Nursing Shortage
Review On Nurses Shortage
The supply of professional nurses relative to the increase in demand for their services has been on a general decline over the years. As a career choice, nursing has been facing perennial shortage of professionals. Most healthcare organizations will affirm that their daunting tasks were recruiting fresh nurses and retaining the ones already in practice. The 2008 projections from the Bureau of Labor Statistics showed that the demand for professional nurses would increase from the then two million to three million, which represents sixty percent increment. In ideal situations, the number of those who have enrolled in nursing will be sufficient to supply the rise in their number. Nevertheless, this would not be the case if nothing were done to salvage the worrying trend of most students not graduating or resorting to other careers. According to Benjamin Isgur of PWHC Health and Research Institute, of the 320,000 who enrolled in nursing college only 78,000 finally graduated in 2008. Furthermore, only twenty-three percent of graduates who stick to their profession while the other fifty percent quit and pursue other careers. Worsening the challenge of the nursing shortage is the increasing number of aged nurses and their expected retirement (Kovner, 2009).
Problem statement
Absence of adequate number of professional nurses is likely to compromise on the quality of care that patients receive. In addition, the nurses may end up being overwhelmed and distressed with the workload leading to job dissatisfaction. Broader disparity in patient-to-nurse ratios is believed to be the greatest cause of job burnout and frustration, which eventually causes increased rates of staff turnover. Those healthcare facilities with understaffed nurse workforce have been found to contribute greatly as far as negative care outcomes are concerned. However, it has been established that facilities with low rates of nurse turnover have, for instance, the least rates of risk-adjusted mortality. In addition, Agency for Healthcare Research and Quality (AHRQ) conducted a research that proved a direct correlation between shortages of professional nurses, the increased workload, and the decline in the quality of care that patients receive.
In light of United Nation’s Millennium Development goals, the shortage stands out as one of the major impediments to the attainment of these objectives. Among these development goals are those that touch on health care and include a reduction in child mortality, improving maternal fitness, and fight HIV / AIDS, malaria and other serious diseases (Buerhaus, Staiger, & Auerbach, 2009).
Search Strategy
In this paper, electronic searches have been used to find articles related to nursing shortage. While the search was random, the key databases that were used include CINAHL, Pubmed, Purdue, EMBASE and Cochrane library. The search phrases were nurse shortage, causes of nurse shortage, impact of nurse shortage, and solution to nurse shortage. On this particular research, a sum of 10 articles and books, mostly those published within the last 5 years, were gathered from the search result. This research materials formed the basis of this literature review.
Revision of Search Strategy
Whereas the phrases described above were crucial in providing necessary resources, most of the articles and books gathered were quite general in the discussion of the topic. Therefore, to improve the quality of search result, more specific terms and phrases were utilized. For example, instead of simply searching for nurse shortage, specific phrases search as impact of nurse shortage or causes of nurse shortage were used.
Literature Review
The nursing shortage is a global problem that affects the U.S. And other nations around the world. Canadian nurses, for instance, are faced by similar workforce deficiency, complain of job burnout, and stress (McIntyre & McDonald, 2014). On a global scale, nurses are an indispensable component of the health care system and account for the greatest percentage of health care professionals. The year 2020 certainly sends jitter among caregivers in the U.S.A. As it is the year where the many nurses are expected to retire from public service. This implies that the remaining workforce would be overstretched beyond their limit: something must be done earnestly to salvage the situation. Blakeley and Ribeiro (2008) assert that the factors affecting to a nurse’s choice of premature retirement include the desire to relieve workload and freedom from tight schedules.
In 2000, the approximated number of registered nurses in the U.S. stood at about two million against an overall demand of two million. This represents a six percent shortage, which is equivalent to one hundred thousand nurses. Surprisingly, instead of this gap closing up, it widened uncontrollably over the last couple of years. For example, in 2008, the number of registered nurses was two and a half million. However, projections show that there will be a shortage of close to one million nurses equating to about thirty percent as of 2020. The already delicate health care base is in jeopardy because of ineffective recruitment and retention programs, insufficient nurse educators, and ever growing number of the aged population that require care (Newman, 2013).
Besides the challenges experienced by indurate nurses, job dissatisfaction and disillusionment are always reported as significant contributors to the high rate of new nurses quitting the profession. As for the case of disillusionment, it is not just simplistic to consider nursing entirely in regards to personal commitment. It goes far beyond to other aspects such as knowledge of various illness, proper medication and treatment, managerial skills, strong personal attributes and emotional stability. It is critical to show an accurate professional brand in any career, but this is more so in the case of professional nursing. If individual are expected to portray affective commitment for their work, then job satisfaction plays a significant role (Denman, 2008).
