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Nursing

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Clearinghouse on Nursing Shortage Issues

Updated: March 2008
Introduction | Retention | Recruitment | Education | Technology | Data Collection | Clarify Existing Laws and Regulations

Introduction

The New York State Education Department is pleased to present you with a collection of initiatives and strategies used in the field to support practicing nurses and address the nursing shortage in New York State. This clearinghouse is available to you as a result of the work of the New York State Board of Regents Task Force on the Future of Nursing. It is the hope of the Board of Regents and the State Education Department that the clearinghouse will stimulate creative thinking and encourage further activity and collaboration.

Each entry exemplifies one or more of the six major recommendations of the Regents Task Force:

Following a brief description of the activity or practice, contacts for additional information or opportunities for alliance are provided. Activities are added to the clearinghouse as they are identified and represent only a portion of the important initiatives that are underway. We encourage you to pursue the activities that interest you and e-mail additional examples of best practices and strategies to the New York State Education Department's Office of the Professions at nursebd@mail.nysed.gov. The New York State Education Department does not endorse the programs and strategies listed in this clearinghouse.

The Board of Regents and the State Education Department hope this comprehensive resource will assist you as you launch creative initiatives and collaborative activities to ensure a strong future for the nursing profession.

Retention

  • In a September 5, 2007 news release, the National Foundation for American Policy identifies factors that must be addressed to solve the nursing shortage. They cite increasing faculty addressing school infrastructure and immigration quotas to foreign nurses as key practical solutions.
  • The U.S. Department of Labor has announced a $202,000 grant to study ways to retain older workers in health care as a key strategy in meeting future workforce needs. The Maryland Department of Labor, Licensing and Regulation will use the grant to examine incentives or conditions that would persuade workers nearing retirement or recently retired to continue in their jobs.
  • A new study by the Robert Wood Johnson Foundation has found that flexible work hours, increased benefits, new managerial roles, better designed hospital equipment and facilities, and more autonomy in decision making are among the factors that would encourage older nurses to stay in the workforce.
  • US News and World Report is now including information about whether a hospital has received Magnet Recognition as one of the criteria used in its annual report ranking "America's Best Hospitals." The annual survey is included in the July 13, 2004 issue of the magazine. In addition to finding lower patient mortality rates and lower patient-to-RN ratios, nurses employed in Magnet Hospitals tend to stay longer and have higher satisfaction scales and lower stress scores.
  • Legislation was signed into law on May 19, 2004 that will place limits on overtime in hospitals for nurses and require the Commissioner of Public Health to adopt regulations establishing minimum nurse-to-patient ratios.
  • Members of the Reforming States Group, a voluntary organization of state health policy leaders, identified 10 "particularly promising state policy responses" to addressing the growing shortage of health care workers. The report also examines why state governments should address the health care worker shortages despite their current fiscal difficulties.
  • A 30-member Nursing Advisory Council has been established to assist the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in addressing the recommendations of its recent report: Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis.
    • Contact:
      www.jcaho.org [Under Public Policy, click on "Nurse Staffing Crisis" ]
      phone: 630-792-5800
    • Date: August 2006

  • Hospitals and health systems are working hard to improve the work environment for nurses as part of their efforts to relieve the widespread nursing shortage. A report released by the American Organization of Nurse Executives contains insights from a survey of 21 hospitals and 61 individuals about their experiences, best practices and lessons for strengthening the nursing work environment.
    • Contact:
      www.aone.org [Click on "Publications," then on "Books," then enter the title Healthy Work Environments which can be downloaded free.]
    • Date: August 2006

