The problem of the nursing shortage in the United States is primarily connected with three factors: permanent poor health care workforce planning, ineffective system of payments, and disadvantageous geographic distribution of nurses. According to MacLean, Hassmiller, Shaffer, Rohrbaugh, Collier, and Fairman (2014), in 2008 almost 50,000 applicants to nursing programs were denied because of the insufficient number of classrooms and clinical sites for practice (p. 448). The system of payments favors the sphere of acute care, and that is why dentists and neurosurgeons outnumber primary care physicians and nurse practitioners. The majority of nurses are trained and employed in urban areas, predominantly in private institutions, while rural areas experience the lack of professional nurse practitioners.
The organization of interprofessional care teams and development of task shifting system may serve as possible solutions to the problem of nursing shortage (MacLean et al., 2014). The system of task shifting may serve as a temporary measure to provide the population with qualified professionals in the nursing sphere that were trained as physicians until the country solves the problem of nursing shortage. The creation of interprofessional teams as groups of medical specialists that share their goals and knowledge are closely connected with task shifting because these teams create a professional medium that facilitates the process of retraining. Of course, the suggested solutions are not the only possible ones and do not present a comprehensive strategy for nurse problem solving; the complex changes in the U.S. legislation are also required to solve the problem of nursing shortage in the country.
Background of the Problem
The nursing shortage started in the late 1990s when management costs increased, and many public and private healthcare institutions reduced the number of registered nursing personnel (Huston, 2013). Soon the system of medical care realized the strategic mistake when the majority of institutions started to experience the lack of nurses. Since that moment, there has been a constant struggle to change the situation by improving the image of nurses, developing the recruitment and retention policies, increasing salaries, and employing the foreign medical workforce.
Political Setting and Structures Involved
At a state level, the problem may be solved if Congress passes the appropriate laws and acts that will concentrate on increasing funds for nurse training and reducing nurse-to-patient ratios (Petigara & Anderson, 2007). Hospitals, in their turn, should approach the problem not only with short-term solutions such as employment of foreign workforce, temporary staff, and the increase of salaries but also implement a long-term approach that will focus on the reconstruction of the workflow. Moreover, non-governmental and charity organizations may contribute to this reconstruction, funding specific programs such as Retaining Experienced Nurses Program.
The analysis of the involved stakeholders shows that the number of patients realizing the problem of nursing shortage increase, and, together with nurses, they approve possible legislative decisions concerning the improvement of the professional workflow of health care institutions as well as the approaches that hospitals use and the help that non-governmental and charity organizations provide. Hospitals, in their turn, are supportive of legislation; however, they do not approve unfunded nurse-to-patient ratios (Petigara & Anderson, 2007). State organizations and administration support an extensive number of attempts and approaches to solving the problem of nursing shortage.
Nursing shortage problem solving implies the thorough assessment of values that is different on the levels of government and healthcare institutions. Nursing professionals appreciate various social and health programs, but their needs are not limited to these values. They also demand to increase the nursing research and education funding. Governments, however, along with nursing demands, have a range of values that concern different spheres, and health care is simply one of them. Thus, they should decide which values are more important and will be beneficial not only for nurses but for the population.
Resources and Power Base
Among the resources that are needed for the implementation of appropriate policy for nursing shortage solving there are money, time, ideas, and people. Before passing the legislation, its designers should estimate all possible costs for its implementation. Time and ideas are needed for the development of programs and projects, and human resources are required at all levels of the problem-solving process: starting with nurses themselves and all stakeholders that are involved. Analysis of power base is crucial for the understanding of all possible leverages that may prompt the improvement of the situation. Thus, Mason, Leavitt, and Chaffee (2013) claim that the power base consists of coercive, reward, legitimate, expert, referent, information, connection powers and empowerment as a form of shared power.
Plan of Action
Political analysis of the nursing shortage shows that the plan of action should be based on the opinion that all qualitative and effective changes occur gradually. That is why pilot approach would be the most beneficial in solving of nursing shortage problem (Mason et al., 2013). The plan of action presupposes the collection and analysis of all data that will help to see the problem from different angles and will provide its deeper understanding. Then it should focus on three main aspects: recruitment, retention, and collaboration (Huston, 2013). The organizations should create a positive image of nurses, recruit students from high school into nursing training, and provide them with financial support. For professionals that are already work in the nursing sphere, a state should increase salaries and reconstruct the workflow, creating a positive working environment with rewards for research and teaching activities. Educational, healthcare, and state institutions should cooperate in order to solve the problem of nursing shortage.
Huston, C. J. (2013). Professional issues in nursing: Challenges and opportunities. Philadelphia, PA: Lippincott Williams & Wilkins.
MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014). Scale, causes, and implications of the primary care nursing shortage. Annual review of public health, 35(1), 443-457.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2013). Policy and politics in nursing and healthcare-revised reprint. Amsterdam, Netherlands: Elsevier Health Sciences.
Petigara, T., & Anderson G. (2007). The Nursing Shortage in the United States. Health Policy Monitor. Web.