April 1981

An in-depth look at its causes, its cures
Our Nation's Growing Shortage of Nursing

The nursing shortage . . . we've all heard a lot about it, and, as component members of one of America's largest health care complexes, it is important for us to keep abreast of its probable causes, possible cures and, more importantly, its impact in the Texas Medical Center.

While there has been disagreement - between nurses' professional organizations, various special interest groups and educational funding sources - as to whether the shortage is real or contrived, a quick check of employment ads in Houston newspapers stands evidence to the number of staff nursing positions available.

A report by the American Hospital Association stated that nationwide some 100,000 budgeted nursing positions remained vacant last year.

Figures for Texas also reflect a shortage: a recently published 40-page study by Texas Nurses Association (TNA) Blue Ribbon Committee reports that a minimum of 12,000 additional RNs are needed to augment the 51,000 registered nurses presently in the state's health care delivery system. The committee attested that the optimal figure would be 22,500 more RNs.

In the Texas Medical Center, although the shortage is not yet critical, a hospital canvass reveals several vacant and budgeted positions. The vacancies have forced administrators to: 1) turn to temporary nursing personnel agencies for additional staffing during peak census periods and 2) consider both more effective nurse recruitment and retention programs.

A 1977-78 inventory of registered nurses by the American Nurses Association (ANA) showed that 75 percent of the nation's 1,375,000 licensed nurses - more than ever before - were employed in the nursing field. So why the many vacancies?

To determine the true picture Congress has mandated a special two-year study by the Institute of Medicine of the National Academy of Sciences.

Among issues to be studied are future supply, requirements, distribution and retention of nurses. Special attention will be focused on reasons why nurses do not practice in underserved areas, why they leave active nursing and the costs of nursing education to institutions and students, plus sources of financing available to both.

Future status of federal funding for nursing education depends in great part upon the study's findings.

Coupled with expanding facilities and decreasing enrollments is yet a third significant reason for the shortage - failure of hospitals to retain nurses they already have.

The ANA registered nurse inventory showed that 75 percent of the licensed nurses were employed in nursing, but what about the other 25 percent?

While 3 percent of those responding were employed in other fields, only a scant 2 percent were unemployed yet looking for nursing jobs.

The remaining 20 percent indicated they were not only unemployed but were no longer seeking work in nursing.

In Texas alone there are reportedly 18,000 unemployed RNs who make the same claim.

What drives qualified nurses to abandon their career field?

Many answers surfaced last June with publication of a study commissioned by the Texas Senate Special Committee on Delivery of Human Services.

Specifics cited by both employed and unemployed nurses as reasons for job dissatisfaction included:

• Lack of administrative support by hospital and nursing service administrators
• Lack of professional autonomy
• Inflexibility of working hours
• Being "pulled" or "floated" from the regular work unit to an area of the hospital experiencing a staffing shortage.

Positive features included:

• A head nurse with baccalaureate degree (and frequently a master's) would have full responsibility on the unit for personnel, including hiring.
• All nursing care would be provided by registered nurses, with associate staff doing secretarial and other non-nursing related activities.
• Nurses on day and night shifts would have equal input into the total nursing care program.
• Inservice training would be planned so nurses could meet their own education needs.
• Pay differential would be provided for day and night shifts so enough nurses would choose nights and day nurses would not have to rotate to other shifts.
• Collaboration among other units and hospitals would enable nurses to have a choice of opportunities to update skills.
• Salary increases would be tied to performance and recognition of good work.
• Nurses would have input into all policies affecting them, including nursing practice, patient care and personnel benefits.
• Finally, nurses would share planning for patient care with physicians and other health-care administrators and take part in decisions about patient discharge or movement to another care unit.

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©2006 Texas Medical Center

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