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With predictions that this nursing shortage will be more severe and have a longer duration than has been previously experienced, traditional strategies implemented by employers will have limited success. The aging nursing workforce, low unemployment, and the global nature of this shortage compound the usual factors that contribute to nursing shortages. For sustained change and assurance of an adequate supply of nurses, solutions must be developed in several areas: education, healthcare deliver systems, policy and regulations, and image. This shortage is not solely nursing's issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media. This paper poses several ideas of solutions, some already underway in the United States, as a catalyst for readers to initiate local programs.
Key words: nursing shortage, solutions
The Nursing Shortage: Solutions for the Short and Long Term
Every article, speech and interview about the nursing shortage notes that it is a different type of shortage than in the past. Some contributing factors remain the same, such as women having more choices for a career. Key differentiators from the previous two shortages are the aging of nurses, the general workforce shortages in ancillary professions and support labor, and the global nature of this shortage. In addition, the fundamental changes in how patients are cared for in a managed care environment is compounding the shortage. With decreased length of hospital stays and more acute care in the ambulatory and home settings, the need for experienced, highly skilled nurses is unmet. A numerical analysis may indicate enough current numbers, but the level of expertise may be the cause of the problem.
From an economic perspective, this shortage is being driven more by the supply side of the supply/demand equation than the demand side. Thus, this is a more complex shortage, which promises to worsen during the next decade as more nurses retire. Past economic solutions such as sign-on bonuses, relocation coverage, or new premium packages will have limited and temporary effect because they simply redistribute the supply of nurses, not increase it.
Past economic solutions such as sign-on bonuses, relocation coverage, or new premium packages will have limited and temporary effect because they simply redistribute the supply of nurses, not increase it.
However, these solutions are already gaining in popularity again as evidenced by ads in local newspapers. The solutions to create a sustained improvement to the nursing shortage will need to be more radical than past shortages and must address many long-term issues.
In addition to the worsening nurse shortage is the shortage of other staff including various allied health professionals, secretaries, and support staff. The shortages of other staff are adversely impacting nurses who have the most continuous and closest relationship with patients and their families. In the early 90's, for cost cutting reasons, there was an increased use of unlicensed assistive personnel. However, these models have failed due to increasing patient acuities, the concerns over medical errors, and the declining numbers of ancillary personnel.

nursing

http://content.healthaffairs.org/cgi/content/abstract/21/5/157

Nursing Shortage Redux: Turning The Corner On An Enduring ProblemJulie Sochalski
Projections of a substantial nursing workforce imbalance in the coming decade have galvanized policymakers, providers, private foundations, nurses, and others to proffer aggressive and sustainable strategies to ameliorate the looming shortage. The solutions are largely ones that seek to increase supply. Analysis of the 1992–2000 National Sample Surveys of Registered Nurses shows that increasing losses from the active workforce, stagnant wages, and low levels of job satisfaction pose major impediments to bolstering supply. Strategies focused on working conditions and retention should occupy a central position in any nursing workforce revitalization plan.

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INTRODUCTION
The proportional over-representation of males at higher levels of the British professional nursing hierarchy has been extensively documented and described (Dingwall 1972, 1977b, Austin 1977a, Carpenter 1977, Jones et al. 1981, Nuttall 1983, LeRoy 1986, Jolley 1989, Mackay 1989, Robinson 1992). Many previous explanations rely on a gender essentialist approach citing quasi-biological differences in career aspirations and pathways, career breaks taken by women after having children or part-time working, for example (Hardy 1983, Winston 1992, Adams 1994, Marsland et al. 1996).
Elsewhere (Ratcliffe 1996), I have posited an alternative theoretical framework within which a non-essentialist examination of gender differences in career progress may be made. This framework looks at processes within the professional nursing labour market which serve to maintain the gendered structure described above. The approach examines the labour market in nursing as a set of external labour markets within an overall national internal labour market. The nature of the labour market for the individual nurse is dependent on the ability to move geographically. Geographical mobility is considered to be a criterion of exclusion which, due to broader patriarchal social structures, conveys an aggregate advantage to males (who tend to be more geographically mobile) and a concomitant aggregate disadvantage to females.
Clearly, this notion requires adequate empirical investigation. For if it is the case that geographical mobility has significant collective gender effects on the labour market structure of nursing then it contributes a hitherto hidden form of 'structural' gender discrimination within the nursing labour market which needs to be exposed and subsequently dealt with by policy makers.

