Hard Facts About Nurse Shortages

The Commonwealth Fund has set straight many of the misunderstandings about the national nurse shortage in a new report proposing ways to solve the problem. Doing away with some of the myths should facilitate appropriate action.

Behind the shortage are paradoxes. The need for nurses in hospitals has increased even as the number of hospital patients has declined, although a record number of nurses are now working in hospitals. Most nurses are working as nurses, not moving to other jobs or sitting on the sidelines. That is particularly noteworthy in Los Angeles, where only 15% of the licensed nurses are not working, the lowest percentage for any of the six national metropolitan areas included in the study. At the same time, 30% of the nation’s working nurses are in jobs outside hospitals.

There is no question about the shortage. About 15% of the nation’s nursing positions are unfilled; the figure is 15.4% in Los Angeles, according to the study. This already has had an impact on the quality of care, necessitating understaffing in some areas, forcing deferral of admissions and closing beds temporarily, the report confirmed.

The critical problem for hospitals is adapting to the remarkable change that has taken place in patient services since 1980. While there are fewer hospital patients, with a major shift to out-patient surgery, the patients coming into hospitals are sicker than ever before. This is a factor in part of the aging population, and also of the availability of complex surgical procedures only recently developed. People in marginal health are being kept alive longer. As a result, more of the hospital patients now require intensive care. “Between 1980 and 1987, while the nation was closing about 30,000 short-term, general hospital beds, it was converting nearly 20,000 such beds to intensive care,” according to the new study. Now 10% of all beds are in intensive care units, and they require 40% of the nurses in hospitals because of the special needs of these patients. The supply of nurses has been further complicated by the leveling off of enrollments in nurse training, with some signs of a net decline.

The Commonwealth Fund researchers have concluded that the situation will be improved only through reform at every level, including reorganization of hospital staffs to make better use of the nurses, plus generous scholarship programs to encourage more to train as nurses and to take graduate training. Community colleges, one of the largest sources of nurse education, must play a major role in meeting future needs if the situation is to improve.

Among the reforms that hospitals need to undertake is greater flexibility in staff assignments and greater compensation. Some hospitals have ignored the fact that the nursing work force is not, as some imagine, made up primarily of newly trained single women working temporarily until they are married. The nursing work force today consists predominantly of middle-class married women in their 30s and 40s, most with school-age children at home, according to the study. An increasing number of nurses complete their training only when they are in their 30s. To recruit and keep them, hospitals must adapt working conditions to their special circumstances. And they must find ways to attract more men into nursing positions.

The two-year study was the work of Marc Roberts, a professor of political economy and health policy at Harvard; Ann Minnick, director of nursing services research at Rush Presbyterian St. Luke’s Medical Center in Chicago; Eli Ginzberg, emeritus professor of economics at Columbia University, and Constance Curran, a nurse and health care consultant. The Commonwealth Fund is based in New York City, specializing in health and education. The foundation supported the project through a grant to the Hospital Research and Educational Trust of the American Hospital Assn.