  • The American Assembly of Men in Nursing (AAMN) maintains a chat room where men can ask questions about the profession, scholarships and other workplace issues. It also supports a legal defense fund to lobby policymakers and ensures that proposed bills do not hinder the ability of men to practice nursing.
  • Jerry Lucas, RN, is publisher of an on-line publication called Male Nurse Magazing and maintains a web site that focuses on issues critical to men in nursing.
  • The American Association of Colleges of Nursing's Web site includes a section on Government Affairs that provides up-to-date information on Capitol Hill initiatives related to funding, appropriations and regulatory policies that support nursing education programs, students and nursing research and practice.
  • A study by Lynn Unruh, Ph.D., RN, shows that the number of licensed nurses in hospitals is a strong predictor of adverse events. Specifically, the study found that hospitals with more licensed nurses (with a constant number of patients) had significantly lower incidences of collapsed lungs, bed sores, falls, and urinary tract infections, but significantly higher rates of pneumonia. Hospitals with a greater proportion of licensed nurses to total nursing staff had significantly lower rates of bedsores and pneumonia. The study is published in the January 2003 issue of Medical Care.
  • Johnson & Johnson's Campaign for Nursing's Future is an example of a national effort to support the profession of nursing and promote it as a career choice. The campaign focuses on retaining the talent already in the profession through advertising, scholarships, fund raising, a web site, and recruitment brochures, posters and videos.
    • Contact:
      Johnson & Johnson
      www.rwjf.org/index.jsp [Type in "nursing" in the advanced search to receive a listing of all Johnson & Johnson efforts.]
    • Date: August 2006
  • Several research studies concur that a major factor influencing nurses to remain in the profession is working with other nurses who are competent. Advanced education is the key indicator for demonstrating competence. The American Association of Critical Care Nurses has completed a paper, titled Safeguarding the Patient and the Profession, on the benefits of specialty certification to nurses, employers and the public. The report provides supporting literature to encourage hospitals to provide expanded support for continuing education and certification.
  • A study by researchers at the University of Pennsylvania demonstrates the relationship between inadequate RN staffing and patient harm. The study also found that as the nurse's workload rose, job dissatisfaction and burnout rose as well.
  • The Iroquois Healthcare Association's Upstate Health Workforce Center administers a $13.3 million grant from the NYS Department of Health to recruit, train and retain individuals to health careers who meet the Federal guidelines for Temporary Assistance to Needy Families. The Center collaborates with health facilities in acute, long term and home care sectors as well as colleges, BOCES, school districts, Workforce Investment Boards and one-stop employment centers across upstate NY.
  • A report by the Georgia Department of Community Health's Health Care Workforce Policy Advisory Committee identifies effective and innovative strategies for workplace excellence documented during a series of forums the committee held with nursing staff and a diverse group of health care providers from hospitals and long-term care. The forums identified communication as the number one factor affecting the workplace. The report, Promoting Health Care Workplace Excellence," is available on their web site.
  • Staff nurses in North Carolina who are responsible for large patient loads or who work in environments where short staffing frequently interferes with their ability to care for patients are less satisfied with their jobs and careers than colleagues in better work environments, according to a new study. The survey found one quarter of hospital nurses who were responsible for six or more patients on an average day said that short staffing interfered with their ability to care for patients. The report, "Staff Nurse Satisfaction, Patient Loads, and Short Staffing Effects in North Carolina" is available on their web site.
  • Good pay, responsive management, adequate staffing levels, flexible scheduling and a positive work environment were found to influence job satisfaction and retention among staff nurses according to "Retaining Staff Nurses in North Carolina", a report on survey findings.
  • "Hallmarks of the Professional Nursing Practice Setting" provides information on environmental characteristics or hallmarks of health care settings that promote professional nursing practice. A companion brochure, "What Every Nursing Graduate Should Consider When Seeking Employment" helps graduates identify appropriate practice settings.
    • Contact:
      American Association of Colleges of Nursing (AACN)
      202-463-6930
      http://www.aacn.nche.edu [Click on "Publications"]
    • Date: August 2006

  • The Occupational Safety and Health Administration (OSHA) will begin inspecting nursing or personal care facilities, primarily those that reported high injury and illness rates under a new National Emphasis Program. Negative environmental conditions have been cited by nurses as a factor in leaving the profession.
  • Magnet Hospital Recognition by the American Nurses Credentialing Center for excellence in nursing services award criteria are presented. Thirteen New York hospitals have received this award.
  • New Jersey adopted a law prohibiting health care facilities from requiring hourly employees to work more than 40 hours a week, except in emergency situations.
    • Contact:
      New Jersey State Nurses Association, Department of Legislative Affairs
      1-888-UR-NJSNA
      http://www.njsna.org/
    • Date: August 2006

