Associate degree nursing schools

Current research shows that there is a shortage of licensed practicing nurses in the United States, and nursing is likely to experience even greater workforce shortages in the future. (1) Many believe that the current nursing shortage is the result of irregularities in supply and demand among the nursing workforce. In California, however, the shortage is more acute, and the demand for nurses is greater than ever because of the economic expansion and rapid population growth in California in the late 1990s. Increasing technology and the increasing prevalence of ambulatory care facilities have led to an increase in the number of patients who need nursing care accessing the health system. (2)

The current nursing shortage in the perioperative setting is the result of several social and technical trends. The social factors include an aging nursing workforce; an aging and chronically ill population that requires health care later in life; and technological innovations that create a changing, demanding, and fast-paced professional environment. (3) In addition, the lack of perioperative curricula in most schools of nursing and decreasing enrollments in many associate and baccalaureate degree programs result in fewer nurses who may be interested in perioperative nursing as a career.

In the large metropolitan area surrounding the city of San Jose, Calif, which is known as Silicon Valley, some hospitals have perioperative training programs in place for currently practicing nurses who are interested in moving into the OR; however, few, if any, of these facilities have preceptorship training programs in place for new graduate nurses interested in perioperative practice. The lack of perioperative curricula in local schools of nursing exacerbates the current and future perioperative nursing shortage because nurses are not being exposed to perioperative nursing during nursing school.

RESEARCH PROBLEM

In light of the current nursing shortage, this study was undertaken to determine whether there are training programs available and what, if any, perioperative curricula are offered at schools of nursing in Silicon Valley. Current perioperative staffing issues, the existence of perioperative training programs, and perioperative nursing school curricula in Silicon Valley became the focus of this study. The project evaluated whether training and socializing new graduate nurses into the perioperative setting would help alleviate staffing shortages. For this study, the perioperative setting is defined as the practice area--including preoperative, intraoperative, and postoperative clinical areas--in which a nurse ultimately is prepared to practice exclusively as a perioperative nurse. The variables of interest are

* local perioperative staffing issues,

* current facility-specific perioperative training programs available, and

* perioperative nursing curricula offered at local schools of nursing.

LITERATURE REVIEW

One main reason for the shortage of nurses is the aging of the RN workforce. Nurses have the most rapidly aging population of any occupation in the nation. For 17 years, from 1980 through 1996, the average age of the nursing workforce increased by more than four years--from 37 years of age up to 41 years of age--compared to a less than two-year increase in age for all other workers. During the same period, the proportion of the nursing workforce younger than 30 years of age decreased from 30% to 12%, and the actual number of working nurses younger than 30 years of age decreased by more than 40%. (4)

More than one-third of the nurses in California are 50 years of age or older, and nearly 15% are age 60 or older. (5) This trend indicates that fewer individuals chose nursing as a career during the past 20 years, and it shows that as the nursing workforce has aged, young nurses have not entered the profession in sufficient numbers to replace them. In addition, the current nursing shortage is not like the shortages of the past. It is driven by unique demographic issues and requires complex and far-reaching solutions that only now are being addressed by professional and government entities. (6)

Admissions to four-year and two-year nursing programs declined in the late 1990s and into the year 2000 as the expanding economy at that time provided many professional opportunities outside of nursing. Enrollments in basic baccalaureate nursing programs decreased by almost 5% in the fall of 1999, which was the fifth consecutive decline in as many years. (7) Another factor in the current nursing shortage is the age of associate degree program graduates versus the age of baccalaureate degree program graduates. In 1996, graduates of associate degree programs on average were 33 years of age versus an average of 28 years of age for graduates of four-year programs. (8)

On the demand side of the nursing shortage, there are some compelling social trends that are leading to the need for more nurses in the health care setting. These include an increasingly aging population, the rapid expansion of long-term care, and increased advances in and use of health care technology. In addition, improved approaches to primary preventive care, use of fiscal restraint in the health care setting, and increasing numbers of individuals with health care insurance are significant indicators of an increasing demand for nursing services in the future. (9)

The perioperative nursing shortage and its effect on patient outcomes is another important consideration. Literature documents the link between levels of nurse staffing and patient outcomes. Nurse skill mix and staffing ratios in general medical areas predict mortality, adverse incidents, and other complications. (10) It is not unreasonable to assume that this finding would extend to the perioperative setting in terms of increased turnover time, increased anesthesia time, elevated surgeon and staff member frustration, and higher incidences of clinical mistakes as more novice nurses are being asked to perform in an expert manner.

STATEWIDE NURSING SHORTAGE

The nursing shortage is particularly acute in California, where there were approximately 230,000 nurses practicing in 1998, with two-thirds (ie, 64%) employed in acute care hospital settings. (11) Projections for California's future nursing workforce needs are placed somewhere between an additional 43,000 nurses by the year 2010 and an additional 74,000 nurses by 2020. (12) California also was ranked the lowest out of 50 states in the ratio of RNs per 100,000 patients (ie, 566 per 100,000) in one study and 49th in another. (13) Also in California, researchers found that since the early 1990s, the number of hours worked by RNs per hospital and per patient day have increased substantially. (14) These numbers tend to indicate that, in California, fewer nurses are caring for more patients than in other areas of the country. This trend, which shows increased workloads, may have a significant negative impact on the long-term retention of experienced professional nurses. Also of concern is the ability of nurses to provide safe patient care in this stressful environment.

In Santa Clara county, there currently are more than 12,000 RNs employed in varying job descriptions, and more than 7,500 (ie, 63%) are employed in acute hospital settings. The job growth projection for the period from 1995 through 2002 for nurses in Santa Clara county is estimated to be 21.6%, which is slightly lower than the projected county average growth of 23.2%. (15) This lower rate of job growth in the nursing profession may be attributed to the greater economic and career choices available in Silicon Valley at the time of this study. This situation provided prospective nursing students and practicing RNs more lucrative career opportunities outside of nursing.

LACK OF PERIOPERATIVE NURSING CURRICULA

In the OR, an even more alarming trend toward nursing workforce shortages can be seen. (16) The nursing shortage in this area is caused by the same factors as stated earlier, but they become even more acute because nursing students often do not receive clinical exposure to perioperative care during their schooling, and preceptorship training programs in the OR for new graduate nurses are scarce. These clinical experiences traditionally have not been sought out as models for student preceptorships or as curriculum components, however, because of the environmental complexity, student inexperience, and lack of faculty members with a perioperative clinical background. (17)