Hospital staffing has been shown to correlate directly with patient outcome, and with nursing shortages and strikes on the rise more negative events are likely to happen. There have always been periods of fluctuation in registered nurse (RN) vacancy rates, but the current shortage is different as it is predicted to last and only increase in the coming years. The current average vacancy rate is 13 percent, with an anticipated rise to 29 percent by 2020. This rise would mean a shortage of approximately 800,000 nurses in the United States.
The rise in the shortage of RNs is thought to be related to the trend in the age of the workforce and the population of the patients. Nursing dissatisfaction with their work environment also plays a part. The average length of life in the U.S. is increasing, creating a greater number of elderly people requiring care. These new additions are added to the already existing clientele in the hospital setting. The growing number of patients is not being matched by new nurses entering the field.
There has been a slight increase in nursing staff numbers in recent years, but this is thought to be from older nurses, specifically those who had previously retired, rejoining the work force. The slight bump up in numbers is predicted to decline, and continue doing so, as these nurses permanently retire. This will contribute to the growing shortage of nurses in the hospital setting.
The increased patient load and growing vacancy rate of employees is creating a stressful environment for those currently working. Mandating for additional hours of work can occur, which can mean staying beyond what is an already 12 hour shift. An AHRQ-funded study in Pennsylvania found that 40 percent of nurses were dissatisfied with their jobs. This number is four times higher than the dissatisfaction of all employees surveyed. Length of workday, as well as the type of work are thought to add to the nurses dissatisfaction. Physically fatigued, as well as mentally drained, hospital staff have demanded more happen to help them and have started strikes.
Strikes have been around for many years. Evidence has shown that during a nursing strike there is an increase in mortality by 19.4 percent and that hospital readmission rates increase by 6.5 percent. Patients keep coming to the hospital even if the regular staff do not. Many companies exist that try to help staff hospitals when they are on strike. Hospitals with temporary staff show no better improvement in the mortality and readmission rate then those who do not. Strikes seem to disrupt the structure and flow of the patients care and the negative results are seen no matter what measures are taken to prevent them.
Increased wages in often a point discussed during strike negotiations. It is one of the easier points to reach when staffing is not being adequately met. Additional steps are also being taken to improve nursing numbers and work place satisfaction. Many nursing programs have been expanding to accommodate more students in their programs, however, despite having the faculty and resources available to teach, approximately 75,587 qualified applications were still turned away last year. These numbers were not just for RN programs but also for those looking to enter a graduate program in nursing.
Evidence is available to support the fact that strikes cause conflict, and sometimes even death, to happen in the hospital. Further efforts to improve nursing satisfaction and staffing problems are being addressed. More entry into nursing programs, as well as more hiring into hospitals needs to occur. Strikes are not good for anyone and all measures to promote a happy and safe work environment should be taken before a strike even occurs. For hospitals and nurses priority number one is always the patient, and strikes seem to affect the patient most of all.
By Latasha Alvaro
The National Bureau of Economic Research
American Association of Colleges of Nursing
Agency for Healthcare Research and Quality