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Hospital Steps Ease Nursing Shortage in Near Term but Long-Term Worries Persist
Stopgaps Include Higher Pay and Temporary Staff, Raising Cost and Quality Concerns
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Across the communities, hospitals also are pursuing longer-term strategies to address the nurse shortage, including investing in nurse education and improving working conditions. However, a lack of nursing school capacity remains an important barrier to meeting long-term nursing needs, despite such hospital efforts as subsidizing faculty salaries and loaning their own nurses to serve as nursing faculty, the study found.
"Higher pay and increased use of temporary nurses have helped hospitals in the short run, but these are high-cost, stopgap solutions, and many hospitals believe longer-term strategies such as investing in nurse education, while still high cost, will provide greater return on investment," said lead author Jessica May, a health research analyst at HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
Many hospital executives also were concerned that heavy reliance on temporary or inexperienced nurses could affect patient care, according to May and coauthors Gloria Bazzoli, Ph.D., a senior HSC consulting researcher and professor at Virginia Commonwealth University, and Anneliese Gerland, an HSC health research assistant.
The Health Affairs article, titled "Hospitals Responses to Nurse Staffing Shortages," is based on HSCs 2005 site visits to 12 nationally representative communitiesBoston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets for the past 10 years.
Along with investments in nurse education, some hospitals are working to improve nurses working conditions, including higher nurse staffing levels and greater use of support staff for patients personal care needs.
Half of the 32 hospitals in the study reported either achieving or planning to apply for "nurse magnet" status, an American Nurses Association initiative that recognizes hospitals performance on quality indicators and standards of nursing practice that contribute to nurse retention and quality of care.
The authors point out that "it is likely that hospitals will need to turn again to expensive short-term strategies, such as large wage increases and use of temporary staff," given government forecasts of a shortage of more than 1 million nurses by 2012. Future shortages also could affect patient access to and quality of care, they noted.
Therefore, "there is an important role for public financial support to
expand the nursing education system and especially to address the shortage of
.Our research [also] concludes that policymakers can guide
the ways hospitals respond to the nurse shortage
for example, by using
performance on the nurse-sensitive quality measures formalized by the National
Quality Forum" to recognize high-performing hospitals, the article concludes.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.
Health Affairs, published by ProjectHOPE, is the leading journal of health policy.