National Nursing Shortage Research Articles

Using immersive virtual reality technology to enhance nursing education: A comparative pilot study to understand efficacy and effectiveness

The U.S. faces a national shortage of nurses. The emergence of human-centered digital technologies has directly impacted nursing education. Using immersive Virtual Reality related digital technology to assist and enhance nurse education is promising but not yet fully understood. This study aims to understand the effectiveness and efficacy of immersive Virtual Reality nursing education approaches through a comparative pilot study. Three immersive Virtual Reality scenarios based on basic nursing skills were developed. A traditional video lecture approach including the same contents was used as a comparable approach to investigate the effectiveness and efficacy performance of the proposed immersive Virtual Reality approach. 22 participants were recruited from a college. Effectiveness was measured through motivation and knowledge gain, while efficacy was evaluated through simulation sickness, user experience, and system usability. The results showed that the VR approach has above “acceptable” efficacy performance, which indicates participants are willing to accept this novel education approach. The effectiveness results indicate that the VR approach has similar performance with the video approach in delivering nursing contents. One limitation of this investigation is that the sample size is relatively small and further larger sample sizes are needed for future analysis.

A Focus Group Study of Retirement-Age Nurses: Balancing Tension and a Love of Nursing in a Changing Healthcare Environment.

The aims of this study were to explore the experience of retirement-age nurses and identify decision-making factors and innovations to enhance retention. A national shortage of nurses has created challenges to preserving quality patient care and level of nursing competency and managing turnover costs. A qualitative study using focus groups was conducted of nurses 55 years or older who were working or recently retired. Data were audiotaped and transcribed verbatim, with content analysis used to code in an iterative process until consensus was reached. The tension of balancing the love of patient care within a changing healthcare system was described. Patient acuity, competing roles, and the centrality of computers were stressors and integrally related. Flexibility in work schedules and new practice models were important to retirement decision making for work-life balance and retention. Passion for patient care dominated decisions to continue working. Innovations in practice models and scheduling offer opportunities to enhance the retention of experienced nurses.

Vantage point - A 'wicked' problem.

SENIOR NURSES everywhere are facing a 'wicked' problem, wicked in the sense that it seems to defy resolution. The problem is this: the national shortage of nurses, particularly of those at band 5, is forcing us to use agency nurses so that we have enough staff to provide patient care safely.

Back to the Future: A Standardized Approach to Delivering Effective Nursing Care

Two federal bills were introduced in the US Congress for the 2011-2012 sessions. The National Nursing Shortage Reform and Patient Advocacy Act (S 992/HR 2187) essentially mandates the nation's hospitals to adopt strict, direct care, nurse-to-patient ratio requirements. The Registered Nurse Safe Staffing Act (S 58/HR 876) addresses organizational accountability to develop and implement unit-specific nurse staffing plans. Whereas both bills cite increased patient safety and promotion of quality patient care as potential positive outcomes, only HR 876 comes close to building in the needed flexibility in decision making, variability in patient care, and nurse education and competency levels.

Factors Predicting Organizational Commitment among Nurses in State Hospitals, Malaysia

Introduction: With an increase in national nursing shortage, organizational commitment is extremely important for retention of nurses. This predictive study determines the level of organizational commitment and the predictive ability of perceived organizational support, components of job satisfaction, including pay, task requirement, organizational policies, autonomy, interaction and professional status as well as years of experience on organizational commitment. Method: Data were collected from 416 nurses in four state hospitals in Malaysia, using self-administered questionnaires. The hospitals were selected from each region in Peninsular Malaysia and samples were selected by a random sampling method. Questionnaires, including demographic data, Organizational Commitment Questionnaires, Survey of Perceived Organizational Support, and Index Work Satisfaction were distributed by researcher and research assistants. Stepwise multiple regression technique was used to analyze the data. Results: The results discovered that (1) nearly half of the subjects (48.07%) reported high level of organizational commitment. (2) Professional status, autonomy, interaction, task requirement and years of experience could predict the organizational commitment (ß = 0.52, 0.17, p < 0.01); ß= 0.13, 0.11, 0.09, p < 0.05 respectively). Overall, all predictors explained 33% of variability in the organizational commitment among nurses in state hospitals. Conclusions: This study found that nurses in state hospitals were highly committed to their organizations. Results of this study provide information for nurse administrators to consider and maintain these factors in nursing practice to foster a high level of organizational commitment among Malaysian nurses.

