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The National Advisory Council on Nurse
Education and Practice (NACNEP), in this
first report to the Secretary of Health
and Human Services and the Congress, provides
an overview of its activities and its
perspectives on the nursing workforce,
education and practice improvement. The
report is called for under the responsibilities
outlined for NACNEP in the legislation
reauthorizing Title VIII, Nurse Education
and Practice Improvement Act of 1998 (P.L.
105-392).
NACNEP undertook its tasks as the health
care system continues to evolve. Registered
nurses (RNs) are essential to the many
dimensions of health care, well beyond
direct patient care.
They practice in all the varied types
of settings providing health care and
in a variety of capacities in addition
to providing direct patient care. Access
to health care services is dependent on
having an adequate supply of RNs who are
the core staff for these services both
in and out of hospital settings. An aging
nurse workforce and a decreasing student
body contribute to the RN shortage of
today and in the future.
NACNEP’s Activities
Since undertaking the responsibilities
called for in the November 1998 legislation,
NACNEP completed three major activities
by 2000 concerning the use of Federal
financial resources for nursing education,
improving the substantial disparity between
the diversity of the RN population, and,
in partnership with the Council on Graduate
Medical Education, improving patient safety
through interdisciplinary education and
practice. NACNEP, most recently, addressed
the nationwide concerns of a current and
future nursing shortage by devoting its
last two meetings to obtaining perspectives
on the shortage issues from experts in
the field and representatives of 16 national
nursing organizations. As a result of
its examination, NACNEP prepared a policy
document stressing the immediacy and critical
importance of the shortage issue. The
document provides NACNEP’s strategies
to help reverse this severe and complex
evolving nursing shortage, including approaches
to strengthening the effect of the provisions
under Title VIII legislation.
View of the Current
State of Nursing
The report points out that today’s RNs
are practicing in a far more complex environment
than in the past brought about by continuing
changes in delivery of health care; rapid
advances in technology, drug therapy,
and equipment; increasing number of older
adults with multiple chronic conditions,
and expanding diversity of the country’s
residents. The changing environment for
nursing practice raises a multiplicity
of workforce, education, and conditions
of practice issues.
Workforce. A slower growth rate
in size of the RN workforce and the continuing
aging of this workforce are accompanied
by significant decreases in the number
of entrants into nursing education programs
that prepare individuals to become RNs.
Barring significant changes in the flow
of entrants into nursing, projections
show that the supply of RNs will decline
within about 10 years and that, by 2020,
the RN workforce will be 20 percent below
projected requirements. Significant disparities
still exist between the diversity of the
RN population and that of the country’s
population. Increasing numbers of RNs
from minority backgrounds is a prime consideration
in reducing the substantial racial and
ethnic disparities in health. Nursing
remains an overwhelming female occupation.
In the face of continually expanding opportunities
for women in other occupations, it is
critical to develop recruitment strategies
to recruit men as well as women into nursing.
Promoting nursing as an economically attractive
career is necessary for increasing its
competitive standing as a career choice.
Education. Today’s increased
complexity of care demands a better educated
RN. All levels of RNs have an important
role to play in the evolving health care
system. Baccalaureate education with its
broader, more scientific base provides
the sound foundation for the variety of
nursing positions and for entry to advanced
nursing education and practice. The majority
of today’s RNs are educated at less than
the baccalaureate level. Dramatic efforts
are needed to meet the NACNEP target for
a 2/3 BSN-prepared nursing workforce by
2010. Only 10 percent of today’s nurse
workforce has graduate education at the
master’s or doctoral level.
Graduate education provides the advanced
knowledge necessary for specialized nursing
and health care; managing and directing
nursing in the varied complex clinical
care settings, and educating the next
generation of nursing students. Nursing
education programs, from practical nursing
to doctoral nursing education, employed
46,655 RNs, not all of who had the appropriate
level graduate education. Furthermore,
the average age of nurse educators in
2000 was 49.4 years. Of particular significance
is the competition between the nursing
education programs and the clinical and
administrative areas of health services
organizations for the relatively scarce
number of RNs with advanced degrees.
Practice Improvement. Changes
in the organization of the health care
system have affected the distribution
of nursing positions. Expanding opportunities
for RNs have led to far greater growth
rates in RN employment in settings other
than hospitals. Hospitals, however, are
still the predominant RN employment setting,
employing 59 percent of the RNs. Increasingly,
media from all parts of the country carry
stories about difficulties in recruiting
RNs for vacant nursing positions. In addition
to the se reports, data from a number
of national and State studies reveal significant
shortages. Most of these reported data
focus on hospital difficulties. Along
with the media reports of vacant hospital
nursing positions are the reports of nurse
dissatisfactions with their conditions
of work including staffing levels that
are insufficient for providing appropriate
care to patients and mandatory overtime
that exacerbate the unsafe practice conditions.
Furthermore, the increasing RN age level
requires consideration of the work structure
needs of older workers and of approaches
to attracting and retaining nurses in
positions of particular stress that are
usually filled by RNs from the younger
age cohorts.
NACNEP believes that the issues concerning
the size and composition of the workforce;
the nurse educational system and the work
environment identify matters for consideration
in affecting the current and future critical
nursing shortages. These must be addressed
to ensure the availability of the size
and quality of the RN workforce necessary
for the nation’s health care service requirements.
Title VIII Contributions
Federal support for nursing education
and practice under Title VIII spans almost
forty years. Funding through this mechanism
has resulted in major contributions to
the health care available to the country’s
population. The report demonstrates how
the available, though limited, funds have
been used for the development of numerous
innovative approaches to enhancing nursing’s
ability to address new and emerging health
care issues, provide care to the underserved,
and recruit into nursing minority and
other individuals from disadvantaged backgrounds.
Current levels of funding are woefully
inadequate to accomplish all the clearly
indicated objectives of the Title VIII
legislation. Continued funding, at least
at the current levels, is essential but,
also, it is important that assessments
be made of the availability of necessary
funds to meet arising critical needs in
the development of an appropriate nurse
workforce.
Conclusions and Recommendations
NACNEP, in undertaking its responsibilities
since the enactment of the 1998 legislation,
specifically targeted aspects that affect
Federal policy matters and those for which
the Federal government can be particularly
instrumental in affecting change although
recognizing that change can only take
place through concerted activities of
all partners involved. It sees, however,
a distinct leadership role for the Federal
government through Title VIII and other
Federal government vehicles that fund
nursing education and nursing services.
To that end, NACNEP reiterates the conclusions
and recommendations contained in reports
of the projects it undertook during the
period. NACNEP presents thirteen recommendations
in response to the severity of the current
and impending future nursing shortage
and its implications for the nation’s
ability to provide its residents with
health care from an adequate and qualified
nurse workforce.
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