The nursing shortage: dynamics and solutions. A research perspective

The nursing shortage continues to be described as a crisis. Attempts to delineate the nature and scope of the problem and its impact on all aspects of health care from the individual human to the organizational and societal levels have been direct and comprehensive. A growing body of facts and perceptions has led to some specific recommendations for action. The potential for elaborating and explicating a base of scientific knowledge is powerful. The view expressed in this article is that a body of knowledge that can guide action to remedy the shortage problem requires directing knowledge development to serve the purposes of nursing and its constituents, clarifying and creating conceptual and theoretic perspectives, and giving attention to critical methodologic analysis of the current and emerging research programs in this domain. Knowledge directions will be guided by the goals and aims of nursing. Conceptual and theoretic perspectives derived from the phenomena of concern and congruent with knowledge development directions will provide a base for organizing and interpreting the growing body of facts. Finally, the understanding of research as modes of engagement will supply a means to analyze critically the methodologic approaches and the consequences of knowledge development in the domain of the nursing shortage inquiry.     

The nursing shortage: dynamics and solutions. The art of creative solutions

The development and implementation of creative alternatives to minimize the overall effect of the nursing shortage is a national concern. This article examines the concept of creativity and suggests methods to generate creative ideas and solutions to this problem.     

The nursing shortage: dynamics and solutions. Positioning for success

Positioning involves creating a positive image in the minds of those "buying" the products or services offered by an individual or an organization. Any organization can position itself for success. Utilizing the strengths inherent within the organization and acting on the opportunities readily presented in the environment, an organization can rapidly achieve the goals and objectives it chooses. The major deterrent to success frequently lies within the organization itself. As the organization continually focuses on areas that need improvement, it is unable simultaneously to focus on and positively position its strengths. Within the organization, such a phenomenon often leads to staff dissatisfaction, organizational dysfunction, and failure to meet goals and objectives. Through the strategic use of positioning, old images can be strengthened or changed, new images can be created, and the organization's many "publics" can be positively and significantly influenced. Successful organizations are those that have mastered the art of positioning and view it as an essential part of their everyday life.     

The nursing shortage: dynamics and solutions. A response from an educational perspective

The dynamics underlying the current shortage of nurses are complex and embedded in a historical heritage of relative deprivation in terms of status, decision making, and resource allocation. Within this context the work of nurses has been largely invisible and lightly regarded. Challenging the status quo and proactively striving to create opportunities that empower nurses for greater risk taking, flexibility, and tolerance for differences will enhance nursing. Nursing education has a unique responsibility to provide socialization experiences that promote collegiality and self-confidence. Educational opportunities need to be planned to attract potential students who are currently underrepresented in nursing. The future of nursing is unlimited in its potential for nurses themselves and the people for whom we care, provided the professional maturity that supports full collegial partnership in the delivery of health care is achieved.     

The nursing shortage: dynamics and solutions. Reflections on a recurring theme

The passage of individual state nurse practice acts in the 1900s sharpened and focused attention on the practice and function of professional nurses. However, this had little effect on increasing the demand for nurses. In the 1930s student nurses were in ample supply. They staffed units in hospitals, and seniors served as charge or head nurses. It was World War II when one finally began to see the theme of nursing shortage emerge with a vengeance. The demand far exceeded the supply, creating a severe imbalance. The intervening next 4 decades brought forth many excellent models to minimize the shortage. Even the federal government contributed to the nursing shortage by offering opportunities for better-educated practitioners, teachers, and supervisors. Thus, as the nurse became better prepared, the demand for services increased. Several milestone studies are referenced during the 1970s and 1980s that attempted to balance the nursing shortage equation. The US objectives for the year 2000 provide specific guidelines as to what demands will be placed upon the nurse practitioner and educator. Can we meet those demands? Yes--with the full utilization of information technology to prepare the student and nurse practitioner to take advantage of this enormous information explosion. Will the nursing shortage continue to be a recurring theme? Yes! As nurses become better educated and ready for practice and patient-client problem solving, and as they provide strong voices in health policy formulation, the demands for their services will continue to far exceed the supply.     

The nursing shortage: dynamics and solutions. Solutions in a pluralistic environment

America's education and health care environments have been intensely pluralistic since the founding of the republic. Monolithic national solutions to health problems therefore do not occur in the United States, unlike most European countries. As a result, America does not have a national health policy. The current cycle of the shortage of nurses is also complicated by deep differences of opinion among nurses, physicians, and hospitals regarding the origin of, and therefore the solution to, the problem. Despite this, I predict that by the characteristic American version of "muddling through" in health policy, the nursing shortage will be "solved," or at least resolved, by 1993.     

