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Shortages of registered nurses have taken place repeatedly in the past. Agencies have examined the reasons for the decline in the supply of nurses. There seems to be a cycle of nursing shortages in the United States. “Economist argue that the shortages are related to the lack of increase wages, an imperfectly competitive market, geographic distribution problems, or the delay between salary increases and the ability to afford the education needed to enter the job market,”(ACHE, 2013). Other resources site the nursing shortage on the aging nurse population or the “baby boomers” leaving the workforce. The decrease individuals attending the nursing programs due to not enough professors to teach are causing a reduction in the number of graduate nurses. This paper will discuss two economist tools used to understand the nursing shortage. The two tools are supply and demand and marginal analysis. How the nursing shortage can affect the economy will also be discussed. Supply and Demand
Nursing shortages are a predictable occurrence in healthcare. In the United States alone, five significant shortages have happened in the last 50 years (Censullo, 2008).The lack of nurses lasts 1 to 2 years. It is predicted the by the year 2016 nearly 587,000new jobs will be on available for new nurses (Aiken, Cheung, & Olds, 2009); the United States Bureau of Labor and Statistics have determined there will be a shortage of 581,520 nurses by the year 2018 (Conley, 2012). The decrease in the number of new graduate nurses from colleges and universities have put a strain on the supply needed to meet the needs of an aging population. Graduate nurses are met with high expectations from employers. The transition from graduate nurse to staff nurse can be challenging. Quality care and high performance standards are required of the new nurses.
Accountability is required in the work arena as the acuity of the patients is high. Patient satisfaction, complying with the National Patient Safety Goals, and never events as well as extensive documentation can be difficult for the nurse transitioning into a new role. The holidays, weekends and various shifts to meet the demand of the already short nursing workforce cause some graduate nurses to leave the profession thus decreasing the nursing supply. Universities and colleges are not able to meet the growing demands of providing nursing education and clinical rotations in the associate or baccalaureate programs (Erlen, 2004). In 2008 more than 40,000 potential nurses were turned away from universities or colleges for registered nurses (Aiken, et al., 2009).
The inability to access these programs were due to the lack of nursing instructors for the classroom and for the practical instruction in the clinical areas. Individuals feel the shortage is related to decreased job satisfaction and wages. What this establishes is the lack of supply or qualified instructors available for meeting the growing demands for nurses. The lack of educational instructors causes a decrease in the number of nursing students accepted. The decrease in the students in the qualified programs causes a drop in the number of nurses in the market for the vacant or new jobs. The decline in nursing instructors is due to the educational requirements of the instructor such as the baccalaureate (BSN) and masters (MSN) in nursing.
The low wages and the educational requirements to teach nurses keeps many from becoming instructors (Yucha, Carolyn; Smyer, Tish; Strano-Perry, Sybil, 2014). According to research and statistics the demand for registered nurses will continue to grow. The supply of nurses will increase when the universities and colleges provide the nursing instructors to meet the demands of the students. Nursing schools need to find a means to provide competitive salaries in order to reduce the nursing shortage. Marginal Analysis
As stated, the second economic tool to discuss is marginal analysis as it relates to the nursing shortage and health care facilities. When using cost or revenue as a measure of supply and demand, the difference between the cost/revenue and supply and demand is the marginal analysis (Getzen,2007). In the healthcare field, the marginal analysis can be the cost of the nursing staff as compared to the revenue generated from the inpatient admission. When a nursing shortage occurs and there are not enough nurses to staff the department, patients may have to be transferred to another facility. When the transfer occurs, the hospital loses revenue.
To understand the concept better let’s imagine a patient has come to the emergency department and the emergency department doctor determines the patient requires an admission. Before the admission can occur, a decision has to be made to determine the availability of necessary equipment, appropriateness of the admission as well as the adequacy and skills of nursing staff. If the critical decision is made the resources are available the patient will be admitted. If the determination reflects the lack of appropriate supplies, nurses or skills then the decision to transfer the patient will be declared. Once the patient is transferred to another facility, revenue is lost.
When a trend or increased in the volume of transfers is higher than a determined rate for the facility measures need to be put into place to be able to accept the admissions. With the nursing shortage, the hospitals senior management team must determine ways to restructure staffing within the hospital to meet the demands of the admissions. The team may also choose to hire RN’s on an as needed basis. The marginal analysis will assist in determining the cost of staff and revenue, it will show when it is cost effective to hire more nurses or to implement the restructuring of staff or the hiring of nursing staff. Conclusion
With the projection of nearly 587,000 new jobs by 2016, there will continue to be a demand for nurses (Aiken, et al, 2009). The affordable care act may elicit an increase in patients entering the healthcare arena for the first time in years. The supply for nurses or nursing instructors is not an overnight fix to the issue. Increasing the wages for the instructors at the universities and colleges may retain professors however the requirements to teach are bachelors and masters prepared nurses. With the increase in the instructors to teach nursing more nurses can return to obtain a higher level of education and an increase in graduate nurses may emerge helping decrease the nursing shortage? Short staffed health care facilities may not have to transfer patients to other facilities increasing revenue and making it cost effective to hire more nursing staff.
Censullo, J. (2008). The nursing shortage: Breach of ideology as an unexplored cause. Advances in Nursing Science, 31(4), E11-E18. Retrieved from http://search.proquest.com. Conley, B. (2012). What Does “Shortage” Really Mean? Tennessee Nurse, 75(1), 5. Retrieved
Erlen, J. A. (2004). Wanted-nurses: Ethical issues and the nursing shortage. Orthopedic Nursing, 23(4), 289-92. Retrieved from http://search.proquest.com/docview/195969568. Getzen, T. E. (2007). Health economics and financing. (3rd ed.). John Wiley and Sons, Inc.: Hoboken, NJ. Yucha, Carolyn; Smyer, Tish; Strano-Perry, Sybil (2014). Sustaining nursing programs in the
face of budget cuts and faculty shortages. Journal of Professional Nursing, 30 (1) 5–9.