Clinical Experiences That Nursing Students Have To Go Through
You’re just going to feel a little pinch is the biggest lie a nurse can tell you as a kid. Getting shots seems like the worst part of going to the doctor’s office when you’re a little kid but as an adult sitting in the waiting room reading boring, outdated magazines might be worse. As the wait gets longer and longer over the years it is probably because of the shortage of nurses in the United States. There are many factors that play into the shortage such as high retiring rate, aging population, or stress in the workplace. Whatever the issue is, the United States is in high demand for nursing staff. The shortage is causing lots of problems not only for nurses but for the patients too. Fewer nurses mean longer waits at the doctor’s office and more mistakes from exhausted nurses. The shortage of nurses in the United States is causing physical and mental stress for nurses resulting in many to leave the profession. With an aging workforce about to retire and insufficient faculty to train nursing students, steps need to be taken to increase faculty and residency programs for nursing students and recent graduates.
After World War II ended in 1945 and nearly two million soldiers came home the population in the United States increased significantly. According to the article “The Baby Boom,” before World War II the average number of births in the United States was about 200,000 every month. The birth rate was at its lowest due to the effects of the great depression. However, towards the end of the war couples were eager to get married and have children due to the rising economic status in the US. Soldiers could look forward to extra pay to help support their families in thanks to the GI Bill (The Baby Boom). After demobilization, the return home of soldiers, the birth rate had increased to 350,000 birth per month in 1946 (The Baby Boom). The birth rate continued to grow for the next twenty years before it began to decline in 1964 (The Baby Boom). This generation of babies is known as baby boomers. Now in 2019, the baby boomer generation is reaching the age of retirement and this is having a serious impact on the healthcare field. In the article “What the Aging of Baby Boomers Means for Nursing,” baby boomers are living longer than previous generations and have “increased instances of chronic conditions and other diseases that require care.” As the rate of people needing care increases so does the need for nurses. This is also causing a higher demand for specialty nurses. In Jessica Kim Cohen’s article “How Bad Is the Nursing Shortage?” she states “By 2035, adults age 65 and older are expected to outnumber children” estimated by the U.S. Census Bureau. One of the big causes of the nursing shortage is an aging workforce. Many of the nursing staff in hospitals, doctor’s offices, and private care facilities are nearing the age of retirement. It is predicted that around one million registered nurses will retire between the years 2017 and 2030 (Cohen). This means that the number of nurses leaving the field is greater than the number entering. As these nurses leave there are not enough nurses being trained to make up for the loss. This is in large part due to low faculty for nursing programs.
In order to fill the opening nursing positions in hospitals new nurses need to be trained, but with a lack of faculty in nursing schools, many applicants are being turned away. To be a nurse, student need in class learning as well as hands-on clinical site training. The article “The Shocking Truth about the Nursing Shortage in the United States” claims hiring faculty to teach nursing students is difficult because a “teaching position requires a nurse to have a higher level of education, be an expert in their field, and often, be willing to take a pay cut.” Most nursing schools do not have the funds to offer competitive pay or financial incentives to recruit current nurses to leave their jobs to teach (The shocking truth). The need for teachers is still growing, with the current nursing faculty median age in the fifties many will be looking to retire soon (The Shocking Truth). Another problem nursing schools face is the lack of clinical sites. It is important for a nursing student to get hands-on, real-life experience before entering the field. Without proper practice or training nurses are entering the workforce underprepared which can lead to mistakes when dealing with life or death situations. Andis Robeznieks’ article “Looming Nursing Shortage Fueled by Fewer Faculty, Training Sites” quotes Kenneth Miller, president of the American Association of Nurse Practitioners, “But we’re competing for clinical-training sites with physician assistants, we’re competing with medical students.” Once nursing students do graduate and join the workforce there is a noticeable gap in experience. New nurses do not have experience working in high stress environments with multiple patients to take care of. There are not enough experienced nurses to help mentor the incoming nurses. Tim Seiter’s article “5 Of the Biggest Issues Facing Nurses Today” states that registered nurses “self-reported making medication errors (40%) and missing signs of life-threatening conditions (50%) at a higher rate than more experienced RNs,” according to Advisory Board. Not having anyone to ease new nurses into the field can cause them to experience burnout.
