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After reading the article what are the present demand for nurses? Use this reference only Abstract According to healthcare experts, the present nursing shortage is going to extend to 2020 with an estimated 400,000 RN vacancies. A number of factors are contributing to the shortage: an increase in the age of registered nurses, decreased school enrollment, increased career opportunities for women, changes in the healthcare delivery system, nurse “burn-out,” and the public’s misunderstanding of what nurses do. Additionally, a number of social and economic trends are going to affect the healthcare delivery system in the future, such as: aging of the population, increased technology, the increase of the health/wellness movement, changes in employee’s work ethic, influence of Generation X and dot.com workers, and scarcity of entry-level and low-wage workers. If nursing is going to be a major player in the healthcare delivery system in 2020, nurses must take an active role in developing and implementing a strategic plan. We need to look beyond solutions used in the past, such as increasing compensation and modifying school curriculums. Why do we study nursing history and what value does this information have for the future? Alma Woolley from Georgetown University says that history is important for 4 reasons: to be educated people, to honor our foremothers, to learn from the past, and to try and make different mistakes. 1 If we can better understand the past, then we can use this information to impact the future.The past gives us knowledge and experience, and the present gives us the power to change things: together the past and present allow us to envision—and shape—the future.2 p.26The future, according to healthcare experts, includes a major national shortage of healthcare workers, especially registered nurses. 1-8 More than one-quarter of hospital respondents in a 2001 survey said that they have had to divert patients from their emergency rooms, 28% report reducing beds and 15% have canceled surgeries. 9 The experts speak out on the nursing shortage: Denise Thornby, President of the American Association of Critical Care Nurses:With this shortage projected to be the worst we’ve ever experienced, the American Association of Critical Care Nurses is concerned that patients will lose the personal connection and healing effect that only nurses can provide. Richard Davidson, President of the American Hospital Association:We have an impending public health crisis sitting out there just waiting to happen over time. Pamela Thompson, Executive Director of the American Organization of Nurse Executives:A critical shortage of nurses exists in this country that could jeopardize hospitals’ ability to provide patient care services. This multifaceted problem requires investment from those inside and outside the healthcare delivery system to solve. Charles Roadman, President/CEO of the American Health Care Association:Finding, training and keeping qualified nursing staff is one of the most important challenges facing America’s long-term care providers . . . failure to do so will have detrimental consequences to future retirees and to the very future of long-term care in America. Gail Kincaide, Executive Director of the Association of Women’s Health, Obstetric and Neonatal Nurses:The nursing shortage is an extremely serious and complex healthcare problem that affects all Americans. Researchers Buerhaus, Staiger, & Auerbach:Unlike past shortages, the coming RN shortage will be driven by fundamental, permanent shifts in the labor market that are unlikely to reverse in the next few years . . . The RN shortages we foresee are in stark contrast to the oversupply expected by the Pew Health Professions Commission in 1995.The projected nursing shortage is attributed to multiple factors: an increase in the age of the RN workforce, decreased nursing school enrollment, increased career opportunities for women, rising wages for women relative to men, higher hospital census/greater acuity, and changes in the workplace that are contributing to nurse “burn-out.” Additionally, an overall perception by the public that a nurse’s work consists of long hours and low pay is believed to seriously affect recruitment of nurses. 4,13The actual size of the nursing shortage is difficult to quantify. As of March 2000, the total number of licensed RNs in the United States was estimated to be 2,696,540, which is the lowest increase (5.4%) reported in previous national surveys. 14 According to the Department of Labor, there has been a steady increase in nurses entering the profession and a decrease in actual job demands of 2.7% between 1992-1997. 7 This compares to a 3.6% annual increase from 1985-1991. 7 Additionally, the number of registered nurses employed in nursing practice rose by an average 3.4% between 1992-1997, culminating in an employment rate of approximately 83%. 