1

Policy Action Plan- Nursing Shortages

Kayla Adkins

Delaware Technical Community College

Nursing 420 Nursing Policy

Ms. Layer

February 21, 2021

Policy Action Plan- Nursing Shortages

 2

Nursing shortages is a nationwide issue and something that is not going to get resolved

any time in the near future, but there are steps that can be taken to help ease these issues with

staffing. According to the U.S. Bureau of Labor Statistics (2020), employment of registered

nurses is projected to grow seven percent (3 million to 3.3 million) from 2019 to 2029, faster

than the average of all occupations. This growth will occur for a number of reasons, including an

increased emphasis on preventative care; increasing rates of chronic conditions; and demand for

healthcare services from the baby-boom population, as this group leads longer and more active

lives. “The combination of advancements in medical science and general improvement of quality

of living is helping Americans live longer as compared to the past. This trend is evident from the

fact that the proportion of Americans older than sixty-five to the total population has risen from

12.4 percent in 2000 to 14.9 percent in 2016, and expected to rise to 22 percent by 2050”

(Bradley University, n.d.). Not only do you have to worry about taking care of that “baby

boomer” population, but there are also nurses who are getting close to that age of retirement and

their positions have to be replaced. “In 2020, baby boomer registered nurses (RN) will number

660,000, roughly half their 2008 peak” (Auerbach, et al., 2017). In all the ultimate goal with any

healthcare organization that is affected by nursing shortages is to still make sure that patients are

still getting the proper care and nurses have a safe work environment.

According to the American Association of Colleges of Nurses (2020), Dr. Peter Buerhaus

and colleagues found that more than 75% of RN’s believe the nursing shortage presents a major

problem for the quality of their work life, the quality of patient care, and the amount of time

nurses can spend with their patients. Aiken, et al. (2002), conducted research to determine the

association between the patient to nurse ratio and patient mortality, failure to rescue among

surgical patients, and factors related to nurse retention. “It was found that each additional patient
 3

per nurse was associated with a seven percent increase in the likelihood of dying within thirty

days of admission and a seven percent increase in the odds of failure to rescue. After adjusting

for nurse and hospital characteristics, each additional patient per nurse was associated with a

twenty-three percent increase in the odds of burnout and a fifteen percent increase in the odds of

job dissatisfaction” (Aiken, et al., 2002).

Aiken, et al. (2012), found there was a significant association between patient to nurse

ratio and urinary tract infection and surgical site infection. They also found that only nurse

burnout remained significantly associated with urinary tract infection and surgical site infection.

Hospitals in which burnout was reduced by thirty percent had a total of 6,239 fewer infections

(Aiken, et al., 2012). As a nurse one of the biggest things to do to help patients is advocating for

them and if the staffing ratios are not appropriate for proper care then nurses will not be able to

teach their patients, and this is how nurses build rapport with them.

Senator Barbra Boxer, of California has established a bill into law for the healthcare

workers, more importantly, the nursing shortage called “National Nursing Shortage Reform and

Patient Advocacy Act”. This bill is, “To establish direct care registered nurse to patient staffing

ratio requirements in hospitals, and for other purposes'' (Congress.gov, 2015). This bill also

states, “A hospital’s staffing plan shall provide that, at all times during each shift within a unit of

the hospital, a direct care registered nurse shall be assigned to not more than the following

number of patients in that unit: one patient in trauma emergency units, one patient in operating

room units, two patients in critical care units, three patients in emergency room units, step down

units, and telemetry units, four patients in medical-surgical units, five patients in rehabilitation

units and skilled nursing units, and six patients in well-baby nursery uits and postpartum units. It

also states that hospitals shall not impose mandatory overtime requirements to meet the hospital
 4

unit direct care registered nurse to patient ratios required under this section” (Congress.gov,

2015). Along with Senator Barbra Boxer, Senator Richard Durbin from Illinois has written a bill

to “Address health workforce shortages and disparities highlighted by the COVID-19 pandemic

through additional funding for the National Health Service Corps and the Nurse Corps, and to

establish a National Health Service Corps Emergency Service demonstration project”

(Congress.gov, 2021). Even though this bill has not been passed yet the goal of this bill is to

ensure an adequate health care workforce during a public health emergency.

