|February 7, 2001
Nursing -- 'A Workforce in Crisis'
California is experiencing a shortage of
registered nurses that differs fundamentally from prior nursing shortages, according to a
new report released by the UCSF Center for Health Professions.
titled: Nursing in California: A Workforce Crisis is the first of several to be
released by the UCSF Center for Health Professions' California Workforce Initiative.
not just another cyclical shortage of nurses that can be rapidly cured by paying nurses
higher wages and enrolling more students in nursing schools," said Edward O'Neil,
director of the UCSF Center for the Health Professions and principal investigator of the
study. "The aging of the nursing work force, the upheaval in the health care system
and the expansion of career opportunities for women (who make up 94 percent of the nursing
work force in California) are combining to produce a chronic shortage of nurses. That
shortage can only be resolved by improving the work environment for nurses and redefining
" Part of
the nursing supply problem is itself related to aging, according to O'Neil. "One in
every five RNs licensed in California is 55 or older, and many RNs retire in their late
50s and early 60s. If these patterns continue, retirees will represent much of the RN
shortfall. This shortage will become more acute over the next several decades as the
health care needs of aging baby boomers increase," he said.
also cite changes in the nursing work environment that have led to more stress among
nurses and growing tension between nurses and managers. "Pressure to contain costs
has led to efforts to reduce the length of patient stays in the hospital and limit
admission to those who are most in need of services. Consequently, there is a higher level
of patient illness in hospitals. This means that more critical decisions and work need to
be carried out in less time," said Janet Coffman, MPP, associate director of
Workforce Policy at the UCSF Center for Health Professions and a co-investigator on this
report. She explains that these changes have had a major impact on the 60 percent of
California's RNs who work in hospitals.
consequence, careers in health care have become less attractive relative to other
industries, said Coffman, adding that the problem is compounded by the fact that nursing
has traditionally been known as a women's profession. "The fairly recent expansion in
opportunity for women means that the health professions can no longer count on a large
number of young women entering the profession. This means that nursing will have to
re-position itself as an attractive career to compete successfully for the interest of
people entering the work force."
trends suggest that wage increases, signing bonuses and image campaigns are not sufficient
to alleviate this crisis," said O'Neil. "Young people are looking for careers
that offer autonomy, flexibility and the chance to participate in the management of the
organizations in which they work."
made the following recommendations for improving the nursing work environment:
· Leaders in health care and unions representing RNs should partner with one another to
strengthen trust between labor and management.
· Senior health
care executives need to constantly evaluate their organizations, engage RNs in these
efforts, and take seriously their assessment of current practices and suggestions for
· Health care
organizations should invest in the retention of RNs. Specific recommendations include
elimination of mandatory overtime and the provision of greater financial rewards for
experienced RNs, financial incentives for RNs to complete further education, and adequate
representing RNs should place greater emphasis on career development and nurses'
participation in the management of organizations in which they work.
The system of
nursing education also needs attention, expansion and integration, according to the
researchers. Even with a properly functioning system, California has an inadequate supply
source for new nurses, said Coffman. She explained that historically the state has
imported a large proportion of nurses from around the country and abroad. "With
growing demands for nurses across the country and the rising cost of living in California,
we can no longer rely on others to educate our nurses." The researchers made the
following recommendations for improving nursing education:
· Increase the
numbers of non-white and male nursing students.
· Make nursing
education more accessible (evening and weekend classes, distance learning).
clinical education in order to ensure that nursing graduates are well prepared for
clinical practice. A range of approaches should be explored, including designated mentor
programs, extended orientation/preceptor programs, and formal residency programs.
students with standardized information about nursing education programs (prerequisites,
number of required credits, pass rates on licensure exam).