Don’t be fooled

De­mo­graph­ics en­sure nurs­ing short­age will re­turn with bet­ter econ­omy

Modern Healthcare - - Opinions Commentary - Karen Cox, Su­san Lacey and Rand O’Don­nell

As the re­ces­sion started to ac­cel­er­ate, reg­is­tered nurses who had eyed re­tire­ment found them­selves fac­ing an un­sure fu­ture. Spouses and part­ners lost jobs, and the value of nest eggs plum­meted, caus­ing many to post­pone their planned re­tire­ments. This has cre­ated a false sense of se­cu­rity in the nurs­ing work­force, specif­i­cally as it re­lates to lower turnover and in­creased re­ten­tion. Nurses con­tinue to be wary as the econ­omy slowly edges to­ward re­cov­ery, al­beit so far a job­less re­bound. This amal­ga­ma­tion of events has many in health­care lead­er­ship claim­ing the nurs­ing short­age is of­fi­cially over.

Not so fast. This pat­tern of nurses work­ing past re­tire­ment can­not be sus­tained, and here are the num­bers:

In an ar­ti­cle in the Jour­nal of Nurs­ing Ad­min­is­tra­tion, it was stated that 33% of RNs are 50 years old and over—the baby boomers.

The Amer­i­can As­so­ci­a­tion of Crit­i­cal-Care Nurses re­ports that half of RNs in­di­cate their de­sire to re­tire within 15 to 20 years.

The pipe­line for new nurses con­tin­ues to be clogged by an ag­ing nurse fac­ulty that also is poised to re­tire, ac­cord­ing to the AACN. The av­er­age age of nurs­ing fac­ulty with mas­ter’s and doc­tor­ates is roughly 60 and 56 years old re­spec­tively. AACN also found that nearly 55,000 qual­i­fied ap­pli­cants were not ac­cepted into schools of nurs­ing due to short­ages of fac­ulty, ad­e­quate clin­i­cal sites and other re­sources.

In his book The Age Curve, Ken­neth Gron­bach wrote that, com­pared to the baby boomers who are leav­ing the work­force, there are 9 mil­lion fewer Gen­er­a­tion Xers, those born be­tween 1965 and 1984. That rep­re­sents an 11% de­crease in po­ten­tial nurs­ing school ap­pli­cants.

In nurs­ing, the short­fall has been es­ti­mated by the Bureau of Health Pro­fes­sions to be close to 1 mil­lion. This num­ber was cal­cu­lated be­fore pas­sage of health­care re­form. We have now en­tered the un­charted wa­ters of re­form with a tsunami of an­tic­i­pated newly in­sured pa­tients now hav­ing ac­cess to health­care goods and ser­vices at the pre­cise time when these re­tire­ments will start to ac­cel­er­ate. Let’s look at the de­mand num­bers to com­plete the sup­ply-de­mand pic­ture.

In the book The Fu­ture of the

What works to­day will be­come ob­so­lete with new so­cial, eco­nomic and po­lit­i­cal de­vel­op­ments

Nurs­ing Work­force in the United States, Peter Buer­haus and col­leagues re­port that the num­ber of peo­ple over age 65 is es­ti­mated to in­crease by 127% be­tween 2000 and 2050. By 2030, it is es­ti­mated that 71 mil­lion Amer­i­cans (1 in 5) will be over the age of 65. Ac­cord­ing to the In­sti­tute of Medicine’s The Fu­ture of Nurs­ing, the pas­sage of health­care re­form will bring in an ad­di­tional 32 mil­lion peo­ple as newly in­sured.

Be­tween 2000 and 2020, the Health Re­sources and Ser­vices Ad­min­is­tra­tion projects a 73% growth in the de­mand for RNs em­ployed in nurs­ing homes and a 91% growth in home health. Be­tween 2000 and 2020, HRSA also projects a 40% growth in the de­mand for RNs em­ployed in hos­pi­tals and in nurs­ing ed­u­ca­tion. To meet the de­mand for RNs, HRSA of­fi­cials es­ti­mate the U.S. must grad­u­ate 90% more nurses from nurs­ing pro­grams.

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion es­ti­mates that as many as 1 in 3 Amer­i­cans may be di­a­betic by the year 2050, with di­a­betes be­ing one of the high­est life­time us­ages of health­care re­sources of all di­ag­noses.

So, what is a pru­dent hos­pi­tal leader to do? You cer­tainly can­not hire un­less po­si­tions are open. You can tinker with nurse-to-pa­tient ra­tios, but there are qual­ity and pa­tient sat­is­fac­tion is­sues as­so­ci­ated with those strate­gies. How­ever, the vi­sion­ary leader will un­der­stand this de­vel­op­ing per­fect storm and plan ac­cord­ingly. The win­ners in the Nurs­ing Short­age, Part 2, will im­ple­ment the fol­low­ing strate­gies:

■ Im­prove the work en­vi­ron­ment for nurses, us­ing Mag­net prin­ci­ples for which a strong busi­ness case has been made.

■ Em­ploy knowl­edge trans­fer work­shops that al­low RNs near­ing re­tire­ment to share ex­per­tise be­fore this ma­jor brain drain oc­curs in your or­ga­ni­za­tion.

■ Im­ple­ment phased re­tire­ment for older RNs as a way to keep them in the work­force longer.

■ Work with older em­ploy­ees to trans­fer within the or­ga­ni­za­tion, yet away from the phys­i­cal de­mands of di­rect pa­tient care, al­low­ing them to use their ex­ten­sive clin­i­cal ex­per­tise.

■ View nurses as val­ued pro­fes­sion­als, not com­modi­ties, with the req­ui­site in­put into clin­i­cal man­age­ment and de­ci­sion-mak­ing.

■ Uti­lize the IOM’s rec­om­men­da­tions on nurs­ing, par­tic­u­larly rec­om­men­da­tion No. 2, which calls on or­ga­ni­za­tions to “ex­pand op­por­tu­ni­ties for nurses to lead and dif­fuse col­lab­o­ra­tive im­prove­ment ef­forts.”

There is no sil­ver bul­let. In fact, as the work­force land­scape emerges, the best or­ga­ni­za­tions will re­main nim­ble in terms of their plan­ning. What works in to­day’s mar­ket will be­come ob­so­lete given a new set of so­cial, eco­nomic and po­lit­i­cal de­vel­op­ments. But, to be sure—the nurs­ing short­age will be back. It is not a mat­ter of if; it is a mat­ter of when.

From left, Karen Cox is ex­ec­u­tive vice pres­i­dent and chief op­er­at­ing of­fi­cer at Chil­dren’s Mercy Hos­pi­tal and Clin­ics, Kansas City, Mo. Su­san Lacey is its di­rec­tor of nurs­ing work­force and sys­tems anal­y­sis. Rand O’Don­nell is the pres­i­dent and CEO of the hos­pi­tal.

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