Causes of the Nursing Shortage
Concisely, the following are attributed as major reasons as to why there is a general global decline in the number of registered professional nurses:
Career Options: advancements of technology and the surfacing of new career lines entice more people to shun away from traditional careers such as nursing. Nowadays, most young women and men opt to pursue careers in law, engineering, and business management. They are lucrative and derive more job satisfaction. Nursing is an involving profession, but with limited job satisfaction.
Wage Disparity: the broad discrepancy between the compensation nurses receive and those of other health care professionals are considerably shocking. In fact, nurses are mostly considered as the bottom line staffers relative to doctors. Ironically, they receive less compensation and yet they are the ones spending much of their time with the patients performing most of the work.
The Nursing School Dilemma: of the high proportion of students who enroll for courses in nursing, just a handful of them end up graduating. As already stated in the introduction, less than a third of the 320,000 graduates in 2008 enrolled in nursing college in 2008. This dilemma has been linked to several factors, including heavily theoretical class work, insufficient nurse trainers, and little motivation in the learning process (Buerhaus, Staiger, & Auerbach, 2009).
Old Age
The standard age of registered nurses is slowly going up. This implies that the high number of nurses who joined the profession during the period of nurse boom in the 1970s will soon be retiring from the profession. It is expected that 2020 is the year that the highest number of nurses will hang their boots thus aggravating the shortage even further.
Leaving the Profession
Inadequate staffing has always been the genesis of stress, which often mars their job performance and forces some to abandon the profession. As the economy grows, other opportunities come into play and many people already in the nursing profession encounter difficulties and stresses related to their practice. Both women and men are considering various career options and settling for those that will guarantee them worthy compensation and boost the quality of their life (Denman, 2008).
Impact of the Nursing Shortage on the Health Care System and Patient Care
Patient Safety
Studies have already established a strong and a direct correlation between the number of nurses in a healthcare facility and the quality of care that patients receive. According to American Association of Colleges of Nursing (2009) from their 2007 metanalysis, “the deficiency of registered nurses, coupled with increased workload, posed a significant risk to the quality of care.” On the other hand, minimizing the nurse-to-patient ratios resulted in reduced hospital-mortality and a reduced length of stay but increased the number of successful patient rescue operations.
Stress
Nurse shortage implies that the present few are compelled to be at the workplace for longer hours to cover up the problem. This creates instances job burnouts and dissatisfaction. In the nursing profession, most of them report this challenge, which, they further assert, affects them negatively on their personal health. Reports relating to dynamics in the labor industry have constantly indicated that nursed are among the most stressed, overworked, and sickly professionals, with about eight percent of the workforce failing to turn up for their duties on reasons related to their health status (Cummings et al., 2008). Therefore, it is not surprising for the unhappy nurses to quit the profession eventually for the sake of salvaging the state of their personal health.
Suggested Solutions and best practice
Since nursing shortage is a challenge that needs urgent attention, the following could be some of the long-term and short-term interventions to salvage the situation:
Short-Term Solutions — Retain More Staff
To address the challenge of high nurse turnover, and thus the retention of more staff, a retention committee to address the issues facing nurses should be formed. Among the issues include improvement of job satisfaction at the workplace, rewarding nurses, promoting those who serve exemplary and diligently, and improving the compensation that nurses receive (Denman, 2008).
Long-Term Solutions
These solutions will certainly concern increasing the number of the labor force in this profession. One of the immediate strategies that can be adopted is enhancing enrollment rates at various colleges and ensuring that many those who enroll eventually graduate. This is achieved by the existence of a sufficient number of nurse trainers who can mentor the students to be ardent about their career choices. Secondly, the syllabus should focus on both theoretical and practical aspects. Students with practical experience tend to appreciate and absorb much of what they learn in class than those who hardly have any experience in a practical set-up (Newman, 2013).
Evidently, while both long and short-term solutions are necessary for effectiveness in the profession, finding the short-term solution stands out as the best practice. This is because high rate of turnover is linked to problems that can be solved effectively by retention committee as discussed in the short-term solution. A point worth noting is that more people will be attracted to the profession, thus high enrollment and completion rate, if the future prospects within the profession are bright.
Gap of Knowledge in Literature search
Significant number of authors have already added their voice on the topic of nursing shortage. Most have expressed their fears regarding the future of the profession if nothing is to be done to resolve the crisis. However, majority of the search results point to the fact that the shortage is orchestrated by the aging nurses who are a product of nurse boom of 1971. That is to mean that there is little discussion on the challenges faced by the “modern” day nurses some of which include competition from other careers thought to be “lucrative.”
Conclusion
The nursing shortage is indeed a serious challenge facing the health care sector. The sudden decline of registered nurses is bound to impede the achievement of United Nations Millennium goals, especially those that relate to health care. This is because the shortage has a serious impact that can also affect the overall growth of an economy. For instance, shortage of nurses implies that those available are overworked. Overworked nurses experience job burnout and eventually become dissatisfied with what they do. This also results in demotivation and the cycle continues to that level where the quality of care given is crippled. Such a situation is not proper as it results in a sickly population (Melnyk & Fineout-Overholt, 2011).