  • Nurses for a Healthier Tomorrow, a coalition of 32 nursing and health care organizations, announced a national advertising campaign to recruit and retain nurses. "Nursing, It's Real, It's Life," targets middle-and high school-age youth, as well as current nurses who may have considered leaving the profession. The campaign consists of seven print advertisements and one television public service announcement.

Recruitment

  • Virginia Partnership for Nursing, Nurses Change Lives campaign aims to educate and inspire children and young adults to consider nursing as a career. Schoolchildren in three age brackets (K-3, 4-8 and 9-12) can learn about nursing by visiting age appropriate sites.
  • Explore Health Career is a new web based site that provides information about multiple health careers, including nursing. The site includes comprehensive information about minimum salaries, maximum years in school, funding, job opportunities and more.
  • In a September 5, 2007 news release, the National Foundation for American Policy identifies factors that must be addressed to solve the nursing shortage. They cite increasing faculty addressing school infrastructure and immigration quotas to foreign nurses as key practical solutions.
  • The Kansas state legislature recently approved $3.4 million in funding for the first year of a ten-year Board of Regents' initiative to address the state's nursing workforce shortage. The Board's ten-year nursing initiative is a three-part $30 million program that aims to increase nursing capacity in the state by 25% chiefly by expanding postsecondary program capacity at nursing schools. The program will direct $22 million from the state and $8 million in matching funds from participating educational institutions to nurse educator scholarships, and nursing supplies, equipment and facility upgrades. The Kansas Department of Labor predicts that a total of 11,350 nurses will be needed by 2010 to meet workforce demand.
    • Date: August 2006

  • The New Jersey Collaborating Center for Nursing (NJCCN) has warned that as many as half of those who seek healthcare in the year 2020 may be denied, as a result of the state's dire nursing shortage. A study released by NJCCN claims that 50% of nursing positions will be unfilled, and the states nursing schools will not be able to train enough nurses to meet the growing needs of an aging population. The study also states that even though recent efforts have indeed encouraged more nursing candidates, the state has failed to educate and retain enough nurses to avert a major shortage.
  • A report by the Massachusetts Association of Colleges of Nursing recommends strategies for addressing the state's growing shortage of registered nurses. The recommendations include increasing the percentage of baccalaureate and higher degree nurses practicing in the state and the number of nurses qualified to teach, and developing partnerships between health care facilities and nursing schools to expand and prepare additional faculty and clinical resources to support increased enrollment.
  • A recent report titled, Hospital Quality: Ingredients for Success - Overview and Lessons Learned, documents that hospitals with consistently good performance records retain nurses and avoid shortages. For a list of recommendations to help hospitals improve performance, access the research on their website.
  • Members of the Reforming States Group, a voluntary organization of state health policy leaders, identified 10 "particularly promising state policy responses" to addressing the growing shortage of health care workers. The report also examines why state governments should address the health care worker shortages despite their current fiscal difficulties.
  • The National Institutes of Health has launched a web site designed to help middle and high school students explore the diversity of health care careers, including nursing. Users can browse or search for information based on interest area, salary, education or other criteria, and read about real people who have achieved success in their careers.
  • Nurses for a Healthier Tomorrow, a coalition of 43 leading nursing and health care organizations addressing the nursing shortage, is launching a national advertising campaign titled "Nursing education . . . pass it on." The goal of the campaign is to increase the number of nurse educators, a shortage of which is causing some nursing schools to turn away prospective students. Through first-person testimonials, the new faculty recruitment ads convey the personal satisfaction and rewards nurse educators receive.
    • Contact:
      www.nursesource.org [here visitors can also learn more about education careers]
    • Date: August 2006

