As we entered the new century it was clear that there was growing concern that America was going to be faced with a nursing shortage that would be different than our historically cyclical shortages. Some analysts have proposed that nationally there is not a shortage of nurses, but a shortage of working nurses. It is clear that as you look across the country that the depth of the shortage currently varies. However, it is projected that by 2020 the number of registered nurses will fall 20% below demand and there will be 400,000 unfilled positions. 1

In a recent report entitled Health Care's Human Crisis: The American Nursing Shortage,2^(p6) four themes emerged:

1. "The current nursing shortage is quantitatively and qualitatively different from past shortages."

2. "The majority of efforts to address the current nursing shortage, modeled on past market-driven solutions, provide only short-term fixes. Resources would be better spent on addressing the underlying issues driving the shortage."

3. "A shortage of nurses endangers quality of care and places patients at risk for increased illness and death. A long-term shortage could undermine the American health care system and emerge as a prominent public health issue."

4. "The burden of care on nurses has increased, yet work-saving technologies have not been implemented. At the same time, new regulations and documentation requirements take nurses away from patient care. These work environment issues create formidable recruitment and retention challenges."

Whether or not there currently is a nursing shortage in your state and where you practice, the reality is that nursing care as we know it today will change over the next decade. Porter-O'Grady articulates the challenge that nursing faces.

Nursing practice in its current configurations and forms is dying as the demands of the health system are changing both substance and service...Without engaging and embracing the issues around a new emerging foundation for nursing practice in the 21st century, it is quite possible that nurses will fail to find a meaningful place in 21st century health service. 3^(pp182,186)

The HPNA staff and board members are actively working with other nursing organizations to address the current and future nursing shortage. In September 2001 Judy Lentz, our Executive Director, attended a summit that launched "Nursing's Agenda for the Future"(http://nursingworld.org/naf). The agenda focuses on 10 key domains-leadership/planning, economic value, delivery systems/nursing models, work environment, legislation/regulation/policy, public relations/communication, nursing/professional culture, education, recruitment/retention, and diversity. HPNA has identified strategies under 9 of the domains.

Unfortunately, very little is known about how the nursing shortage is currently impacting end-of-life care. Recognizing that nurses are central to providing the highest quality of end-of-life care, the Board and staff welcomes comments and suggestions for how we can support you, the membership, as you continue to care for persons, and their families, who are receiving palliative or hospice care. It is essential that hospice and palliative care nurses continue to have a meaningful place in the health services continuum.

References