The government and the health sector department must intensify their efforts in rescuing the already ailing health care through proper policy formulations. Some of the suggested interventions include establishing a committee that will ensure that the rate of nurse turnover is minimized through addressing those factors that contribute to the problem. The medical shortage in any nation varies but eventually they share similar effects on medical care systems in each nation (Cummings et al., 2008). The U.S. government must develop incentives to improve the number of the medical faculty to accommodate the existing high demands for medical enrollment. Furthermore, the government must set up recruitment of younger nursing staff into the career and retention of older nursing staff to remain in the profession. The government must also set up a competitive workforce training to sustain its own medical care system and domestic supply of nursing staff to improve health care (McIntyre & McDonald, 2014).
Similarly, countries should set up aggressive health care systems and improved access to medical education to improve job opportunities for nursing staff to eradicate nursing migration. The magnitude of the nursing shortage is negatively affecting the goals of improving healthcare systems globally. Ultimately, the failure to deal with the nursing shortage whether it is local, regional, national, or international will lead to failed health care systems and deteriorating healthcare outcomes. Further research in employees training and international health policy to enhance the career of nursing worldwide is warranted.
Evidence-Based Practice Matrix of Ten Pieces of Primary Research on One Topic Related to Nursing
Authors
Resource/
Database
Year of Publication
Research Type
Population/
Sample Size
Outcome Variables Measured
Pertinent Data from Results
Author’s Suggested Conclusions
Comments
AACN
Cochrane Library
2009
quantitative
Rate of nurse retirees
Greatest nurse shortage expected by 2020
General decline in number of registered nurses
Excellent
Buerhaus, Staiger, & Auerbach.
PubMed
2009
quantitative
Rate of nurses retiring
Nurses taking early retirement
Early retirement caused by job stresses
Excellent
Blakele & Ribeiro
PubMed
2008
qualitative
Rate of early retirement
Nurses taking early retirement
Early retirement to rest
Excellent
Cummings, et al.
Evidence — based textbooks
2008
qualitative
Percentage of affectively commitment nurses
Great percentage nurses swapping career
Other careers i.e. law and business seem lucrative and less stressful
Excellent
Isgur
EMBASE
2008
qualitative
Rate of nurse retention
Great percentage nurses swapping careers
Other careers are preferable to nursing
Excellent
Kovner
Purdue
2009
quantitative
Rate of retention
Significant number of nurses quit after 2 years of practice
Nurses quit out of disillusionment
Excellent
Melny & Fineout
PubMed
2011
qualitative
96
Rate of early retirement
Nurses taking early retirement
Early retirement caused by job stresses
Excellent
McIntyre, & McDonald
EMBASE
2014
quantitative
3 states
New number of registered nurses per year
General decline in the number of registered nurses in Canada
Students shying away from practice due to its involving nature
Excellent
Denman
CINAHL
2008
quantitative
65
Rate of retention
Nurses taking early retirement
Nurse shortage leads to job stresses causing more nurses to quit
Excellent
Newman
PubMed
2013
quantitative
Rate of enrollment and percentage graduants
High enrollment rate but low completion rate
Nursing curriculum discourages students
Excellent
References
American Association of Colleges of Nursing. (2009, September, 28). Nursing Shortage Fact Sheet. USA: AACN.
Buerhaus, P.I., Staiger, D., & Auerbach, D.I. (2009). The future of the nursing workforce in the United States: Data, trends, and implications. Boston: Jones and Bartlett Publishers.
Blakeley, J., & Ribeiro, V. (2008). Early Retirement among Registered Nurses: Contributing Factors. Journal of Nursing Management, 16(1), 29 — 37
Cummings, G., et al. (2008). The Relationship between Nursing Leadership and Nurses’ Job Satisfaction in Canadian Oncology Work Environments. Journal of Nursing Management, 16(5), 508 — 518.
Isgur, B. (2008, July / August). Conference of State-based Nursing Workforce Centers Explores Retention Issues and Solutions. Retrieved from www.NursingWorld.
Kovner, B. (2009). Changing Work Needs of New RNs: Literature Review. The Online Journal of Issues in Nursing, 15(1)
Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
McIntyre, M., & McDonald, C. (2014). Realities of Canadian nursing: Professional, practice, and power issues. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins
Denman, B. (2008). Nursing Shortages: A Phenomenological Study of Nurses who worked in Opioid Treatment Programs. New York, NY: ProQuest.
Newman, P.I. (2013). The Contributing Factors to the Nursing Faculty Shortage: Nursing Faculty Shortage. Sydney: Xlibris Corporation.
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