ElderWeb

The General Accounting Office (GAO) has prepared a report on the national nursing shortage. They point out in their report that the shortage is very real, and is not likely to improve anytime soon. For instance, the average age of a registered nurse (RN) increased from 37 in 1983 to 42 in 1998. At the same time, the population as a whole is aging, so demand for nurse aides is expected to grow dramatically. The availability of nurses in the future is not likely to get any better. Between 1995 and 1998, enrollment in baccalaureate programs declined 19%, and enrollment in master's programs decreased 4%.

Hiring and retention of nurse aides is a also a significant problem for many providers, with some studies reporting 100% turnover rates for aides working in nursing homes. The nurse aide shortage is so severe that in 1999, 30 states indicated that they were addressing nurse aide recruitment and retention through task forces, initiatives, and research. This shortage is also going to get worse. By 2008, the overall number of nurse aide jobs is projected to grow an additional 36%, compared to the 14% projected growth in all jobs, and jobs for nurse aides working in home health care are projected to by 58%.

Part of the problem is the poor wages and benefits that most aides receive. In 1999, the national average hourly wage for aides working in nursing homes was $8.29, compared to $9.22 for service workers and $15.29 for all workers. For aides working in home health care agencies, the average hourly wage was $8.67, and for aides working in hospitals, $8.94. GAO analysis of CPS data indicates that many nurse aides have such low earnings and family incomes that they qualify for public benefits such as food stamps and Medicaid. They found that one in three aides working in nursing homes earned less than $10,000 per year, and 36 percent reported family incomes below $20,000.

As one way to address the wage differential, as of 2000, 26 states had established some form of a wage pass-through, wage supplement, or related program for nurse aides and other direct care staff, but the GAO raised concerns that funds may not be used as intended, and point out that few states have addressed the issue of benefits for nurse aides. According to a 1999 study, only three states had considered or taken action to require any form of benefits for nurse aides and other workers.

Source: General Accounting Office (GAO) analysis of data from the Bureau of Labor Statistics (BLS) Current Population Survey (CPS) and Occupational Employment Statistics (OES), May 2001.

The Federation of Nurses and Health Professionals (FNHP) commissioned Peter D. Hart Research Associates, Inc., to conduct a study among current direct care nurses and former direct care nurses to examine their perspectives on the nursing profession. Seven in ten current nurses say that their facility has a major or moderate problem retaining and recruiting qualified nurses, with more than two in five saying that each is a major problem. 50% of current nurses say that they have considered leaving the patient care field for reasons other than retirement in the last two years. They report that the health care profession faces a serious risk of losing one in five current nurses (21%) from the direct patient care setting for reasons other than retirement.

The top reason why nurses have considered leaving the patient care field for non-retirement reasons is to have a job that is less stressful and less physically demanding. 81% say that morale is fair or poor and only 18% say it is excellent or good. Most nurses say that, if they were younger and just starting out, they would pursue a different career rather than become a registered nurse.

When current nurses are asked to rate the seriousness of selected problems that they face on the job, issues relating to staffing levels continually top the chart. They cite inadequate staffing levels to handle the number of patients during a shift, inadequate staffing levels to handle the level of acute care required by most patients, and not having enough time to spend with patients as the three biggest problems in nursing.

The two most-often cited improvements that nurses would like to see are increased staffing levels and higher salaries. Three in four potential leavers say that they would consider continuing in patient care for longer if conditions at their job improved.

The Senate Health, Education, Labor, and Pensions Committee held hearings on the subject of the nursing shortage in the United States, and asked witnesses to discuss the source and possible solutions to the problem. Witnesses talked about the problems created when nurses work 12 and 16 hour shifts because there is no one available to relieve them. This burns them out, and leads to unnecessary medical errors and oversights. The committee was told that one third of nurses report that patients under their care received delayed medications or treatments at least once a week due to staffing shortages, and that 90% of nurses say they have witnessed a serious medical error. They said some nurses are leaving the profession because they don't feel good about the quality of care they can provide under these conditions.