7However, if the demand has stabilized, as reported by the Bureau of Labor Statistics, which is certainly debatable, and the number of practicing nurses is increasing, why is a shortage predicted? The answer is not just in simple numbers. Multiple factors enter into the equation, such as school enrollment, graduation rates, number of schools producing nurses, types of nursing educational programs, mobility within the profession, projected age of the workforce, numbers of nurses leaving traditional bedside nursing jobs, and the myriad of changes that affect how healthcare is being delivered and will be delivered in the future. Additionally, the reengineering trends of the late 1980s to early 1990s resulting in RN layoffs and elimination of positions has been reversed, which may explain the decrease in the job demands as reported by the Department of Labor for the period from 1985 to 1991. Nursing Enrollment is DecreasingEnrollment of entry-level bachelor’s degree students in the nation’s nursing schools has been decreasing for 6 consecutive years including: a 5.5% decrease in 1998, 4.6% decrease in 1999, and another 2.1% decrease in the fall of 2000. 16-18 Enrollment in 5-year baccalaureate nursing schools has dropped 16.6% during the past 5 years, from 72,452 in 1996 to 60,443 in 2000. However, associate degree graduates in 1996 made up over 60% of new RN graduates, continue to increase in numbers and percents. 19 Of the approximately 2.7 million nurses licensed in 2000, 41% (1.1 million) are associate degree prepared compared to 29% (792,000) at the baccalaureate level. 14Nursing’s ImageThe literature reports that nursing has lost some of its luster as a career opportunity, partly because nursing is a traditionally female profession and options for women have increased. 4,9,20 Women graduating from high school in the latter part of the 1980s and during the 1990s were 35% less likely to become RNs compared to women in the 1970s. 4 Additionally, the changes in the healthcare work environment in the 1990s (ie, downsizing, reengineering, and reorganization) have resulted in lingering negative impressions of nursing’s image. 18,20-22 Nancy Mills, Dean of Nursing at University of Missouri at Kansas City, states, “there have been so many headlines the last few years about how healthcare is changing, about downsizing, consolidating . . . it’s going to take a while to undo those headlines.”Recent surveys suggest a dichotomy between the public’s perception of nursing as a noble profession and an equally strong opinion that nursing is difficult, unglamorous, and often unpleasant. Spokesperson for the American Association of Colleges of Nursing, Dan Mezibov, suggests that the public lacks information on the many opportunities for nursing created by the healthcare changes, such as advanced practice roles and informatics, and continues, “[the public walks] around with old headlines in their heads.”Despite the media’s presentation of nursing, the public continues to give nursing high ratings for honesty and ethics. A Gallup poll of 1,028 adults found that for the 2nd year in a row nurses are perceived as #1 by the public in honesty compared to other professions such as pharmacists (#2), veterinarians (#3) and physicians (#4), and as #1 in ethical behavior, the same rating as the clergy. 25-26 A national survey on managed care revealed that the majority of Americans (83%) thought nurses were doing a good job. 27 However, on the negative side, the Jobs Rated Almanac 2001, based: the workplace environment, income, future prospects, physical demands, job security, job stress, wages, length of work-day, and hiring trends, rated nursing as the 137th most desirable job out of 250 professions. Unfortunately what the public sees and hears are what the public believes. Furthermore, the results of the Woodhall study indicating that nurses were cited only 4% of the time in over 2000 health-related articles from 16 major news publications gives further evidence of the lack of a positive and realistic nursing image presented to the public. 28 The few references to nurses were mostly in passing and many of the stories would have been strengthened by including a nurse. Nurse “Burn-out”Only one-half as many women select nursing as a career than 25 years ago 30 and 54% of nurses surveyed say that they would not recommend their profession to their children or friends. A number of factors could be contributed to the lack of referrals, such as the increased opportunities for women in the job market and higher salaries; however, some nurses within the field think that the job itself is responsible. Many hospital nurses are frustrated to the point of burn-out from what they consider inadequate numbers of nurses, rising patient loads, declining quality of patient care, and verbal abuse directed at them while on the job. Among a 1998-1999 survey of 43,329 registered nurses at 711 hospitals in 5 countries, more than 43% scored high on a “burn-out inventory” used to measure emotional exhaustion and the extent to which they felt overwhelmed by their work. One out of every 3 nurses in the United States younger than 30 plans to leave their jobs within the year due to dissatisfaction with scheduling, mandatory overtime, and high stress. A 1999 study by a national consulting firm, William Mercer, Inc., found that the primary reason for nurse turnover is increased market demand exacerbated by dissatisfaction with the job and other career prospects. 