Strategies for reducing nursing shortage

A recent report published in Health Affairs by the Center for Studying Health System Change finds that while competitive salaries, agency labor, and other short-term fixes have helped temporarily alleviate the nursing shortage, health care officials need to place more focus on long-term efforts to increase the size of the nurse workforce and improve nurses' work environments. Based on a survey of 32 hospitals in 12 nationally representative markets, researchers estimate that 75% of hospitals use temporary nursing staff, 31% use internal staffing agencies, and 19% employ foreign nurses to meet short-term staffing needs.

Ten of the 24 hospitals that use agency nurses said they had reduced their reliance on temporary nurses, with several facilities creating internal per-diem nurse pools to help reduce reliance on agency staffing. Other short-term strategies include raising salaries; offering sign-on, retention, or referral bonuses; implementing flexible and self-schedule systems; and offering a broader range of shift types. All but one of the hospitals surveyed reported using at least one strategy involving the expansion of nurse-education programs.

Nine of the 22 hospitals that had implemented nurse training initiatives reported plans to expand the programs, with many facilities using their training capabilities to operate nursing schools, offer loan repayment in return for a work commitment, or tailor nursing-degree programs to meet the needs of current ancillary staff. In addition, several of the hospitals have begun directly subsidizing nurse faculty salaries, loaned their own nurses to help teach courses at nursing schools, or helped local nursing schools recruit new faculty.

Meanwhile, 88% of hospitals have made changes to nurses’ working environments to help recruit and retain nurses, including altering nurse staffing levels; repositioning nursing roles and responsibilities; making nursing units more accessible and nurse-friendly; and implementing changes to improve care quality. The authors note that while hospitals have expressed a commitment to reducing the nursing shortage, there is an “important role for public financial support.” They also call for further expansion of state and federal grant initiatives for prospective nurses, as well as other strategies to increase nurse faculty positions and training opportunities.

May J.H., Bazzoli G.J., Gerland A.M. (2006) Hospitals' responses to nurse staffing shortages. Health Aff (Millwood). 25(4):W316-23. Epub 2006 Jun 26