|
|
|
|
The study identified six recommendations
for HRSA and other organizations to consider
as they attempt to identify facilities
with critical shortages of RNs accurately
and reliably. These recommendations are
presented below.
- Of the methods examined in this study,
the Preferred Method outlined in this
report was the best choice for assessing
the severity of nursing shortages in
counties in the U.S. It met more of
the desirable criteria identified by
the study advisory panels, and it can
be implemented with currently available
data. Additional steps outlined below
could further improve the effectiveness
of this method.
- Additional review and validation of
the Preferred Method would be required
by stakeholders who would be affected
by its implementation. Ideally, this
validation should take place in a representative
sample of states, counties, and facilities
across the U.S., and would address the
following kinds of questions:
- Are facilities and counties classified
correctly by the method? Is the
method biased in favor of or against
a type of facility, community, county,
or region of the country? If so,
how should the bias be addressed
and overcome?
- Are the basic data required to
support the method both available
and accurate for all regions and
states in the U.S.? How should sampling
errors for small rural counties
be addressed?
- How should facilities that have
nursing shortages due primarily
to persistent poor management be
dealt with in the method? What criteria
should be used to identify facilities
with poor management, and should
their identities be made public?
- Should the method be supplemented
by some sort of appeals process
to permit a facility with a genuine
shortage to qualify for NELRP and
NSSP even though the method does
not place it in a sufficiently severe
shortage category?
- Should the method identify just
enough severe shortage counties
and facilities to allocate all NELRP
or NSSP recipients, and other related
funds based on nursing shortages?
Or should it identify extra facilities
to provide flexibility to account
for other factors?
- More accurate estimates of RN employment
and supply should be developed at the
county level. This may not require new
data collection if appropriate refinements
can be made to the sampling frames for
existing datasets, especially the NSSRN.
- More research should be conducted
on factors related to the demand for
RNs, including HMO penetration, alternate
service delivery models, the use of
LPNs and other types of staff, and new
diagnostic and treatment technologies.
Factor analysis may be a fruitful avenue
for additional research. Another promising
avenue for research will open up when
the revised Nursing Demand Model becomes
available sometime in 2007.
- More research should be conducted
on factors related to the supply of
RNs, including RN commuting patterns,
how very rural communities can recruit
and retain RNs, how inner-city facilities
can recruit and retain RNs, etc. A promising
avenue for research will open up when
the revised Nursing Supply Model becomes
available sometime in 2007.
- Because shortcomings in available
data and extenuating circumstances might
cause certain facilities to be assigned
the wrong shortage designation, a formal
protocol by which facilities can appeal
and correct their shortage designation
should be developed. The development
process should consider a variety of
appeal options, including single facility
designation changes and blanket designation
changes for entire classes of facilities.
|
|