The Call for Health Care Reform and the Pediatric Nursing Shortage

Abstract

Curiously, the intense debate pertaining to health care reform has directed scant attention to the current and growing shortage of health care professionals, including registered nurses (RNs), to provide health care to the American public. This workforce shortage of RNs will surpass 1 million by 2016, just 7 years away. This labor crisis will be exacerbated with the projected extension of health care coverage to at least 15 million more Americans, with the goal of ensuring all Americans, estimated at 45.6 million, who do not currently have health insurance (U.S. Department of Health and Human Services, 2009U.S. Department of Health and Human Services Take the health reform quiz.http://www.healthreform.gov/index.htmlDate: 2009Google Scholar). The American Nurses Association, 2009American Nurses Association ANA reaffirms support of health reform legislation.http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2009-PR/ANA-reaffirms-support-for-Health-Reform-Legislation.aspxDate: 2009Google Scholar has affirmed support for health reform, although currently it is not known what provisions would be contained in the final legislation. An early proposal draft from the House of Representatives contains provisions that include universal coverage and expansion of the Nursing Workforce Development programs. Nursing constitutes the largest group of health care professionals, amounting to 2.5 million active RNs (American Association of Colleges of Nursing, 2008American Association of Colleges of Nursing Accelerated programs: The fast-track to careers in nursing.http://www.aacn.nche.edu/Publications/Issues/Aug02.htmDate: 2008Google Scholar, U.S. Department of Labor, Bureau of Labor Statistics, 2008U.S. Department of Labor, Bureau of Labor Statistics Occupational Outlook Handbook, 2008–09 Edition, Registered Nurses.http://www.bls.gov/oco/ocos083.htmDate: 2008Google Scholar). Nearly 60% of RNs work in hospitals; the remaining amount of nurses work in ambulatory care, nursing homes and extended care facilities, public health, and other community settings (United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, 2007United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions Toward a method for identifying facilities and communities with shortages of nurses.ftp://ftp.hrsa.gov/bhpr/nursing/nurptsummary.pdfDate: 2007Google Scholar). The projected nursing workforce shortages are predicated in part by the U.S. Department of Labor, Bureau of Labor Statistics, 2008U.S. Department of Labor, Bureau of Labor Statistics Occupational Outlook Handbook, 2008–09 Edition, Registered Nurses.http://www.bls.gov/oco/ocos083.htmDate: 2008Google Scholar projections that nearly 600,000 new positions in nursing will be created in the decade from 2006 to 2016, amounting to a 23% employment growth (U.S. Department of Labor, Bureau of Labor Statistics, 2007U.S. Department of Labor, Bureau of Labor Statistics Occupational outlook handbook, 2008–2009 Edition. Registered nurses.http://www.bls.gov/oco/ocos083.htmDate: 2007Google Scholar). This employment growth is attributable to a variety of factors that include technological and medical advancements, the increasing numbers of the aged, the rising population growth, and the changing service delivery model from acute care to community care settings (United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, 2007United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions Toward a method for identifying facilities and communities with shortages of nurses.ftp://ftp.hrsa.gov/bhpr/nursing/nurptsummary.pdfDate: 2007Google Scholar). The professional growth rate of nurses is and will continue to be hampered by the anticipated retirement of RNs, alternative professional options available, decreased numbers of candidates passing the RN licensing examination, drop in the number of nursing school graduates, and the shortage of educational placements for nursing applicants (United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, 2007United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions Toward a method for identifying facilities and communities with shortages of nurses.ftp://ftp.hrsa.gov/bhpr/nursing/nurptsummary.pdfDate: 2007Google Scholar). It is difficult to estimate what this convergence of events, the nursing shortage, the increase demand for services, and health reform will have on specialty areas of care such as pediatric nursing. It is not possible to generate workforce estimates of specialty areas of nursing practice as these data are not collected. Currently, the National Sample Survey of Registered Nurses, the national survey of the RN workforce, is limited to collection of data pertaining to employment settings (United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, 2007United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions Toward a method for identifying facilities and communities with shortages of nurses.ftp://ftp.hrsa.gov/bhpr/nursing/nurptsummary.pdfDate: 2007Google Scholar, U.S. Department of Health and Human Resources, Health Resources and Services Administration, Bureau of Health Professions, 2004aU.S. Department of Health and Human Resources, Health Resources and Services Administration, Bureau of Health Professions What is behind HRSA's project supply, demand, and shortage of registered nurses?.ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdfDate: 2004Google Scholar, U.S. Department of Health and Human Resources, Health Resources and Services Administration, Bureau of Health Professions, 2004bU.S. Department of Health and Human Resources, Health Resources and Services Administration, Bureau of Health Professions The registered nurse population. Findings from the March 2004 National Sample Survey of Registered Nurses.ftp://ftp.hrsa.gov/bhpr/workforce/0306rnss.pdfDate: 2004Google Scholar). The widespread effects of the nursing workforce shortage on specialty care areas of nursing practice have been primarily based on the observations of experts and data collected with smaller samples of specialty nurses (Betz, 2006, March/AprilBetz C.L. Nursing shortage, pediatric, child and family nursing.Journal of Pediatric Nursing. 2006, March/April; 2: 85-87Abstract Full Text Full Text PDF Scopus (4) Google Scholar, Betz, 2003Betz C.L. Vanishing pediatric nursing faculty.Journal of Pediatric Nursing. 2003; 18: 1Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, Lacey et al., 2008Lacey S.R. Kilgore M. Yun H. Hughes R. Allison J. Cox K.S. Secondary analysis of merged American Hospital Association data and U.S. Census data: Beginning to understand the supply–demand chain in pediatric inpatient care.Journal of Pediatric Nursing. 