Nurses work in a very high stress environment that can put a strain on them physically and mentally. Burnout can affect all nurses no matter their experience or how long they have been in the profession (Seiter). The article “Avoiding Burnout as a Nurse” explains that nurse burnout is caused by many different things in the workplace. The most common signs of burnout include irritability, frequently calling in sick, intolerance to change, exhaustion, and “checked out” mentality (Avoiding Burnout). While all nurses face stressful situations some specialties of nursing are more stressful than others such as emergency departments or oncology (Avoiding Burnout). Nurses deal with death all the time and may not realize the emotional stress that can have on the body. Nurses are able to form bonds with their patients and it can be difficult to lose one. Losing a patient or helping a grieving family can be overwhelming and is a big cause of burnout (The Shocking Truth). Many of the reasons nurses are experiencing job burnout are being amplified by the shortage. Nurses are having a higher workload due to the shortage (the shocking truth). Alan De Keyrel’s article “The Biggest Causes of Nurse Burnout and What You Can Do” states nurses who work twelve-hour shifts have higher stress levels than nurses who only work eight-hour shifts. The shortage may cause nurses to take longer shifts or cover shifts for other people (The Shocking Truth). Nurses are always collaborating with other nurses and doctors which can be very stressful. If the people working together do not communicate well or there is tension between workers, it can cause stress for the whole group. In addition to job burnout, nurses also face a high risk of injury. Adam Rubenfire’s article “Taking a Load off Nurses” mentions that “healthcare workers have one of the highest rates of occupational musculoskeletal injuries in the U.S.” Nurses often have to lift and move patients by themselves because there is not an adequate supply of mobilization equipment readily available (Rubenfire).
According to the U.S. Bureau of Labor Statistics’ article “Occupational Injuries and Illnesses among Registered Nurses: Monthly Labor Review,” nurses are vulnerable to “hazardous substances, including drugs, diseases, radiation, accidental needlesticks.” Patients are also a concern for injuries. In 2016, only 12.2 percent of injuries were from violent events but that is still three times greater than any other occupation (U.S. Bureau of Labor Statistics). All of these reasons such as burnout, stress, or injury are causing some nurses to leave the profession when they are in high demand.
The need for new nurses is not only the result of an aging workforce but also an aging population. With today’s advancements in technology and healthcare people are living longer. The article “What the Aging of Baby Boomers Means for Nursing” claims older people have more chronic conditions adding to the need for healthcare professionals. The American Association of Colleges of Nursing: The Voice of Academic Nursing’s article “News and Information” reports that by 2050, people age sixty-five and older are projected to be 83.7 million, which is almost double what they projected in 2012. This large population of adults is expected to outnumber children by just 2035 (Cohen). This generation was coming of age in the ’60s and ’70s, a time when many people smoked cigarettes, did drugs and indulged more than previous generations (What the Aging of Baby Boomers Means). This has caused an increase in high cholesterol, diabetes, and obesity (What the Aging of Baby Boomers Means). Along with the growing elderly rate more people than ever have access to healthcare. Will Kenton’s Article “Affordable Care Act (ACA)” explains that the Affordable Care Act, also known as Obamacare, was signed into law in 2010. Its main purpose is to provide healthcare to uninsured people by giving savings on health insurance plans to qualifying low income families and “prevent[ing] insurance companies from denying coverage due to pre-existing conditions and requires plans to cover a list of essential health benefits” (Kenton). This means that more people can afford to have health insurance and an increase in people seeking medical treatment. As more and more people are needing healthcare it continues to put a strain on the nursing profession. The shortage does not only affect nurses, but it also affects the patients.
As nurses take on bigger workloads due to the shortage, it is causing patient care to take a downfall. The gap between new nurses entering the field and older nurses leaving is creating a gap in patient care (Seiter). New nurses do not have the experience in a real day to day work environment and there are not always well experienced nurses to show them the ropes (Seiter). The article “The Nursing Shortage and How It Will Impact Patient Care” shows that below target registered nurse staffing caused a 12% increase in patient mortality. It also showed that 46.8% of nurses committed a medical error in the past year (The Nursing Shortage). Nurses with increased patient loads are not able to spend adequate time getting to know the patient and might miss signs of life-threatening issues. Heather L. Tubbs-Cooley and colleagues found that nurses with larger amounts of patients also had higher readmission rates (News and Information). The nursing shortage is one of the main reasons for overcrowded emergency rooms. 92% of emergency departments report overcrowding (The Nursing Shortage). This means patients can wait up to three hours before seeing a doctor and once they are admitted 81% of emergency departments report having patients on a bed in the hallways (The Nursing Shortage). Nurses are also having less time with patients due to paperwork. The article “Survey Shows Nurses Spend Most of Their Time on Paperwork” states hospital nurses spend a fourth of their shift doing paperwork instead of spending that time with patients. Nurses often have to fill out the same information in different locations and complete “logs, checklists and other redundant paperwork” (Survey Shows Nurses). This takes a lot of time away from patient care and steps need to be taken to fit this problem.
