Controversy concerning the “nurses shortage” is not unknown. A variety of prescriptions have been offered to meet the supply problems that beset the health area. But diagnosis, not prescription, is the first step in treatment. This volume offers an economic diagnosis-an economic framework for discussion. It will not eliminate all controversy and differences in opinion diagnosis involve judgments and diagnosticians sometimes disagree. Different weights and interpretations can be attached to various observations. The study is designed to raise questions, illuminate areas, and offer policy implications.
A “crisis” is a turning point–things will improve or deteriorate. What does the future hold? This study projects the future demand for nurses’ services and the future supply of nurses. The asymmetry in the previous sentence is unfortunate but necessary. It is demand for physicians’ services that is projected for we have data to do so. But though data are available on the future supply of physicians, they are sparser on the quantity of services that may be available. The knowledge about future increases in productivity, in the number and quality of services a given number of physicians may offer, thus, is limited.
Nonetheless, this study will attempt to answer a number of questions. What is the “shortage” that some see today? If it exists, is it likely to ease or grow worse? Will United States medicine be able to meet the demands created by a population that is growing in size, becoming more urbanized, better educated, and more affluent? Is an increase in the physician-population ratio the solution to the problems that beset medicine or should other policies be given higher priority?
While the future quantity of nurses’ visits demanded under certain assumptions concerning socio-economic and demographic changes, the analysis will not be normative. We will not project the number of visits the public “should” make. Nor will we quantify any measure of the current shortage of care the reader may have his own assessment of that matter. Given that assessment, however, we will analyze how the current situation is likely to change over time.
The nurses are one of the most important workforces globally. There has been a major need for more professional nurses worldwide. It is very important to focus the discussion of this study to the nurses’ shortage in the U.S and globally in order to help and suggest solutions to this global problem (Alaszewski, 1995). Basically, there are various kinds of nurses, these are: aides, licensed practical nurses (LPNs) and registered nurses (RNs).
Along with the changing world of technology, high tech machines are now being used in many hospitals around the globe. This technological change has contributed the nurses’ shortage that started in 1960s because hospital required nurses that are knowledgeable with the use of the modern machines like machines on respiratory therapy and chemotherapy (Alford, 1975). Professional associations required nurses to take eligibility and professional exams before practising in the field of nursing in order to cope up with the social and economic, technological changes. Although, the American Hospital Association has developed inexpensive assistants, technicians and technologists to relieve the shortage without losing control over the health care system, it did not relieve the problem of shortage.
The AHA and the administrators of the hospitals hired more educated nurses that are Bachelor of Science degree holder and masters’ degree graduates (Allen, 2001). They fired the less skilled, licensed practical nurses that were not trained theoretically. These highly educated nurses were overworked. There are over 300,000 shortages of nurses in New York alone, this professional challenge can show the economic position of nurses staff and head nurses. At the same time, the financial management of health care is turning around beyond staff nurses’ and this significantly affecting them everyday.
The supply of nurses has dramatically decreases; the field is threatened on all of its aspects brought by the rising need of the new supporting health care specialties (Kerr, 2001). Although, hospitals benefited from the competition in some ways, on the other hand, generally speaking, this does not give them unification in their workforce, that results to decrease in their institutional strength (Institute of Medicine, 2003). Moreover, Staff nurses had insignificant control over this. Hospitals hobbled its people and job types like a deck of cards in order to take full advantage of its economic gain, an effort that was generated by deteriorating federal support for health care. Since nurses have a very minimum control over their workplace, they have low economic class positions and have no direct impact to the division labour. This resulted to high quit rates in the nursing field. The high quit rates continue the ratio of medical and non-medical workers increases. The patients population became more than the number of nurses in the hospitals. A vital administrative office presents exclusively to conclude the number of nursing staff that will be organized on each unit, according on a daily patient poll (number of patients) and their keenness levels (level of illness). Using such computations, nurses are suggested to diverse units as the requirement arises, in spite of their capability.
