ShortageChicago Seago 2

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Published on October 29, 2007

Author: funnyside

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Nurse Shortage 2004 :  Nurse Shortage 2004 Jean Ann Seago, PhD, RN Associate Professor Nurse Shortage & Surplus:  Nurse Shortage & Surplus Shortages Have occurred for nearly a century Have received much attention Surpluses Have occurred for nearly a century Have received little attention History of Nurse Shortage and Surplus:  History of Nurse Shortage and Surplus 1880-1929 Military & Religion:  1880-1929 Military & Religion Established during Crimean War (1853-56) & acquired a high profile in US Civil War(1861-65) Came of age in WWI & gained power in WWII, Korea, Vietnam Military and religious roots. Tasks & rules at expense of reflection, interpersonal relations, & long-term planning. Heterogeneous workforce of women: attracted both upper class and working class women. Allowed women to lead an independent life. Women’s Social Status: 1880-1929:  Women’s Social Status: 1880-1929 Rampant sexism in society and medicine. But, gender does not tell the whole story. Physicians held out the promise of cause/cure rather than preventing disease or reducing symptoms. Physicians were connected with universities. Working Conditions: 1880-1929:  Working Conditions: 1880-1929 Nutting in 1926 wrote that working conditions contributed to shortage of applicants Long strenuous shifts Character/culture of hospitals Better alternative work opportunities for women. Low salary related to lack of promotion and advancement Working Conditions:  Working Conditions Before 1913-students worked 8 hour days with 2 hours off in the middle of the day 6.5 days/week 12 hours on night shifts Education: 1880-1929:  Education: 1880-1929 First baccalaureate degree at University of Minnesota in 1909. Hospital administrators opposed formal nursing education. At the time physicians had a college degree, diploma nursing schools were the norm. Student nurses provided free labor to hospitals. Education:1880-1929:  Education:1880-1929 Goldmark Report Recommendations (1923) Nursing education be standardized. Two levels of registered nurses. Education in colleges rather than hospitals Committee on the Grading of Nursing Schools Recommendations (1928) Nurses should restrict the supply of nurses over-production nurses. Too few nurses in rural areas. 1930 to World War II:  1930 to World War II Hospitals expanded. Most nurses worked in hospitals by WWII. Poor working conditions and salaries. Hospitals and physicians dominated the profession. Belief that nursing had no intellectual component. Slide11:  In the 1940’s there was speeding up of the process of training nurses doubling of enrollment during the early 1940’s Started offering physician-taught courses 2X/year put students on a 48 hour week 1943 formation of the Cadet Nurse Corps Slide12:  By 1944, 88% of students were in the Corps Students obligated themselves to nurse for the “duration plus 6 months” Response indicated pragmatism, tenacity and determination that are characteristic of the culture of the profession World War II to the 1960s:  World War II to the 1960s 1943: Nurse Training Act. 1946: Average annual salary $2,100. 1947: NY first mandatory licensure law. 1948: NLN set standards 3.5 nursing hours/patient/day 2/3 of nursing hours required to be given by RN 1956: Professional Nurse Traineeship Program World War II to the1960s:  World War II to the1960s Brown Report (1948) Equivalent to 1919 Flexner Report for medicine. Stated apprentice nursing training was no longer sufficient. Nursing education belonged in colleges, but still…this did not widely change. UCSF School of Nursing:  UCSF School of Nursing 1947-attempt to limit training to one year A systematic effort to deny nursing faculty promotions (threatened the quality and the existence of the school) First Master students in the Fall, 1949 1949, the Nursing Faculty & students were relieved of their responsibilities for patient care in the University of California Hospital But, 1952--in Executive Committee minutes there was discussion of weekend shifts by students Wages: World War II to the 1960s:  Wages: World War II to the 1960s Monopsony & Oligopsony. Monopoly & Oligopoly. A few hospitals controlled patient market and worker market. Kept patient prices up and wages down. Nursing: 1960s to 1970s:  Nursing: 1960s to 1970s 1965: Medicare 1966: Medicaid Nursing: 1970s to 1990s:  Nursing: 1970s to 1990s RN wages fell in comparison to comparable occupations. 1982-83 DRGs 1983: IOM said the aggregate nurse supply was adequate & that funds should be targeted to underserved populations. Slide19:  “Floating” became less practical because most units were highly specialized Mid 80’s there was a closer match between supply and demand 1986-90 there was a “shortage” again 1990-92- there was an “surplus” again Current Status:  Current Status Real wages after 1986 were erratic. Salaries declined in 1992 and 1993. Inflation-adjusted wages declined through the 1990s The cycles of nursing shortages & surpluses continues... Response:  Response Typically based on supply and demand. We enact policies to increase supply Distribution problems are not solved by increasing the overall supply. Long standing problems are not addressed Consistent and Repetitive (aka same ole…same ole):  Consistent and Repetitive (aka same ole…same ole) Pay issues (overall and salary compression) Working conditions in hospitals Educational issues & control Do nurses require intellect? Control over the work Control over the job Needs or wants? What determines demand? Slide23:  Why should employers (ie hospitals and physicians) depend on the government (state & federal) to supply nurses? Especially when hospital employment practices create many of the problems Predictors of Shortage Seago, J. A., Ash, M., Grumbach, K., Coffman, J., & Spetz, J. (2001). Hospital registered nurse shortage: Environmental, patient and institutional predictors. HSR: Health Service Research.:  Predictors of Shortage Seago, J. A., Ash, M., Grumbach, K., Coffman, J., & Spetz, J. (2001). Hospital registered nurse shortage: Environmental, patient and institutional predictors. HSR: Health Service Research. Persistent shortage Deep South & West High Medicare & Medicaid populations. High county % of non-white population. Using team/functional instead of primary/total patient care as method of nursing care delivery. Intermittent Shortage (1990) Deep South & Midwest Higher case mix index High county % of non-white population. Using team/functional instead of primary/total patient care as method of nursing care delivery. Life Cycle of Shortages:  Life Cycle of Shortages Cycles of shortage/excess are probably normal. Nursing markets are local, not national. Intermittent shortages will self-correct as local wages increase. Subsidized educational programs depress the wage rate. What to do...:  What to do... Allow the market to correct itself. Link education to licensure… recognition that all nurses are not the same Eradicate salary-fixing practices of employers. Change “on-the-job” behaviors of physicians and hospital executives that drive nurses from the direct care hospital workforce. Acknowledgements:  Acknowledgements Friss, L. (1994). Nursing studies laid end to end form a circle, Journal of Health Politics, Policy and Law, 19(3), 597-631. Yett, D. E. (1970). The chronic "shortage" of nurses. In H. Klarman (Ed.), Empirical Studies in Health Economics (pp. 357-397). Baltimore: The Johns Hopkins University Press. Yett, D. E. (1975). An Economic Analysis of the Nurse Shortage. Toronto: D. C. Heath and Company. Drs. Jane Norbeck, Marilyn Flood, and Catherine Waters for information & assistance

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