Multiple steps need to be taken to fix the nursing shortage in the United States and it is not going to be a quick or inexpensive fix. In order to teach new nurses, the faculty shortage needs to be dealt with. Registered nurses earn around the same as nurse faculty so as a way to entice nurses to teach would be to offer a sign on bonus or some kind of student loan reimbursement as many nurses are still paying off loans (Robeznieks). Nursing students need to gain hands-on experience in a clinical setting but not all hospitals have the accommodations to take on a group of students. The article “Limited Clinical Sites for Nursing Students: Simulations Are the Answer” explains that 50% of clinical learning can be replaced with simulated learning. In most clinical settings a teacher is running back and forth between students watching them perform basic skills such as medication administration or injections (Limited Clinical Sites). The students rarely get to make decisions for themselves and do not get to experience “high stake scenarios such as a heart attack or stroke (Limited Clinical Sites). Simulations are able to provide a number of different scenarios that real world clinical settings might not. Training on manikins also allows room for mistakes. Students are able to make decisions about what they think is best for the situations and if they are wrong no one’s life was at risk and they can reflect on their decisions and try again (Limited Clinical Sites). By using simulation training, students are able to refine their decision-making skills while experiencing a wider range of scenarios and also not putting anyone in danger. Once a nursing student has graduated it is important for them to know how to deal with physical and emotional stress to avoid burnout.
It is important for nurses to know the signs of burnout and seek help early on in order to prevent the symptoms from escalating (Avoiding Burnout).
Nurses should take advantage of the programs offered by most hospitals. “hospitals offer employee assistance programs for nurses that include free phone counseling sessions, or other forms of stress management and self-care support” (Avoiding Burnout). Being able to keep work life separate from home life will also allow nurses to have a space to relax and unwind after a long or difficult shift (Avoiding Burnout). Nurses need to be able to have a time when they are not carrying the stress and burden of the job around. Another big problem nurses face is injury. Injuries may cause nurses to retire early or have a prolonged time off work putting stress on the other nurses. One solution to prevent injuries is to install overhead lifts in patient rooms (Rubenfire). Overhead rail systems allow nurses to secure the patient in a sling and safely move them (Rubenfire). This significantly decreases the risk of injury to nurses and the patient. This being one of the more expensive fixes, not all hospitals can afford overhead lift systems in every patient room. A cheaper solution would be to have more mobile lifting devices with stricter rules on when to use them (Rubenfire). More states need to have more patient handling laws. Only five states have these laws and had “7% to 29% fewer injuries in 2013 compared to the year before their laws took effect” (Rubenfire). Some other steps hospitals can take to lessen the effects of the shortage are to hire international nurses or traveling nurses.
Many problems caused by the shortage can be fixed by hospitals. Hiring international nurses may be a way to temporarily increase the number of nurses in the United States (Seiter). Hiring nurses from other countries allows nurses with more experience to come to American hospitals and fill the gap between the new nurses and experienced nurses (Seiter). They will be able to mentor newly graduated nurses in the field and help them adjust to the fast-paced working environment. The article “Why Your Hospital Benefits from International Recruitment” comments that most international nurses work on a contract and do not have to be hired after the contract is up. This means hospitals can increase their nursing staff and lessen the strain of the shortage. Many of the problem’s nurses face are effects caused by the shortage. In order for nurses to not feel overworked, there need to be more nurses to take care of patients. This will reduce stress significantly and help nurses avoid burnout. Another way for hospitals to increase nursing staff is to have traveling nurses. Hospitals can hire nurses from other hospitals where the shortage has not had as much of an effect. States can also pass a nurse staffing ratio law. The article “Health Experts Debate the Merits of Nurse-Staffing Ratio Law” explains how the nurse to patient ratio affects the state with the law and the states without it. California is the only state that limits the number of patients a nurse can take care of at a time (Health Experts Debate). Nurses could have up to ten patients to take care of before the law was passed (Health Experts Debate). Having too many patients makes a high stress job even more stressful and with limited time to take a break, many nurses do not take time to take care of themselves. Now the ratio of patients to nurses is regulated and may be different for different nurses in certain departments (Health Experts Debate). Having a set number of patients allows nurses to have proper time with each patient and had time to take breaks if needed (Health Experts Debate). It also had a positive outcome for the patients. There were fewer mistakes made by nurses and patients had fewer returns after the first treatment (Health Experts Debate). Although this law is good for nurses and patients it is expensive. Hospitals must hire more nurses and that often means having to raise nursing salaries to raise interest and keep nursing staff (Health Experts Debate). This law could put an end to the shortage very quickly if states and hospitals are willing to withstand the expenses.
As the United States population continues to grow and age the demand for nurses continues to increase. Nursing faculty needs to be increased in order to raise the number of student nursing schools that are able to accept. With fewer clinical sites available, nursing schools should integrate more simulation training into their programs as it gives the students real experience and hands-on learning. After graduating, nurses should be made aware of the signs of burnout and where to get help. Hospitals need to provide more equipment such as lifting devices to help prevent the chance of injury for nurses. Nurse staffing laws could also help lessen the physical and mental stress nurses face day to day in their field of work. With a continuing shortage in the field of nursing, these steps need to be taken in order to reduce the stress for nurses and increase nursing school faculty and attendance.
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