hospitalrestructuring on nurses are mostly negative with a decrease in efficacy andability to provide quality care, reduction in job satisfaction, and disparityin t eamwork among care providers, which resulted in an increase in turnoverrate. Cost enclosement initiatives in many healthcare establishment can also further deplete the nursing workforce. The U.S.health care expenditure has skyrocketed over the past decade and accounted for17.9 percent in the overall share of gross domestic product (GDP) and more than$10,000 per capita in 2016 (Llanos & Rothstein, 2007) (CMS, 2016). Regardless, the U.S. index for health careoutcomes such as life expectancy, maternalistic mortality, child and infant mortalityare far behind other OECD nations (Institute ofMedicine, 2007). As a result, several health reform programswere introduced in an attempt to increase access-to-care for the population,reduce the health care cost, and improve the quality of health care. The fulfilation of these pilot programs put tremendous pressure on health careproviders and organizations to contain their cost while maintaining optimumtreatment to their patients. Many care facil ities decided to restructure theirworkforce by decreasing the overall labor pool. As one of the largest personnelgroup in the health care workforce and oftentimes claimed for the largest pieceof the hospital budget pie, approximately 33 percent of hospital appendage cost(Walston,Burns, & Kimberly, 2000), nursing positions were the primary targetfor cost-containment strategies in many organization. The result was anincrease in substitution for lower credential nursing position, such asLicensed Practical Nurse which only required two years of associate degrees, oreven unlicensed personnel like patient-care technicians. This shift in workforce in the 1990s, however, had driven up the rate of medication errors,patient injuries and infection (Kunen, 2001). To better adapt to the ever changing environment of health care bureaucracy and population health priorities with finite capital and human resources, all health-related establishments should develop strategies with emphasis in organiz ation and culture restructure that has positive impact on the outcomes of patients and nurses. Beside financial incentives, political advocacy from both the federal and state government, as well as professional opinion and standard setting can further make changes to the recruitment and retention of qualified nurse workforce. THE GOVERNMENTSEFFORT IN SOLVING THE ISSUE OF NURSE returnOne of the problems the healthcare system in the U.S. is facing is that of shortage of nurses. Some factors which contribute to this shortage is the fact that women have more options in choosing their career path in society immediately when compared to the past. From an economic point of view, this problem of shortage is cause more by the supply side rather than the demand side thus, making it a more complex shortage (B. & J.I., 2001). This shortage of nurses might worsen in the long run if the government do not develop and implement solutions to solve this problem. Some economic solutions where develo ped in the past to attend solve this problem such as relocation coverage, new agio packages and sign on bonuses however, they were all short-term solutions which helped in redistributing the supply of nurses instead of increasing it (B. & J.I., 2001). Due to the shortage of nurses in the healthcare system, the government has developed and implement solutions which will be examined below.The government is trying to recruit more students and educators in the nursing field to combat with the increasing demand in the workforce. For some years now, recruitment of students in the school of nursing has been declining. According to the American Association of College of Nursing, the number of nursing students who enrolled in the bachelors degree program had been declining in the past five years (Larson, 2016). In 1999, the number of nursing students felt by 4.6% nationwide. Nursing master program also suffered the same fate with a decline of 1.9% in some states (Larson, 2016). To better lend oneself the current aging workforce, healthcare circles decided to recruit the old and retired practicing nurses who can no longer administer treatment to the growing population and appointed learning positions to them in nursing schools. They came to a conclusion that this ageing nurses will better teach the students as they are teaching out of experienced and it is said experienced is the best teacher (Johnson et al., 2006). Practice and experience are two important factors that teachers most acquired in order to teach students effectively. Also, in San Diego,six hospitals donated $ 1.3 million to support a program known as Nurses Now,which will be an luck to add faculty members and additional nursingstudents in the San Diego University (Costantini, 2016). Moreover, in orderto support students to do nursing, the Texas hospital donated $ 425,000 inscholarships to local students to do their bachelors degree program innursing. Moreover, in New Jersey the Board of Free holders d onated scholarshipsto local students who accepted to work in the long term care facility in theUSA (Costantini, 2016). These are examplesof some successful collaborative efforts between healthcare organizations,nursing schools and the USA government to help solved the problem of nursingshortage in the USA. Moreover, in order to solve to problem of shortage, hospitals are re-implementing intensive training programs for nurses in various specialities. This has gone a long way to retain nurses who are seeking for a transfer and has also help build a vocation development path for nursing staff. A research that has been done on Magnet hospitals indicate that some of the organizational characteristics that create a centre of attention and retain nurses are professional practice models for delivery of healthcare with independence and responsibility to make decisions (B. & J.I., 2001). Moreover, effective managerial structure, quality patient services and investment in nurses professional d evelopment in the healthcare system are very necessary and important. Nurses must be involved in developing and implementing the practice of care in hospitals since they are very close to patients. Some of this practise includes participating in the financial management of the hospital and developing new strategies in hospitals. If healthcare leaders developed intensive programs for nurses in each specialities, it will motivate them to realize that they are very important in the healthcare system thus, encouraging them to remain in their various specialities in nursing.Furthermore, healthcare leaders need to developed models of care in order to solve the problem of nurses shortage in the USA, the government need to implement regulatory and policy issues (Johnson et al., 2006). Some regulatory and policy problems could also cause the nursing shortage such as federal and state laws, licensure and nursing practice act, and requirements from reimbursement organizations, private organiza tion and the government (Johnson et al., 2006). Inside an organization, insistent process developments initiatives can assist standardize and simplify documentation. Healthcare leaders should drive this problem with some consultation from some internal experts in reimbursement, patient documentation and risk management.Furthermore, nursing trainers should use technology as one of the training tool.Although most of the character in nursing learning is clinical experience, most of the classroom teaching can be done through the new technology we have today such as internet teaching, distance education, and accelerated educational programs.As the healthcare of patients become more associated to technological improvement, routine nursing performance can drilled by utilizing the same technology. Technology improvement could also be use to test and certified nursing educators (Larson, 2016). All these new methods of teaching nurses through technology advancement will motivate younger adul ts who like using the internet and other forms of technology to learn to join the nursing field thus, dower to solve the problem of nursing shortage.In addition, to help solve the problem of nurse shortage in the USA, healthcare leaders should concentrate on training our own nursing and retaining them from traveling to other countries such as Canada. One sizable approach to solve this problem is to employ bachelors and masters students who are already in the faculty programs and provide them with qualified training and prepared them as well-trained nurses to be employ in the nursing field (Buchan & Aiken, 2008). Guidance into the clinical faculty is one of the best in this context, and this will improve nursing students capacity to do their work in the nursing field efficiently. The main idea is to guide them to grow into the nursing profession and eventually make nursing their profession of choice. This strategy will work well to the nursing field advantage because, it will encou rage students to choose nursing as a career thus, increasing the number of nurses for the future.To continue, to solve the problem of nursing shortage in the USA, the government should augment the supply of nurses by using tax credit. For example, three bills where pass to permit the creation of refundable tax credit for all register nurses (Johnson, Posner, Biermann & Cordero, 2006). This is a positive impact that would have help retain nurses in the profession and it will also help to increase their salaries. Moreover, it will motivate them to maintain their various positions in hospitals thus, working positively in reducing the problem of nurse shortage in the USA.More so, in order to solve the problem of nursing shortage in the USA, hospital managers should offer bonuses to nurses who accept and sign up to work in that hospital for a long period of time. For example, in St. capital of Minnesota hospital in Minnesota, the hospital leaders are giving out bonuses of about $8,000-$1 0,000 to nurses with essential care experience who have sign up to work in the hospital for a long period (Larson, 2016). This strategy has help St. Paul hospital to keep most of it nurses. If more hospitals could adopt this method, it will help solve the problem of nurses shortage in the USA.Moreover, in order to solve the problem of nurse shortage in the USA, the government need to increase the salaries of nurses. The work load of nurses especially register nurses is much as they are the ones who spend most of the time taking care of patients (B. & J.I., 2001). Most of them leave the nursing field because they are not well pay for the work they do and most of the time, some are not pay for the extra work they do. In order to solve this problem, the USA government has increased the salary of nurses for example in California the salary of register nurses went up to $94, 120 per year (B. & J.I., 2001). This has motivated many people to join the nursing field. According to experts pro jections from the Bureau of Labour Statistics, by 2022, the nursing field will experience an increase in the number of register nurses of about 526,800 (B. & J.I., 2001). This is a good sign for the healthcare field for the future absolutely a field with good prospects. ALTERNATIVES FOR THESHORTAGE IN NURSING SUPPYNurses form an essential part of the working force in the healthcare system in the USA and the great role they play cannot be ignored. This explain why the USA government, over the years have been trying to solve the problems nurses are facing in the healthcare system in order to motivate more people to join the nursing field. Due to all this, some recommendations are made to help improve the nursing working force.One of therecommendations is that, healthcare leaders should change consumers knowledgeof healthcare services. Most patients like meeting register nurse for them totake care of them whereas they are other nurses in the hospital who can takecare of them better. H ealthcare leaders need to change this perception somepatients have concerning the choice of nurses.More so, somepatients believe that nurses who are well paid do the work better than nurseswho are less pay. That is why patients keep traveling from one state to anotherin order to seek for hospitals where nurses are been well pay. For example,most Americans travel to big states such as California in order to receivetreatment from physicians and nurses. This believes is not good because itcreates nurses shortage in big states compare to small states (Costantini, 2016).The USA governmentshould develop and implement public health programs that will help educate thepopulation on how to prevent certain illnesses. This will help reduced thenumber of people who get sick, thus reducing the number of patients, nurseshave to take care of. People should do more of physical activities and eathealthy in order to avoid unnecessary illnesses which could be avoided by doingthis. Also, the population should be sensitize about the problem of nursingshortage in the country. This will motivate them to take good care of themselvesin order to avoid falling sick.Based on theexecution of these recommendations, it will assist to achieve healthy people2020 objectives. These recommendations are strategic plans that can be utilizeby the government, people, private and public health providers and communitiesto improve the health of the population thus making the USA government toachieve its goal of healthy people 2020.CONCLUSIONNurses play a verysignificant role in providing medical treatment to patients and they also helpto re-enforce the physicians shortage compass force in the USA. Many healthcare organizations can not do with out nurses as they play a significant role.If the shortage of nurses worsens, many patients will no longer have access tocare thus, creating a huge problem in the country. The USA government need totake the problem of nursing shortage in the country very serious a s the babyboomer nurses retirement will cause a serious shortage. With the fast growingpopulation of America, as many immigrants are coming in, it is necessary forthe USA government to attract more nurses into the health care system. It thereis profusion of nurses in the country, it will help the government, Medicare& Medicaid and other health organizations contain healthcare cost which isvery expensive. It will also increase quality and access to medical care.REFERENCESB., N., &J.I., E. (2001). The nursing shortage solutions for the short and long term. Online Journal of Issues in Nursing, 6(1),4. Cho, S.-H., Ketefian, S., Barkauskas, V. H., &Smith, D. G. (2003). The effects of nurse staffing on adverse events,morbidity, mortality, and medical costs. NursingResearch, 52(2). CMS. (2016). National Health use of goods and services Data. Retrievedfrom https//www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.htmlCost antini, S. D. (2016). Challenged by a NursingShortage? 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