Is the Shortage of Hospital Registered Nurses Getting Better or Worse? Findings from Two Recent National Surveys of RNs

Peter I. Buerhaus; Karen Donelan; Beth T. Ulrich; Linda Norman; Robert Dittus

Disclosures

Nurs Econ. 2005;23(2):61-71,96. 

In This Article

Results

RNs were asked about their perceptions of the supply of RNs working in patient care in the communities in which they practice. In both surveys, most RNs working in direct patient care positions in acute care facilities reported that the supply of RNs was less than demand. In the 2004 survey, however, RNs perceived a decrease in the size of the imbalance between supply and demand. As shown in Figure 1, 29% of RNs in 2004 compared to 43% in 2002 perceived that supply is much less than demand. In addition, more RNs in 2004 (55%) than in 2002 (44%) perceived that the supply of RNs was somewhat less or equal to demand.

Supply and Demand in their Practice Community, Perceptions of Registered Nurses Working in Direct Care Positions in Hospitals, 2002 and 2004

To assess the seriousness of the shortage, the most recent survey included a new question asking RNs if, during the past year in the hospital where they worked, there had been a shortage of RNs. In 2004, 23% observed the shortage was very serious, 64% a somewhat serious shortage, and only 13% of RNs perceived there had been no shortage in the past year.

RNs in both surveys were asked about their views concerning the main reasons for the nursing shortage. As shown in Table 2 , in some areas the perceptions of RNs changed significantly in 2004 compared to their views 2 years earlier. For example, the percent of RNs who identified salary and benefits as a main reason for the shortage dropped from 58% in 2002 to 41% in 2004. Similarly, in 2004 fewer RNs (32%) than in 2002 (44%) perceived more career opportunities for women, undesirable hours (27% vs. 38%), and a negative work environment (15% vs. 29%) as main reasons for the nursing shortage. In addition, the 2004 survey contained new responses for RNs to consider as main reasons for the shortage: a little more than one-quarter agreed that nursing is not seen as a rewarding career, 17% perceived nursing is not a respected career, and 11% perceived faculty shortages as a main reason for the shortage (see Table 2 ).

Most RNs continue to perceive the shortage as a major problem affecting nurses. Figure 2 shows the majority of RNs in both surveys perceived the shortage as a major problem for the early detection of patient complications, maintaining patient safety and, to a lesser degree, the time for collaboration with teams. Even stronger majorities (above 75%) of RNs in both surveys perceived the shortage as a major problem for the quality of their own work life, quality of patient care, and for the amount of time to spend with patients (see Figure 2).

Problems Associated with the Nursing Shortage, Perceptions of Registered Nurses Working in Direct Care Positions in Hospitals, 2002 and 2004

RNs have observed other problems associated with the shortage. In the most recent survey, RNs were asked if, in the past year, they perceived the nursing shortage had resulted in problems for hospitals and physicians (see Table 3 ). A clear majority perceived the nursing shortage had resulted in delayed responses to pages or calls, increased staff communication problems, increased patient complaints about nursing, reduced number of hospital beds, increased patient wait time for surgery or tests, and delayed discharges from the hospital. A little more than half felt that the shortage had increased the workload on physicians, and 43% perceived the shortage had resulted in hospitals discontinuing or closing patient care programs.

To respond to the shortage of RNs, hospitals have initiated various strategies to recruit and retain nurses. In the 2004 survey, RNs were asked whether they had observed any of seven different recruitment and eight different retention strategies and, if they had observed a strategy, to indicate whether it was effective or ineffective. As shown in Table 4 , although most of the strategies were perceived as effective by at least half of the RNs who had observed them, the strategies were not widely observed. Specifically, among recruitment efforts, providing tuition benefits was the most frequently observed strategy and also was perceived as effective by a large portion (72%) of RNs. Although observed by fewer RNs, recruitment efforts such as offering signing bonuses, increased advertising, sponsoring career fairs or community outreach programs, providing flexible work schedules, and increasing salaries were generally perceived by the majority of RNs as effective. The least frequently observed recruitment effort, outreach to foreign nurse graduates, was perceived by 65% of RNs as an ineffective approach to recruiting nurses (see Table 4 ).

