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ANSI Member Recommends Solutions for Nursing Shortage


New York, Aug 07, 2002

The heavy healthcare demands of the 78 million rapidly aging "Baby Boomers," combined with a nursing shortage that is expected to leave at least 400,000 positions vacant by the year 2020, is "a prescription for danger," says the national organization that accredits hospitals.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an ANSI-member whose mission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations, issued earlier today an urgent call for action to those who influence, develop and carry out policies that can lead to a "transformation in the nursing workplace."

According to JCAHO officials, a number of inter-related underlying factors are to blame for the current nursing shortage. Among these are complaints from healthcare workers that they are unable to keep up with demands placed on them due to overcrowding (e.g., too many patients per health care worker), working too many hours, and doing paperwork rather than focusing on patient care. Failure to address these problems aggressively, JCAHO warns, is likely to result in increased deaths, complications, lengths-of-stay, and other undesirable patient outcomes. Evidence from the report further suggests that understaffing can be directly attributed to nearly a quarter of the unanticipated problems that result in death or injury to hospital patients.

Although a lack of healthcare workers is not a new problem, experts fear that this shortage may be prolonged by the fact that the nurses themselves are aging as well. The current average age of the working Registered Nurse (RN) is 43.3 years and is projected to be 50 by the year 2010 ? that average age is increasing at a rate of more than twice that of all other workforces in the country. As a result, the number of nurses reaching retirement is increasing, but there are too few new nurses joining the workforce to fill those vacancies.

In a special report, "Health Care at the Crossroads," the first in a series of planned white papers on key public issues created by a special Joint Commission Expert Roundtable, three strategies to combat the nursing shortage within the U.S. healthcare delivery system were identified. First, by bolstering the nursing education system, including giving incentives to those pursuing advanced degrees and enhancing faculties at schools, nurses become better prepared to care for patients. Second, the government must make federal funding available to give incentives to those hospitals investing in nursing services. Finally, hospitals must improve working conditions to make nursing staffs feel empowered and respected, thereby increasing retention rates due to a renewed sense of professional satisfaction.

"The need for solutions to this [nursing shortage] is particularly urgent," said Dr. Dennis O'Leary, president of JCAHO. "We must, as a country, understand not simply what needs to be done, but who specifically is responsible for getting each task done. Otherwise, we face a future in which patient safety and health care quality will be significantly compromised."

To work in conjunction with the suggestions of the report, JCAHO developed new industry standards on staffing effectiveness, which can be found in the "Comprehensive Accreditation Manual for Hospitals," that took effect on July 1, 2002.* Developed by a panel of healthcare experts, the standards require organizations to choose specific and multiple screening indicators (such as overtime, vacancy rates, adverse drug events) that are clinical/service-related and human resource related. The new approach allows organizations the ability to evaluate and assess staffing effectiveness based on the number, competency, and skill mix of the staff by linking effectiveness to clinical outcomes.

Though the Joint Commission evaluates and accredits more than 17,000 health care organizations and programs in the United States, its new standards are merely good ideas unless personnel in the health care delivery system begin conforming to them, which means that until then, "care is literally being left undone."

*Note: JCAHO is not currently an ANSI-accredited standards developer. Thus, the standards referenced here are not currently recognized as American National Standards.

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