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A new era, a growing shortage and the future of nursing

By Terry Miller

In many ways, it is the best of times for the nation’s nursing schools. In the midst of a nursing shortage, the number and quality of applicants to nursing programs continue to rise, the roles and salaries for nursing graduates have never been better, clinical agency support is more collaborative, and the media blitz addressing the nursing shortage has not ended.

At the same time, there is a downside. The competitive demand for quality clinical placements of nursing students make it difficult for any program to expand offerings or increase enrollments. Understanding both the inherent opportunity and the growing challenge presented by the nursing shortage is crucial for the future of health care.

Having more nurses will not solve the problem unless the nurses are better educated, ethically based, service-oriented leaders advocating more for the public’s safety and health, than for personal employment security.

Any long-term solution will require that those entering nursing are better equipped, will stay in practice longer and that a greater number will choose to work full-time. Also, any real solution will require the recruitment and development of more Ph.D. nursing faculty who are both effective teachers and clinicians.

It is important to first define the U.S. nursing shortage. Nursing is the largest faction of the health care workforce. According to recent projections from the U.S. Bureau of Labor ( statistics published in the February 2004 Monthly Labor Review, more than one million new and replacement nurses will be needed by 2012. The U.S. Department of Labor has identified registered nursing as the top occupation in terms of job growth through the year 2012.

In May, the National Commission on Nursing Workforce for Long-Term Care reported that there are nearly 100,000 vacant nursing positions in long-term care facilities on any given day, and the annual nurse turnover rate exceeds 50 percent. The shortage is costing long-term care facilities alone an estimated $4 billion a year in recruitment and training expenses.

An understanding of the shortage requires some analysis of where nurses choose to work and how long they remain in nursing positions. Rural areas have had better results with creating their own nursing programs, admitting a local population who is more likely to stay a rural area. However, this changes with major recruiting efforts by better-resourced urban areas, promising better salaries, benefits and relocation incentives.

The shortage also has been exacerbated by some creative solutions to downsizing nursing staffs in the late ’80s and early ’90s. Many nurses work part-time and have become accustomed to flexibility in scheduling, unknown in previous decades. Continuity of care becomes harder as the number of part-time nurses exceeds those who provide care on a more consistent basis.

Depending on who addresses the issue, the root cause for the nursing shortage has been identified as work environmental issues, inadequate salaries, lack of significant career advancement and the aging demographics of the nursing workforce. In the March-April 2005 issue of Nursing Economic$, Peter Buerhaus and colleagues found that more than 75 percent of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care and the amount of time nurses can spend with patients.

Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%). Some statisticians claim that it is impossible for existing nursing programs to expand in order to adequately address the nursing shortage.

The most prevalent solution for “fixing” the nursing shortage has been driven by multiple interests including: those employing nurses, institutions wanting to get into the business of producing nurses; and educational programs that educate nurses. In other words the solution has been mostly defined in terms of expanding the pipeline of new graduates.

Public awareness of the nursing shortage has driven increases in enrollments more than anything. The PLU School of Nursing student body has grown by 47 percent at the undergraduate level and by more than 200 percent at the graduate level since 2002. Those inquiring about our PLU programs in nursing exceed 400 per month, up from less than 100 six years ago.

Students and their significant others have responded to marketing efforts, such as the Johnson and Johnson ad campaign that showcased the potential for nursing graduates in terms of salary, employability, service, job security and international travel, as well as the chance to make a difference in the lives of others.

Whereas we look to clinical agencies to place our nursing graduates, the employers look to us to produce graduates in sufficient numbers to fill their positions. Similarly, applicants anticipate admission and success, regardless of capacity and demands for excellence.

Regardless of one’s perspective, nursing shortages are serious and affect everyone across the country in more ways than the direct recipient of nursing care recognizes. Unfortunately, the shortage can serve as an impetus for solutions that do not serve either the public’s best interest or nursing as a highly desirable profession in the future.

The nursing shortage colors expectations and drives many of the changes occurring in health care, as well as the programs educating nurses. What is certain is that someone at some price will fill the nursing vacancies – or the present system will implode.

PLU’s School of Nursing continues to be committed to producing excellent nurses who are professionally oriented, focused on lives of service and personally accountable for improving health care.

The PLU School of Nursing has worked very hard to establish a culture of excellence in nursing education such that PLU nursing graduates, nursing faculty and nursing staff represent a professional value system and level of commitment far beyond the usual.

Terry Miller, dean of PLU’s School of Nursing, says better educated nurses and more faculty must be part of the solution to the nation’s nursing shortage.



© Scene 2005  •  Pacific Lutheran University  •  Winter 2005

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