Healthcare in the US: The Health Care Workforce

Introduction

Retention culture and recruitment process in the sphere of healthcare acquires specific importance because medical establishment deals with patients with different social and cultural backgrounds. Lack of high level working conditions, appropriate performance evaluation, and new educational opportunities should be introduced for sustaining the quality of healthcare delivery. However, currently, the healthcare system in the United States encounters difficulties due to the workforce shortage. The phenomenon is predetermined by such factors as increased demand for healthcare service, aging population, and lack of educational opportunities for future nurses and physicians.

Statement of the Problem

The problem of caregiver reduction in the United States appeared in the begging of the 2000s, since the time when the Association of American Medical Colleges (AAMC), alongside with the American Hospital Association (AHA) started exploring the major influence of demographic shifts, such as population growth, baby boomer aging and chronic disease increase. However, despite the slight projections, the consensus has been reached among research studies that have agreed that the caregiver shortage is inevitable. The research studies conducted by Zewiak (2015) have revealed that approximately 124,000 physicians and approximately 500,000 nurses will have been reduced by 2025. Furthermore, the researcher agrees that approximately 32 million covered lives due to the Affordable Care Act demand increasing the projections by approximately 31,000 physicians (Zewiak, 2015). There are multiple reasons for the shortages, and some of them are connected with the lack of programs for physicians and increased demand for care. Specifically, higher demand for care is explain by the aging population with more frequency of chronic disease occurrence. Additionally, the increasing demand is also associated with the population growth. Hence, there are three reasons: populating aging, growth and increase in chronic disease. In response, there is inconsistency between the population growth and demand for caregiver services. Similar to the patient demand, caregivers also undergo aging. For instance, Zewiak (2015) has defined that about 36.4 % of registered nurses involved employees from 50 to 64 years old. Such problem is also caused by the fact that the number of students interested in medical profession has significantly decreased. As it has been researched, there was no evident sign of physician supply augmentation from 1980 to 2005 (Zewiak, 2015). Such position can be explained by insufficient quality of education and absence of beneficial educational opportunities for those who want to connect their life with health care. Tuition fee is another serious obstacle for introducing changes to the ratio of physicians.

Apart from educational challenges, job dissatisfaction among physicians could be another problem contributing to the workforce shortage in medical establishments. In this respect, O’Donnell, Humeniuk, West, and Tiburt (2015) have explored the major reasons and preconditions of physician’s dissatisfaction with job conditions. The results have revealed that from 2556 physicians, almost half of them reported significant levels of fatigue, whereas approximately 70 % proved satisfaction with medical practices (O’Donnel, et al., 2015). However, job dissatisfaction has been identified as a tangible indicator of physician’s perceptions of their responsibilities, as well as of medical decision-making. In general, physicians who were ranked as dissatisfied with their working conditions have been less likely to reduce the probability of promoting reimbursement and expanding basic coverage.

History of the Problem

The problem of workforce shortage in health care is not new because there were precursors of the shortage several decades ago. Specifically, the 2011 workforce report showed the declining statistics and demonstrated 10 % decrease in number of nurses, pharmacists and imaging/radiology technicians (First Consulting Group, 2001). Further, high vacancy rates were identified across rural and urban settings in the country. Approximately 15 % of hospitals revealed an evident shortage of nurses by more than 20 % (First Consulting Group, 2001). The position of registered nurses, as a result, remained vacant. The situation is deteriorated because RN vacancy rates augmented by 60 %. The difficulties with recruitments were also evident.

The phenomenon of nursing shortages took place 30 years ago, when the professionals could affect Congress to provide funding for education with the help of the Nursing Training Act. Currently, the nursing shortage demands similar commitment and will not be eliminated totally unless the issue of current reduction of nursing faculty take place (Judd & Sitzman, 2014). Therefore, lack of qualification was also among the early problems of insufficient resources required for increasing the number of nursing staff. According to Judd and Sitzman (2014), “there are 200 different healthcare professions with nursing being the largest component; 2,9 million nurses hold a license to practice, with 83 % of that population being employed and 59 % of employed nurses working full time” (p. 331). Additionally, the nursing workforce is composed of different nursing personnel, including medical assistants, aides and personal care attendants. It has also been reported that approximately 1 % of all professionals have gained a doctoral degree and, therefore, nurses are now discouraged by the employment opportunities and career perspectives (Judd & Sitzman, 2014). Therefore, the current state of affairs is worse.

International Context

The problem of nursing shortage exists in the global context, as well. Currently, the global problem has a negative influence on health care system across the world. The major reform promoted by the International Council of Nurses introduced significant information related to the shortages, as well as recommendations for improving the situation (Oulton, 2006). Such solutions have been organized into five major areas, such as macroeconomics, policy intervention, workforce policy and planning, positive practice environments, regulations, retention and recruitment and nursing leadership. Internationally momentum provides the opportunity to pay attention to such issues and take the corresponding measures. The government should be the initiator of the program to ensure higher quality of health care and create the favorable conditions for nurses working all over the world. It also should be oriented on knowledge expansion, as well as on the competence og professional workforce.

The international scale of the problem also reveals in separate locations and regions, where nurse shortage is a problem, as well as alongside with distributional challenges and international trade. For instance, the problem of human resource management is urgent for Southeast Asia (Kanchanachitra, et al. 2011). Therefore, the attention to different situations and various locations is important for understanding the situation in general. Considering the fact that communication and health care are interconnected, the government should control the problem of nurse shortage at an international level.

