Dire nursing shortage: How will it affect patient care?

Why the spike in demand?

This demand has grown in large part by the striking rise in the aging population. Between 2010 and 2030, the population of senior citizens will increase by 75 percent to 69 million, meaning one in five Americans will be a senior citizen; in 2050, an estimated 88.5 million people in the U.S. will be aged 65 and older.

Though the number of new nursing students and graduates is growing, the shortage is further exasperated by the rising incidence of chronic disease. Medicare data revealed that two-thirds of traditional Medicare beneficiaries older than 65 have multiple chronic conditions, a number that will only continue to climb.

Adding to this crisis is the reality of an aging nursing workforce. Around 1 million registered nurses are currently older than 50, meaning one-third of the current nursing workforce will reach retirement age in the next 10 to 15 years.

Complicating the current nursing shortage is the limited capacity of nursing schools. According to an American Association of Colleges of Nursing report, “U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.”

Creative nursing shortage solutions

How are hospitals and top nursing schools meeting these challenges?

Instead of cutting back on available beds, hospitals are opting for other short-term solutions, such as:

• Nurses work more hours with financial incentives - In the short term, hospitals are often asking their nurses to work more hours. Those who pick up extra shifts are offered financial incentives. However, when nurses are overworked, they have less time and energy to devote to each patient. Not surprisingly, a fatigued and perhaps burnt-out nursing staff certainly threatens the quality of care and increases the incidence of error.
• “Travel” nurses - Some hospitals come to rely on temporary “travel nurses” who typically work for around 13 weeks at a time, but they come at a premium.
• Advocacy - The American Nurses Association, among other organizations, have advocated that the federal government boost funding for the Nursing Workforce Development Programs contained in Title VIII of the Public Health Service Act. This program provides grants for nursing programs, academic clinical sites and students to help attract, educate and support nursing students. Loan forgiveness programs are also included.

While focusing on short-term solutions to these challenges, hospitals and nursing schools need to also engage in broader long-term solutions. One creative solution to the nursing shortage that some hospitals are exploring is the use of robotic nurses.

Some hospitals have already begun integrating robots into the nursing staff. Japan, with the highest elderly population of any country has developed Terapio, a robotic medical cart that can make hospital rounds, deliver medications and other items, and retrieve records.

Robotic nurses are also useful in nursing homes or other caretaking situations. A “Nursebot” called Pearl reminds patients to take their medicine, to use the bathroom or shower, and to get ready for appointments. Pearl is a nurse robot developed by the University of Pittsburgh and the Carnegie Mellon University in order to help the elderly. It is part of the project called Personal Robotic Assistants for the Elderly, which they started several years ago.

Another quite effective use of robots capable of social engagement is to help with loneliness as well as cognitive functioning with nursing home patients. Telepresence robots which can be controlled through a computer, smart phone, or tablet can even allow family members to “visit” residents, often via a screen where the robot’s face would be.

You can expect to see more mechanized caretakers in hospitals and nursing homes. It’s important to note, however, that robotic nurses don’t decide courses of treatment or make diagnoses. The integration of robots will be more of a collaboration, not replacement for nurses and doctors.

Another longer-term strategy to address the current nursing shortage centers around training the next generation of nurses. Some public and private partnerships, for example, provide fellowships and loan forgiveness for nurses who agree to teach after graduation from nursing school.

Meanwhile, educators are trying to widen the path to a degree for aspiring nurses. Many future nurses, particularly those in rural and poorer areas, enter the field with an associate's degree and pursue an advanced degree later. How can educators provide viable educational opportunities while enabling these nurses to remain in their local communities and possibly current jobs?

One large way is through distance learning. The proliferation of technology and the growth of distance education courses and programs for the delivery of nursing education has increased and that trend is expected to continue in years to come.

Meanwhile, in the classroom…

In the classroom itself, educators are faced with unique challenges for meeting increasing demand for nurses, retaining top talent, and preparing highly skilled nurses who can quickly move into the workforce. There is tremendous pressure on nursing school educators today to relay vast amounts of information to today’s nursing students. Many students find it difficult to truly grasp all of the concepts being taught, and struggle to retain such volumes of information, making passing nursing tests more challenging.

Companies such as Wolters Kluwer are working closely with healthcare industry partners, nursing programs and individual educators throughout the country to build world-class nursing education solutions that meet the demands of today’s healthcare field and today’s busy and mobile students. Delivering cutting-edge nursing education content and training tools, Wolters Kluwer is committed to providing the very best evidence-based content, digital courses and virtual training solutions available anywhere.

Concept-based learning

One powerful tool in the nursing education arsenal that an increasing number of nursing schools are adopting is concept-based learning.

A concept-based curriculum model reduces content repetition and helps students acquire and apply the critical thinking and reasoning skills so essential for practice settings today. Major academic institutions – including the Institute of Medicine, National League for Nursing, American Association of Colleges of Nursing, and the Carnegie Foundation – have all called for profound changes in how nursing students are educated in order to address the realities of 21^st-century health care.

Benefits of a concept-based curriculum include:

• Helps students take a more active role in their learning using the “flipped classroom” model of instruction.
• Streamlines content and eliminates content redundancies across courses.
• Enables faculty to teach clinical reasoning skills more easily.
• Helps students apply concepts from one situation to another—and make connections between those concepts.
• Encourages students to see patterns across concepts and use those patterns to deliver care and anticipate risks.

The potential benefits of a concept-based curriculum are extensive. By far, it is the best method for ensuring that the next generation of nurses is adequately trained and prepared for real-life scenarios they will encounter on the job, and to ensure they can handle the increase in demand for quality patient care. Can we afford anything less?