The U.S. and Global Nurses Shortage
Nursing shortage of unprecedented proportions is being felt throughout the world, but especially in the United States. The shortage is a result of an increased demand for nurses, a diminishing supply, and an attrition of working nurses from the profession ( Georgia Nurses’ Association, 1988). Many reasons have been proposed for this shortage: declining numbers of college-aged young people; expanding career opportunities for women; fewer women attracted to nursing; increasing numbers of nurses leaving the field for other careers; nursing’s being perceived as low in status, income potential, and employment benefits; the realities of unattractive work schedules; and the risks of hospital environments. On the other hand, current economic conditions and rising unemployment of both men and women in many other occupations have made nursing increasingly attractive. Applications to nursing schools have increased in the past few years, and enrollments are up. Characteristics of graduate nurses and their career paths in the future may be more and more diverse and interesting.
Hospitals have lost nurses to newer settings. Nurses who traditionally worked in hospitals have been attracted to the benefits of home health care and out-patient clinics. Changes in Medicare reimbursement to hospitals, introduced in 1983, have encouraged physicians to discharge patients earlier from hospitals. Much of traditional illness care has shifted from hospitals to home and clinic settings. Nurses have left hospitals to work in these environments.
The premise that the nursing shortage reflects declining numbers points out that although actual enrollments in nursing schools have declined some 25 percent since 1984, the numbers of graduates exceeds the numbers of nurses retiring, thus reflecting an increase in the size of the actual pool of nurses. Further, 80 percent of nurses are employed in nursing, a high percentage for a predominantly female occupation. The high turnover in hospital nursing positions, Aiken believes, reflects widespread dissatisfaction among nurses with hospital employment. However, since most nurses who resign hospital positions take a job in another hospital, nurse resignations and hospital vacancy rates do not reflect an actual nursing shortage.
There has been an increasing demand for health care throughout the years. A nursing shortage in almost all countries has been reported (Nursing Shortage – A World Wide Problem, 2001). There are a number of strategies made in dealing with the crisis. With the total population of the world growing, along with the different mutated new diseases that plagued the bodies of mankind, the growth was expected with the nursing shortage along with it. In the United States, It is speculated by the Bureau of labour statistics that by 2012, there will be more than one million new and replacement nurses needed to balance the demand (AACN, 2005). It is reported by American Association of Colleges of Nursing (AACN) in 2005 that although the enrolment in entry-level baccalaureate programs in nursing increased by 14.1% over last year, the growth is not enough to meet the projected demand for nurses. Both nurses and clients are displeased.
Health care contributes over 10 percent of gross domestic product of most developed nations. Nursing is one of the top occupations in terms of job growth (AACN, 2005). The demands are getting higher yet the supply, although growing, is not enough to cope up with the demand. Since health care is one of the primary concerns of people, policies pertaining to health care were made to safeguard people from health problems. There are many different health care structures in different countries, like the employer based coverage or the universal coverage. There are more economic concerns when it comes to the universal coverage. In a universal coverage structure, the government gives health care to all the citizens. The funds are usually taken from taxes. In some countries, people are dissatisfied by the health care given to them due to poor budget allocation. A nursing home that receives federal funds is expected to comply with the legislation that calls for a high quality health care (Rice, n.d.) but they cannot do so if there not enough budget and must compromise to deal with financial shortage. This will also mean that the nurses in these homes will receive a small salary but still works more than the required hours. The same applies to hospitals where there is a bigger allocation in administrative functions rather than in health care systems. This leads to job burnouts and profession dissatisfaction. Profession dissatisfaction and job burnouts are reasons nurses leave the profession.