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Its research survey based on 16-45 year olds, showed that after the 2003 campaign their perceptions of the NHS as a good employer improved. More believed a career in the NHS offered flexible working, was all about teamwork, that there was more information available about NHS careers and that working for the organisation was better in 2003 than it was a year earlier (Box 2). Research looking at the public's perceptions of the NHS as an employer between 1999 and 2002 showed a similar picture, with respondents agreeing with the statement that the NHS was an employer that looked after its staff.
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Box 2. Image of an NHS career (before and after 2003 campaign)

Modern image
The Leo Burnett research also showed that the image of nursing between 2001 and 2003 improved, with more people believing it was a well-respected career with a reasonable salary (Box 3). And it is this modern image of the NHS and improvement in nursing as a supported career that helped bring Ms Wilson back to the intensive care unit.
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Box 3. Image of nursing

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INSPIRED BY THE growing nursing shortage, we surveyed high-school students and adult career-switchers about their interest in nursing as a possible career. We made a startling discovery: Only 5% of students and 3% of adults said they'd choose nursing as a career. We also learned that being happy at your job is the number one motivator for both students and adults—yet only 35% of students and 33% of adults believe that nursing provides this benefit.
Today, 1 in 10 nursing jobs is unfilled in the United States. According to the Bureau of Labor Statistics, the nursing shortage will reach 1 million nurses by 2012. Our telephone survey, commissioned by nurse-executives in the Partners HealthCare System (Partners Chief Nurse Council), was designed to address this crisis. Besides exploring what potential nursing students look for in a career, we wanted to identify deterrents that might steer them away from nursing.
In this article, we'll discuss key findings from this survey, which was based on 800 telephone interviews. (See About this study.) We'll also suggest ways you and your colleagues can use this information at the grassroots level to attract more bright young people and seasoned adults to nursing.
What's the single most important reason for a career choice?
Respondents were asked about their reasons for career choice

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IN 2005, WE BEGAN a six-part series of articles that has focused on the registered nurse (RN) workforce in the United States (Buerhaus, 2005). In preceding articles we reported results of analyses designed to assess: (a) whether the current nursing shortage is getting better or worse (Buerhaus, Donelan, Ulrich, Norman, & Dittus, 2005a); (b) RNs' satisfaction with their jobs and with being a nurse (Buerhaus et al., 2005b); (c) awareness and impact of a major national initiative aimed at drawing attention to the nursing shortage, promoting the image of nurses, and attracting people into the nursing profession (Donelan, Buerhaus, Ulrich, Norman, & Dittus, 2005); (d) the impact of the current nursing shortage on nurses, care processes, and on the quality of patient care (Buerhaus et al., 2005c; and (e) characteristics of older RNs, the fastest growing segment of the nursing workforce in the United States (Norman et al., 2005). These analyses used trended data from national surveys of RNs conducted in 2002 and 2004, as well as a 2003 national survey of nursing students, and a 2005 national survey of chief nursing officers (CNOs). The surveys were conducted as part of a project designed to determine the effectiveness of the Johnson & Johnson Campaign for Nursing's Future (Buerhaus, 2005).
In this article, we pull together key results of these national surveys to provide a comprehensive assessment of the state of the nursing workforce in the United States. Overall, we believe that nurses are telling us that workforce conditions have improved since 2002 when the current nursing shortage, which began in 1998, was at its peak. At the same time, there are lingering problems that, unless resolved, threaten to erase the recent gains that have been achieved and disrupt efforts to accomplish long-term improvements in the clinical workplace environment. If the profession is to thrive, change must continue apace — short-term fixes have failed before. Whether further improvements or setbacks develop over the next few years will depend on how effectively nurses, policymakers, the private sector, and hospital leaders act to address the implications of the current and projected nursing shortage.

nursing

Data Analysis
This study was guided by the basic research question, to what extent does perceived formal power, perceived informal power, and perceived access to work empowerment structures relate to nurses' self-reported intent to stay on the job? To answer this question, a descriptive correlational survey design was used. Frequencies were calculated for the demographic variables and descriptive statistics were calculated for the JAS, ORS, CWEQ, and intent to stay instruments. Pearson's product-moment correlation coefficients were calculated to detect relationships of (a) formal power, (b) informal power, (c) access to empowerment structures, and (d) demographic variables to intent to stay on the job.
Results
The descriptive analyses are shown in Table 3. Consistent with previous studies (Beaulieu et al., 1997; Sarmiento et al., 2004; Wilson & Laschinger, 1994), nurses perceived moderate levels of empowerment at their workplaces suggesting that there is still room for increasing perceptions of access to opportunity, information, resources, and support. Nurses in this study had a slightly higher overall empowerment score, M=12.95 (SD=3.14), compared to the nurses in the aforementioned studies, where the overall empowerment score means ranged from 12.10 to 12.25.
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