Quality of care in African-American communities and the nursing shortage

The National Black Nurses Foundation commissioned a research project to determine the effect of the nursing shortage on African-American communities. The W.K. Kellogg Foundation funded the project as part of a multiphase project aimed at identifying issues related to the nursing shortage among ethnic people of color communities and developing policy recommendations around the supply of nurses to serve those communities. The study was conducted over a six-month period by the nursing research investigative team at Cedars-Sinai Medical Center and Burns and Allen Research Institute in Los Angeles, California. One hundred (N=100) nurse leaders from communities across the United States participated in the research. Each leader completed a questionnaire regarding the existence of the nursing shortage in their community and the effect of the shortage on access to services, clinical quality and the retention and recruitment of nurses. Leaders were queried on nurse vacancy and turnover within their communities, incidence of adverse events and the ability of institutions to meet the demands for nursing and health services in their communities. Forty-five percent of the organizations in the study were reported to be single facilities and 55% consisted of integrated health systems. Respondents identified five major issues resulting from nurse vacancies in their communities: closure of acute care beds or clinical services, delays in providing treatment to patients, inability to retain nurses due to increased workload and decreased nurse satisfaction, diminished capacity to address chronic health problems in their communities and increased incidence of adverse patient events. African-American nurse leaders reported higher rates of nurse vacancy and turnover; higher incidence of adverse events and greater difficulty providing access to health care than was reported in the literature. Nurse vacancy and turnover rates are higher than reported national averages. The study suggests the need for further research at the community level in addition to acute care settings to ameliorate the potential adverse effects of nursing work force shortages on the health of African-American communities. Further research examining the effectiveness of interventions at increasing the supply, improving the retention of nurses at all levels and the effect of increased supply and the utilization of nurses in African-American communities should be conducted. The study reported in this edition of the Journal of the National Black Nurses Association is the first in a series of reports on the nursing shortage and its effect on access to care, the recruitment and retention of ethnic nurses in the pipeline and leadership and policy strategies required to assure the availability of a qualified work force to meet current and future health care demand.