The nursing shortage: a worldwide problem

A worldwide shortage of nurses has been acknowledged by the multidisciplinary Global Advisory Group of the World Health Organization. The shortage is caused by an increased demand for nurses, while fewer people are choosing nursing as a profession and the current nurses worldwide are aging. The shortage applies to nurses in practice as well as the nurse faculty who teach students. The inter-country recruitment and migration of nurses from developing countries to developed countries exacerbates the problem. Although public opinion polls identifies the nurse as the person who makes the health care system work for them, the conditions of the work environment in which the nurse functions is unsatisfactory and must change. Numerous studies have shown the positive effects on the nurse of a healthy work environment and the positive relationships between nursing care and patient outcomes. It is important that government officials, insurance companies, and administrators and leaders of health care systems acknowledge and operationalize the value of nurses to the health care system in order to establish and maintain the integrity and viability of that system.     

Nurses' reports on hospital care in five countries

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.     

Inpatient nursing case management as a strategy for rural hospitals: a case study.

Increasingly, hospitals are facing the dual challenges of cost containment and a nursing shortage. These challenges are especially problematic for rural hospitals where nursing staff must be recruited and quality standards maintained within the financial limitations of lower DRG reimbursement rates when compared with urban centers. Therefore, it has become necessary for rural administrators to find new approaches to maximizing the utilization of available nursing staff. Experts have proposed that one solution to the nursing shortage is redesigning the work of RNs to more fully utilize the knowledge and skill of nurses. Nursing case management--a system in which the registered nurse (RN) assesses patient needs, develops a plan of care, procures and coordinates needed resources, and provides ongoing evaluation of care--is one strategy for redesigning nursing roles which offers potential financial benefits to hospitals. Through daily coordination and evaluation of patient care activities, nursing case managers can ensure cost effective allocation of organizational resources and facilitate early discharge planning. This article includes a case study of a rural hospital that introduced the nursing case management system, the hospital's steps of planning and implementation, and examples of forms associated with the system.     

医院护理人力资源配置模式探索与实践

医院在编护士的补充受编制等诸多因素限制,在编护士配置数量不足,护理人力资源缺编问题突出.为保证护理工作正常运转,提供优质护理服务,编外骋用护理人员成为多数医院缓解护理人力资源配置不足的有效方式.本文主要对医院多元化护理人力资源配置模式、存在的问题及管理进行探讨.     

Nurse residency program: an effective tool for recruitment and retention

In the present health care climate, the critical nursing shortage is detrimentally affecting staffing ratios in hospitals throughout the State of California. The purpose of this newly developed nurse residency program is to have a positive affect on recruitment and retention of new graduate nurses. By providing the opportunity for nursing residents to gain "real world" experience in an acute care setting, this program supports the student nurses in their development as confident and competent practitioners. The result of this program will be manifested in increasing numbers of new graduate nurses remaining with the facilities that have residency programs. The program also leads to increased self-confidence, increased competence, and greater professional socialization, which will thereby, lead to increased quality of patient care, increased job satisfaction, decreased turnover rates, and decreased hospital costs for recruitment and retention.     

What knowledge-accessing modes tell administrators about interdisciplinary crises and conflicts.

In hospitals administrators work with two major groups of medical professionals: physicians and nurses. Together, these three groups of professionals are primarily responsible for the care of patients. The quality of the service they provide is dependent on the working relationships among these disciplines. Potentially, the more harmony among administrators, physicians, and nurses, the better care patients can receive. The research reported in this article addresses the issue of interdisciplinary misunderstanding among these groups of professionals. The research was premised on the assumption that hospital administrators, physicians, and nurses differ in the way they access knowledge. That is, administrators, physicians, and nurses access knowledge in dissimilar ways and, by doing so, set the stage for crises and conflicts. Using a standardized instrument to assess knowledge-accessing modes, data were collected from samples of health administration, medical, and nursing students. The data indicated that the three groups did differ in the way they accessed knowledge. The individual discipline profiles generated from the data also revealed a finding common to the three disciplines, a finding may help resolve a very real problem for hospital patients. Based on the research results, the article discusses ways that administrators may be able to prevent crises and conflicts and enhance harmonious relations among the three disciplines, and thereby improve patient care. Avenues for further research are also suggested.     

Factors related to nurse retention and turnover: an updated study

How to attract and retain hospital registered nurses (RNs) has become a recurring theme discussed by hospital boards, administrators and physicians in the U.S. This study seeks to provide current data on this situation. The exploratory research effort consisted of 13 depth interviews with physicians in a major metropolitan area in the southeastern U.S. and less formal discussions with six hospital nurse administrators. The formal research effort involved hand-delivering questionnaires to nurse administrators for distribution to nurses in six hospitals in the same region. The principle reasons nurses change jobs fall into four categories: salary or benefits, convenience, work schedule, and job-related stress. After one or more hospital moves the nurses become more satisfied. Hospital administrators should institute motivational and hospital commitment programs to improve retention/reduce turnover, e.g., work schedule rotation, work responsibility rotation, team approaches to health care and award/recognition programs.     