Health care is a major concern these days, considering that the population is growing. People are more aware of their health today than they are years ago. Advancements in technology also play an important part – people can be diagnosed for diseases that may threaten life in the future and prevented these diseases from occurring. With these people live longer than before. Everybody in the world has experienced health care in many ways, like when we go to the nurses for checkups, when we go to a health organization to be immunized, or when we have our teeth cleaned. Effective nursing and health care concern has been and still is a growing economic crisis. Due to nursing shortages, there are people who are not given good heath care. It seems that the American system of care spend more on administrative costs that any other health care systems (Feldstein, 1999). Political and Economic forces shape health care delivery (Feldstein, 1999). It is a basic right that should be provided to those who need it. Everybody wants a healthy life and to live life to the fullest.
Health care is a rapidly growing market since it is one of the strong needs of mankind. The strong demand is due to the fact that people invest a lot of money in health. The healthcare industry is one of the world’s largest and fastest-growing industries, consuming over 10 percent of gross domestic product of most developed nations (American Health Association, 2005). The number one pharmaceutical company in the world, Pfizer, attained 22.5 billion in sales in 2001 alone (Pharmaceutical Executive, 2002). Life is so precious, it far more important than anything in the world. Anyone would pay large sums of money just to stay a little bit longer in the world. Health is priceless and anything that would promote it will be in demand. The market is rapidly growing since everybody needs health care. Since the population is growing, the need of more people who will needed in the healthcare workforce. Due to health awareness, people often seek professional help, buy health products, exercise good health habits, anything that will benefit his well being. People’s lives of people longer, making the average population age higher. And since old people need more health care than other age groups (Green, M., 2005), the demand therefore increases.
Age is one of the factors that affect the demand. Older people generally need more attention on their state of health. Older people are more prone to cancers, strokes, organ failures and other old-age related diseases (Kerr, 2001). The body degenerates with age causing the organs do not perform well, making old people weak. Those that are much older require assistance in performing their daily tasks. A person’s demand for health care rises along with age.
The level of technology also affects the demand for health care. The advancements in technology bring highly accurate and specific diagnosis of diseases (Allen, 1997). Special microscopes can multiply image sizes higher than before. Information databases can help in diagnostics. Technology could also bring comfort and satisfaction to the patients (finer syringe needles, lesser pain in some biopsies). There are different diagnostic tests that detect diseases. Albumin, 3D Imaging, Magnetic resonance imaging, Amniocentesis – are different kinds of tests to determine different types of diseases. Accurate early detection and treatment is a highly demanded by people, since a wrong diagnosis could spell death in some cases. Some technologies are very expensive while others lessen the cost. Technology makes health care much more approachable and dependable.
The supply is not enough to cope up with the demand. The nursing shortage affects almost all countries (Allen, 2001). The numbers of graduates are actually increasing yet it is not enough to manage the increased demand.
As discussed before, Health care contributes over 10 percent of gross domestic product of most developed nations. It gives employment opportunities to nurses that until now, it is one of the top occupations in terms of job growth. It provides jobs to hundreds of people in different sectors (Alder and Alder, 1987). The world lacks a subtle supply of nurses that they made campaigns that encourages people to take up the profession. Schools are earning a lot of money due to the numerous numbers of students taking up nursing or other medical professions. Health care also encourages the innovations of new medical technologies, giving light to the area of research and development and technology industry.
In terms of structures, a public based health care insurance system encourages investors to make business in the country because they won’t have to shoulder medical expenses, which can get a bit heavy. An employer based health care insurance system will be least feasible to investors since businesses can expend a lot on the insurance of the employees (Alavi and Cattoni, 1995).
More people are aware of their health than before. The demand for health care is so large and the supply is experiencing shortage. High quality health care is so hard to find these days because of the shortage. In theory, when the supply is scarce, the price increases (Allen, 1997). High quality health care can only be afforded by the rich. The poor will have to settle for low quality diagnostics.