The nursing shortage: dynamics and solutions. A new decade of leadership. From vision to reality

New leadership must move our health delivery system from one that is too costly and declining in quality to one that is less bureaucratic and less procedurally and hierarchically dominant. Changing demographics, with increasing needs of the elderly, disabled, and chronically ill, will require a delivery system focused on the community. Emerging models of leadership will require more collaboration and coalitions, more cooperation and shared resources, and creative incentives for highly motivated self-management at decentralized levels.     

The nursing shortage and specialty practice

This paper has reviewed numerous factors contributing to the nursing shortage. These factors include changes in medical practice and the patient population, professional beliefs and objectives, and economic factors. Although many articles reviewed focus on the reasons for and solutions to the shortage, few note specifics regarding how the shortage may or may not impact on the quality of patient care. The impact of the shortage on specialty areas of nursing practice and specifically the area of peripheral vascular nursing was also reviewed. Although no recommendations were made for alleviating the shortage, recommendations for the preparation of the specialty nurse were discussed. The author agrees with Hoeffer and Murphy who state that the future of specialization is at the masters degree level. Also important is that the various nursing groups support professional credentialing and certification as a means of regulating specialty practice. Only through cooperation will nursing "specialization" be consistent in its definition as well as be recognized by nursing, other health care providers and the public as a meaningful credential.     

The nursing shortage: dynamics and solutions. The three R's: recruitment, restructuring the environment, and reformulating the curriculum

The current and future nursing shortage calls for cooperative efforts by nursing professional organizations, nursing schools, and health care providers. These efforts must be geared toward an all-out recruitment effort aimed at teenagers and workers in non-health care fields, a restructuring of the nursing workplace, and a reformulation of nursing curricula.     

The nursing shortage: solutions for the short and long term

With predictions that this nursing shortage will be more severe and have a longer duration than has been previously experienced, traditional strategies implemented by employers will have limited success. The aging nursing workforce, low unemployment, and the global nature of this shortage compound the usual factors that contribute to nursing shortages. For sustained change and assurance of an adequate supply of nurses, solutions must be developed in several areas: education, healthcare deliver systems, policy and regulations, and image. This shortage is not solely nursing's issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media. This paper poses several ideas of solutions, some already underway in the United States, as a catalyst for readers to initiate local programs.     

A partnership model to address the nursing shortage. The KSU accelerated BSN Program

Metropolitan Atlanta and northwest Georgia, like other regions of the United States, face a critical shortage of nurses. To address this shortage, the Kennesaw State University (KSU) School of Nursing (SON) has developed and implemented a partnership model to offer second-degree students an accelerated BSN Program. The KSU model builds on a competitive statewide initiative that targets funds to educational and corporate collaborations as well as a growing number of nursing school non-nurse applicants who hold other baccalaureate degrees. To offer the accelerated BSN Program, the KSU nursing faculty developed an accelerated curriculum model that allows completion in 16 months. Further, a six member, collaborative partnership has been constructed to allow this curriculum to be offered to 40 second-degree students both on the KSU campus and as an outreach program in rural northwest Georgia. This article describes the accelerated BSN curriculum model as well as the partnerships constructed to implement and fund the program.     

以临床实践为基础的护理科研管理模式探讨

目的:探讨以临床实践为基础的护理科研管理模式,建立完善的护理科研管理制度以及搭建良好的护理科研交流平台的方法。方法:比较建立以临床实践为基础的护理科研管理模式前后各5年内获得的科研成果数量。结果:2005-2009年度与2000-2004年度比较,科研成果数量明显增加。结论:建立以临床实践为基础的护理科研管理模式有助于科研工作的开展,提高护理科研水平。     

Collaborative management. A nursing practice model

The authors discuss an innovative, collaborative management model intended to promote optimal patient care, personal and professional nurse satisfaction, and cost-effectiveness. The model delineates the role components of the nurse manager, the clinical nurse specialist, and the clinical nurse. Although the model is applied to a high-risk antenatal unit, staff members and managers can easily adapt the model to any unit.     

An innovative model of supportive clinical teaching and learning for undergraduate nursing students: the cluster model

Students look forward to their clinical practicum to learn within the context of reality nursing. As educators we need to actively develop models of clinical practicum whereby students are supported to engage and learn in the clinical learning environment. The aim of this paper is to describe an innovative model of supportive clinical teaching and learning for undergraduate nursing students as implemented in a large teaching hospital in New South Wales, Australia. The model of supportive clinical teaching and learning situates eight students at a time, across a shift, on one ward, with an experienced registered nurse from the ward specialty, who is employed as the clinical teacher to support nursing students during their one to two week block practicum. Results from written evaluation statements inform the discussion component of the paper for a model that has proved to be successful in this large healthcare facility.