Nursing Staff in Hospitals and Nursing Homes Is It Adequate? (1996) / Chapter Skim
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4 Nursing Personnel in a Time of Change
4 Nursing Personnel in a Time of Change
Pages 68-91
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From page 68... ...
Most of the direct care in nursing homes has been, and continues to be, provided by nurse assistants. The implications of the trends identified above for the nursing workforce are 68
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From page 69... ...
LPNs primarily provide direct patient care in institutional settings under the direction of a physician or an RN. Nurse assistants and other ancillary nursing Ancillary nursing personnel, nursing support personnel, assistive personnel, nurse extenders, unlicensed nursing personnel, multi-competent workers, nurse assistants, or aides are all generic terms used to refer to the various clinical and nonclinical jobs that augment nursing care.
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From page 70... ...
Registered Nurses RNs are the largest group of health care providers in the United States. For several decades, their numbers have been continually increasing in absolute num2National databases available for nursing workforce supply and demand include the National Sample Survey of Registered Nurses, data from the National Center for Health Statistics, the American Hospital Association (AMA)
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From page 71... ...
Public policies to alleviate the perceived shortages have focused almost exclusively on developing and funding programs for rapid increases in the supply of nurses, rather than addressing and understanding the issues leading to the recurring shortages, the reasons for the increased demand, and the types and educational mix of the nursing workforce needed and available to meet the changing demand (Aiken, 1995~. In 1992, more than 2.2 million persons held licenses to practice as RNs (Moses, 1994~.
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From page 72... ...
labor force, 4Most of the data on nurse supply presented here are from the 1992 National Sample Survey of Registered Nurses and its predecessor surveys. For a detailed description of the registered nurse supply, the reader is referred to the reports of these surveys.
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From page 73... ...
Twenty-nine percent of RNs in 1992 had worked in a health care occupation immediately prior to entering a nursing education program. The SThese projections are routinely developed by the Division of Nursing of the U.S.
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From page 74... ...
Educational Preparation of RNs According to the 1992 National Sample Survey of Registered Nurses, 31 percent of employed nurses in all health care settings had a baccalaureate degree in nursing, 31 percent had an AD in nursing, and 30 percent were graduates of diploma programs. Between 1980 and 1992, RNs with ADs in nursing showed the greatest increase; RNs with baccalaureates also showed a substantial growth.
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From page 75... ...
The total number of nursing education programs that prepare RNs has remained around 1,493 during the past decade. In 1993, there were 507 baccalaureate programs, 857 associate degree programs, and 129 diploma programs.
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From page 76... ...
' DW / ~ ~.~ ~ ..... O ~ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1, 1 1 1 1 1 1 958 NURSING STAFF IN HOSPITALS AND NURSING HOMES Associate Degree .
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From page 77... ...
LPNs are the second-largest group of licensed health caregivers in the United States; only RNs are greater in number. They work in hospitals, nursing facilities, home health care, public health and school health clinics, the military, and prisons.
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From page 78... ...
Of these, 306,000 were employed in hospitals and 643,080 in nursing homes. Unemployment rates for nurse assistants were much higher than for LPNs and RNs.
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From page 79... ...
Hospitals began to restructure the composition of the nursing workforce, often substituting RNs for LPNs and other patient care personnel. The increased demand for RNs in large part resulted from a substitution of RNs for LPNs, NAs, and other patient services personnel.
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From page 80... ...
By 1993, around 874,000 RNs were employed in community hospitals throughout the country. Although this number reflects a continuing increase over previous years in the total number of RNs employed and in the number of RNs as a percentage of the total nursing staff (67.5 percent)
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From page 81... ...
The 1992 National Sample Survey of Registered Nurses found a greater number and proportion of RNs working in a variety of settings, notably ambulatory care, than in previous years. The largest increase in the rate of growth between 1988 and 1992 was in the outpatient areas.
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From page 82... ...
The 1994 NLN survey also showed that the proportion of newly licensed RNs employed in nursing facilities was rising 11 percent compared to 5 percent in 1992. These results indicate a shift in the first place of employment for RNs, but they have little impact on the total supply of employed RNs; newly licensed nurses represent about 4 percent of the total employed RN workforce (NLN, 1994c; personal communications with E
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From page 83... ...
As long as long-term care is almost totally dependent on public and out-of-pocket financing, the current paucity of RNs employed in nursing homes will likely continue for fiscal reasons and because of pay differentials between the RNs employed in hospitals and nursing homes. Implications of Current Trends The trends in RN employment discussed above suggest that a continuation of the current trend toward reductions in inpatient hospitalization rates and hospital occupancy rates could have important implications for the employment of RNs in inpatient hospital settings.
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From page 84... ...
state that the results must be viewed with caution as the data are not adjusted for the differences in hospital output. The hospital product has changed during the study period, and some of the expansion of the administrative staff may have resulted from responses to the changing health care environment, such as marketing for managed care contracts and developing networks and staff needed for new technology.
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From page 85... ...
Hospitals are reported to have restructured patient services and staffing, reducing RNs as a proportion of total nursing personnel and increasing the employment of ancillary nursing personnel (SEIU, 1993; ANA, 1995a)
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From page 86... ...
This could mean that nurses with less training are losing positions in the inpatient hospital sector to nurse assistants and other ancillary nursing personnel, while those with advanced training may be able to find new opportunities.
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From page 87... ...
With an increased emphasis on providing subacute care as well as rehabilitative care, nursing homes are attempting to provide transitional institutional services that, in the past, would have been provided in the acute care inpatient setting. Thus, in each of these care settings, consideration needs to be given to the effectiveness of the current workforce for the future.
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From page 88... ...
The knowledge and skills of all health care professionals require advancement in this rapidly changing health care delivery system. The following general areas are discussed in relation to basic professional nursing education: interdisciplinary education and team approaches to care; management of care, including attention to health care costs, professional accountability, and patient outcomes; new modes of care delivery, including community-based care, managed care, and home care.
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From page 89... ...
Although the majority of clinical experiences that are part of nursing education currently take place in the inpatient hospital setting, a major shift in the primary site for clinical education is expected. In fact, there is evidence that many schools are changing their curricula and clinical learning experiences to match the pace of changes in the design of delivery systems.
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From page 90... ...
has delineated the current and future issues of professional nursing education, indicating several major challenges that clearly need to be addressed if we are to see an appropriate use of professional nursing services in a restructured health care environment. Her call for differentiation of the RN workforce is supported by the work of Aiken (1994, 1995)
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From page 91... ...
has noted that with the health care delivery system being increasingly primary care oriented and boundary spanning, the roles in which nurses will be needed will require more professional judgment and clinical autonomy. SUMMARY This chapter has addressed critical issues affecting the nursing workforce, its supply, and the forces affecting its demand.
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