Page 158 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch10_131-156.qxd 11/6/09 5:59 PM Page 145
chapter 10 | Quality and Safety 145 CikguOnline
6. Single-Payer/National Health Coverage. demand from employers, and the new graduate
A single-payer system aims to decrease the cost pipeline for RNs.
of care by eliminating third-party insurers,
costly overhead, and bureaucracy while provid- ■ Supply of existing RNs. The total supply of
ing coverage for all. Plans may offer choices to U.S. RNs is estimated at 2.9 million and is pro-
consumers regarding providers, hospitals, and jected to remain the same though 2020. The
specialty services, and physicians and hospitals supply of active RNs, including those who are
are paid through negotiates, fee-for-service, or licensed, working, or seeking employment as an
salary. Costs are controlled through budgeting, RN, is projected be 2.1–2.3 million from 2000
bulk purchasing, and negotiation (Physicians to 2020 (U.S. Department of Health and
for a National Health Plan, 2008). Human Services [HRSA], 2006).
■ New graduate supply pipeline. Nursing program
Proponents of a single-payer system cite lower costs graduation and NCLEX-RN pass rates affect
per capita while ensuring access to care for all supply. The American Association of Colleges of
Americans. Opponents cite that the possible trade- Nursing (AACN) reported an increase in bac-
off for decreased cost and improved access leads to calaureate level–entry enrollments, up by 5.4% in
increased mortality, poorer outcomes of care, limited 2006 (AACN, 2008). According to the National
to no-cost savings, and loss of control by consumers Council of State Boards of Nursing (2008), first-
(National Center for Policy Analysis, 2008). time candidates for nursing licensure in 2007
The intended effects of regulation and competi- numbered 200,209, with a pass rate of 69.4%.
tion are to decrease cost. Despite the variety of However, HRSA (2006) projected that U.S.
attempts over the years to drive down costs, they nursing programs must graduate 90% more nurs-
continue to go up, imposing a heavy burden on es to meet the U.S. demands for nurses (p. 2).
consumers or employers (Center for Studying ■ Demand from employers. The Bureau of Labor
Health System Change, 2008). However, improved Statistics predicts the RN job to be among the
quality and safety prevent unnecessary deaths and top 10 in growth rate (U.S. Department of
errors that contribute to the high cost of care Labor, 2008). Total job openings for RNs will
(IOM, 2000; IOM 2003a). The U.S. government, exceed 1.1.million, including new job growth
consumers, providers, and organizations have a and replacement of retiring nurses.
vested interest in controlling health-care expendi-
tures and in preventing waste while maintaining In a survey of over 5000 community hospitals, the
quality care. American Hospital Association (2007) reported
116,000 RN vacancies as of December 2006. The
Nursing Labor Market effects of these vacancies contribute to decreased
employee and patient satisfaction and increased hiring
RNs comprise 77% of the nurse workforce, and of foreign-educated nurses. The majority of urban
almost 60% of RNs are employed by hospitals.The hospital emergency departments reported capacity
nationwide unemployment rate for RNs is only 1%. issues and spend time on by-pass or diversion due to
Vacancy rates nationwide are reported at anywhere a lack of properly staffed critical care beds.
from 13% to 20% and are rising. A serious nursing In 2002 more than 100,000 new RNs were
shortage is here, and it will continue until at least hired; the majority were foreign-born nurses and
2020. The demand for nurses is expected to nurses over age 50 returning to the workforce in
increase even more dramatically as the baby tough economic times. Although the new hires and
boomers reach their 60s, 70s, and beyond. From a sharp increase in RN salaries are positive, the cur-
now until 2030, the population age 65 years and rent nursing shortage is far from over.
older will double.
Factors Contributing to the Nursing Shortage
Defining and Identifying the Nursing Shortage
Many complex factors have led to and continue to
The nursing shortage is defined simply as a supply- contribute to the current critical nursing shortage:
demand issue. Unfortunately, the current nursing
shortage is more complex and severe than previous ■ High acuity, increasing age of patients in
shortages in terms of the available supply, the hospitals. Medically complex patients require