Arizona’s nursing shortage is a very serious problem and it is not going away any time soon. The state is going to need approximately 49,000 new registered nurses by 2017 to keep pace with population growth, RNs retiring and nurses lost to attrition, according to the Arizona RN Shortage: 2007 Results, a report published by the Arizona Healthcare Data Center. The data center was started by the Arizona Hospital and Healthcare Association (AzHHA) in 2007 to study health professions in Arizona.
“I think people are tired of hearing about the nursing shortage,” says Bernadette Melnyk, dean of ASU College of Nursing and Healthcare Innovation. “They don’t understand the adverse effects until they or a family member is hospitalized and they see for themselves the effect it has on the health and safety of people they love.”
Of the approximately 49,000 RNs that will be needed by 2017:
20,000 will be needed to keep pace with the state’s growing population, as well as to close the gap between Arizona’s current average of 681 RNs per 100,000 residents and the U.S. average of 825 RNs per 100,000 residents.
10,000 nurses will be required to replace retiring RNs. More than one-third of Arizona’s current RNs are older than 55 and will retire over the next five to 10 years.
19,000 RNs, or 3.5 percent annually, will be needed to account for the profession’s attrition rate.
Twelve of Arizona’s 15 counties also fall below the national average of RNs per 100,000 people, according to the Health Resources and Services Administration (HRSA). The national average is 3.3 RNs per 100,000 people, and Arizona has 1.9 RNs per 100,000 people. The three counties that exceed the national average — Coconino, Pima and Yavapai — still face shortages of RNs.
Adda Alexander, RN, MBA, former executive vice president of AzHHA, says Arizona colleges have increased their capacity and are graduating more nurses, but it is not enough. Arizona’s nursing programs need to graduate an additional 2,235 students per year just to keep pace with the state’s population growth.
To help address the nursing shortage, Arizona hospitals contributed $57 million between 2006 and 2007 to the state’s education programs in the form of tuition reimbursements, loan forgiveness programs and in-kind giving (providing space for nursing education programs, sponsoring faculty salaries and tuition reimbursement). In 2005, the Arizona Legislature passed the Arizona Partnership for Nursing Education (APNE) bill, which provided $20 million over five years to double the capacity of Arizona’s college and university nursing education programs by increasing the number of nurse education faculty. As a result of the APNE funding, the estimated number of additional nursing graduates in 2010 will be 1,242. Alexander said APNE was a crucial step in helping the nursing shortage, but it sunsets in 2010 and the funding stops.
According to Annual Reports from Nursing Education Programs, 2007, Arizona Board of Nursing, there were 41 vacancies for full-time Arizona nursing faculty in 2006, which was a 13 percent increase from the previous year. In addition, there were 38 vacancies for part-time nursing faculty in 2006, which represented a 600 percent increase in vacancies from 2005.
The report also indicated that due to the lack of capacity, more than one-third of nursing students are wait-listed each year by Arizona nursing programs even though they have met all course prerequisites.
Joey Ridnour, executive director of the Arizona State Board of Nursing, contends that the lack of clinical space also contributes heavily to the nursing shortage. Thus, many states are looking at using simulations in combination with clinical experience to teach students.
“This may be a good combination to consider in the future, but faculty needs to figure out how to maximize it so students get a good education,” Ridnour says. “When I was a student, I would have valued doing some of the procedures through simulation rather than on live patients. It would have given me a better understanding and more confidence.”
Melnyk believes the state has to hit the nursing shortage from two angles: (1) produce more nurses and (2) help them feel satisfied and empowered in their role. She says between 35 and 60 percent of new graduates leave their positions in the first year due to stress from staffing shortages and patient acuity levels.
“I think nurses get out in the real world and don’t expect their jobs to be so stressful,” she says. “People in hospitals are very sick and oftentimes what the nurses are expected to juggle is too much for them to handle.”
Melnyk also thinks nurses and other health care providers should be educated in evidence-based practice (EBP), a problem-solving approach that integrates the best evidence from research studies and combines it with patient preferences and the clinician’s expertise.A number of medical studies show that when nurses, physicians and other health care providers deliver care in an evidence-based manner, the quality of care is substantially better and patient outcomes improved.
“Studies also show that nurses practicing EBP are more satisfied with their role, feel more empowered and make less medical errors,” Melnyk says. “A lot of people don’t realize that 99,000 patients die annually in the U.S. due to medical errors. That’s a staggering number of patients.”