Nurturing the nurturers

The nurse-retention problem plagues hospitals nationwide, but nowhere is the crisis more evident than in rural areas, where, if nothing is done, more hospitals likely will join the growing numbers that have simply closed. Researchers designed a study to identify effective strategies for managers and administrators to pursue in retaining nurses in rural hospitals. They asked nurses to rate 43 strategies according to the degree of influence each would have on the decision to remain on the job. "Winning" strategies fit into four major categories: (1) self- and professional development, (2) monetary needs, including benefits, (3) internal management, and (4) staffing and scheduling. Among the study's suggestions are these: Managers should increase opportunities for upward mobility to alleviate some of the nurses' frustrations at feeling trapped in one position. If a higher educational level is a prerequisite for upward mobility, hospital managers should simplify the process of obtaining that education. Rural nurses clearly do not believe they are being compensated enough for their efforts. Hospitals must respond accordingly if they intend to maintain an adequate nursing staff. Nurses want to know that when conflicts or disruptions arise, they will have a simple, direct means of resolution. Hospitals should manage conflict through communication and training and support at all primary care levels. Because nurses provide the majority of client care, they must have a more active, participative role in staffing and scheduling policies.     

Minnesota nurses' study: perceptions of violence and the work environment

Work-related violence is an important problem worldwide, and nurses are at increased risk. This study identified rates of violence against nurses in Minnesota, USA, and their perceptions of the work environment. A sample of 6,300 randomly selected nurses described their experience with work-related violence in the previous year. Differences in perceptions of the work environment and work culture were assessed, based on a nested case-control study, comparing nurses who experienced assault to non-assaulted nurses. Annual rates of physical and non-physical assault, per 100 nurses, were 13.2 (95% CI: 12.2-14.3), and 38.8 (95% CI: 37.4-40.4). Cases were more likely than controls to report: higher levels of work stress; that assault was an expected part of the job; witnessing all types of patient-perpetrated violence in the previous month; and taking corrective measures against work-related assault. Controls versus cases were more likely to perceive higher levels of morale, respect and trust among personnel, and that administrators took action against assault. Nurses frequently experienced work-related violence, and perceptions of the work environment differed between nurses who had experienced physical assault, and those who had not. Employee safety, morale, and retention are particularly important in light of the nursing shortage, and knowledge of nurses' perceptions will assist in tailoring interventions aimed at reducing the substantial risk of physical assault in health care settings.     

Factors Related to Nurse Retention and Turnover

Abstract

How to attract and retain hospital registered nurses (RNs) has become a recurring theme discussed by hospital boards, administrators and physicians in the U.S. This study seeks to provide current data on this situation. The exploratory research effort consisted of 13 depth interviews with physicians in a major metropolitan area in the southeastern U.S. and less formal discussions with six hospital nurse administrators. The formal research effort involved hand-delivering questionnaires to nurse administrators for distribution to nurses in six hospitals in the same region. The principle reasons nurses change jobs fall into four categories: salary or benefits, convenience, work schedule, and job-related stress. After one or more hospital moves the nurses become more satisfied. Hospital administrators should institute motivational and hospital commitment programs to improve retention/reduce turnover, e.g., work schedule rotation, work responsibility rotation, team approaches to health care and award/recognition programs.     

Transitional planning calls for new thinking, approach

The true challenge for hospital administrators in the future will be to rethink and retool the structure of their institutions. What must they do to accommodate the hospital in a rapidly changing health care field? The author suggests a transitional planning model that will be more than an interim step. It will be the final step in a long line of planning processes.     

Scheduling nursing personnel on a microcomputer

Suggests that with the shortage of nursing personnel, hospital administrators have to pay more attention to the needs of nurses to retain and recruit them. Also asserts that improving nurses' schedules is one of the most economic ways for the hospital administration to create a better working environment for nurses. Develops an algorithm for scheduling nursing personnel. Contrary to the current hospital approach, which schedules nurses on a person-by-person basis, the proposed algorithm constructs schedules on a day-by-day basis. The algorithm has inherent flexibility in handling a variety of possible constraints and goals, similar to other non-cyclical approaches. But, unlike most other non-cyclical approaches, it can also generate a quality schedule in a short time on a microcomputer. The algorithm was coded in C language and run on a microcomputer. The developed software is currently implemented at a leading hospital in Taiwan. The response to the initial implementation is quite promising.     

