Health care persists to face a momentous shortage of registered nurses. This is an old crisis and continues to be a threat to nursing career. There are plenty of studies done to find the reasons behind the nursing shortage. Moreover, it is a global problem. Nursing education, nursing retention unsafe work place, complex quality improvement and patient safety, low nurses’ income and complicated recruitment requirements. All these factors influence nurses’ shortage worldwide.
The aim of this paper is to discuss and analyze global nurses’ shortage and highlight the causes and solutions with a recommendation to deal with nurses’ shortage in health care systems.
Development of Nurses Shortage
Sophen (1954) found that nurses shortage in the United States started 1932-1953 when the number of hospitals changed very little, but the number of beds increased 52% more and this increases nurses’ shortage due to the coverage need (Sophen, 1954). Thirty three years later, Aiken noted that the legislation and diminishing result on nurses salaries at a time when other professions’ salaries were increasing, influencing nurses to depart the career. (Aiken, 2007). During the 1990s, the nurses’ shortage was 11% of full time registered nurses, by 1992, the nurses’ shortage subsided and nurses’ supply was positive. In 1997, hospitals started to feel pressure of nurses’ vacancy rate 13%. But this time shortage has not moved away and stays a topic difficult to solve. (Rebekah, Kathreen 2009).
WHO collected data of nurses, population ratios in WHO regions: The Americas, Europe, Eastern Mediterranean, Africa, South East Asia, and Western pacific. The data analysis shows that in Africa and South East Asia, the ratio declines, while the highest ratio was in Europe regions as it is almost ten times more than the lower regions. (WHO, 2006).
A study conducted in the United States by Buerhaus and his colleges in 2007 and found that in 2020 the nation will be short of 76,000.00 nurses, as well as, he stated that, this nurses’ shortage may shut down most of the system and cause care to be rationed. (Buerhaus, 2008).
The low supreme number of existing nurses in many countries is mixed by difficulties with their geographic distributions or complexities in recruiting and retaining nurses. This is a characteristic of both developed and developing countries.
Definition of the Shortage of Nurses
What is shortage of nursing? Shortage of nurses can be defined in two different means. First, professional standards when the number of nurses is not enough to provide high quality of care. However, administrators fail to determine the quantity of nurses needed to provide the high quality of care. (Goldfarbetat, 2008). Second, in economic terms, nurses’ shortage presents when there are not enough number of nurses to provide the best quality standards and no fund to supply to open additional positions. Thus, definition of nurses’ shortage is difficult and complex. (Rebekah, Abrahamson, 2009).
A diverse definition which is more practical with the reality discovered by Bachnan, defined the nursing shortage is not by nurses number but how the health system functions to facilitate nurses to use their skills effectively. (Buchan, 2008).
Nursing Education and Shortage
Raising demand of Baccalaureate and graduate prepared nurses conveys nurses’ shortage. The National Advisory Council on Nursing Education and Practice (NACEP) is proposing at least two-third of the nurses work force hold a baccalaureate or higher degrees in nursing by 2010. (NACEP, 2004). According to American Association of College of Nursing, professional nurses must be prepared at the baccalaureate level to ward convene developing health career requires. (AACN, 2005).
Professional development refers to study obligation to continue definite skill levels and career lane. This ensures nurses’ skills and knowledge are update and applicable. (Lannon, 2007). Each nurse should take responsibility for personal, professional development. This will enhance quality of care and keep up technological and scientific changes that are occurring in health care sitting. However, the health care systems are not assisting nurses for education development and this keeps the nurses far from the essential profession development. (Copper, 2009).
According to American Association of Colleges of Nursing (AACN, 2005), over 32,000.00 qualified candidates were rejected to baccalaureate and graduate program due to the lack of experienced faculty in 2004,which means shortage in nursing faculty. (Evans, 2009).
The long terms solution is to increase the pool of baccalaureate nurses who can obtain the graduate education needed for various roles like faculty. (Aiken, 2008). On the other hand, nurses will persist seeking higher degree in nursing education, because of the exciting and financially rewarding pulse opportunities for management positions. (Curtin, 2008). As per a study done in the United States by Westphal, concluded that nurses leaders turnover causes nurses shortage in registered nurses at hospitals. So, it is advised to reduce turnover of nurse leaders. (Westphal, 2009).
The Impact of Workplace in Nursing Shortage
Nursing work is traumatic while other professional alternatives are accessible. However, it is challenging to fight for the choice of profession which is not successful to balance financially for this daily tension. (Kaestner, 2005).
Shift work nature causes physical damage to nurses and impact nurses prolong existence in the profession. According to cooper (2003), ‘Registered nurses experiencing the physical, cognitive and emotional challenges of growing older while the profession demands more”.
In addition, working night and evening shifts influence nurse performance and lifestyle which motivate many nurses to move into outside hospital sitting. (Rebekah & Abrahamson 2009). As well as, the new technologies into nursing daily work add a pressure and increase nurses work load and reduce the time nurses have to spend with the patient and affected the ability to detect complications early. (Beurhaus, 2008). Furthermore, nurses felt additional stress due to the idea that if they commit an error, penalizing action might be taken against them. As known that the nurses are responsible for ensuring patient safety without adequate decision making authority or impartial income. (Rebekah & Abrhamson, 2009).
In 1998, the health care quality and safety started to take place, leaders noticed the strong relationship between nursing and patient outcome and realized nurses shortage. Thus, the leaders recognize the need to solve nursing shortage and as are adequate size of nurses or they will see quality suffer and low patients services. (Buerhaus, 2008).
As a result, linking quality of care with adequate stuff will move nurses from the cost category in the direction of believing advantage, which will lead to increase wages and progress practice environment (Elgie, 2007)
Recruitment and Retention
International recruitment require great attention, where an organization in one country recruits nurses from another country. This has been mounting characteristic of global nursing labor markets, as developed countries utilize factors to attract nurses in developing countries. (WHO, 2006). These factors comprise low income, poor career configuration; reduce chance for further, education in some countries threat of violence. The risk is that action might just dislodge the shortage to another country, which may have fewer resources to solve it. (Aike of Buchan 2008).
Nurses are attracted to work and remain working because of the chances to expand professionally to gains self sufficiency, and share in decision making while being reasonably rewarded. (Buchan, 2000).
Aspects linked to work environment are critical, as well as some evidence that a decentralized style of management, flexible employment opportunities, and access to ongoing professional development can improve both the retention of nursing stuff level patient care. (Aiken, 2008).
UAE and Nursing Shortage
3% of the UAE nationals are nurses. Although this percentage is low to UAE hospitals needs, the UAE population are not motivated to study and work in nursing profession. (Khan, 2006). On the other hand, the cause being far of nursing profession, minimum nursing education institution as compared to other specialty and the concept of cultural values (Underwood, 2010).
UAE ministry of health in the process to open new education institutions which will be available in all emirates, as well as, the new council of nursing which started examining nurses skills by licensure examination (Underwood, 2010).
There is particular or universal measure or description of nursing shortage, although, obvious evidence of insufficient nursing resources in several countries, along with, evidence of poor exploit of obtainable nursing resources in many more.
Many countries should augment and support their work force development capacity crossways professions and regulations to recognize the skills responsibility needed to convene identified services requirement. Furthermore, this is partially about extended term alliance between education development, work place environment improvement, quality improved and funded demand. Moreover, improving routine matching of nurses staffing with work load and maintain balance between nurses’ work and personal life.
Health systems need to work on effective skill mix through clearance of roles and better equilibrium of registered nurses, charge nurses, assistance nurses, physicians and health professionals, in order to solve nursing shortage problem.