In 2006, Rhode Island had 13 hospitals and almost 100 nursing homes that employ professional nurses. There are also many visiting nurses who provide in-home assistance. There are six nursing schools at Rhode Island universities and colleges, including University of Rhode Island, Salve Regina, Rhode Island College, the Community College of Rhode Island, the St. Joseph School of Nursing, and the Memorial Hospital School of Nurse Anesthesia.
In 2006 the total number of professional nurses in Rhode Island was about 17,500. There are also about a dozen professional associations and unions for nurses, including the Rhode Island State Nursing Association (RISNA), the Massachusetts/Rhode Island League for Nursing, the Visiting Nurse Association, the United Nurses and Allied Professionals union, and several specialty nursing groups such as those representing critical care nurses, oncology nurses, pediatric nurses, and other specialized forms of nursing.
GROWTH OF NURSING PROFESSION
At first glance, nursing in Rhode Island would seem to be a profession that should be growing in numbers and high in professional status. But there is a current shortage of thousands of nurses in Rhode Island, and that shortage could top 10,000 within less than 15 years. The shortage of registered nurses is more acute than for any other skilled occupation in Rhode Island.
The 2004 study by the State Health Assessment Planning and Evaluation (SHAPE) foundation noted that the number of nurses in Rhode Island was about 8% below what it should be to serve patients in Rhode Island facilities. Every year the deficit was projected to grow worse.
WHAT IS WRONG WITH NURSING?
There are a number of critical and intersecting problems that have caused the nursing shortage. This means there is no simple solution, but rather that many simultaneous issues have to be addressed and improved at the same time.
The initial problem is that the Rhode Island nursing schools cannot graduate new nurses as fast as experienced nurses are retiring or leaving the profession. The nursing population in Rhode Island is growing older, so that retirements are occurring with increasing frequency. Many Rhode Island nurses are age 50 or older, so retirements will probably continue to outnumber new nurses entering the field.
The next problem is the fact that there is a waiting list of almost two years to enter nursing schools in Rhode Island. The waits are so long that many young would-be nurses decide to enter other occupations because they establish other careers before they can even get into a nursing school.
POSSIBLE SOLUTIONS
The primary reason that there are long waits to enter nursing schools is due to the shortage of nursing instructors at all of the Rhode Island nursing schools. The main reason for this shortage is because nursing instructors make less than nurses who work in hospitals. Thus compensation for nursing instructors must be improved before the shortage of instructors can be reduced.
It would also be helpful to increase the number of nursing school scholarships, and to provide low-cost student loans for nurses. The Rhode Island Assembly has taken steps in this direction, but additional steps and funding may be needed.
Not only are Rhode Island nurses retiring in significant numbers, but some younger nurses are leaving the field. A key reason for young nurses leaving the field is due to the extremely heavy work schedules caused by mandatory overtime.
The ratio of nurses to patients is determined by State and Federal regulations. Hospitals with a shortage of nurses require their nursing staffs to work additional hours or extra shifts in order to keep the proper ratios on the floor. This means that nursing in Rhode Island averages close to 12 hours a day, and 16 hour days are not uncommon. The issue of mandatory overtime is a critical one that needs a solution. Mandatory overtime is hazardous for both patients and nurses, and is lowering the quality of life for many nurses.
Every Rhode Island hospital and many nursing homes have legitimate shortages of nurses. But due to the mandatory overtime regulations, it is obvious that keeping the nursing staffs somewhat low might be an economy move for hospitals of marginal profitability. One way to avoid this is to publish the sizes of the nursing staffs and any current shortages.
One somewhat doubtful solution to the nursing shortage is “in sourcing” or hiring nurses from India or other countries and bringing them into Rhode Island with work permits. In the long run, this is likely cause damage to the nursing profession by leading to the false conclusion that Rhode Island nursing schools don’t need to expand their instructional staff.
Another problem in Rhode Island has been the bankruptcy of nursing homes. This problem was approaching epidemic proportions until the State has increased regulatory oversight of nursing home operations. There are still problems with many nursing homes in Rhode Island, but the situation is now under constant surveillance.
The bottom line is that nursing in most states is reaching a dangerous situation. The problems that led to high nursing attrition rates, mandatory overtime, and the shortage of nursing instructors developed over a period of many years. The problems of having sufficient health care providers is becoming more critical in most industrialized economies as populations are aging.