Compared to recruitment strategies, efforts to improve retention (the bottom of half of Table 4 ) were generally less widely observed by RNs. Only one retention initiative was observed by more than half of RNs, mentoring programs for recent new graduates, a strategy that also was perceived as effective by three-quarters of nurses. A majority also perceived continuing education as effective, but less than half of RNs (47%) reported they had observed this strategy. Efforts by hospitals to improve retention by reimbursing for conference fees, improving work performance assessment, and offering nurse recognition events were observed by roughly one-third of RNs; offering career development programs and financial incentives for quality im provement were observed by even fewer RNs. However, these strategies were perceived as effective by roughly half of the RNs who had observed them. The least frequently observed strategy, offering online scheduling bidding, was observed by only 12% of RNs but was perceived as an ineffective approach to recruiting nurses by a considerable majority (77%) of RNs.

In addition to recruitment and retention efforts, hospitals have tried various approaches to increase nurse staffing, including the use of overtime. In both surveys, RNs were asked whether the amount of overtime had increased, decreased, or remained the same during the past year. Data in Figure 3 show that hospitals relied on overtime less in 2004 than in 2002. Specifically, the percent of RNs who perceived that overtime had increased dropped noticeably in 2004. In addition, more RNs in 2004 than in 2002 perceived overtime had remained the same or decreased. Because RNs can feel pressured to work overtime hours, questions about the type of overtime worked were included in both surveys. Figure 4 shows that from 2002 to 2004 more RNs perceived the amount of "strictly voluntary overtime" had increased, "voluntary but feels like it is mandatory" overtime decreased, and that "required" overtime also had decreased (see Figures 3 & 4).

Amount of Overtime, Perceptions of Registered Nurses Working in Direct Care Positions in Hospitals, 2002 and 2004

Type of Overtime Worked, Perceptions of Registered Nurses Working in Direct Care Positions in Hospitals, 2002 and 2004

RNs were asked to indicate their agreement with strategies to help solve the nursing shortage (see Table 5 ). Improving the work environment, increasing salaries and benefits, and raising the status of nurses in the hospital were the strategies agreed to most often by RNs in both 2002 and 2004. Better hours, financial aide, increased capacity to educate more RNs, and using support staff also received support from roughly one-third of RNs in both surveys (see Table 5 ).

When asked about their employment plans for the future, more RNs in 2004 than in 2002 indicated they had no plans for leaving their nursing position (see Figure 5). Similarly, fewer RNs in 2004 reported they planned to leave their nursing position within the next 3 years. Of those planning to leave their present position, better staffing and higher salaries and benefits were the two most frequently identified changes that would cause RNs to reconsider their plans (see Figure 6). Next came more respect from management, administration, and front-line management, followed by more flexible schedules. Having more autonomy ranked last as a change that would cause RNs who were planning to leave their nursing position to reconsider their plans.

Plans to Leave their Nursing Position, Registered Nurses Working in Direct Care Positions in Hospitals, 2002 and 2004

Changes that Would Cause Registered Nurses Working in Direct Care Positions in Hospitals to Reconsider their Plans to Leave their Present Nursing Position, 2002 and 2004

When RNs in the 2004 survey were asked about what they expect the current nursing shortage will lead to in the future, results shown in Table 6 indicate that RNs do not hold positive expectations. Virtually all (98%) perceive the shortage will increase stress on nurses, and more than nine in ten (93%) believe that quality of care will be lower and that nurses will leave nursing for other jobs. Eight in ten (81%) perceive that other staff will perform some nursing patient care activities, and less than half (48%) believe their pay will rise in the future. Only one-fifth (22%) perceive that working conditions will improve or that respect for nurses will increase (20%) (see Table 6 ).

Finally, when asked who is responsible for solving the nursing shortage, nearly all RNs (93%) agree that hospitals are the responsible party (60% strongly agree, 33% agree somewhat). Eight in ten RNs either strongly or somewhat agree that the federal government (78%) and nursing professions (77%) (namely, the American Nurses Association, American Organization of Nurse Executives, American Association of Colleges of Nurses) are responsible for solving the nursing shortage. Nearly two-thirds (63%) either strongly or somewhat agree that the medical profession is responsible. More RNs hold a neutral opinion (33%) toward private industry though 57% either strongly or somewhat agree that it is responsible for solving the shortage.

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