The role of nurses in the world varies but serves only one purpose: To promote and practice health care thru the knowledge they earned from training and practice. It is their job to take care of those who require health care. It is their job to give quality health care so that patients will have confidence in their safety and the excellent practice of medical practitioners (Kerr, 2001). A good nurse shall also serve as a model to her fellow nurses and nurses to be, and teaches them good ethics and practice. A nurse must also be adept to new technologies, especially those that pertain to medicine. To address the current problem of nursing shortage, a nurse must demonstrate good practice so that there will be no negative effects about nursing. Shortage of nurses means that there are people that are not given proper health care.
Nursing Health Care Policy
The importance that the government gives to the health of their constituents is not debateable. It is obvious that they exert all their efforts in order to help the health sector to improve their productivity, efficiency and equity (Institute of Medicine, 2003). These efforts are more inclined to increase than to decline. The government’s objective to improve the health sector is very acceptable. However, the argument is that whether, at present the most is that how the government can increase the number or the rate of the number of nurses available to help the people in need of health care. The government must also put into consideration that adding the number o nurses and nurses’ services is only an alternative method or just a remedy because they must also focus why these nurses quit their jobs. Although, these concerns are not easily solved, they are being solved in a given time, whenever resources are available.
Fairness and other concerns will push government in identifying which parts and population groups to centre on (Institute of Medicine, 2003). Conceivably nurses’ services are most wanted, that is, would give way to the greatest health benefits comparatively to costs. If realized, there are groups of people that will receive less health care, because raising the number of nurses may not justify the needs of the patients. However, an essential provision and policy must be implemented by the government. If the government will increase the nurses’ services this will result to more gains in increasing health levels, the government must also acknowledge that its considerations must appropriately involve the allocation of health services and the approach to financial needs of those services.
Certainly, this may be factual even if several health services do modest contribution to health, but if the people believe they are connected. The government will necessitate acting on the ideas of the population as well as on the “scientific evidence.” It is of little reward to generate the workers to make the services accessible if the services will in fact not be available. It cannot be supposed that in the medical market resources will stream to provide those countries and population groups that “need” them and that were the foundation on which expansion of actions were transmitted (Institute of Medicine, 2003). The government is also ready to fund medical school expansion in order to produce more nurses, then it must be distinguished that further personnel will not essentially make those services accessible to those very people. In that sagacity the policy is useless. Strategies to augment the quantity of nurses, after all, are not accepted to raise the number of nurses but to augment the number of services.
Another argument points to getting or using foreign-trained nurses. The nurses supply protrusions. Every month the U.S. government alone gets 1,600 foreign nurses across the globe. These nurses characterize a significant count to supply (Institute of Medicine, 2003). The questions engaged in the “import” of nurses are multifaceted and engage affairs other than nurse supply. It can be disputed that the United States situation in the world is such that its strategy regarding migration, which means mass departure from other countries, should be established on bases other than the “shortage” in the United States, specifically, when dealing with the nursing workforce who is of such need in the developing economies. The United States has believed tasks regarding health levels in other countries. The conceptualization of a global Health Act gives additional proof of this commitment. Contemplation should be given to the problem whether, if continuous immigration is warranted only because of United States needs, the total promises of the United States, worldwide as well as national, would be better served if it persuaded foreign trained nurses to stay “at home” or return home after training, and boosted its own assembly of nurses (Kerr, 2001). A call for this argument would engage a number of significant issues. Concern would have to be prearranged to a variety of matters. Would these nurses “stay at home” or immigrate to other countries? What is recommended is only that the richest country in the world should not accept policies, if they cannot be acceptable on other grounds, because it can employ more resources itself.
Nursing is one of the few professions in which supply is limited at the point of access into the educational system rather than into the career (Institute of Medicine, 2003). Even if professional licensing bargains are warranted in order to guarantee quality, it is quite a different matter to stop students from pursuing nursing if they so desire and are qualified. This is a social question of important trade in.
It is clearly associated to the broad question of educational prospect for all, the relative degree of financial support given to students in nursing and other expertise and the type of subsidy such as, loans or grants. It is vague that nursing should be particularly out as one of the few careers in which the number of students established is more a purpose of future “needs” than of the number of capable persons who desire to study and practice. Contemplation should be certain to this query of social policy and to the size and type of student assistance.
