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Nursing Shortages and Patient Care Outcomes
Pepper Losely
James Madison University
Professor Janelle Garman
November 15, 2020
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Abstract
This paper discusses the issues with the current nursing shortage. It covers the factors that precipitate
how the nursing shortage has occurred as well as recommendations on ways to improve nurse staffing
for the future. Patient care outcomes are greatly affected by nursing shortages due to time constraints
vs. responsibility that nurses have on a daily basis.
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Nursing Shortages and Patient Care Outcomes
The changes in healthcare such as Affordable Care Act, experienced nurses reaching retiring age,
increased need for nursing care, limited continuing education and other healthcare policy changes have
created a nursing shortage. These shortages have had effects on patient care, healthcare outcomes and
patient satisfaction. There are several outlined recommendations to help curve the current nursing
shortage if hospitals and other care facilities could implement them. Unfortunately, with the current
staffing shortage of Registered Nurses, the expected patient care outcomes and quality care of patients
are at risk.
Background
Some background on what is causing the nursing shortage is of no shortage of its own. There are
many factors that are causing such a blow to the national workforce of nursing. Some of the conspiring
factors affect the nursing population, some affect the patient population, and some affect the
institution. One of the major downfalls is the age of the retiring population. In the article by Galehouse
(2019) there is a reference of about twenty five percent of the nations nursing workforce being within
ten years of retiring.(Galehouse, 2019). When these nurses retire there will be no one to take their
place unless the education of new nurses increases. But that experience and critical thinking skill will still
be greatly missed at the bedside. Another larger problem is the amount of the population that is
approaching the need for nursing care. Because of the baby boomers dense increase to population
coming to the age of needing nursing care more and more the nursing community is going to take a
large hit. There are not enough nurses to cover the population that will soon be needing us. Blouin and
Pojasek (2019) bring up a standard issue in their article about nurse satisfaction. When nurses are not
feeling adequately heard the move away from beside nursing only contributing to the staffing issues.
(Blouin & Pojasek, 2019). Another issue is continuing education. Blouin and Pojasek (2019) state,
“According to the American Association of College of Nursing (AACN), 64,067 qualified nursing
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applicants were denied admission to baccalaureate and graduate nursing programs. This was attributed
to insufficient faculty, clinical sties, workspace, preceptors, and budget limitations” (Blouin & Pojasek,
2019, pg. 223). But there is another side to education that is also leaving a dent on the nursing shortage.
Nurses who are continuing their education have learned they can make more money as a nurse
practitioner than as a bedside nurse. This is causing a deficit in bedside nursing which is where the
greatest demand is. (Gatehouse, 2019). Not only is the nursing shortage affecting hospitalized patients,
but nursing home and long term care patients are being affected to. Friedrich (2017) states, “Nursing
homes on the other hand, saw a striking 13% rise in mortality among those aged 85 and older”
(Friedrich, 2017). Nurse staffing is taking a large hit everywhere in the U.S. and all over the world. Many
nurses are leaving the beside because the environment is too stressful. Nursing is an emotional job that
takes higher than average strength to continue in. Haddad, Annamaraju, and Toney-Butler (2020) write
about the workplace violence that nurses are subject to in the form of emotional and physical abuse.
Haddad, Annamaraju, and Toney-Butler (2020) state, “Health care workers are at high risk of violence in
all parts of the world with between 8% and 38% suffering some form of violence int their career”
(Haddad, ANnamaraju & Toney-Butler, 2020).
Student perspective
My perspective on the nursing shortage is that patient care is taking a major hit because of lack
of time and ability to correctly care for patient needs. Nurses don’t have the necessary time to handle
the number of tasks that they are presented with throughout their shifts and this causes them to
become overwhelmed and burdened with the amount of responsibility. The increase in patient to nurse
ratio causes many issues like nurse burnout, quick turnover, and ineffective patient care. Blouin and
Pojasek (2019) comment, “The current nursing turnover rate is 14.6%,...” (Blouin & Pojasek, 2019, pg.
