Health Care Policies and Economics

This paper explores the causes of the nursing shortage, interventions in a nursing shortage environment, and the impact of role legislation on the trends of the nursing shortage.

Running Head: HEALTH CARE POLICIES AND ECONOMICS 1
Health Care Policies and Economics
Student’s Name
Institutional Affiliations

HEALTH CARE POLICIES AND ECONOMICS 2
Health Care Policies and Economics
Introduction
The healthcare discipline heavily relies on nursing – a section that makes up the largest
part of the discipline. The World Health Organization’s statistical report showed that there were
more than 2.9 million nurses around the world. The report noted that the United States alone was
responsible for more than 3.9 million nurses out of the total worldwide number (Andrew
Scanlon, Denise Hibbert, Freda DeKeyser Ganz PhD, Linda East PhD & Debbie Fraser, 2014).
There has been a prospective expectation of an increase of nurses with the increase of need for
their services. The American Nurses Association prospectively posited that more job
opportunities are likely to increase for the registered nurses through 2022 than other professions.
The shortages that have been experienced have been taken as a possible indicator of the growth
of job opportunities in the discipline. This paper seeks to explore the causes of the nursing
shortage, the interventions that a nurse would take while working in a nursing shortage
environment, and the impact of role legislation on the trends of the nursing shortage.
Factors that Lead Nursing Shortage
The nursing shortage has been impacted by multiple factors. The stunted growth of the
nursing school enrolments could be tightly linked to the shortage of nursing. The rate at which
the population grows is not relatively associated with the rate at which nursing school enrolls
students. According to a report by Williams (2018), there was a 3.7% increase in enrollment in
the school of nursing. The increase is drastically low and is not sufficient to meet the demand for
nursing services.

HEALTH CARE POLICIES AND ECONOMICS 3
There is a significant shortage of facilities in the nursing school faculty which leads to
restrictions in the enrolment of nursing students. A report by Meyers, Mor & Rahman (2018),
posited that the 2018-2019 enrollment of nursing students in the US turned away more than
70,000 applicants that were qualified for nursing programs. This was attributed to the shortage of
clinical sites, clinical receptors, and classroom space as well as the constraints in budgeting. 75%
of the nursing schools that responded to the survey articulated their shortage of faculty as the
main reason for failing to enroll qualified students into their programs.
Most registered nursing practitioners are of an old age that is nearing retirement. A
survey conducted by the National Council of Nursing showed that 50.9%r of the registered
nursing workforce was of 50 years and more (Spector, 2015). This projection shows that more
than one million nurses will retire in the next ten years which would lead to a hiring shortage
regarding the low intake.
There are major changes in the demographics with a higher number estimating the
growth of the aging population. The United States Census Bureau issued a report on the older
population in the US estimating that the US will have more than 83.7 million citizens aged over
65 (Snavely, 2016). This estimation was almost double of the population of aged people in the
2012 report that was 43.1 million. A bulging number of older adults increase the need for
geriatric care – including care for individuals with comorbidities and chronic diseases.
There is an increased level of nurses leaving the profession due to stress and lack of
satisfaction that is caused by insufficient staffing. A study by Sutcliffe, Paine & Pronovost
(2017), recorded that better outcomes in acute care hospitals were associated with the availability
of more nurses at the bedside. The reduction of nursing skills by addition of assistive personnel

HEALTH CARE POLICIES AND ECONOMICS 4
that lacks the professional nursing qualification contributes to the levels of preventable deaths,
eroded quality of care given, and a higher contribution of the shortage of nurses. The report also
posited that the RN workforce believed that a shortage of nurses reduced the quality of their care
for the patients and the general time that the nurses could spend with their patients. 98% of the
interviewed nurses conquered with the hypothesis that the shortage of nurses increased stress on
nurses. 93% of the nurses explained that critical levels of stress caused by a shortage of nursing
could make them quit their profession.
Efforts of Addressing Nursing Shortage
Multiple initiatives would be implemented by states to address the shortage of nursing
educators and Registered Nurses. Some of these initiatives would include offering grants and
educational support for the students who are willing to pursue nursing either as nursing
practitioners or as nursing educators. The University of Wisconsin implemented such an
intervention in 2014 which offered $ 3.2 million during the Nurses for Wisconsin initiative
(Rosseter, 2014). This project was launched as an intervention to curb the projected nursing
shortage in Wisconsin that was estimated at 20,000 nurses by 2035.
Expanding the student capacity in nursing schools would be a vital step to manage the
nursing shortage. Nursing schools can strategically form partnerships and seek private support to
help in the expansion of student capacity. Such interventions have been implemented by
universities such as the University of Minnesota which partnered with Minnesota VA Health
Care System in 2013 to increase the capacity of student enrolment in the BSN programs (King,
Roberts & Bowers, 2013). With the focus on the enhancement of care for veterans, the
Minnesota VA committed more than $5.3 million to the University in the expansion of the

HEALTH CARE POLICIES AND ECONOMICS 5
clinical placement sites, funding of additional faculties, and supporting the inter-professional
engagement.
Capacity building is the centerfold of addressing the nursing shortage. The expansion of
the NursingCAS announced by AACN in 2010 was a fundamental step in ensuring the inclusion
of nursing programs at the graduate level. Launching of the NursingCAS ensured an improved
intake of nursing students into the faculties to fill up the vacant chances of the schools of
nursing. Notably, there was an identification of more than 49,000 vacant positions in 2018 in the
field of baccalaureate and graduate nursing programs (Busch & Bliss, 2018). Other organizations
like the Robert Wood Johnson Foundation (RWJF) have implemented private campaigns
promoting the education of nurses.
Role of a Nurse in a Nursing Shortage Crisis
The nursing shortage is a problem that hinders the delivery of care to the patients.
However, nurses working in a nursing shortage environment have to critically device ways to
ensure delivery of the utmost care to the patients. The task of the nurses could include additional
interventions as the means to improve their resilience against the nursing shortage crisis.
Working as a nurse in a nursing shortage crisis would offer an important chance to learn
as well as develop team working and leadership skills. A nursing shortage crisis would create a
scenario where nurses would be required to work at the minimum staffing ratios possible. This
would create constricted schedules for nurses who would be required to deliver optimum care to
patients. Working under these conditions would require my collaboration and passionate
dedication to my career.