Officer. Nurse. Woman. Army Nurse Corps Recruitment for the Vietnam War

In April 1969, the American Journal of Nursing (AJN) ran U.S. Army advertisement featuring the headline Officer. Nurse. Woman. In it stood young, smiling, attractive nurse wearing combat fatigues and carrying surgical scissors in her pocket. This confident and determined officer, nurse, and woman appealed to other women to join her in the Army Nurse Corps (ANC), where she was Heading up her own staff and Making her own decisions. Working where it counts. She called women like her to be Army nurses, emphasizing that Today's Army Nurse can do because Army Nurses were not just nurses-they were also officers and women1 (Figure 1). The advertisement in Figure 1 was of many tactics used by the ANC in its efforts to recruit nurses during the Vietnam era. As the number of U.S. troops in Vietnam increased, the ANC needed larger numbers of nurses for the hospitals in Vietnam, along the chain of evacuation, and to continue staffing Army hospitals in the United States. The first Army nurses in Vietnam had actually arrived in 1956, when three female nurses were assigned to help train Vietnamese nurses at military hospital in Saigon.2 The first U.S. military hospital, the 8th Field Hospital, arrived on 6 April 1962, and the Army began regularly assigning nurses to the Republic of Vietnam with its arrival, but until the call-up of troops in 1965, die number remained relatively low. By 1966, however, there were approximately 333 Army nurses stationed in Vietnam, number that rose to approximately 640 in 1967, more than 800 in 1968, and peak of 916 in January 1969. Thereafter, the numbers declined with the removal of U.S. troops until the last Army nurses left on 29 March 1973.3 In all, more than five thousand Army nurses served in Vietnam during the Vietnam War, and thousands more served in other locations during the era.4 Recruiting these nurses was major focus of the ANC throughout the Vietnam War. Compounding the immediate need for nurses brought on by the war was an already problematic national nursing shortage that had begun in the early post-World War II period.5 This overall shortage was the result not of fewer nurses but of greater demand due to larger population seeking medical care, longer life expectancies, expansion of medical insurance programs, and shifting of particular facets of health care from home to hospital.6 In addition, in the 1960s and early 1970s nursing was predominantly woman's occupation, and as many women began to move to occupations previously closed to them where they could find higher pay and more advancement potential, the pool of potential nurses decreased. Moreover, as an occupation historically linked to traditional femininity, some factions of the growing women's movement criticized nursing as one of the ultimate female ghettos from which women should be encouraged to escape.7 Regardless of women's positions on feminism, however, as socially acceptable careers for women changed, nursing became of many career options for women instead of of few. In the ANC, the retirements of thousands of World War II era nurses in the late 1950s and early 1960s further compounded this shortage. The number of Army nurses fell from wartime peak of 57,000 in 1945 to 2,961 in 1963, far below the authorized strength of 5,000.'' Until the Vietnam War, the ANC managed its nurse shortage by using corpsmen for clerical and supply duties and hiring civilian nurses to work in stateside hospitals.10 However, the October 1962 Cuban missile crisis demonstrated that this solution was not completely effectual because civilian nurses could not be assigned overseas. As active duty nurses were sent to four field hospitals and two hospital trains during the crisis, base hospitals were left short-staffed and the Army realized that the low numbers of Army nurses posed a hazardous situation in the event of national emergency.11 The following year, the ANC stated that recruiting enough young women to be Army nurses is the most serious personnel procurement problem the Army faces today. …

Clinical leadership in contemporary clinical practice: implications for nursing in Australia

Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.