The specific strategy implies that stream of analysis of the need for and supply of nurses’ services that are likely not justifiable to be at hand in the approaching decade can increase the number of services (Adams et al, 2000). The supply of nurses will not be substantial to fill the breaches that are present in the supply of nurses’ services accessible in the U.S. and the other parts of the world. The nurses’ workforce problem will not be so stretched as to affect efficiency benefits to be trying to keep rate with the past.
There are prospects for such employees are better if nursing practice is systematized in larger units than solo nursing practitioners. Many individual nurses could make use of extra support, but improvement would certainly come slower in individual training: the disadvantages are greater and the time for apprehension with such issues is less. In addition, as more and more nurses practice specialties, the problems related with the training of this type of nurse develop since; perhaps with the exemption of paediatric practice and internal medicine, the preparation must be ever more specific (Adamson et al, 2005).
It is almost certainly also true that supplementary nurses are best employed in combination with the kinds of apparatus that are more likely to be established in group exercise facilities and in hospitals and clinics. Of course, even if such nurses are engaged primarily in the hospital setting, the inferences for more efficient application of nurses and raised services to patients are significant. This analysis has focused on the nurses’ services outside the hospital, but an increase in nurses’ productivity, wherever it occurs, is of value in easing a supply situation.
The productivity increases and may accumulate as a result of the auxiliary expansion of group practice and other governmental units that bring a number of nurses together are not inadequate to those that may result from the use of nursing assistants and other specifically trained health workers. More competent business organization would mitigate the nurses of slowing decisions and defer benefits (Institute of Medicine, 2003). The supplementary compensation of decreasing repetition of tools now found in nurses’ offices and of having costly equipment obtainable to outpatients should also be familiar with. It would also be easier to coordinate for refresher courses, postgraduate training, and so forth, with consequential contact on the quality of service.
Nurses Shortage Solution
The nursing shortages in this country have been chronic since the end of World War II. There are periods of crisis, leading some observers to define the shortage as cyclical, but there have been few periods when all experts would agree that supply and demand were in balance (Allen, 1997). The last crisis occurred in 1980; the previous one occurred in the late I950s and the I960s. Nevertheless, most health care policy experts say that the current shortage is different and far more serious. They see no end in sight.
Three methods for solving the chronic nursing shortage have been used, but each with limited success. The first has been to increase the number of students coming through the educational system (American Association of Colleges, 2005). Traditionally this has been accomplished by student loans, scholarships, and financial aid to institutions having or wanting to start up new programs to educate nurses. In the case of the growth in the number of students and programs resulting from this approach has been remarkable.
The second means of remedying the nursing shortage has been to attract inactive nurses back to the work force. The most commonly used strategy is to offer short-term educational programs to refresh the nurses’ skills and abilities. Another means of attracting inactive RNs back to work is to offer competitive salaries. At times, economic difficulty, whether individual or social, has accomplished the same purpose. In nursing the work force participation rate has grown from about 55 percent in 1960 to 76 percent in 1980, and it has risen even higher, to 80 percent, in recent years (Alford, 1975). The ADN program has made a significant contribution to growth in the number of working nurses by admitting students who were older, married, and in many instances single parents. For many of these people, the ADN program was the first and only program to offer such opportunity.
Most often attempted is the creation of a nurse assistant to relieve the RN of tasks that can be safely performed by others with less education. This solution has been used repeatedly since the end of World War II, but with only partial success (Alavi and Cattoni, 1995). The categories of nurse assistants thus created include LPNs, nurse’s aides, ward clerks, ward managers, and others, some of whom have come and gone with the times. Most recently, the AMA has suggested yet a new category of assistant called “registered care technologists.” The irony of this newest “solution” from the point of view of ADN educators and policymakers is that ADN education itself was designed to vastly reduce the need for nursing assistants.
