The Nursing Shortage, Pediatric and Child Family Nursing
Article Outline
The professional literature is replete with evidence as to the current and projected status of the nursing shortage. The most current National Sample Survey of Registered Nurses (NSSRN), the seventh national survey conducted by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services that provides a statistical profile on the nursing professional revealed interesting trends regarding the status of registered nurses (RNs). As of March 2004, it is estimated that there are 2,909,467 RNs representing an increase of 7.9% of RNs since 2004. This increase is greater than the percentage increase during the four previous years (5.2% between 1996 and 2000) (HRSA, 2004).
The 2004 NSSRN reported the average age of RNs surveyed was 46.8 years as compared with 2000 NSSRN, which was 45.2 years. As the survey findings demonstrated, the proportion of RNs continues to shift to older age groupings. Since 1980, the largest proportion of age grouping of RNs shifted from the 25 to 29 years group to the 45 to 49 years group. The average age of RN graduates indicated that the average age decreased from 30.5 years in 2000 to 29.6 years in 2004 (HRSA, 2004).
The percentages of men and ethnically and racially diverse individuals have remained static since 1996. In 2004, 5.7% of RNs were men and 10.6% of RNs were ethnically and racially diverse. This survey also examined employment settings wherein RNs worked. Survey findings indicated that hospitals (56.2%) were identified as the predominant employment setting of RNs followed by community and public health settings (14.9%), ambulatory care (11.6%), other settings such as prisons/jails and insurance companies (8.6%), nursing home/extended care facilities (6.3%), and nursing education (2.6%). The 2004 NSSRN revealed that 3.5% (100,791 nurses) were educated outside the United States. Currently, there are approximately 125,000 unfilled registered nursing positions in the United States; this number is projected to nearly quadruple in the next two decades (HRSA, 2004). A recent report by the Joint Commission on Accreditation of Healthcare Organizations (JACHO) revealed that the RN vacancy rate in hospitals was 13% (JACHO, 2002).
The estimates related to the subspecialty of nurses who provide services to infants, children, youth, and families are not available. However, inferences can be made as to the potential impact on the subspecialty workforce of child and family nurses in the future. As the current trend statistics revealed and projected estimates by experts suggest, the workforce shortages will continue and result in serious consequences in terms of the quality of care available and inadequate supply of RNs to provide the care. This projection is especially worrisome when considering the predominate subspecialty choices made by nurses as child and family nursing is composed of fewer subspecialty nurses compared with the other subspecialties. This same comparison can be applied to the projected shrinking pool of child and family faculty available in the future (HRSA, 2004). Another area of concern is the acknowledgement of the need to allocate of additional health care resources to a growing population of elder U.S. citizens. What will be the consequences upon children and their families?
A number of reasons have been offered to explain the challenges and obstacles to recruiting individuals to nursing and retaining them as nurses. These challenges include the lack of attractiveness of nursing as a career option for young women given the breaking down of the gender barriers enabling them to pursue other careers that offer better job conditions, incentives, compensation and work conditions, the “graying” of the workforce, and the attrition rate of practicing nurses that exacerbates the current problems with the nursing shortage. A generational divide has been described as it relates to perceived work incentives and negatives. The value differences between the older and younger generations result in life and work philosophies that can create tensions and clashes when brought together in nursing employment settings (Rivers, Tsai, & Munchus, 2005).
Negative factors associated with the work environments cited by nurses include the dependency status of nurses as professionals in the work environment, unappealing and oppressive work environments, lack of staff support to assist with workload, and high patient-staff ratios contributing to a sense of uneasiness related to safe and competent nursing practice. Consumer demands and advocacy for a voice in the provision of care, and increased consumer access to health care information spurred by the Internet and search engines such as Google has created more work pressures. These aforementioned factors have contributed to the recruitment and retention problems in nursing (United States General Accounting Office, 2001a, United States General Accounting Office, 2001b, Lynn & Redman, 2005, Rivers et al., 2005, Robnett, 2006).
Child and family nurses have greater work demands and unique challenges in working environments unlike others that nurses. Unlike other clients, pediatric nurses provide care to both the child and family. Over the years, the traditional family unit has changed into contemporary forms that involve varied groupings of caregivers that include the divorced parents with varied custodial arrangements, stepparents, birth parents, adopted parents, surrogate parents, foster parents, custodial grandparents and family members, and legal guardians. These contemporary parenting models can complicate the provision of nursing care resulting in more complex psychosocial issues, legal, and ethical issues that need to be addressed. Additionally, technological, scientific, and medical advances have created neonatal and pediatric health care environments that require nursing professionals who possess not only the highly specialized clinical knowledge and skills to provide care but also the temperaments to deal with the human drama that surrounds the critically and acutely ill child and the technical expertise to manage the sophisticated medical technology.
A number of strategies have been suggested to circumvent the tide of the nursing shortage. These include improved recruitment strategies to outreach to men and culturally diverse populations, to advocate for increased state and federal funding of nursing programs, and more involvement in policymaking (National Association of Pediatric Nurse Practitioners (NAPNAP), 2001, Robnett, 2006). Other recommendations offered to solve the problem of the workforce shortage in the face of growing service demands include the use of technology to decrease workloads, promoting improved collaboration between disciplines, and improved staffing ratios (Bowles & Candela, 2005, Rivers et al., 2005, Robinson et al., 2005). Some suggest that nontraditional models of care delivery, such as the use of unlicensed assistive personnel (UAP) be used and rigorously tested (Lookinland, Tiedman, & Crosson, 2005). A recent report by JACHO (2002) offered suggestions to improve nursing retention that included teaching team-training, enhance the orientation programs, implement career ladders, create a positive culture for retention, and provide both the authority and responsibility nurses need to perform their work.
The challenge for pediatric nursing leaders and administrators is to develop, implement, and test recruitment and retention models that result in clinically meaningful outcomes. There are “pockets of excellence” that show promise in effecting significant changes in the workplace for pediatric nurses such as the RN residency program first developed at Childrens Hospital Los Angeles that has since been replicated in other pediatric hospitals nationwide through its non-profit, public benefit corporation, Versant (Versant, 2005). The recruitment and retention issues in attracting individuals to the subspecialty of pediatric nursing are unique as has been previously discussed. We need a concerted national effort to develop a strategic plan for the future to replenish the supply of pediatric, child and family nurses needed to work in clinical, administrative, community, and educational settings.
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PII: S0882-5963(06)00148-5
doi:10.1016/j.pedn.2006.02.011
© 2006 Elsevier Inc. All rights reserved.