Use High Awareness and Judgment to Screen Emergency Department Patients for Radiation Exposure

Use High Awareness and Judgment to Screen Emergency Department Patients for Radiation Exposure

Nurses, Medical Errors, and the Culture of Blame

In June 2004, an article in American Journal of Nursing reported findings of a three-year study of organizational culture, attitudes, and assignment of responsibility for patient safety in small, rural hospitals in nine Western states. The study found that most errors fall within realm of nursing practice and that physicians, administrators, and nurses themselves tend to see patient safety as largely a nursing responsibility. Asked to identify which profession has primary responsibility for ensuring patient safety, 96 percent of nurses and more than 90 percent of physicians, administrators, and pharmacists assigned primary responsibility to nurses. Only 22 percent of respondents believed that physicians, nurses, pharmacists, and administrators share responsibility for patient safety equally. Unfortunately, however, nurses and physicians differed on role of nurses in effecting change. Most of nurses indicated that they had several responsibilities in reducing medical errors, including reporting them, educating themselves and colleagues, serving as role models, making recommendations for changes in procedure and policy, reviewing reported adverse patient-safety events, and participating in investigations. Only 8 percent of physicians who responded to survey identified nurses as members of decisionmaking team. Nurses have a genuine impact on patient safety. Studies have found a link between patient safety and RN staffing and an increased rate of error when hospital nursing staff has a smaller proportion of RNs. These are worrisome findings in light of severe national shortage of nurses. Part of medical malpractice crisis, then, is confusion in health care system and how it affects role of nurse. There is no confusion in American Nurses Association's code of ethics. This document, first adopted in 1950 and revised in 2001 to reflect and embrace role of today's nurse, consists of a set of planks that set out nurses' fundamental values and commitments. They also offer a starting point for understanding how nurses should be involved in thinking about medical error, and why nurses blame themselves for medical errors. The first few planks are most important. These planks state that nurse's primary commitment is to patient (plank 2), and that nurse promotes, advocates for, and strives to protect health, safety, and rights of patient (plank 3). Interpretive Statements that accompany code add that nurses are committed to patient's health, well-being, and safety throughout patient's life span, and in all settings in which health care needs are addressed. Further, code directs that, as an advocate for patient, the nurse must take appropriate actions regarding any instances of incompetent, unethical, and illegal practice by any member of health care team or health care system or any action on part of others that places rights or best interest of patient in jeopardy. For nurses to function effectively in this role, they must be knowledgeable about code of ethics, standards of practice, relevant laws, and their own organization's policies and procedures. Moreover, when nurse is aware of inappropriate or questionable practice in provision or denial of health care, concerns should be expressed to person engaging in questionable practice. Attention should be called to possible detrimental effect upon patient's well-being or best interests, as well as to integrity of nursing practice. When factors in health care delivery system or health care organization threaten welfare of patient, concerns should be directed to responsible administrator. If indicated, problem should be reported to an appropriate higher authority within institution or agency, or to an appropriate external authority. The interpretive statements for third plank also remind nurses that they have a responsibility to implement and maintain standards of professional nursing practice. …

Magnetic energy.

ONE OF THE GREATEST CHALLENGES facing the manager of a neonatal intensive care unit is to retain qualified professional nurses. During the current national nursing shortage, most organizations are having difficulty providing adequate professional staffing. Studies of organizations that have received the American Nurses Credentialing Center’s Magnet designation illuminate leadership and environmental characteristics that help attract and retain good nurses.1–4 By incorporating these characteristics into the NICU, the manager can create an environment that will serve as a “magnet” to professional nurses.

