Case shortage and finally will go over possible approaches

Case Write-Up

Kevin Nguyen

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HCA 312

California State University, Long Beach

2017 December 9

Title: Shortage of Nursing Staff in California


Learning Objectives


I learned while I was working on this presentation is that California hospitals
have a mandatory minimum nurse to patient ratio, there is a very large deficit
of nursing staff (as well as health care professionals in general). There are
simply not enough nurses and nursing staff to take care of everyone, and that
is a big problem. In this presentation, I will explain the problem with the
shortage of nurses and nursing staff in California, including the reasons for
the shortage and finally will go over possible approaches and steps that can be
applied to relieve the shortage.




many failed attempts at legislation, California finally passed a bill that
mandated a minimum ratio of nurses to patients for California hospitals in
October 1999, and after a lengthy process the implementation finally went into
effect in 2004 (Mark, Harless, & Spetz, 2009). Mark, Harless, and Spetz,
write that the shortage of nurses in California is so severe that nursing wages
would have to increase by many times just to be able to meet the increasing
demand (Mark et al., 2009). With the shortage of nurses continuing on for well
over a decade, many have attempted to address the problem by developing methods
and strategic plans to try and resolve this dilemma.


Case Issue


nursing is already very competitive then why is there a shortage? One of the main
reasons that there is a shortage of nursing staff is because there is a lack of
qualified nursing staff (Ganley & Sheets, 2009). Another reason is the cost
to hire and train new staff. The shortage is a direct result of not hiring and
training new nurses, while trying to retain the nurses already employed at
their current health care organizations. According to an article written by
John M. Welton, Phd, RN, although there is a minimum required ratio of nurses
to patients, does not necessarily mean that the quality of patient care is
actually better (Welton, 2007). The needs of each patient are not “one size
fits all” and are different; the care that one patient needs may be much less
or more than another. An example of this is geriatric care. The crisis in
geriatric nursing will continue to increase as well due to the longer life
expectancies of the aging population (Ganley & Sheets, 2009). According to
nurses Janet Scholl and Marilyn Swarts, we can no longer afford the luxury of
waiting for nursing graduates to gain experience before being hired at their respective
organizations (Scholl & Swarts, 2006). 


Case Solution


order for the minimum nurse to patient ratio to be effective, Welton proposes
reimbursement for patient services be based on the quality of care given.

Scholl & Swarts suggest that students in nursing grad programs can learn
while simultaneously gaining work experience if all hospitals set up their own
grad programs. One such hospital is El Camino Hospital in Mountain View,
California (Scholl & Swarts, 2006).

possible approach to the problem is to assess the organizational commitment of
each organization’s nursing staff. In the article, “A Nursing Shortage:
Building Organizational Commitment Among Nurses, Donna McNeese-Smith suggests a
series of 7 steps that nurses can follow to be able to increase the
organizational commitment: 1) every member of the administrative team to work
with a nurse or clinician for two hours every month in order to better
understand their organization’s mission and the roles of health care providers,
2) develop a strategy to increase organizational commitment, job satisfaction,
and reduce turnover, 3) prioritize continuing education while simultaneously
creating flexible schedules and supporting personal needs, 4) support
executives of nursing, and other administrative departments with nursing to
build a strong team of committed staff, 5) encourage employees to continue to
educate themselves in the organization as well as outside of it, 6) push for a
diverse nursing team of all ethnic and cultural backgrounds, 7) respect all
between physicians, nurses, and other clinicians (McNeese-Smith, 2001).




insufficient number of nursing staff is a severe problem for not only the
California health care system, but also for the entire American health care
system. It will continue to increase with the aging workforce and is projected
that we will be 193,000 nurses short in the year 2030 (Clavreul, n.d.). It is
my opinion that we base the reimbursement of a hospital and health care
organization based on the quality of care given, and not just a standard rate.

I believe that implementing this reimbursement strategy will not only improve
quality patient care, but also improve the shortage. It has been well over a
decade since this problem has arisen, and we still have yet to fix the problem.

There are many suggested and possible approaches to be able to alleviate the
pressure of the nursing shortage as well as the shortage of health care
professionals overall, not only in California but the entire United States. We
have already identified the problem, the contributing factors, and have even
developed strategic plans to combat them; now the next step is to implement
those strategies.











G. M. (n.d.). The nursing shortage paradox in California. Retrieved December            9, 2017, from    in-California


B. J., & Sheets, I. (2009). A strategy to address the nursing faculty
shortage.     Journal of Nursing Education, 48(7), 401-405.


B., Harless, D. W., & Spetz, J. (2009). California’s minimum-nurse-staffing
          legislation and nurses’ wages. Health Affairs, 326-334.


D. K. (2001). A nursing shortage: Building organizational commitement        among nurses. Journal of Healthcare Management, 46(3), 173-186.


C. L. (n.d.). “More nurses required— music to my ears. Nursing2002, 32(3), 8.


J. V., & Swarts, M. A. (2006). New graduate programs ease nursing shortages
while educating. Nursing Management, 10-12.


J. M. (2007). Mandatory hospital nurse to patient staffing ratios: Time to take
a             different approach. Online Journal of Issues in Nursing, 12(3).