  • The Henry County (IN) Memorial Hospital Foundation has published an illustrated storybook designed to introduce children in pre-school through third grade to nursing as a career. "Where Do Nurses Work?" revolves around a tea party with Grandma, during which the children play a game to name different places where nurses work.
    • Contact:
      Ceil Martin, Chief Regulatory Officer
      Henry County Memorial Hospital
      765-521-1504
      cmartin@hcmhcares.org
    • Date: August 2006

  • International Nurse Mobility: Trends and Policy Implications, has been released by the World Health Organization(WHO), the International Council of Nurses (ICN) and the Royal College of Nursing, UK. This report examines trends in international recruitment and migration of nurses. It studies the experiences of five "destination countries" and four "source" countries/regions. The report identifies those "push" and "pull" factors that stimulate nurses to migrate and discusses some of the policy implications related to this migration. The issue of nurse migration continues to be of interest to ANA from the perspective of the nursing shortage, as well as issues related to changing US immigration law and the ongoing efforts by the US government to negotiate numerous bilateral and multilateral trade agreements that include trade in services.
  • Nursing students at the George Mason University College of Nursing and Health Sciences have published an exciting book, The Magic Stethoscope, designed to interest junior high students in a future nursing career.
  • A 30-member Nursing Advisory Council has been established to assist the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in addressing the recommendations of its recent report: Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis.
    • Contact:
      www.jcaho.org [Under Public Policy, click on "Nursing Staffing Crisis" ]
      phone: 630-792-5800
    • Date: August 2006

  • The American Assembly of Men in Nursing (AAMN) maintains a chat room where men can ask questions about the profession, scholarships and other workplace issues. It also supports a legal defense fund to lobby policymakers and ensures that proposed bills do not hinder the ability of men to practice nursing.
  • Jerry Lucas, RN, is publisher of an on-line publication called Male Nurse Magazing and maintains a web site that focuses on issues critical to men in nursing.
  • The Texas Nurses Association has produced a videotape that promotes nursing as a career by addressing what nursing is, what nurses do, where nurses work, what it takes to be a nurse, and how to become one. Each of the videotape's three segments is geared to a different age group including elementary, junior high and high school students. The tape is $25. The Texas Nurses Association also has additional information about nursing and educational opportunities for young people.
  • The American Association of Colleges of Nursing's Web site includes a section on Government Affairs that provides up-to-date information on Capitol Hill initiatives related to funding, appropriations and regulatory policies that support nursing education programs, students and nursing research and practice.
  • One section of the California Board for Nursing's Web site is devoted to providing information on how to become a nurse, why nursing is a good career choice and how to receive financial aid. The site also provides information on how RNs can help recruit future nurses.
  • The Iroquois Healthcare Association's Upstate Health Workforce Center administers a $13.3 million grant from the NYS Department of Health to recruit, train and retain individuals to health careers who meet the Federal guidelines for Temporary Assistance to Needy Families 200%. The Center collaborates with health facilities in acute, long term and home care sectors as well as colleges, BOCES, school districts, Workforce Investment Boards and one-stop employment centers across upstate NY.
  • The New York State Nurses Association (NYSNA) has developed Career in Nursing Recruitment Kits to assist volunteers promote nursing as a career to local schools and childrens' community groups. Each kit contains materials for presentations as well as tips on how to contact schools/groups to discuss possible presentation options. Kits can be borrowed or purchased for $139 plus tax and shipping.
    • Contact:
      New York State Nurses Association
    • Date: August 2006

  • A Nursing Exploration patch is available to Girl Scouts in Pennsylvania who complete activities designed to introduce them to the variety of career opportunities in nursing.
  • "Hallmarks of the Professional Nursing Practice Setting" provides information on environmental characteristics or hallmarks of health care settings that promote professional nursing practice. A companion brochure, "What Every Nursing Graduate Should Consider When Seeking Employment" helps graduates identify appropriate practice settings.
    • Contact:
      American Association of Colleges of Nursing (AACN)
      202-463-6930
      http://www.aacn.nche.edu [Click on "Position Statements."]
    • Date: August 2006