After some research some important stakeholders to contact in regard to changing or

implementing the current policies with nursing shortages. At a local level Sarah Arnett, DNP,

MS, RN, NEA-BC, who is the Chief Nursing Officer (CNO) of Tidal Health Peninsula Regional

would be the point of contact because she is in charge of everything nursing at a local hospital

and she would be able to take any suggestions to the CEO of the hospital and together they

would be able to implement these changes. At a state level there are a few people that could be

reached in regard to these shortages but the most important is Delaware Board of Nursing. They

oversee all Delaware activities and make sure they comply with Delaware Code of rules and

regulations. Another stakeholder that would be good to contact is Martin O’Malley. In 2008,

Maryland Governor Martin O’Malley announced new initiatives to recruit more nursing faculty

and students to address the nursing shortage in the state (Southern Maryland Online, 2008).

“Governor O’Malley also announced the allocation of 3.4 million dollars to the University of

Maryland School of Nursing to help address these shortages” (Southern Maryland Online, 2008).

Governor O’Malley may not be able to enforce many things when it comes to staffing issues at

hospitals but at least he is doing all that he can in his position to make sure there are many

chances for people to become nurses. Finally, at a national level, an important stakeholder to
 5

contact is again Senator Barbra Boxer and the National Nursing Shortage Reform and Patient

Advocacy Act bill.

There are many strategies or steps that can be taken to implement the current system

surrounding nursing shortages, but I believe the most important ones are reimbursing for

working extra shifts, reimbursing for education, giving nurses a break in education, and hiring

temporary staff (travel nurses). According to Cozine & Hassmiller (2006), on average, nurses

work eight and a half weeks of overtime every year. Working these extra shifts are very draining

on nurses and can cause that increase in nurse burnout but if there is an incentive for picking

these extra shifts up, it could cause less stress for these nurses. Also, some nurses who are

currently in school to further their education have only two years to get their bachelor’s degree

so therefore they are working thirty-six plus hours a week and trying to fit school work on top of

that. Again, all of this extra work will cause these nurses to become more stressed. Hospitals

could have a program for these nurses that reimburse them for their schooling or even better

letting nurses get at least a year under their belt before asking them to go back to school for their

furthering degree. Finally, hiring travel nurses would be beneficial but these are all short term or

temporary fixes and not long-term solutions.

If I was ever face-to-face with the decision makers in this policy the points that I would

discuss with them in regards to nursing shortages are the burnout and its effects on nurses and

patients, an increase in pay, the lack of education/teachers at colleges, an important step for the

new graduates would be developing a residency program to make their transition easier, and

finally assembling a contract for the medical/surgical nurses and not just the critical care areas.

According to Bradley University (n.d.), lack of an adequate number of nursing staff can impact

patient well-being in a number of ways including, higher patient mortality (an increase of one
 6

full time RN per one-thousand inpatient days was associated with a 4.3 percent decrease in

patient mortality), and more medication errors (46.8 percent of nurses have committed a

medication error in the past year). Aiken, et al. (2002), found that nurses nationwide consistently

report that hospital nurse staffing levels are inadequate to provide safe and effective care and

thus can lead to nursing shortages. “The shortage of hospital nurses may be linked to unrealistic

nurse workloads and forty percent of hospital nurses have burnout levels that exceed the norms

for health care workers” (Aiken, et al., 2002). Aiken, et al. (2002), also stated that one in five

nurses report that they intend to leave their current jobs within a year. If all hospitals had a

residency program for all new graduate nurses, I believe this would help with retention rates

because these nurses would feel more comfortable and during their residency days they would be

able to ask any questions and voice any concerns they may have to their teachers and it doesn’t

have to be said on the floor. This program was something that I attended as a new graduate at

Tidal Health and I found it very beneficial because it eases the transition from nursing school to

the real world of nursing. An increase in pay would be beneficial because nurses at one hospital

may feel that they are underpaid and may start looking for other hospitals and would therefore

cause their current place of employment to have a lack of nurses. If this hospital was to increase

their average pay, then it would be harder for these nurses to leave. According to American

Association of Colleges of Nursing (2020), U.S. nursing schools turned away 80,407 qualified

applicants from baccalaureate and graduate nursing programs in 2019 due to insufficient number

of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.