Oregon's Economic Crisis and the National Nursing Shortage: A Transformational Opportunity for Rural Areas

Oregon’s drastic budget cuts and the national nursing shortage pose severe barriers for consumers and providers of human services and health care in rural areas. Because of the unique culture, demographics and a deficit of human service and health care providers, metropolitan based decision and policy making aimed at improving human service and health care delivery, may actually cause harm in rural areas. This time of crisis must be viewed as a transformational opportunity for nurses. Creative alternatives must be explored to decrease the higher rates of human service and health-related disparities for individuals, families, and communities in rural areas compared to those in metropolitan areas. In addition, nurses must invest in furthering the development of the field of nursing to reverse the nursing shortage and prevent shortages in the future. This paper will explore the effect of Oregon’s economic crisis and the national nursing shortage on human service and healthcare delivery and economic development in rural areas. In addition, the effects of the unique culture of rural areas and metropolitan-based decision and policy making on recruitment and retention of nurses in rural areas will be explored. Finally, solutions will be explored to reverse the nursing shortage, prevent future nursing shortages and further the field of nursing.

A Continuing Challenge: The Shortage of Educationally Prepared Nursing Faculty

The profession is facing a unique shortage of nursing faculty. Schools of Nursing have always had a shortage of doctorally prepared nursing faculty. The academic norm for faculty teaching in baccalaureate and graduate programs to hold earned doctoral degrees was established later in nursing than for other disciplines. At best, 50% of nursing faculty in such programs have met this academic standard. In addition, the shortage is predicted to escalate in the next decade due to the retirement of a "graying professoriate" of nursing faculty. The shortage of nursing faculty is interwoven with the current national shortage of nurses. The shortage of nurses requires the educational programs of the profession to supply more graduates. But the shortage of nursing faculty will limit student enrollments and likely decrease the number of graduates. Conversely, the shortage of nurses will offer many opportunities and choices to nurses and may decrease the number selecting graduate studies and an academic career, thus contributing to the shortage of nursing faculty The shortage of nursing faculty will also have consequences for the generation of the knowledge base for nursing practice. With a decreased number of individuals to conduct research and the loss of senior investigators through retirement, continuing development of nursing's knowledge base may be curtailed. The shortage of nursing faculty will also limit the professional leaders who are able to shape health policy in the state, national, and international arenas. This article outlines a number of factors influencing the shortage of nursing faculty. Several institutional School of Nursing strategies are suggested for countering the shortage situation. In addition, several national professional and policy strategies are suggested. More creative strategies need to be developed and evaluated by Schools of Nursing and by the profession.

A lesson from the last nursing shortage: the influence of work values on career satisfaction with nursing.

With an emerging national nursing shortage and evidence of dissatisfied registered nurses, it is useful to revisit the issue of satisfaction by analyzing data from the prior nursing shortage in 1989. The authors explore the relationships that work values have on the satisfaction that nurses experience with a career in nursing. The relevance of the findings are discussed within the context of the nursing shortage.

The nurse shortage. Myth or reality?

The proportion of vacant positions for registered nurses in hospitals doubled between September 1985 and December 1986,1 reaching the levels of the last national nursing shortage of 1979. Current r...

The Nurse Labor Market

The national shortage of nurses, which grew to crisis proportions in many communities in the late 1970s, has subsided. Recent evidence suggests that hospital nurse vacancy and turnover rates have declined significantly since 1979. The recent swift reversal in the availability of nurses, from shortage to waiting lists in some hospitals, has taken many by surprise. It also raises the possibility that greater understanding of the factors that influence the market for nurses might make it possible to avert future shortages.

The Nurse's Quest for a Professional Identity

As 1981 progresses, American Hospital Association is engaged in a major media campaign help hospitals successfully overcome their problems that relate to current national nursing shortage (see accompanying review). At same time, The Wall Street Journal has reported that despite a professed love for nursing, some nurses in Atlantic City area are forsaking their health-care assignments to work in new gambling casinos. While all this is happening, many physicians are shaking their heads and wondering what has happened to traditional physician-nurse relationship. Perhaps reading this book by Dr Cohen, who is director of psychological services for Chicago's Cook County School of Nursing, will bring beginning of some understanding of current status of nursing in United States. She suggests that underlying problems include the lack of a theoretical system to delineate a unique body of knowledge, and existence of