Another solution is increasing frequency is unionization. Current estimates indicate that some 6 million non- union health care workers employed in American institutions and hospitals may expect over the next few years a substantial increase in union activity. It is doubtful that RNs will join any mass union movement, but isolated strikes supported by individual nurses are likely to reoccur (Alder andAlder, 1987). The unionization of nurses has been a concern not only of health care agencies but also of foundations and other supporters of nurses and their educational institutions.
None of these solutions has been shown to cure the chronic state of nurse shortage in the country. Obviously, the right solution is yet to be discovered. Apparently, more basic issues must be addressed if a solution is to be worked out. On 27 May 1988 the DHHS secretary’s Commission on Nursing presented an interim report to Secretary Otis Bowen of Health and Human Services. The commission had been asked to identify the factors contributing to the nursing shortage and to propose solutions (Adams et al, 2000). It attributed the nation’s failure to supply nurses to meet the demand to several factors, most notably the increasing level of illness of hospitalized patients, increased federal staffing requirements, cutbacks in auxiliary personnel, shorter lengths of hospital stay, advances in technology, increases in the number of elderly patients, and new hospital cost-containment measures.
Other factors of equal importance included low wages for staff nurses, the lack of enough nurses with advanced educational preparation in nursing, the lack of RN retention programs in hospitals, inadequate management policies in several hospitals, and changing career opportunities for women. In June of 1988 the Federation of Nurses and Health Professions (FNHP) issued a report that was not essentially different. The report said, in part, that the data on the nursing shortage were startling (CrashCards.com,2001). FNHP President Owley said that “because of the growing number of senior citizens, the continued spread of diseases like AIDS, advances in technology, and the decreasing number of women choosing to go into the health professions, the demand for health care services is outstripping the supply of trained, qualified workers. What this is leading to is a potentially devastating curtailment or even ‘rationing’ of services. Such actions will impact most heavily on the poor, the elderly, and individuals who rely on government services.”
The FNHP recommended several strategies that have been extensively explored in the chapters of this book. The FNHP wanted career ladders and career mobility programs, a job design that effectively uses existing personnel, stronger linkages between hospitals and the educational institutions preparing novices, and a complete evaluation of salary structures (Rice, 2005).
The American Association of Colleges of Nursing (AACN) suggested in May of 1988 the following remedies: new staffing systems to increase the time the nurse spends with the patient, better use of auxiliary personnel, the retention of experienced nurses in hospitals, better use of informational systems, outreach educational programs, career mobility avenues, work-study programs, and financial assistance for students (Sellers, 2002). The need for federal assistance to alleviate the shortage is again under consideration. On 19 May 1988 legislation to reauthorize nursing education programs under Title VIII of the Public Health Service Act was introduced. The bill, entitled the “Nursing Shortage Reduction and Education Extension Act of 1988,” is the counterpart to Senator Edward Kennedy’s Nursing Shortages Reduction Act of 1987. Al though the bills are not identical, they provide for essentially the same level of funding.
When the Nurse Education Act was last reauthorized in 1985, the funding was aimed at graduate education. The proposed legislation continues that funding for nurse practitioners, nurse midwives, gerontological nurses, administrators, and researchers but also provides new authorization levels of undergraduate nursing scholarships (Green, 2005). For the first time in five years, funds are being made available for a loan repayment program. The bill also addresses innovative hospital nursing practice models, long-term care nursing practice demonstrations, and nurse recruitment centers.
Beginning in the I960s the ADN educational program made a large difference in the shortage crisis by graduating nurses in a shorter time than did other RN programs. Another such shot in the arm cannot be expected today, but ADN programs will continue to graduate as many nurses as their present structure permits (Institute of Medicine, 2003). What ADN faculty and graduates can do effectively is to pursue those remedies to the nursing shortage that have been described in this book or currently suggested by organized voluntary and governmental bodies addressing the crisis of nurse supply.