223). Nurses are not adequately supported with patient care assistants or techs to help deliver some of
the care tasks that patients may need could be delegated to these aids. This infringes upon time that
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could be better used by the nurse to have conversations with their patients while developing the nurse-
patient relationship that is so important in patient care and attempt to help educate the patients with
better health options. With the average nurse patient ratio of five to six patients, in the hospital that I
work in, to one nurse that means that a nurse really only have about ten minutes to spend in each
patient’s room per hour. For complex patients ten minutes is not enough. Many care activities are
missed do to overload on nurses’ responsibilities (Blouin &Pojasek, 2019)
Recommendation
In the article by Galehouse (2019), there is mention of several ways to combat the nursing
shortage. Nursing schools are accepting students more often than one time a year. There are some
schools who are accepting students to begin the program up to three times a year. This creates a steady
flow of graduating nurses. Many hospitals are creating a relationship for new nurses by having a
residency program. This allows new nurses to be with more experienced nurses and help them to bridge
the gap for bedside nursing. There is also along with the residency program a sign on bonus at some
hospitals. Once you stay for an extended length of time you are given this bonus. There are other things
hospital can do to help combat the shortage. They could offer different scheduling for upcoming retiring
nurses like shorter shifts or give them preceptor positions where they are giving new grads great nursing
information and guidance. Another idea that is presented is working with high schools to offer the basic
nursing classes and allow those to transition over to nursing programs and get more young people
interested in nursing. The stability and the pay for some could greatly affect how their family is living
and possibly pull them out of poverty. (Galehouse, 2019).
The Joint Commission (n.d.) writes about how workplace violence can be combated. There is a
new effort by hospitals to create a “zero-tolerance” environment. This policy helps to work against
medical professionals that are choosing to lash out at nursing staff when they are questioned or paged
to clarify specific orders. In the Joint Commission’s booklet (n.d.) they describe ways to create a culture
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of retention including minimizing paperwork, only using the mandatory overtime for extreme situations,
increase diversity of nursing workforce, using more ergonomic technology for patient care, and
increasing compensation to a fair wage as well as better benefits for nursing staff. With these efforts
retaining nurses could prove easier. (Joint Commission, n.d.).
Legal Standards
In California there is a staffing mandate that was passed back in 1999. This mandate gave
regulations to implement minimum staffing for different areas of nursing. Kaiser Permanente suggested
the ratio be stricter in med surge locations. Many hospitals under this mandate have pushed back
because of the cost of supplying the nurses to satisfy the mandates order. (Joint Commission, n.d.) In
the paper by Wong (2020) the reference of Title 42 of the COde of Federal Regulations 42CFR 482.23 (b).
This code is a mandate for hospitals to supply adequate numbers of nursing staff to sufficiently care for
all patient needs. (Wong, 2020).
Conclusion
Due to the increasing demand for nursing tasks on a daily basis these factors will not change
unless something else does. The environment for patient care is reaching an unsafe level for nurses. The
options to help combat the shortage are all things that are going to take many years and need to be put
in place sooner than later. Patient care is declining due to shortage of staff and this can in turn cause an
environment that is not welcoming to new nurses and in turn create nurse turnover and cause more
shortage. This is a cyclical process that with the right education and staffing by hospitals could end.
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Reference:
Blouin, A., & Podjasek, K. (2019) The continuing saga of nurse staffing: Historical and emerging
challenges. 49. (4). 221-227. Wolters Kluwer Health, Inc. https://cookcountyhealth.org/wp-
content/uploads/SP-discussion-Nursing-article-3-04-16-19.pdf
Friedrich, B. & Hackmann, M. (2017) What happens to patient care when there are not enough nurses?.
Kellogg Insight. Kellogg School of Management at Northwestern University.
https://insight.kellogg.northwestern.edu/article/what-happens-to-patient-care-when-there-are-
not-enough-nurses
Galehouse, M. (2019) What’s behind the nursing shortage? How can we fix it?. TMC News. Texas
Medical Center. https://www.tmc.edu/news/2019/08/whats-behind-the-nursing-shortage-how-
can-we-fix-it/
Haddad, L., Annamaraju, P., & Toney-Butler, T. (2020) Nursing shortage. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK493175/
Joint Commission of Accreditation of Healthcare Organizations. (n.d.) Health Care at the Crossroads:
Strategies for Addressing the Evolving Nursing Crisis [Booklet]. Joint Commission.
https://www.jointcommission.org/-/media/deprecated-unorganized/imported-
assets/tjc/system-folders/topics-library/health_care_at_the_crossroadspdf.pdf?
db=web&hash=262C8CFD6F7CAFE1B083A6E77CB52D6B
Wong, J. (2020) State nursing staffing laws related to hospital acquired infections (HAIs). EScholarship,
UCLA. https://escholarship.org/uc/item/26m0s00c