HEALTH CARE POLICIES AND ECONOMICS 6
Working as a healthcare employee amid a nursing shortage crisis would be critical. The roles of
this position would require a safe staffing strategy to ensure compliance with the law and
adherence with the patient needs. Flexible nursing schedules would improve service delivery in
the acute care units where several nurses would be slightly higher than the minimum stipulated
ratios to ensure better results. The units with stable patients could be staffed with an averagely
lower number of nurses.
Role of Legislature in contributing to safe staffing during a shortage
Having effective staffing is vital in preventing nursing shortage which results in better
patient care. The legislators have been aiming at implementing better staffing legislation. In the
state of Columbia, there was legislation requiring the hospitals to maintain a minimum nurse
staffing number (Ross, Rogers & King, 2019). Other safe staffing initiatives have been
implemented in multiple states. There has been legislative advocacy of hospitals to maintain the
minimum staffing ratios around the country to prevent escalation of the problem into a crisis.
Safe staffing has been on the menu of most legislative discussions. The federal legislation
has tried to pass legislation regarding safe staffing in acute care settings. The federal bills filed in
2004 eliminated mandatory overtimes and floating Registered Nurses (White, 2006). The bills
created units that required nurses to publicly report to their daily unit staffing levels, protect the
whistleblowers of the nurses, and linked safe staffing ratios to the federal reimbursement.
However, the American Nurses’ Association (ANA) made strong opposition to the legislations
positing that it was fundamental to have nurse-driven staffing. The implementation of nurse-
driven staffing factored the qualification of the nurses, patient acuity, technological demands,
and other personnel.

HEALTH CARE POLICIES AND ECONOMICS 7
Two bills were filed in the state of Massachusetts to offer divergent strategies which
addressed RN staffing and addressing patient safety. These bills acknowledged the presence of a
nursing shortage and posed two ideologies regarding the causes of the nursing shortage and the
possible solutions. The Massachusetts Nursing Association supported the bill that acknowledged
that having inadequate nurse staffing lead to nurse burnout and increased the ratios of inferior
patient outcomes (Buerhaus, Donelan, Ulrich, Norman, DesRoches & Dittus, 2007). The state of
Massachusetts implemented the minimum nurse staffing ratios (MSRs) in units of acute care – an
intervention that has improved nurse retention in the state and patient outcomes. The Senate has
also supported the reflection on the ideology that MSRs is a representation of inflexible policies.
The Senate has since focused on the development of strategies that would improve recruitment
and retention of nurses in the US.
The legislature should implement other interventions to ensure a clear strategy that will
improve the levels of nurse enrollment and retentions. Higher wages is an intervention that can
have a significant improvement in the nursing shortage crisis. Embracing diversity by increasing
the number of minorities enrolling for nursing would address increase the supply of nursing
expertise. The government should also consider improving the rate at which foreign nurses are
hired in the country.

HEALTH CARE POLICIES AND ECONOMICS 8
References
Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N., Linda
East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting
advanced nursing practice worldwide. Online journal of issues in nursing, 19(2), 1.
Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., DesRoches, C., & Dittus, R. (2007).
Impact of the nurse shortage on hospital patient care: Comparative perspectives. Health
affairs, 26(3), 853-862.
Busch, J., & Bliss, V. (2018, November). Why build custom categorizers using Boolean queries
instead of machine learning? Robert Wood Johnson foundation case study. In
International Conference on Dublin Core and Metadata Applications (pp. 51-55).
King, B. J., Roberts, T. J., & Bowers, B. J. (2013). Nursing student attitudes toward and
preferences for working with older adults. Gerontology & Geriatrics Education, 34(3),
272-291.
Meyers, D. J., Mor, V., & Rahman, M. (2018). Medicare Advantage enrollees more likely to
enter lower-quality nursing homes compared to fee-for-service enrollees. Health Affairs,
37(1), 78-85.
Ross, C., Rogers, C., & King, C. (2019). Safety culture and an invisible nursing workload.
Collegian, 26(1), 1-7.
Rosseter, R. (2014). Nursing shortage. American Association of Colleges of Nursing.
Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United
States. Nursing Economics, 34(2), 98-101.
Spector, N. (2015). The National Council of State Boards of Nursing’s Transition to Practice
study: implications for educators. Journal of Nursing Education, 54(3), 119-120.
Sutcliffe, K. M., Paine, L., & Pronovost, P. J. (2017). Re-examining high reliability: actively
organising for safety. BMJ Qual Saf, 26(3), 248-251.
White, K. M. (2006). Policy spotlight: staffing plans and ratios: What’s the latest US
perspective?. Nursing management, 37(4), 18-22.
Williams, C. (2018, April). Recruiting middle school students into nursing: An integrative
review. In Nursing forum (Vol. 53, No. 2, pp. 142-147).