The FNHP’s suggestion, for example, that the job design of nursing be restructured to effectively use existing personnel is likely to have a profound effect on the retention of RNs in hospitals (Allen, 2001). The work reported here has highlighted the necessity of employing nurses to work at the level of competence for which they have been educationally prepared. When they have worked together, faculty and service personnel have been able to reach agreement on the work role of the new graduate. Hospital units have been established and operated on the basis of differentiated practice defined in terms of nurses’ educational attainment. These units have proven highly desirable places of employment for both new and older graduates. What is clearly demonstrated is that burnout or demoralization is greatly lessened when employer expectations do not exceed the graduates’ abilities.
While clinical ladders and career mobility programs, also suggested by FNHP and AACN, have been successfully developed and put into operation (American Association of Colleges of Nursing, 2005). Closer links between hospitals and educational institutions preparing novices have also been established, with good results. Joint committees and appointments, preceptorships, and joint marketing activities have also been highly successful. Financial incentives for nurses who improve their practice skills and abilities through advanced education should be instituted. In the early years of the ADN movement, graduates seldom sought additional formal education; they were content to upgrade their knowledge and abilities through on-the-job training and continuing education programs. Since 1979, however, the number of nurses holding the ADN degree who have later graduated from BSN programs has steadily increased, from 3,007 in 1979 to 4,585 in 1983, and the number is expected to grow substantially in the years ahead.
It is noteworthy that the criterion-based model used to project nursing manpower needs that was developed by a panel of experts for the federal government has predicted that by the year 2000 there will be roughly one-half as many BSN and higher-degree nurses, one and one? third as many AD nurses, and one and one-half the LVNs and LPNs required to meet the conservatively estimated nursing personnel need (Alder and Alder, 1987). This represents a deficiency of 619,100 prepared at the baccalaureate and higher level; an excess of 296,900 prepared at the AD level, and an excess of 204,200 licensed vocational nurses. It can be concluded from such data that the original view of the ADN program as a terminal one should be modified to include the original mission of the junior college to provide the first two years of a baccalaureate degree.
Furthermore, consideration must be given to career planning for ADN graduates who choose to work at different hospitals or other health agencies during their working life. Carefully designed benefit packages, salary differentials, and incremental increases for advances in education and increased clinical expertise, and flexible scheduling are absolutely essential if we are to relieve the nursing shortage. The future role of the ADN graduate in health care is quite clear. The graduates of the two-year program will remain the most numerous employees of acute care hospitals. Some of the AD nurses may move to chronic or long-term health facilities, but their educational preparation best prepares them for general hospital practice (Alavi and Cattoni, 1995). Consensus concerning the work role of the associate degree graduate has now been reached.
The early projects concerned with the ADN program were often focused on the preparation of teachers for two-year nursing students. Early concerns were directed to specialized programs of teacher preparation, attracting faculty to the effort, and providing continuing education for teachers already employed in the ADN effort. Financial assistance to those pursuing the graduate degree was therefore deemed essential. Federal traineeships and foundation funding were an important ingredient in this effort. Current work indicates that concern in ADN education now rests with other issues (Alavi and Cattoni, 1995). Student access to educational opportunities is paramount to success, and access involves the availability of both faculty and instructional materials. ADN educators have evinced a strong interest in the use of instructional technology instructional modules, VCRs, CAI, audio-cassettes. And ADN education will continue to attract teachers partially because its pressures on faculty to publish or conduct research are lower than in baccalaureate and graduate nursing education. The emphasis in ADN programs is on teaching.