7 This fact is supported by continued negative trends in employee opinion survey results of registered nurses according to human resource consultants, Velghe & Associates (Personal communication, July 5, 2001). This low morale and dissatisfaction with the “status quo” are also evident in the current increase in nurse unionization. Future NeedsThe Bureau of Labor Statistics reports that the registered nurse is the largest U.S. healthcare occupation, and is one of the 10 occupations projected to have the largest number of new jobs, up to a 23% increase. 13,33 This is good news for the new graduate, but not such good news for the job market that is requiring more and better-educated nurses. The overall number of full-time nurses per capita will reach a peak in 2007, and then will decline through 2020. 11,12,18,34 These predictions equate to up to a 20% shortage in the next decade, and 400,000 vacant RN positions by 2020. 11,35 And the shortage is already being felt today with a reported 126,000 RN vacancies. Experts suggest that this nursing shortage will not be easy to fix, especially with the aging nurse population (average 45.2 years of age) 14 and a lack of 650,000 BSN prepared nurses required. This shortage is not just in hospitals, but also in nursing homes, which project that they will need 66% more RNs in 2020 based on the 1991 data. Additionally, the decline in the supply of RNs will come at a time when the first of 78 million baby boomers begin to retire and enroll in Medicare. 11The Future as Possible, Plausible, Probable, and PreferableAccording to Hancock and Bezold the future is plastic so it must be looked at from 4 viewpoints: the possible, plausible, probable, and preferable. Science and technology will produce sweeping changes in how healthcare is delivered, making the possible very much a reality. “Knowledge being used today will be obsolete tomorrow.”Technological AdvancesTechnology is advancing at a rate unprecedented in history. Americans cannot read a single newspaper or popular journal without seeing a glimpse of the future and the impact technology has on daily living. Computers are faster, telephones have gone wireless, and driving directions can be obtained from automobile dashboards. “No one knows what life will be like in 2020, but if we know the developmental rates of different technologies, we can anticipate many of the things that will be possible and when they are likely to happen.” Who would have thought that 10 years ago that the public would discuss chip sizes, bandwidths, and computer viruses over lunch? Or who would have understood a “smart card?”The notion that all doors in a building should contain a computer chip seemed ludicrous 10 years ago, but now there is hardly a hotel door without a blinking, beeping chip. Soon, every FedEx package will be stamped with a disposable silicon flake that smartly tracks the contents. If an ephemeral package can have a chip, so can your chair, each book, a new coat, a basketball.And more mind-boggling ideas are in our near future. Within one year it is expected that the DNA sequence will be completed for 5 humans; by 2004 Japan’s robot population will exceed 1 million; by 2006 artificial electronic life will be available; by 2008 households will have digital bathroom mirrors; and by 2010 there will be designer babies, electronic wallpaper that responds to mood, and artificial nervous systems for autonomous robots. Biomedical research will lead to advances, such as refined biological markers of disease states; and optical fiber technology whereby blood analysis could be done without drawing blood. Think the imaginable and enjoy the Stephen Spielberg movies, because science fiction will be reality for home life, the workplace, and how healthcare is delivered.Technological changes will also have a major impact on what the future of healthcare will look like, and what role the registered nurse will have. Envision healthcare in 20 years. Much of the care will be outside of the hospital. Inpatient units will be intensive care units staffed by clinical and technical experts. Patients will be monitored continuously and highly intelligent computers will deliver medications, adjust ventilator ratings, and measure bodily fluid input/output. Charting will be done on voice-activated computers and communications with others on the healthcare team by wireless headphone. Robots programmed with artificial intelligence will provide direct patient care.Healthcare information technology will change how patients access care. A patient of the not-to-distant future will be likely to receive care at home, communicate with his or her healthcare providers by e-mail and groupware, and access information via the Internet. Ambulatory and home patients will be monitored by Telenets. If a patient needs a prescription filled he or she will go on-line and click once; if the patient needs to talk to a healthcare provider, the patient will go on-line and click twice. Wireless phones will be used to obtain vital signs and scan body systems. Obstetric caregivers will read fetal heart tones, check for placental circulation, monitor blood glucose and blood pressure from the patient’s home or workplace, eliminating the need for on-site prenatal visits. Patients with chronic illness will have implants to read heart rates, insulin levels, and arterial functioning.Economic, Social and Labor TrendsEconomic and