Nursing Shortage: Assumptions and Realities Chapter 19 PDF

The Nursing Shortage: Assumptions and Realities Chapter 19 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Objectives Identify relevant issues in relation to the nursing...

The Nursing Shortage: Assumptions and Realities Chapter 19 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Objectives Identify relevant issues in relation to the nursing shortage Articulate selected frameworks for analyzing issues arising from the nursing shortage Analyze selected strategies to address these issues Identify past and current barriers to resolution of the nursing shortage Discuss strategies for resolution of the nursing shortage Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Nature of the Nursing Shortage CNA has highlighted an impending shortage of nurses who have the skills and knowledge to meet the healthcare needs of the Canadian population, a shortage that has been unequaled in past decades. When the inability to fill vacant positions is conceptualized simply in terms of shortage, as a temporary and easily corrected mismatch of supply and demand, mainly instrumental or quick-fix solutions suggest themselves; the concern with quick-fix solutions is that there is an element of distress that remains unaccounted for. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Framing and Analyzing the Issue The nursing shortage can be best understood as multiple problems, all raising issues for nurses. Viewed simply as a problem of numbers, the nursing shortage could be resolved by producing more nurses. Viewed as a problem of working conditions, the issue could be resolved by mobilizing resources to improve working conditions. Viewed as a problem of work satisfaction, the issue could be resolved by addressing nurses’ concerns about salaries and other contractual issues. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Historical Analysis of the Nursing Shortage There is still no consensus about what constitutes a shortage and the relationship between persistent vacancies and the apparent availability of nurses to fill them. Until we know better what is going on when faced with vacancies in nursing positions, we will continue to talk about the situation as a shortage. In many instances, nurses are excluded from important decisions about the number of nurses needed, how nursing positions are best managed to provide care, or even what constitutes adequate care. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Historical Analysis of the Nursing Shortage (cont.) Shortages are linked to an increased demand for what it is that professional nurses are to provide—nursing care. Nurse positions are created for many reasons, which are not always clearly linked to the need for nursing service. Structural changes seldom mean improved healthcare services. What remains unacknowledged are the underlying conditions that created the surplus and the conditions— now about a decade later—that have led to a predicted nurse shortage of crisis proportions. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Ethical Analysis of the Nursing Shortage In addition to the ethical issues raised for individual nurses when they are not able to practice in accordance with the CNA’s Code of Ethics (2008) in the provision of safe, competent, and compassionate care, an ethical issue of great concern is the recruitment of nurses internationally to fill positions in Canada. An appealing standard of living contributes at least in part to Canada’s ability to recruit nurses from international countries, who have not only invested in those nurses’ education but themselves suffer from even more extreme shortages of nurses. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Social and Cultural Analysis of the Nursing Shortage This type of analysis provides the background to how particular issues develop in particular contexts that influence both the way the issue is understood by others and its possibilities for resolution. The disparity between what society believes it means to be a nurse and the reality of the nature and conditions of nurses’ work continues to grow. What is less well understood are the assumptions and discourses that underlie these conditions, the values that are attached to nurses’ work that perpetuate unsatisfactory working conditions. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Social and Cultural Analysis of the Nursing Shortage (cont.) What are the prevailing attitudes in society about this issue? What values and priorities of the dominant culture influence this issue? In what ways, if any, do these values and priorities privilege the dominant culture over other members of society? Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Economic Analysis of the Nursing Shortage An economic analysis can highlight how the forces of supply and demand work in a particular issue. What some call a nursing “shortage” may manifest itself principally as a “problem” of numbers, which in turn can be most effectively addressed by managing or rebalancing supply and demand. Vacancies only indicate “the inability to recruit people or retain them in a particular position”; there is no analysis of how the numbers of needed nursing positions are determined or who determines this. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Political Analysis of the Nursing Shortage Although some nurses claim they are not political, others insist there is no escaping politics. To be able to persuade others that nurses working to their full capacity will produce different outcomes, that practice could be restructured to maximize nurses’ skills and knowledge, and that nurses are a scarce resource that cannot be spared to do non-nursing tasks is to have power. Nurses have, in many provinces, through changing legislation, acquired legal powers that legitimize various nurse roles. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Critical Feminist Analysis of the Nursing Shortage What are the structures and ideologies in our world that contribute to errors or myths about a nurses’ abilities or realities? Is this issue influenced by the power inequities or the hierarchic or patriarchal structures of institutions over patients? In this situation, is expert power given authority over the right to be the subject of one’s life? Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Barriers to Resolution of the Nursing Shortage The biggest barrier to resolving the nursing shortage is the way this issue has been conceptualized and understood; shortages have been viewed as short-term problems solved temporarily either by educating more nurses or by recruiting nurses internationally. Another barrier is the viewing of nurses as temporary workers created to fill a gap in services. Another barrier is the incongruity between the complex nature of nursing practice and the status of nurses’ work and nurses’ knowledge. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Barriers to Resolution of the Nursing Shortage (cont.) A fourth barrier is the government’s failure to consider the long-term ramifications of cost cutting on healthcare and of the nurses who are central to its provision. Perhaps a large part of the current situation in nursing has to do with how conditions of practice conflict with “nurses’ beliefs about what is necessary in terms of care.” Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Strategies for Resolution Emphasis is placed on the contributions that nurses have to make in the resolution; strategies that nurses can carry out are central, beginning with what nurses must change to move the shortage issue to resolution. A pivotal strategy is to acknowledge that nurses’ concerns have been largely ignored in past decades. Rather than discounting nurses’ experiences or interpreting nurses’ differing viewpoints as simply wrong, we might profitably ask why it is that we as nurses interpret our experience of the healthcare system and its working differently from others. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins  Summary Those who understand nurses as something more than a pair of hands or more than technical support for the real work of medicine will recognize the need to question the current situation that has been named the nursing shortage. Questions raised about the relationship between recurrent shortages and the conceptualizations of nurses’ work, women’s work, and nursing knowledge must be addressed. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins