HD67 - The Supply and Demand of Nurses in the Commonwealth

  • Published: 1990
  • Author: Joint Subcommittee
  • Enabling Authority: House Joint Resolution 165 (Regular Session, 1988)

Executive Summary:
AUTHORITY AND STUDY OBJECTIVES

House Joint Resolution No. 165, adopted by the 1988 Session of the General Assembly, established a joint subcommittee to study the supply and demand of nurses in the Commonwealth. The Committee's study was authorized to continue in 1989 pursuant to Rule 23 of the Rules of the House of Delegates and Rules 20(h) and 20(m) of the Rules of the Senate. Charged with the responsibility of determining the existence, origins, and effects of a perceived critical nursing shortage, the committee was directed to coordinate the expertise of the public and private sectors and to develop recommendations that protect the public health, safety, and welfare. Throughout this two-year study, the Committee has conferred with state agencies, nurses, educators, professional organizations, and the medical community. The Committee also reviewed the work of the U.S. Department of Health and Human Services Secretary's Commission on Nursing as well as actions of other states addressing the nursing shortage. The Committee made a number of recommendations after the first year of its study. These recommendations resulted in legislation and resolutions regarding nurse scholarships, recruitment, compensation, professional relationships, and the use of temporary nursing services.

THE SUPPLY OF AND DEMAND FOR NURSES IN THE COMMONWEALTH

Nurses are an integral part of the modern health-care system. Responsible for a wide variety of tasks, nurses must possess a broad range of knowledge and skills, leadership ability, and initiative. The need for accomplished nurses is greater today than at any time in the history of the profession. Although the nursing profession has survived numerous cyclical shortages, the current shortage plaguing Virginia and the nation will be more difficult to solve. The demand for nurses is expected to be double the supply by the end of this century.

The effects of the nursing shortage are evident throughout the health-care system, but are perhaps most severe in the hospital sector and in long-term care. High vacancy rates and lengthy recruitment periods for registered nurses have threatened the overall quality of health care. Consequences of a continued shortage may include deteriorating work environments, heavier workloads, and hospital bed closures. In the Commonwealth, the nursing shortage has been manifested in declining enrollments in certain nursing programs, serious nurse vacancy rates, and reported difficulties in the recruitment and retention of nurses. Hospitals and nursing homes across Virginia have reported vacancy rates comparable to those documented nationwide. Addressing the origins and implications of this critical nursing shortage requires analysis of economic, educational, and situational factors, as well as societal and professional attitudes.

The Code of Virginia authorizes specific classifications of nurses and provides for nursing education and scholarships. Registered nurses, licensed practical nurses, clinical nurse specialists, and certified nurse aides are all subject to the various regulations, standards, and educational requirements established by the Board of Nursing. The Department of Education funds and administers 46 schools of practical nursing; in addition, baccalaureate and associate degree nursing programs are offered at a number of Virginia's institutions of higher education. Enrollments in these programs declined in the mid-1980's, and national statistics predict a continued decline in nursing school enrollments and graduates.

The demand for nurses nationwide is expected to increase, despite declining hospital utilization. The development of new medical technology has intensified the nurse's role in health-care delivery; more nurses are required to monitor patients and to operate complex equipment. Because the patient population has become not only older but more severely ill, more nurses are needed to provide special and continuous attention. Changing reimbursement systems and cost-containment measures have also encouraged earlier patient discharge, creating a greater need for home health-care nurses. These changes have also encouraged cost-conscious hospitals to require nurses to assume many non-clinical tasks previously performed by support staff or other medical personnel. Although it is clear that the demand for nurses in Virginia is very real, the lack of Virginia-specific data regarding the nurse labor supply and distribution has hindered the development of effective measures addressing this need.

While some reports attribute the current nursing shortage primarily to increased demand, a number of factors have clearly prevented the nurse supply from meeting this demand. Despite increasing college enrollments, fewer students are interested in nursing careers. Expanded career opportunities for women and a lack of professional status may discourage entry into nursing. In addition, comparatively low wages and limited career and salary advancement opportunities within the nursing profession hamper not only recruitment but also the retention of experienced nurses. Compensation is of great concern to nurses, including those employed in the Commonwealth's agencies. The Department of Mental Health, Mental Retardation and Substance Abuse Services has encouraged state facilities to develop competitive compensation packages, and the Department of Personnel and Training is currently reviewing salary schedules for nurses employed by the Commonwealth.

The Committee has also learned that the work environment greatly affects the nurse supply. Stress, heavy workloads, long hours, and lack of input in determining patient care discourage many nurses from remaining in the profession. Restructuring work schedules, eliminating poor nurse utilization practices, and enhancing benefit programs have been suggested as strategies to improve work conditions. The nurse's poor professional image, often reflected in treatment by employers and other medical professionals, also contributes to the nursing shortage. Improving this image requires including nurses in policy and planning and encouraging nurses' input in determining patient care.

