Green Room

Obamacare and the Nursing Shortage

posted at 8:56 pm on January 7, 2010 by

Last month, the Carnegie Foundation for the Advancement of Teaching released a study on nursing education in the United States. In their research, they studied the nursing shortage in the country, and the extent of the problem is startling.

To meet current and projected shortages, nursing education programs need to increase their capacity by approximately 90 percent. However, these programs are faced with a severe shortage of faculty, making it difficult to expand; and the already small pool of qualified faculty is rapidly shrinking—almost a third are over the age of 55 and there is a dearth of baccalaureate-level nurses eligible to enter graduate programs. This has caused a sixfold increase in the number of applicants denied admission to nursing schools since 2002.

In other words, nursing schools need to almost double the number of students they graduate into the workforce. There is no shortage of students who want to enter nursing programs, but accreditation requirements mandate a very low student-faculty ratio for those programs, so the number of slots tends to be extremely limited. And, as the excerpt above indicates, the already-small number of faculty is dwindling, which further limits the number of nurses entering the workforce. As the shortage grows worse, the nurses already in the field are forced to work longer hours, which both increases the burnout rate and decreases the quality of patient care.

In short, we don’t have enough nurses in this country to meet our healthcare needs, and those needs are only going to grow as the baby boom generation ages and requires more acute medical care. So what does this have to do with Obamacare? To answer that question, one only needs to look north, where the nursing shortage is reaching near-epidemic levels. Because Canada’s healthcare is “free,” there is high demand for those services and the available resources are consumed all-too-quickly, leading to shortages. How has that affected nursing care? I’ll let the Canadian government explain:

As budgets have been cut in healthcare settings, nurses have been caught in the middle of a speed-up. Simply put, there are fewer nurses to do more nursing, and nurses are simultaneously expected to pick up non-nursing tasks that were not previously the routine responsibility of nursing staff. Nurses are educated to care for patients, but the shortage of support staff has meant that nurses must attend to ancillary needs while patient care is neglected. Unfortunately those other tasks cannot be ignored – patients need meals delivered, they need to get to operating rooms and they need supplies and equipment – and nurses are doing them.

Nurses have a finite number of hours in their shifts, so time they spend performing such tasks is time they cannot spend on direct patient care. Add into that equation the effect this has on nurse morale, and you have a perfect recipe for nurse burnout, which leads to nurses leaving the workforce and a further deterioration of quality in care. So where do those nurses go?

One guess.

President Obama and the Democrats may denigrate the American healthcare system in order to pass their version of “reform,” but it would be interesting to see them explain why, if our healthcare system is so terrible, nurses flock to our shores for the chance to work in it. There is a major difference between our nursing shortage and Canada’s. Here, we lack the capacity to train enough nurses to meet our needs. In Canada, they lack the funds to pay enough nurses to sustain the system. True healthcare reform would seek a solution to the problem of supply in the interests of improving care. Obamacare, on the other hand, puts political correctness first.

Under the Democrats’ plans, if a medical school wants to receive contracts and grants from the federal government, it must operate under a quota system and be able to prove it. On Page 909, the House bill states: “In awarding grants or contracts under this section, the (HHS) secretary shall give preference to entities that have a demonstrated record of the following: . . . training individuals who are from underrepresented minority groups or disadvantaged backgrounds.”

This policy may help fund nursing programs in some parts of the country, but it will do little to alleviate the shortage of medical care in geographic areas where there simply are not enough minorities to recruit into medical programs. Our shortage of healthcare professionals – nurses and doctors – is too serious to be subordinated to a misguided affirmative action program.

The Carnegie study is not the first to show the extent of the nursing shortage, but Democrats in Congress should fully understand the effects of their reform on that shortage as they ‘debate’ the bill behind closed doors.

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Our shortage of healthcare professionals – nurses and doctors – is too serious to be subordinated to a misguided affirmative action program.

Compounded by urban schools, predominately minority, where the high school completion rates is 3 out of 10 because so many students refuse to submit to the white man’s education.

Skandia Recluse on January 7, 2010 at 10:34 PM

Heh. I know several nurses, they’re all feeling the pressure.

There are a couple possibilities that Carnegie leaves out – one being the “90-day-wonder-nurse”, i.e. products of non-baccalaureate nursing programs. They learn mostly patient care issues, how to give injections, how to change sheets, clean bedpans, basic anatomy. The rest, they learn on the job.

Does patient care suffer? Depends. If the hospital can afford to staff the floor with 1 senior nurse, 1 experienced (2-3 years) wonder-nurse, and a fresh wonder-nurse (i.e. 3 people) instead of 2 senior nurses, the patients will all get seen more often, although not necessarily as competently.

For all but a small fraction of the patients, the ones not in intensive care or with very odd hidden defects, i.e. the ones that can’t be made into episodes of “House”, this would appear to be an improvement… and I’m reasonably sure the ICU won’t be staffed by wonder-nurses in any event – too much chance of the hospital getting sued, eh?

But yeah, we need more nurses, and imports only go so far.


acat on January 8, 2010 at 12:05 AM

Let’s round up the usual suspect. First is the PC affirmative action requirements you mention. Second is the trend to mandate how many patients a nurse can care for per shift. If the patient to nurse ratio is lowered, then the hospital will cut back on less skilled ancillary workers to control costs. This results in the nurses having to do this lower skilled work, with less job satisfaction etc.

So the usual suspect is government intervention, rules, and regulations. No doubt Obummercare will fix all this. /s

GnuBreed on January 8, 2010 at 1:28 AM

In the meantime, current students are taking a look at what will happen to their earning potential and the effects of additional government control of their careers under Obamacare and are changing their majors! The nursing program my daughter WAS in, lost 20% of their students who changed their majors because they don’t see the profession as being “worth it” in 10 years. Same thing happened with the pre-Med program… oddly enough the pre-Vet program applications are through the roof!

2nd Ammendment Mother on January 8, 2010 at 11:10 AM

Another strong factor in nurses’ dissatisfaction with their jobs is the amount of paperwork. Everything a nurse does (and doesn’t do!) has to be documented. Far more time is spent on this than on actual patient care. EMRs are supposed to help cut this down (e.g. things won’t have to be written down in more than one place), but as stuff is streamlined in the EMR, the government, insurance companies, and the Joint Commission come up with new stuff that must be documented, or else the nurse is obviously not giving quality care.

LibraryGryffon on January 8, 2010 at 3:09 PM

give preference to entities that have a demonstrated record of the following: . . . training individuals who are from underrepresented minority groups or disadvantaged backgrounds.

Just what we need in a time of decreasing the time a doctor has for each patient – an influx of quickly trained nurses selected based on their minority status.

katiejane on January 9, 2010 at 4:40 PM