Global Nursing Shortage and Strategies for Recruitment and Retention
Nursing forms the largest body of employees in the health care system. A shortage of nurses, jeopardize the provision of quality health care to clients. The current global nursing shortage challenges the provision of a well qualified and sustainable health work force to meet future population health needs. A competent, confident and regulated health workforce is a critical part of a society’s health and wellbeing. Many countries have been considering nursing work force planning as a matter of priority to meet the future health service needs of their population. The demand for highly skilled and qualified nurses in developing countries is rising and those countries are facing the shortage of nurses due to international recruitment and migration. Hospitals are operating in a competitive labour market. As nurses are in demand worldwide, retention of nurses is an issue of the highest priority for health services (Holloway, et al., 2009; Jardali, et al., 2007). This paper is analysing the issue of nursing shortage worldwide and strategies for recruitment and retention.
Nursing Shortage Impact
In March 2005, The International Council of Nurses (ICN) published the first series of commissioned issue papers, providing a unique, international analysis addressing the global shortage of nurses. The ICN also released papers on international migration of nurses and nurse’s retention and recruitment. Nursing shortages have occurred in the past, but the factors involved in the current nursing shortage are different, because of the increased use of and demand for nurses, diverse population and demographics, increased growth in the population, broadening carrier opportunities for women, an ageing nursing workforce, high stress working environments, unsafe working condition, low status and job dissatisfaction. National and international efforts and initiatives are being undertaken to address these issues. Until these efforts and initiatives bear fruits, countries will continue to recruit nurses to fill their current shortage (Allen, 2004).
The global nursing shortage has attracted much discussion in recent times. This shortage encompasses both limited capacity to accept new recruitment and retention factors. Recruitment factors include students, the cost of academic fees and the low salary upon graduation. Nugyen (2008), states retention as keeping nurses in the workforce once they graduate .On the other hand, one retention concern related to the fact that limited resource to
meet the needs of more experienced nurses decreases the retention of these nurses, thus exacerbating the shortage. Mature workers have different needs than do younger workers. Contemporary research suggest that older nurses are less likely to work in acute care settings and prefer shorter shifts, flexible working hours, recognition and valuing of experience, the introduction of new paid roles, such as mentor and work place trainer, greater autonomy, lighter duties, improved professional development opportunities, especially in relation to technology, have all been identified as strategies that can help to keep older nurses in the workforce. Loss of these experienced nurses may impact negatively on patient care and organisational performance (Drury et al., 2009).
The growing population, expanding opportunities, and shifting demographics have all contributed to the rising nurse vacancy rate. To keep skilled nurses and use of their satisfaction as a recruitment tool to attract others, Health care leaders must create work environment that are meaningful to their employees. Even with the lowest turnover rates, it is clear that nurses as well as other key hospital staff will need to be recruited in order to replace the staff that will be reaching retirement. The self sacrificing nurse is an outdated image that the younger nurses will not mould themselves into. They will however respond to programs that signal the possibility for maintaining balance in their lives. Flexible scheduling is an obvious choice, but other more creative programs that some hospitals promoting are free massage therapy or exercise programs for the staff along with yoga classes or other forms of stress reduction (Satterly, 2004).
Globalisation and free trade have changed the market place. Nursing is just one of many professions that are seeing people migrate from underdeveloped to developed countries. Nurses who migrate from underdeveloped countries are actually offsetting some of the universal causes of the nursing shortage in developed countries. It can be reasoned that nurses expect better working conditions, increased pay and job satisfaction and decrease work stress and violence when they migrate from an underdeveloped country to a developed one (Christmas, et al., 2007). According to Falk (2007), solution to the nursing shortage should not be left entirely to the market. Increased public funding for the nurse education is the first step. Developed countries can apply political and economic pressure on under developed countries to redirect resources towards healthcare. Countries that comply should be rewarded with increased economic aid. Public and private partnership also can help to solve the problem. Global Scholarship Alliance (GSA) is a private company that partners with hospitals and health care systems to provide foreign trained RNs with scholarships for advanced degrees at U S. Nursing schools. This nurse’s work and study for up to three years before returning home as nurse leaders and educators. Innovative programs like this will help to solve the nursing shortage. An individual nurse may not make a difference but nurses working together will lead the way.
A reduced supply of nurse’s, especially new graduates, has been attributed to a variety of factors including a reduced number of student nurses with in each country. This may be associated with a lack of funding for places, low demand from school graduates, poor course progression, as well as closure or rationalization of school of nursing. Less satisfied nurses are more likely to exit or reduce the number of hours they work and those who are thinking of entering the work force are dissuaded from making a long term commitment to the profession as other employment options promise greater levels of satisfaction and benefits (Hein, 2004; Hogan, et.al., 2007).