RECOMMENDATIONS

In studying the many complex and sometimes sensitive issues influencing the supply of and demand for nurses, the Committee has coordinated the expertise and perspectives of those state agencies, individuals, and organizations having a crucial role in the advancement of the nursing profession. While legislation may not be the appropriate remedy for all of the causes of Virginia's nursing shortage, action by the General Assembly may well address and alleviate certain aspects of this dilemma. The Joint Subcommittee recommends the following actions:

RECOMMENDATION 1:

That the Nurse Practice Act be amended to permit licensed practical nurses to teach certified nurse aides pursuant to regulations which may be promulgated by the Board of Nursing.

Presently, the Code of Virginia only grants teaching authority to registered nurses (RNs). The Committee has received testimony throughout its study regarding the critical need for RNs, especially in long-term care. This Committee has concluded that extending teaching authority to licensed practical nurses (LPNs), subject to Board of Nursing regulations, might alleviate this shortage by permitting RNs to return to patient care.

RECOMMENDATION 2:

That funding for the Nurse Scholarship Program be increased.

The 1989 Appropriations Act provides $100,000 each year for the Commonwealth's nurse scholarship program. Because the costs of nursing education have increased substantially over the years, this Committee recommends that funding for the nurse scholarship program be increased to assist in the recruitment of qualified students.

RECOMMENDATION 3:

That the Virginia Health Planning Board be charged with the responsibility of developing proposals for data collection systems for health-care manpower distribution and for mortality and morbidity rates for citizens of the Commonwealth.

The Committee has concluded that the development of statewide data collection systems for health-care manpower distribution would not only greatly enhance the effectiveness of measures to remedy the current nursing shortage but also would assist in the prevention or mitigation of future problems in health-care labor supply and distribution. The collection of statewide mortality and morbidity data will also prove valuable in the assessment of health-care manpower needs.

RECOMMENDATION 4:

That the State Council of Higher Education for Virginia study and compare the salaries of nursing faculty to other faculty members, administrators, and other service professionals in order to identify and address the need for competitive compensation for nursing instructors.

The nursing instructor plays an invaluable role in the development of qualified nursing professionals. Competitive compensation is necessary to recruit and retain capable instructors and to maintain excellence in Virginia's nursing programs. The study conducted by the Department of Personnel and Training pursuant to SJR 140 provides valuable information regarding the salaries of Virginia state- employed nurses; however, it does not provide specific data regarding the compensation of nursing faculty. Therefore, the Committee recommends that the State Council of Higher Education study and compare the salaries of nursing faculty to those of other faculty members, service professionals, and administrators.

RECOMMENDATION 5:

That the Department of Education encourage high school counselors to promote nursing and health-care professions in career counseling; that health-care providers, nursing organizations, and medical societies participate in "career day" promotions to recruit high school students; and that these health-care providers and professional organizations promote nursing as a "second career" for adults and returning students.

RECOMMENDATION 6:

That the State Council of Higher Education for Virginia, in cooperation with the Commonwealth's colleges and universities and professional nursing organizations, study and develop articulation agreements to facilitate transfers between nursing programs.

Articulation agreements that ease transfers between various nursing programs may facilitate further education for nurses. These agreements not only provide "career ladder" opportunities for nurses but also may increase the supply of experienced, skilled nurses. Articulation agreements would ideally minimize the loss of academic credits, reduce duplication in course requirements, and ultimately make nursing more accessible to new recruits and returning students.

RECOMMENDATION 7:

That the Department of Health Professions be commended for its current study of the services and capabilities of nurse practitioners and that the Department report its findings and recommendations to the House Committee on Health, Welfare and Institutions and the Senate Committee on Education and Health.

This Committee's study has focused largely on those issues and practices affecting RNs, LPNs, certified nurse aides, and, to a lesser degree, other nursing professionals. Nurse practitioners are unique nursing professionals, licensed by both the Board of Medicine and the Board of Nursing to perform tasks that may actually constitute the practice of medicine. The Department of Health Professions has impaneled a task force to study the services and capabilities of these nursing professionals. The Task Force has been challenged by a lack of specific data regarding practice settings, demographics, and services rendered. This Committee wishes to commend the Department's Task Force for its examination of a broad range of significant issues, such as utilization practices and working relationships between the nurse practitioner and other health-care professionals.

RECOMMENDATION 8:

That the Commonwealth be urged to assess the compensation of its state-employed nurses based on comparative national data and that salaries of these health-care professionals be increased as indicated by these data and by the findings and recommendations of the Department of Personnel and Training, developed pursuant to SJR 140.

The preliminary findings of the Department of Personnel and Training (DPT) study indicate that the salaries of the Commonwealth's state-employed nurses are consistently lower than those reported regionally and nationally. It is expected that the Department of Personnel and Training will submit its findings and final recommendations regarding the compensation of these health-care professionals to the Governor and the 1990 Session of the General Assembly.