January 1, 2011 | Health System Risk Management


The nursing shortage is a healthcare issue that just will not go away, and there is no indication that relief is coming anytime soon. Nursing shortages have been studied for decades, and some past observations are still applicable today. For example, during a shortage in England in the 1940s, nurses left training programs due to long workdays and schedules, poor compensation, and a lack of respect (West et al.); these complaints are echoed by today’s nurses (Line). Despite the prevalence of the problem of understaffing, solutions evade governments, healthcare corporations, and nursing organizations—though this inability to solve the shortage is not for lack of trying.

From 2004 to 2008, the registered nurse (RN) workforce increased by about 5% to just over 3 million workers, with 85% of these RNs working in the nursing field. The percentage of RNs working full-time rose to about 63% in 2008 from approximately 58% in 2004—the first increase since 1996. Also in 2008, the percentage of hospital-based nurses increased for the first time since 1984 (from about 56% in 2004 to about 62%). (HRSA “The registered nurse population: findings”) While it is promising that the number of RNs increased between 2004 and 2008, whether the increase is enough to stave off worst-case scenario shortages in the future has yet to be seen. (HRSA “The registered nurse population: initial”)

The shortage has been broadcast publicly through stories in the popular media, which can cause patients to worry whether caregivers will be available when needed. Experts predict that there will be a shortfall of as many as one million RNs by 2018, with half of the deficit stemming from workers leaving the profession (Lacey and Wright). Some areas of the United States have been hit harder by the shortage than others. In 2005, some states were able to balance their supply and demand, while others, such as Texas, needed as many as 28,000 nurses (HRSA “What”).

The shortages faced today have their roots in the early 1990s, when the future financial security of acute healthcare services looked uncertain. External pressures from medical cost inflation and budget cuts threatened the efforts of hospitals and nursing homes to maintain economic viability. Under pressure for cost containment, healthcare organizations sought to downsize, redesign, and reengineer the delivery of patient care services. The reduction in inpatient hospital stays, increases in patient acuity, and a switch to outpatient services resulted in changes in the healthcare workforce. (Peterson)

This Risk Analysis will examine the risks associated with understaffing, how healthcare facilities...

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