  • The New Jersey Hospital Association's Center for Nursing and Health Careers launched a Web site with information on career options in nursing and allied health professions. The site provides details on salaries, educational requirements, certification and licensure standards.
  • The United States Department of Labor's free Web site links displaced workers and others to new careers in long-term care. Job seekers can research local and national job listings and post their resumes, while employers can post jobs and access resumes.
  • The North Carolina Center for Nursing developed a campaign to promote awareness and spark an interest in nursing careers among youth and minorities. Posters, English and Spanish fact sheets and public service announcements target middle and high school students. The "Nursing Exploration Patch Program" was developed to enable youth groups, including Girl Scouts and Boy Scouts, to earn a patch for learning about nursing careers.
  • The Jefferson Health System in Pennsylvania presents innovative recruitment strategies for enticing young people to nursing.
  • The U.S. Department of Health and Human Services announced a campaign to attract young people to nursing, starting at the junior high school age. The campaign, Kids into Health Careers, includes an informational Web site and tool kit.
  • Nurses for a Healthier Tomorrow, a coalition of 32 nursing and health care organizations, announced a national advertising campaign to recruit and retain nurses. "Nursing, It's Real, It's Life," targets middle-and high school-age youth, as well as current nurses who may have considered leaving the profession. The campaign consists of seven print advertisements and one television public service announcement.

Education

  • A guide to accredited programs offering a Master's Degree in Nursing organized alphabetically by state. This practical guide provides a brief description of each program and indicates its accreditation status.
  • A new report by the Massachusetts Association of Colleges of Nursing recommends strategies for addressing the state's growing shortage of registered nurses. The recommendations include increasing the percentage of baccalaureate and higher degree nurses practicing in the state and the number of nurses qualified to teach, and developing partnerships between health care facilities and nursing schools to expand and prepare additional faculty and clinical resources to support increased enrollment.
  • The American Association of Colleges of Nursing issued a white paper titled, Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply. AACN's paper summarizes the scope of the problem, presents issues contributing to the shortage and offers strategies for expanding current capacity.
  • Johnson & Johnson's Campaign for Nursing's Future is an example of a national effort to support the profession of nursing and promote it as a career choice. The campaign focuses on retaining the talent already in the profession through advertising, scholarships, fund raising, a web site, and recruitment brochures, posters and videos.
    • Contact:
      www.rwjf.org/index.jsp [Type in "nursing" in the Advanced Search to receive a list of all Johnson & Johnson reports.]
    • Date: August 2006

Technology

  • Telehealth increasingly is being used by psychiatric health practitioners to treat patients in rural regions of the U.S. Telehealth treatment, which includes appointments by video screen or telephone, enables practitioners to reach patients who otherwise might not have access to care.
  • Free assessment tools for direct-care nurses who care for older adults, Try This: Best Practices in Care for Older Adults, are now available as personal digital assistant (PDA)-based download for nurses, educators and nurse leaders. The series is available from the Hartford Institute, which is based at NYU College of Nursing.
  • Installing one of the latest-generation computerized medical information management systems in a hospital intensive care unit could reduce the time nurses spent on documentation by 31%, with much of the time gained transferred to direct patient care, a new study indicates.
  • Created in 2001 by the US Department of Health and Human Services (HHS), the Advisory Committee on Regulatory Reform, which includes doctors, nurses and other professionals, released its first report on November 21, 2002 on how to "streamline unnecessarily burdensome or inefficient regulations." The report recommends 255 changes to reduce obstacles to patient care, lessen time providers spend completing paperwork, improve communication with consumers, boost utilization of technology and promote quality care. HHS already has implemented 26 of the recommendations.
  • The Nursing Shortage: Can Technology Help? was developed by First Consulting Group for the California HealthCare Foundation and provides an overview of a variety of support systems and technologies that may assist in decreasing nurses' workload and improving the work environment.