Almost two-thirds of the nursing schools responding to the survey pointed to a shortage of

faculty and/or clinical preceptors as a reason for not accepting all qualified applicants into their

programs. Lastly, if all hospitals developed the same program that Tidal Health Peninsula
 7

Regional has developed in regard to making critical care staff sign a two-year contract that states

they will stay for two years and if they don’t they have to pay to get out of it but do this with all

staff it could help keep nurses for a longer period of time. Again, some of these topics may only

be helpful in the short term but these suggestions could help make a solution for nursing

shortages.

To implement or set this plan into action over the next ninety days I would start by taking

the information that I have gained from this research and organize it, so I could take it to my

current manager and ask her and other coworkers for any input. Once they were finished with

their input I would then take it to the CNO and CEO of the hospital for approval. If they

approved it then I would trial it on the current floor that I work on, if it was successful then I

would trial it on other floors. If the other floors found it to be successful, then I would take it

back to the CNO and CEO and get this policy set into action for the whole hospital with hopes

that other hospitals could then use this action plan. My ultimate goals of this policy action plan

are to increase staffing levels in order to decrease nurse to patient ratios and increase nursing pay

without working an increase in the number of hours, which in turn will decrease the stress level

of nurses.

References
 8

Aiken, L., Cimiotti, J., Sloane, D. M., & Wu, E. S. (2012, July 29). Nurse staffing, burnout, and

health care–associated infection. American Journal of Infection Control.

https://www.sciencedirect.com/science/article/abs/pii/S0196655312007092.

Aiken, L., Clarke, S., Silber, J., Sloane, D., & Sochalski, J. (2002, October 23). Hospital Nurse

Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction.

https://jamanetwork.com/journals/jama/fullarticle/195438.

Auerbach, D., Buerhaus, P., & Staiger, D. (2017, May 3). How Should We Prepare For The

Wave Of Retiring Baby Boomer Nurses?: Health Affairs Blog.

https://www.healthaffairs.org/do/10.1377/hblog20170503.059894/full/.

Bradley University. (2018, June 15). The Nursing Shortage and How It Will Impact Patient

Care. https://onlinedegrees.bradley.edu/blog/the-nursing-shortage-and-how-it-will-

impact-patient-care/

Boxer, B. (2015, March 25). Text - S.864 - 114th Congress (2015-2016): National Nursing

Shortage Reform and Patient Advocacy Act. Congress.gov.

https://www.congress.gov/bill/114th-congress/senate-bill/864/text.

Cozine, M., & Hasmiller, S. (2006, January). Addressing The Nurse Shortage To Improve The

Quality Of Patient Care: Health Affairs Journal. Health Affairs.

https://www.healthaffairs.org/doi/10.1377/hlthaff.25.1.268.

Durbin, R. J. (2021, January 26). S.54 - 117th Congress (2021-2022): Strengthening America's

Health Care Readiness Act. Congress.gov. https://www.congress.gov/bill/117th-

congress/senate-bill/54.
 9

News & Information. American Association of Colleges of Nursing: The Voice of Academic

Nursing. (2020, September). https://www.aacnnursing.org/news-information/fact-

sheets/nursing-shortage.

Southern Maryland Online. (2008, February 7). State, Health Officials Address Severe Nursing

Shortage. Southern Maryland Online. http://somd.com/news/headlines/2008/7158.php.

U.S Bureau of Labor Statistics. (2021, February 18). Registered nurses : Occupational outlook

handbook. https://www.bls.gov/ooh/healthcare/registered-nurses.htm.