Stakeholders

Judging from the above-presented problems and considerations, three major stakeholders could be outlined – government, nurses and patients. They can be regarded as dependent variables, which are affected by the problems described, such as populating aging, growth, increased demand, job dissatisfaction and reduction of qualification among nurses. Therefore, it is important to explore the role of each of stakeholders in creating and aggravating the current situation with nurses’ workforce reduction. To begin with, the government should take an active part in educational programs for nurses. Instead, as the prices for education grow, fewer students are willing to enter the course due to the high cost of education, although their talents and skills are sufficient for contributing to the professionalism of the current nursing staff. As a result of poor organization and lack of investments, the current nursing staff is not renewed regularly.

Public sector or clients also suffer from workforce shortage because they have fewer possibilities for addressing a professional physician who can help them cope with the disease. As a result, the health care conditions of such clients worsen and the rate of chronic diseases increase. Besides, due to the shortage, the demand for health care services increases, as well. Therefore, the community suffers significantly from the decline in the availability of expert and professional physicians who are able to provide prompt and timely help.

Finally, the nurses are also among the leading stakeholders affecting the workforce shortage rate. Some of the individuals are negatively impacted by the lack of financials support on the part of the government and, consequently, they cannot carry out research and development procedures for improving the quality of care. The shortage also affects other nurses working in hospitals, since staff aging is a common problem leading to the increase of responsibilities and duties they have to perform. All the considerations must be analyzed to define further policies and reforms to be introduced for removing the problem and alleviate workforce shortage in future.

Policy

The policies introduced by the government and health care establishment can have potent impact on the situation with nurses’ shortage. The shortage occurs due to the reforms and principles proposed by the health care executives and governmental institutions. In response to such problems, some of the hospitals have still resorted to a range of long-term and short-term strategies to cope with nurse reductions. The efforts include competitive compensation, nurse education, interviews with managers and leaders and employment of temporary staff. However, such initiatives require advanced costs and create new problems regarding their impact on patient care (May, Bazzoli, & Gerland, 2006). As a result of the failed attempts to improve the situation, there must be new measures, which investigate the core of the problem better.

The government’s reforms are also unsuccessful because the quality of education is closely associated with the prices and fees students should provide. Nonetheless, there should be other methods for improving education and promoting new level of expertise among employees (First Consulting Group, 2001). They should not merely focus on the financial questions. On contrary, they should be more concerned with the development of strong ideological missions and visions of each educational establishment.

Recommendations

An in-depth consideration of problems, challenges and origins of workforce shortage provides a strong platform for new recommendations that could alleviate the problem and provide new perspective for development and quality improvements in hospitals. All the recommendations are tied to the problems discussed above. Additionally, they are developed both for the government and for the hospitals to take the corresponding measures.

Regarding the governmental reforms, the emphasis should be placed on educational fees. In particular, due to the fact that the costs for education are increasing, the government should provide funding and scholarship for talented and promising applicants who do not have the possibility for paying for tuition. The grants and scholarships would be more encouraging and attracting for students. Furthermore, such approach will help the educational establishment search for willing and committed student who will later contribute to the development of health care sector in the United States. In addition, the educational establishment should also be more active and cooperate with voluntary and non-governmental organizations that can support them in research and development initiatives and evidence-based practices. In such way, the quality of education will be increased, as well. The more specialists the sector receives, the higher probability of introducing qualified nurses to hospitals.

Apart from the governmental financial support, the hospitals should also reconsider their policies and promote new reforms and ideas, which could increase collaboration and cooperation among nurses. It particularly concerns technological advancement and nurses’ engagement into processes of decision-making and problem solving. Regular meetings and attention to details should improve the communication and interaction among nurses and physicians. For instance, there should be specialized training programs for nurses, as well as performance assessment tools for keeping nurses attained to the current events and challenges taking place at hospitals. Due to the fact that the quality of patient care depends on communication, the managers should pay attention to such value because it defines the extent to which treatment is successful. Although all the medications are prescribed, lack of psychological support can have detrimental effect on patient’s welfare.

Finally, the community should also be more concerned with the problem of workforce shortage in health care sector because it directly affects their welfare. Specifically, they should be more concerned with their health and introduce new environmental reforms for removing the external factors, which affect the quality of life. For instance, the medical aid should be introduced in school and business establishments for reducing the frequency of addressing the hospitals. Workers and students can visit local medical campus in case their concerns are not serious. As a result, the demand will decrease and the nurses will be less overloaded with work.

Conclusion

In conclusion, the U.S. health care system experiences significant problems in workforce management due to the nurses’ shortage and increasing demand. The problem is aggravated due to the population aging and growth, and, as a result of it, the chronic disease rate increases. In response, the nursing staff is aging as well due to the fact that fewer students are willing to apply for the position of a registered nurse or caregiver. The statistics is not promising because the shortage will continue if corresponding measures will not be taken. Specifically, the major stakeholders – the government, patients and nursing professionals – should take an active part in decision-making and quality improvement of such areas as financial support, education, research and development and partnership with voluntary organizations. In addition, the external and internal aspects must be considered. The external support must come from educational institutions, which should provide grants and scholarships to talented students who have insufficient financial support. Further, the government should cooperate with voluntary organizations that agree to introduce additional support for research and development reforms. The internal factors refer to hospitals’ ideology, mission and vision to provide new perspectives and professional development for their health care personnel. Specifically, they should be more concerned with improving collaboration, cooperation and interaction with patients. Psychological dimension, therefore, is the key in alleviating shortage among nurses and physicians. As soon as such recommendations are introduced, both education and health care system can contribute to the political and economic development of the United States in general.