1. Nelson, Roxanne BSN, RN


Report offers suggestions for correcting system's ills.


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"The current medical workforce model is under great pressure and, in many cases, is broken," says a report by the Health Research Institute at PricewaterhouseCoopers analyzing current and future health care staffing. Entitled What Works: Healing the Healthcare Staffing Shortage, the report summarizes the major challenges of and possible solutions to staffing shortages at health care facilities. Among the challenges are the following:


* Many facilities now routinely use registry nurses instead of hiring staff nurses.


* Turnover among staff nurses is high-and expensive. A 1% increase in the turnover rate "costs an average hospital about $300,000 annually."


* Hospital executives "are in a state of denial about nurse dissatisfaction," believing that nurses in general are dissatisfied with their working conditions but that those in their employ are not. And many consider filling vacancies to be of a lower priority than reimbursement and regulatory issues.


* Nursing schools are rejecting applicants in record numbers because of a lack of faculty. And the scarcity of federal subsidies for nursing programs-as opposed to physician education-means that nursing schools tend to operate at a loss, making administrators reluctant to expand programs and increase faculty salaries.



The report is shining a much-needed light on workforce topics, said Jeannette Lancaster, president of the American Association of Colleges of Nursing. "It's insufficient to keep producing students if we haven't figured out how to keep them in the workplace," she said.


Hospitals employ about 60% of nurses, a percentage that has steadily declined. The proliferation of ambulatory-care centers and disease-management companies is important in contributing to the 7% to 10% vacancy rate in hospitals. Almost half of all nurses today don't provide direct patient care. Many who complete nursing programs don't pursue a career in nursing, and half of new nurses who enter the hospital workforce leave their first job after two years.

Figure. California n... - Click to enlarge in new windowFigure. California nurses took to the streets October 10 in a protest against 15 hospitals in the Sutter Health system, in what may be the largest strike by nurses to date. A new report says that many hospital executives underestimate RNs' job dissatisfaction.

The report's recommendations for ameliorating the shortage of nurses (and physicians) include developing public-private partnerships for the rapid education of nurses, using technologies such as patient simulators in education and training, and requiring nurses to be competent in information technology to promote the use of electronic medical records and enhance continuity of care.


"Technology that helps the providers, not just the administrators, is crucial to more efficient and reliable care," said Linda R. Cronenwett, dean and professor at the University of North Carolina at Chapel Hill School of Nursing. "We desperately need technology to reduce, not increase, the time spent on administrative duties. We also need to stop switching technology every time a cheaper product emerges." She cited the "enormous" costs of training and the potential for error when training is insufficient.


Nurses' satisfaction is deemed vital as well, with hospitals being urged to be flexible with nurses' schedules and especially their roles.


Roxanne Nelson, BSN, RN