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Executive Summary
* Nursing has and continues to face significant challenges to its identity and sustainability due to prevailing forces of economics and demographics and due to the professional and political response of the profession to date.
* While the 1990's Pew Commission report on nursing missed the mark by predicting an oversupply of nurses, it did call for increasing accessibility and affordability of education, developing integrated education and practice models, strengthening clinical ladders, and increasing the points of entry into the profession.
* Despite this prophecy, nursing education remains hospitalcentric when the majority of health care is delivered outside the acute care setting.
* Future educational models should emphasize more sophisticated methods of problem solving and analytical skills rather than attempting to teach an increasingly complex body of knowledge.
* Similarly, care delivery models should emphasize radical redesign instead of incremental layering of tasks that are quickly becoming unmanageable.
* The interdependency of constructs driving nursing education and practice need to be radically redefined, not just retro-fitted, to keep pace with the uniquely different challenges apparent in health care today.
WITHIN THE PAST DECADE, the nursing shortage has presented many faces: fewer persons are interested in nursing; few students are enrolled in schools of nursing (Green [1987] described this as "trouble in the pipeline"); and fewer nurses are employed by hospitals. Another component of the shortage is that nurses, especially hospital nurses, express dissatisfaction with their practices (Aiken et al., 2001).
This lack of satisfaction has several causes but similar outcomes: decreased retention, especially among specialty practice nurses; frequent turnover; early retirement; or departure from nursing. In some hospitals, a significant component of the specialty nurse workforce is outsourced. Active international recruiting has increased the number of foreignborn nurses in the workforce. Nurses over 50 years of age have been lured back to work or encouraged to increase their participation in the workforce. Hospitals employ more travel nurses, agency nurses, foreignborn nurses, and older married nurses (Buerhaus, Staiger, & Auerbach, 2003). The changing composition of the nursing workforce and the dissatisfaction of practicing nurses contribute to the complexity of the nursing shortage.
Looking at the nurse workforce, you might wonder why the profession is challenged by a shortage. There are approximately 2.8 million...