Financial assistance is a catalyst for attracting students to the MSN program, which supplies ADN faculty. Even small sums are effective in retaining the graduate student in the teacher preparation program. Federal assistance or endowments may prove equal to meeting the future need (Adamson et al, 2005). The effort of professional nursing organizations to label the AD graduate as a technician, an associate nurse, or an assistant to the professional nurse has subsided, though titles have not been decided upon yet. What remain of that drive is the efforts of state nursing organizations to legislate the 1965 ANA Position Paper. Deadlines have again been set, but successful achievement of the 1965 goals remains very much dependent upon what happens as a result of the crisis of nurse supply. The future of AD nursing is bright. Its history is starred with accomplishments. The most notable is the movement of nursing education from privately controlled hospitals to the general education system of this country. Many health care policy experts believed that it could not be done. As our research has shown, this most fundamental of all changes in nursing education in the last half of the twentieth century was the result of the convergence of several trends. The associate degree in nursing seems to be an example of yet another idea in history whose time had come.
Summary and Conclusions
It is, perhaps, useful once again to shape openly the viewpoint of this study. It is not an attempt to define the levels of health or medical care the American people and people globally should have or should strive to attain. The goals to be sought after in the nurses shortage, as in other countries, are set by a society which must have a sense of balance all the reward of accomplishment those goals against all the attempts needed to achieve them. In such assessment, it is essential to know what other objectives could be accomplished if those same hard work were committed to their realization. Which of the many possible goals the nations around the globe strives for, the degree to which efforts are devoted to their attainment, the targets that are set, all these depend on the values that are held.
The problem of nurses’ shortage in various parts of U.S. and by particular population groups globally is most likely to remain serious. Several, but not all, of these problems are attributable to a shortage of effective demand. Even with earnings growth and special attempts on the demand side, it is not likely that an enough number of nurses will find practice attractive in these “problem” countries. Other tools may, therefore, be needed if more of the health needs of this populace are to be met. Many of the solutions engage the same changes that would help elevate the productivity of all nurses. Even as productivity raises would apply to all nurses, the benefits of such increases in rural and other countries may be even more remarkable: (1) they may be important in expanding the supply of nurses in those countries. (2) If care is planned in such countries through bigger medical units or hospitals, even larger productivity benefits than would be valid somewhere else might be possible. In many of these countries, enhances in medical care services involving the addition of auxiliary personnel do not involve a reallocation of function as is the case in more “richly endowed countries.” Thus such changes are easier to accept by the consumer who can see the expansion and is not as likely to feel, however correctly or incorrectly, that there is a downgrading of quality. Choices in such countries are more limited. It is surely easier to accept an auxiliary when the alternative is no care than when one feels that he is receiving a different type of care than previously offered.
Such policies are tempting, in part because they appear most general that is, not involving government in distribution matters or in decisions concerning which population groups to serve. While special services would be available only to some defined category, nurses are presumably available to all. This study suggests that presumption may be in error, that nurses’ services may not reach all the people. Thus, even if increasing the number of nurses are justified because nurses’ services contribute to health, it is illogical to stop short of a concern with whether these available services reach the people who might be most helped by them. This is true even aside from the important equity considerations. In a cost-benefit analysis alone, the benefits must be calculated with reference to who is likely to receive the services since benefits will differ by population group. If the market cannot be relied upon to create sufficient nurses’ services in the aggregate, can it be relied upon to distribute the aggregate supply of services, created with government support, in sufficient quantities where needed? The benefits of the program to create additional nurses’ will as a consequence are different from the benefits which served as a basis for justifying the need for the program. Therefore, if it is determined that increased health services would yield the greatest health benefits, broadly defined, consideration should be given not only to the types of programs to be supported to increase these services but also to the development of methods to deliver those services to those who may not be able to purchase them.
Economic analysis can help measure some, but not all, of the benefits yielded by reaching various goals. It can measure some, but not all, the costs of attaining them. It can, therefore, contribute to enlightened decision-making. It cannot do more than that; it does not make the decision. When choices are made, society is governed by more than the ratio of measurable benefits to measurable costs. Decisions are, and should be, made on the basis of the totality of benefits, broadly defined, and the totality of costs, equally broadly defined. The totality of benefits depends in no small measure on society’s set of values and beliefs. Increasing production or its potential is only one of the things that motivate a nation. Resources, after all, are devoted to the aged and others retired from the labour force.
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