2008; 23: 161-168Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, Leonard et al., 2008Leonard B.J. Fulkerson J.A. Rose D. Christy A. Pediatric nurse educator shortage: Implications for the nursing care of children.Journal of Professional Nursing. 2008; 24: 184-191Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, Perlino, 2006Perlino C.M. The public health workforce shortage: Left unchecked, will we be protected?.http://sph.ucdavis.edu/documents/APHA_issuebrief_sept2006.pdfDate: 2006Google Scholar, Woodring, 2001Woodring B. The newest addition to the endangered species list: Pediatric nurses.Journal for Specialist in Pediatric Nursing. 2001; 6: 53-54Crossref Scopus (4) Google Scholar). Recently, the findings of two studies examining workforce issues pertaining to pediatric nursing practice and education were conducted. Both of these studies represent important exploratory efforts to investigate the status of the pediatric nursing workforce in clinical and academic settings. Using merged data from the American Hospital Association Annual Survey of Hospital and the U.S. Census Bureau, a secondary analysis was conducted to estimate current and projected pediatric registered nursing full-time equivalent (FTEs) in states with the highest and lowest bed and nursing resources. Findings revealed that significant variability exists among states. California, Texas, and New York have the highest number of pediatric beds and RN FTEs as well as projected pediatric demand, whereas the states of Delaware, Wyoming, and Hawaii have the lowest (Lacey et al., 2008Lacey S.R. Kilgore M. Yun H. Hughes R. Allison J. Cox K.S. Secondary analysis of merged American Hospital Association data and U.S. Census data: Beginning to understand the supply–demand chain in pediatric inpatient care.Journal of Pediatric Nursing. 2008; 23: 161-168Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar). This seminal study indicates the need to investigate further the dynamics of supply and demand related to the provision of pediatric care. Although this analysis focused on inpatient care, the dynamic shifts in the provision of health care indicate the need to investigate the supply and demand relationships associated with the scope of health services provided to children in primary, and community settings. A recent survey was conducted to assess the perceptions of pediatric nursing faculty and directors of U.S. nursing schools regarding the workforce status and projections of need for pediatric nursing faculty. Findings revealed that 70% of faculty members and 52% of the nursing school directors believed that pediatric nursing faculty shortages exist. The consequences of this shortage, which they believed will worsen in the future, are fewer clinical training experiences in acute care settings and the reduction of pediatric content in nursing school curricula (Leonard et al., 2008Leonard B.J. Fulkerson J.A. Rose D. Christy A. Pediatric nurse educator shortage: Implications for the nursing care of children.Journal of Professional Nursing. 2008; 24: 184-191Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar). The inability to recruit faculty members who have pediatric expertise has clinical ramifications as well. Students' limited exposure to pediatric acute care can adversely affect the recruitment of new graduates into pediatric nursing. The demand for pediatric nurses will intensify in the years to come based on population projections. According to the U.S. Census Bureau, there are 74.9 million children aged 0 to 17 years. This estimate increases to 75.2 million in 2010, 78.1 million in 2015, 81.6 million in 2020, and to 84.6 million in 2025 (United States Census Bureau, Population Division, 2008United States Census Bureau, Population Division Table 2. Projections of the population by selected age groups and sex for the United States, 2010 to 2050.http://www.census.gov/population/www/projections/files/nation/summary/np2008-t2.csvDate: 2008Google Scholar). The trend line for the increase in the number of children will rise from 300,000 in 2010 to 1.2, 6.7, and 9.7 million in 2015, 2020, and 2025, respectively. According to the National Survey of Children with Special Health Care Needs (Child and Adolescent Health Measurement Initiative, 2005/06Child and Adolescent Health Measurement Initiative National Survey of Children with Special Health Care Needs, Data Resource Center for Child and Adolescent Health website.www.cshcndata.orgDate: 2005/06Google Scholar), it is currently estimated that 13.9%, amounting to 10.2 million U.S. children, aged 0–17 years have special health care needs. Children with special health care needs (CSHCN) refers to “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally” (McPherson et al., 1998McPherson M. Arango P. Fox H. Lauver C. McManus M. Newacheck P. Perrin J. Shonkoff J. Strickland B. A new definition of children with special health care needs.Pediatrics. 1998; 102: 137-140Crossref PubMed Scopus (908) Google Scholar, p. 138). Using the current prevalence rate with the Current Population Estimates, the number of CSHCN would increase upward to 10.5 million in 2010, 10.8 million in 2015, 11.3 million in 2020, and 11.7 million in 2025. These projections indicate that the population of CSHCN would increase by 1.5 million children in the next 15 years. Likewise, using the Centers for Disease Control (CDC) estimates, the prevalence rate of U.S. children with intellectual and development disabilities (IDD) aged 0–17 years is 17% (Centers for Disease Control, 2006Centers for Disease Control Prevalence of four developmental disabilities among children aged 8 years—Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1996 and 2000.Morbidity and Mortality Weekly Report. 2006; 55: 1-10PubMed Google Scholar). The number of children with IDD would then be projected to increase by 1.6 million by 2025. The following question arises: Will there be sufficient numbers of pediatric health care professionals, including pediatric nurses to provide the evidence-based care these children, youth, and their families require? It is important for all pediatric nurses and its leadership to have empirical data for strategic planning to address the unique issues affecting the recruitment of new graduates and experienced nurses interested in making career changes and their retention in pediatric nursing practice. These statistics demonstrate the importance of engaging in rigorous outreach efforts to recruit potential students beginning during the formative years of adolescence when youth begin to seriously consider career options. Dynamic, persistent, and focused leadership is needed by the pediatric nursing associations. The voices of pediatric nursing leaders need to be heard at all levels—in local communities, at state levels, and nationwide. Our leaders need to develop a strategic plan to address the pediatric nursing workforce issues sooner rather than later.