Retaining nurses through conflict resolution. Training staff to confront problems and communicate openly can improve the work climate

The way nurses resolve conflict may be leading them to quit their jobs or leave the profession altogether. Conflict is inevitable in a dynamic organization. What is important is not to avoid conflict but to seek its resolution in a constructive manner. Organizational conflict is typically resolved through one of five strategies: withdrawal, force, conciliation, compromise, or confrontation. A recent study of nurses in three different hospitals showed that the approach they use most is withdrawal. This might manifest itself in a request to change shifts or assignments and may lead to a job change and, eventually, abandonment of the field altogether. Given this scenario, changing nurses' conflict resolution style may help administrators combat the nursing shortage. Healthcare organizations must examine themselves to determine why nurses so frequently use withdrawal; then they must restructure work relationships as needed. Next, organizations need to increase nurses' awareness of the problem and train them to use a resolution style more conducive to building stable relationships: confrontation. Staff should also be trained in effective communications skills to develop trust and openness in their relationships.     

某医院门诊护理人员工作压力调查分析

目的：了解某医院门诊护士的主要工作压力源,以便采取相应的对策,帮助护士减轻工作压力。方法：采用整群抽样和问卷调查的方法对198名门诊护士工作压力水平及压力源进行调查。结果：工作量大、工作时间不规律、待遇低等是护士工作的主要压力源。结论：护理管理者应关心护士工作和生活,减少压力源。     

Occupational health nursing education for the 21st century

Occupational health nurses are the largest group of occupational health professionals, and are critical to the delivery of quality health care services to the nation's work force. Educational preparation of occupational health nurses has advanced in recent years, and the need for occupational health nurses with advanced degrees is expected to increase. Occupational health nurses use licensure, continuing education, certification, supervisor and peer assessment of job performance, formal education, and practice to maintain their professional competence and protect the public's health. New strategies must be developed to prepare nurses to promote a safe and healthful work force. Funding for programs to prepare occupational health nurses will be essential for meeting this demand. Continuing education programs for occupational health nurses must be developed that demonstrate effectiveness in developing occupational health nurses' skills while minimizing their time away from the workplace.     

The effects of hospital downsizing on staffing and quality of care

Hospital managers are making aggressive changes in their caregiver staffs to meet challenges such as reductions in utilization and capitated care. Managers are doing this to decrease the cost of care while maintaining or improving quality of care. However, the literature addressing the impact of hospital staffing practices on quality of care indicates that these changes may negatively influence quality. Department administrators must be cautious, yet proactive in their approach to patient care restructuring in order to ensure continued quality as well as cost-effectiveness.     

Improving the distribution of health care services by understanding nurse job choice decisions

The application of multi-attribute choice models in the field of nursing provides a method for health care administrators to use in coping with the high level of turnover and nurse shortage. By segmenting respondents via multi-attribute model importance characteristics, the problems of reducing turnover and attracting nurses can be approached with greater efficiency and effectiveness. This study found that the use of multi-attribute models for predicting employment, and for segmenting and nurses' attitudes toward hospital employment, can be applied in a meaningful and usable fashion.     

Staff nurse views of their productivity and nonproductivity

Could better collaboration and cooperation to improve productivity occur between administrators and nurses if we understood nurse views of their productivity? Interviews of 30 staff nurses revealed that these nurses evaluated their productivity by the quantity and quality of their work. Working hard, finishing everything, and providing excellent care made them feel productive, while anything that interfered with this was a source of feeling nonproductive.     

Balancing service and education: ethical management of student-run clinics

At medical schools across the United States, students operate free clinics that have the potential to provide health benefits to patients while furnishing unique educational opportunities for students. While they provide the energy necessary to make these clinics successful, students must, due to their inexperience, collaborate with faculty, clinic preceptors, community members and medical school administrators to ensure that their clinics attain high standards in health care and education. Medical school faculty and clinic preceptors must make certain that appropriate health care is provided and that desirable educational messages regarding physician professionalism and altruism are conveyed effectively. As faculty availability in such clinics is limited, it is important that the pursuit of educational goals not compromise clinics' patient care. By valuing faculty time dedicated to this work and actively supporting clinic organizers' applications for external funding, medical school administrators can facilitate high quality care and education at student-run clinics.     

Supplemental nursing agencies--a tool for combating the nursing shortage

Supplemental nursing agencies can help administrators combat the nursing shortage. By filling seasonal increases in demand with supplemental nurses, administrators can effectively staff units, ensure continuity of care and decrease total labor costs. Use of supplemental nurses also reduces the workload of regular staff nurses and spares supervisors from having to recruit employees for vacant slots.