Christmas and Hart (2007), discussed about immigration issues and economic inequities related to workforce shortage. In some countries like Botswana most health care professionals are trained outside the country. After training in the developed countries that have the latest technology and equipment, they return to practice in poor rural areas that may even be without running water. The developed nations welcome these professionals with open arm. These nurses migrate to developed countries to enhance their standard of living. According to Barnett et al., (2010), 57 countries have critical shortage of health care workers. 36 of these countries are located in the sub- sehran region. In this part of the world, the prevalence of HIV/AIDS has caused a dramatic decline in average life expectancies from 60 year of age down to an unbelievable 29 years of age.
Butter and Felts (2006), explains the strategies for improving retention among new graduates. This includes fostering a positive collegial working environment and supporting professional practice development. For that they introduced a toolkit named mentoring. It is a process through which a relationship is established between an experienced individual and an individual in need of guidance, for the purpose of maximizing the retention and enhancing professional developing. The utilization of aging nurse faculty, the educational institution must invest time, energy and financial resources to develop strategic plans that focus on building and sustaining desirable work environment, discussing and understanding the needs of faculty members. So the strategic plan reflects balance understanding and need. Legislators and community leaders should be involved in creative problem solving. Academic institutions must stay competitive with other employers by building work environment that are supportive, welcoming and as stress free as possible. The employers should acknowledge and value work and worth of the employees. They should provide suitable work stations and classrooms, promote and support lifelong learning and professional affiliations. They should build intergenerational teaching and learning opportunities and also to entertain workplace flexibility options (Falk, 2007).
Satterly (2008) suggests that in this climate of global nursing shortage, the need to nationalize the nursing workforce in the U A E as well as in other Gulf states is paramount. However several factors may be contributing in varying degrees to the reduced number of U A E nationals in the nursing profession. Among such factors are the low status of the nursing in the U A E, the variations in basic nursing programs in the country, lack of Arabic educational resources, the affluent lifestyle of U A E nationals, as well as strict cultural norms and religious values they live by. For emaratization of the nursing work force, they have to overcome these barriers. The formation of ENA (emirates nurses association) is a powerful indication that nursing is ready to move forward in U A E.
A more stable nursing workforce will reduce the direct and indirect costs associated with staff turnover. Reduced nurse staffing levels have been linked to poorer outcomes for hospital patients, when compared with higher levels of nurse staffing. These poorer outcomes are measured via an increase in mortality rate, infection rates, length of hospital stay, drug error rates and accident rates. Therefore an increase in nurse retention rates will increase staffing levels, reduce the rates of poorer health outcomes for consumers and reduce the costs associated with staff turnover. As a potential solution to the skilled nurse’s shortage, many countries are recruiting immigrants. All humans see the world not as it is but as they are. So the hospitals should be more flexible in dealing with workers.
Allen, D. (2001). The Changing Shape of Nursing Practice. London; Routledge.
Barnett, T. Namasivayam, P. Narudin, D.A.A. (2010). A Critical review Of Nursing
Shortage. International Nursing Review, 57, 32-39.
Butler, M.R.and Felts, J. (2006). Toolkit for the Staff mentor: Strategies for improving
Retention. The Journal of Continuing education in Nursing. 37(5), 210-213.
Christmas, K.and Hart, K.A. (2007) Workforce shortage are a Global issue. Nursing
Economics, 25(3), 175-177.
Drury, V. Francis, K. And Ysanne, C. (2009). Where Have All the Young ones Gone. Online
Journal of Issue in Nursing, 10913734. 14(1).
Falk, N.L. (2007). Strategies to Enhance Retention and Effective utilisation of aging Nurse
Faculty. Journal of Nursing Education, 46(4), 165-168.
Hein, E.C. (2004). Nursing Issues in the 21st century. Philadelphia; Lippincott.
Hogan.P. Moxham, L. Dwyer, T. (2007). Human Resource Management Strategies for the
Retention of Nurses in Acute care setting in Hospital. Contemporary Nurse, 24, 189-
Holloway, K. Baker, J. and Lumby, J. (2009). A Missing link in Work force Planning. Policy
Politics and Nursing Practice, 45(5), 186-189.
Jardali, F.E. Dumit, N. Jamal, D. Mouro,G. (2007). Migration of Lebanese Nurses; A
Questionnaire survey and Secondary data Analysis. International Journal of Nursing
Studies, 45, 1490-1500.
Nguyen, B.Q. (2008). Tomorrow’s Workforce; The need for immigrant workers and
Strategies to retain them. Public Personal management, 37(2), 175-184.
Satterly. (2004). Where Have all the Nurse’s Gone. Newyork; Prometheus Books.