social trends are also going to impact the future for healthcare and the job market for registered nurses. Futurists Cetron and Davies predict a number of social trends, such as: increases in population numbers, aging of the population, the growth of the information industries, creation of a knowledge-dependent society, increased acceptance of cultural diversity, integration of a global economy, increased acceptance of the personal-health movement, increase in nutrition and wellness programs, diversity of family structures, increased environmental focus such as recycling, air purity and water conservation, and the loss of biodiversity. New trends in the labor force and workplace are also predicted, such as: improvement in the equality in women’s salaries as compared to men’s salaries, changes in unionization practices, increases in 2nd and 3rd careers, dual-income couples as the norm, changes in employee’s work ethic, influence of Generation Xers and dot.com workers, scarcity of entry-level and low-wage workers, and acceptance of the virtual corporation. SolutionsThe future for registered nurses depends on how nursing’s leaders address the issues at hand. Well-known nursing expert Luther Christman emphasizes the need for well-educated nurses working in varied employment settings. According to the most recent National Sample Survey, 59.1% of RNs today work in the hospital setting, 18.3% in public/community health, 9.5% in ambulatory care, and 6.9% in nursing homes/extended care. The future will provide more nonhospital job opportunities. New careers will surface, such as clinical care providers at Telenet sites, coordinators of clinical robotics, and program experts for healthcare artificial intelligence. A recent example of new roles for nursing is the “Thoughtmill” project, a software approach for chronic congestive heart failure (CHF) patients. The prototype will incorporate automated, telephone-based acquisition of clinical data to successful management of CHF, and direct nurse case manager advice to patients most likely to benefit from intensified intervention. 47The experts suggest that the numbers of RNs are decreasing, especially baccalaureate graduates; the number of older Americans are increasing; and the healthcare delivery models are changing, all at the same time. If nursing leaders and employers can begin working together now to plan, they can best use the increasingly scarce RNs to deliver patient care in the future. Short-term and long-term strategies are needed to avoid a catastrophic impact on the delivery of quality healthcare to those who need it. Some of the solutions suggested by the experts have been tried before, while others offer creative and innovative visions of how nurses can be assisted in future health delivery models. Some of these solutions include:Conclusions and RecommendationsThe future can be frightening, especially if we are not prepared; however, the future can also offer opportunity. The job market will look different for both the demand and supply sides. If nurses are involved in the planning process, then the road becomes clearer and more manageable to addressing both sides. What if the above scenarios were designed without nursing? What if the insurance vendor, information technologist, or risk manager constructs the design without input of the primary caregivers? What if Telenet programs are developed without the RN to address wellness, nutrition, medication interactions, and teaching? What if healthcare executives design an inpatient healthcare delivery system without professional nurses?The experts tell us that there will not be enough nurses to meet future need; however, if changes are made now and nurses become involved in the strategic planning, then the nursing shortage can be dealt with as possible, plausible, probable, and preferred. Nurses must be visible to the power makers and the power, telling them what nurses do, how they do it, and what they cost. The future for nursing demands visibility with the public, visibility with the power makers, visibility in Washington and in front of the policy makers. “If people don’t know what you do at the bedside, and recognize its importance, they won’t miss you when you’re gone.”If nursing is going to be a major player in the healthcare delivery system in 2020, then, nurses must take an active role in developing and implementing a strategic plan. It will take more than the solutions used in the past, such as increasing compensation and modifying school curriculums. Throwing money at the problem is like stomping on the ants as the elephants stampede. This shortage is going to take creativity and visibility of nursing as a profession, as well as visionary leaders who can articulate what nurses bring to the arena. As the technological innovators create the prototypes nurses will need to be there with solutions that are possible, plausible, probable and preferable. These solutions necessitate addressing both the present and future market such as: burn-out, decreased school enrollment, aging workforce, and the impact of technology on patient care. The future will be different than both the past and the present and this is nursing’s opportunity to run the marathon.

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