Learning Objective #1: Identify the impact of the nursing shortage on hospital processes and quality of patient care using the Institute of Medicine's six indicators for quality improvement

Learning Objective #2: Identify policy implications to improve the quality of patient care in hospitals given the available supply of RNs

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Context: In 2005 the current shortage of registered nurses (RNs) entered its eight year, lasting longer than any previous shortage in the past half century. Objective: Determine RNs' perceptions of the nursing shortage and its impact on hospitals and nurses. Design: Cross-sectional, self-administered, mailed surveys of RNs. Setting: National samples of RNs in 2002 and 2004 Participants: RNs reporting positions in direct care positions in acute care settings. Main Outcome Measures: RNs' perceptions of extent and severity of nursing shortage, impact on hospitals, reasons for and solutions to the shortage, recruitment, retention and staffing strategies, and expectations for the future. Results: Although the gap between supply and demand for nurses has narrowed between 2002 and 2004, most RNs perceive a nursing shortage still exists in their practice communities. The majority have observed the shortage having negative affects on the early detection of patient complications , maintaining quality of care and patient safety, increased patient complaints about nursing, increased patient wait time for surgery or tests, and delayed discharges from the hospital. RNs perceive most recruitment and retention strategies have been effective, and that mandatory and total overtime hours have decreased. Fewer RNs in 2004 than in 2002 perceive stress resulting in burn out, fewer plan to leave the nursing profession in the next three years, and more RNs report they are very satisfied with their job. Most RNs are not optimistic about where the shortage will lead to in the future, and believe that improving the work environment and increasing wages and fringe benefits would help resolve the shortage. Conclusions: Efforts to improve the workplace and expand the size of the RN workforce are needed to prevent further disruptions in the delivery of hospital care, avoid decreased access to care, and avert a deterioration in the quality and safety of care.