California is experiencing a shortage of registered nurses that differs fundamentally from prior nursing shortages, according to a new report released by the UCSF Center for Health Professions.

The report titled: Nursing in California: A Workforce Crisis is the first of several to be released by the UCSF Center for Health Professions' California Workforce Initiative.

"This is not just another cyclical shortage of nurses that can be rapidly cured by paying nurses higher wages and enrolling more students in nursing schools," said Edward O'Neil, director of the UCSF Center for the Health Professions and principal investigator of the study. "The aging of the nursing work force, the upheaval in the health care system and the expansion of career opportunities for women (who make up 94 percent of the nursing work force in California) are combining to produce a chronic shortage of nurses. That shortage can only be resolved by improving the work environment for nurses and redefining nursing practice."

Part of the nursing supply problem is itself related to aging, according to O'Neil. "One in every five RNs licensed in California is 55 or older, and many RNs retire in their late 50s and early 60s. If these patterns continue, retirees will represent much of the RN shortfall. This shortage will become more acute over the next several decades as the health care needs of aging baby boomers increase," he said.

The researchers also cite changes in the nursing work environment that have led to more stress among nurses and growing tension between nurses and managers. "Pressure to contain costs has led to efforts to reduce the length of patient stays in the hospital and limit admission to those who are most in need of services. Consequently, there is a higher level of patient illness in hospitals. This means that more critical decisions and work need to be carried out in less time," said Janet Coffman, MPP, associate director of Workforce Policy at the UCSF Center for Health Professions and a co-investigator on this report. She explains that these changes have had a major impact on the 60 percent of California's RNs who work in hospitals.

As a consequence, careers in health care have become less attractive relative to other industries, said Coffman, adding that the problem is compounded by the fact that nursing has traditionally been known as a women's profession. "The fairly recent expansion in opportunity for women means that the health professions can no longer count on a large number of young women entering the profession. This means that nursing will have to re-position itself as an attractive career to compete successfully for the interest of people entering the work force."

"These trends suggest that wage increases, signing bonuses and image campaigns are not sufficient to alleviate this crisis," said O'Neil. "Young people are looking for careers that offer autonomy, flexibility and the chance to participate in the management of the organizations in which they work."

The researchers made the following recommendations for improving the nursing work environment:

• Leaders in health care and unions representing RNs should partner with one another to strengthen trust between labor and management.
• Senior health care executives need to constantly evaluate their organizations, engage RNs in these efforts, and take seriously their assessment of current practices and suggestions for addressing problems.
• Health care organizations should invest in the retention of RNs. Specific recommendations include elimination of mandatory overtime and the provision of greater financial rewards for experienced RNs, financial incentives for RNs to complete further education, and adequate sick leave.
• Unions representing RNs should place greater emphasis on career development and nurses' participation in the management of organizations in which they work.

The system of nursing education also needs attention, expansion and integration, according to the researchers. Even with a properly functioning system, California has an inadequate supply source for new nurses, said Coffman. She explained that historically the state has imported a large proportion of nurses from around the country and abroad. "With growing demands for nurses across the country and the rising cost of living in California, we can no longer rely on others to educate our nurses."

The researchers made the following recommendations for improving nursing education:

• Increase the numbers of non-white and male nursing students
• Make nursing education more accessible (evening and weekend classes, distance learning)
• Improve clinical education in order to ensure that nursing graduates are well prepared for clinical practice. A range of approaches should be explored, including designated mentor programs, extended orientation/preceptor programs, and formal residency programs.
• Provide students with standardized information about nursing education programs (prerequisites, number of required credits, pass rates on licensure exam).

This research for this report and its production were funded by the California Health Care Foundation. The California Health Care Foundation is an Oakland-based, independent, non-profit, philanthropic organization whose mission is to expand health care access for underserved individuals and communities, and to promote fundamental improvements in the health status of Californians.

The UCSF Center for Health Professions' California Workforce Initiative (CWI) is funded for the California Health Care Foundation and The California Endowment. The California Endowment is a private foundation with staff throughout the state whose grants are made to organizations and institutions that directly benefit the well-being of Californians. For more information about the report, visit http://futurehealth.ucsf.edu/CWI/nursingneeds2.html