Data Collection

  • Healthcare Workforce Solutions has developed a comprehensive national workforce resource database featuring up-to-the-minute health workforce news headlines from the American Hospital Association, a detailed listing of upcoming workforce conferences, and an intuitive, easy-to-use search taxonomy. This resource consolidates a wealth of disparate health workforce information in one site.
  • HRSA projects growing shortage of registered nurses, increasing demand for higher quality health care and a significant number of retiring nurses in The National Center for Health Workforce Analysis within the Bureau of Health Professions, Health Resources and Services Administration (HRSA), has released a paper that provides an overview of two models to project future RN supply and demand. Additionally, the paper describes the data, methods, and assumptions used to project RN supply and demand; presents findings from the models; and discusses the limitations of these and other models and methods to forecast demand for health workers.
  • The University at Albany's Center for Health Workforce Studies has released a comprehensive review of State Responses to Health Worker Shortages.
  • Fitch Ratings, a nationally recognized credit rating agency, reports that the shortage of nurses and other personnel continues to present one of the greatest challenges for health care providers nationwide. Fitch says that while many hospitals are developing innovative strategies for workforce development, and federal, state and local governments are creating programs and providing financial support to help alleviate shortages, the benefits of many of these initiatives may not be realized for years.
    • Contact:
      www.fitchratings.com [A copy of this report can be found at this Web site by clicking on "US Public Finance" and then "Special Reports".]
    • Date: August 2006

  • A study by Lynn Unruh, Ph.D., RN, shows that the number of licensed nurses in hospitals is a strong predictor of adverse events. Specifically, the study found that hospitals with more licensed nurses (with a constant number of patients) had significantly lower incidences of collapsed lungs, bed sores, falls, and urinary tract infections, but significantly higher rates of pneumonia. Hospitals with a greater proportion of licensed nurses to total nursing staff had significantly lower rates of bedsores and pneumonia. The study is published in the January 2003 issue of Medical Care.
  • The Center for Health Workforce Studies publishes reports related to the supply and demand of nurses in New York State. Reports provide trends in the supply and demand of health workers in general and nurses in particular. A report, titled, "New York State Registered Nursing Graduations, 1996-2007," states that while the number of RN graduations in 2004 and 2005 is higher than in previous years, this may not be sufficient to meet the future demand for new registered nurses in New York State.
    • Contact:
      chws.albany.edu [Click on Recent Reports and Presentations.]
    • Date: August 2006

  • Registered Nurses applying for license renewals in the state of Pennsylvania between April 2002 and October 2003 completed a 14 item survey related to job satisfaction. Researchers reported that 85% of the PA nurse respondents were satisfied with their job compared to a 69.1% national average. Of concern is the finding that 28% of RNs under the age of 35 state that they plan to leave nursing within 10 years. The average age of the RN respondents is 46.
  • Three survey findings from the North Carolina Center for Nursing provide information about (1) the length of time that RNs and LPNs have been with their current employers and the degree to which they intend to stay with those employers, (2) the number of nurses seeking additional education and the degree to which their employers provide incentives or rewards to support that goal, and (3) reduction in the amount of time that nurses provided patient care over the last three years.
  • "Nurse-Staffing and Patient Outcomes in Hospitals" reports on an association between a higher proportion of registered nurse-hours per day and lower rates of specific adverse outcomes.

Clarify Existing Laws and Regulations

  • Johanna Duncan-Poitier, Deputy Commissioner, Office of the Professions, and Barbara Zittel, Executive Secretary, NYS Board for Nursing, sent a memo to all licensed nurses and health-care facilities in September 2002. This memo seeks to clarify the NYS Education Department's position regarding actions that could be considered abandonment and lead to charges of unprofessional conduct against a nurse's license.
  • The Economic Policy Institute (EPI) reports that employers that mandate nurses to frequently work overtime can create situations that jeopardize the health of patients.
  • New Jersey adopted a law prohibiting health care facilities from requiring hourly employees to work more than 40 hours a week, except in emergency situations.
    • Contact:
      New Jersey State Nurses Association, Department of Legislative Affairs
      1-888-UR-NJSNA
      http://www.njsna.org/
    • Date: August 2006


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