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Things are improving in hospitals, and the shortage has eased somewhat according to the 2004 National Survey of Registered Nurses. The new study is one of the first that shows positive changes says coinvestigator Peter Buerhaus, RN, PhD, FAAN. “Though we’re making progress, there are still long-standing problems associated with the shortage and the workplace environment,” says Buerhaus, Valere Potter Professor of Nursing, senior associate dean for research at the School of Nursing, Vanderbilt University, Nashville, Tenn.

The 2004 NSRN is a follow-up study to the landmark 2002 NurseWeek / AONE National Survey of Registered Nurses. “Unique to both studies is the focus on the perceptions of nurses themselves,” says coinvestigator Beth Ulrich, RN, EdD, CHE, Nursing Spectrum vice president, professional and editorial services, South Central, Mountain West, and Western regions. The survey presents the views of a random sample of nurses across the country about the nursing shortage, work environment, nursing as a career, recruitment and retention of RNs, and Johnson & Johnson’s Campaign for Nursing’s Future. Because many of the questions were repeated from the prior survey, researchers could detect trends and compare results. Johnson & Johnson and Nursing Spectrum funded the study, conducted by Harris Interactive from May 11 through July 26, 2004. The first data released from the study concerns RNs’ views of the shortage and nursing as a career.

Although a large majority of the RNs surveyed said the shortage still existed, they described some improvements. In 2004, nurses observed a reduction in the amount of overtime. Fewer perceived a negative work environment or referred to inadequate salary and benefits as the main reasons for the shortage, although they said both were key factors that could contribute to solving the shortage. “Perceptions often drive reality so it is important to get the message out that nurses are seeing some positives,” Buerhaus says.

“In comparison to the previous study, more RNs in 2004 indicated they had no plans for leaving their nursing position, and fewer reported they planned to leave their nursing position within the next three years,” Ulrich says. Of those who planned to leave, the vast majority expected to move into other nursing positions or continue their nursing education.

On the other hand, problems persist. More than 70% of nurses surveyed who were in direct care positions in acute care facilities responded that the shortage contributed to a reduction in the number of available hospital beds, increased patient wait time for surgery or tests, and delayed discharge from the hospital. Nurses perceived they had less time to spend with patients, and the quality of patient care and their own work life suffered. Despite a narrower gap between nurses’ supply and demand, nearly nine in 10 perceived a shortage where they worked. Buerhaus calls this finding “surprising” because it comes after a two-year surge in employment growth. “Perhaps many nurses believe that staffing didn’t increase enough where they work to enable them to provide the amount and quality of nursing care they think is needed by patients,” he says. “Also, the demand for RNs may have been rising during the past few years, as was projected to occur by the federal government.”

In the current survey, nurses had pessimistic expectations of where the current shortage would lead. Almost all (96%) thought the shortage would put increased stress on nurses. Only one-fourth perceived that working conditions would improve, and one-fifth that respect for nurses would increase.

“We’re looking closely at the implications of the different perspectives of nurses about their work and their work environment and their impact on how teams work together, the opportunities for better collaboration, and obstacles to better teamwork,” says coinvestigator Karen Donelan, ScD, senior scientist in health policy, Massachusetts General Hospital, Boston. “The aim is to see how we can reshape teamwork to enhance better quality of care for patients.”

In this eighth year of what is the longest nursing shortage in 50 years, Buerhaus recommends that nurses, hospital executives, and policy makers stay concerned about the workforce and focused on the major challenge to come: replacing the aging workforce in time to provide enough RNs to care for aging baby boomers during the next decade and beyond. “We must continue making progress, or there will be another shortage even before what is projected for the future,” he says.

The 2004 National Survey of Registered Nurses aims to keep the problems, issues, and challenges in front of nurses, executives, and policy makers. Buerhaus’ first article on the 2004 NSRN, “Six-Part Series on the State of the RN Workforce in the U.S.,” is in the March/April edition of Nursing Economic$. As study data is analyzed, look for more information in upcoming issues of Nursing Spectrum and NurseWeek and in articles written by the coinvestigators in peer-reviewed professional journals.

Lorraine Steefel, RN, MSN, CTN, is a senior staff writer for Nursing Spectrum.