Written by: Victoria Wendy
Nurses are an essential part of the healthcare system, and they constitute the largest part of healthcare professionals (Haddad, Annamaraju, and Toney-Butler, 2020). According to a report by the World Health Statistics, there are over 25 million nurses and midwives across the globe. Of this number, about 4 million are in the United States (Mehdaova, 2017). Over 1 million additional nurses will be needed this year.
Furthermore, the American Nurses Association (ANA) reported that the United States would employ more nurses up to 2022, more than any other profession. The nursing profession will grow by 15% by 2026 (Haddad, Annamaraju, and Toney-Butler, 2020). However, there is a shortage of nurses at the moment. The US Bureau of Labor Statistics estimates over 10 million nurses to avoid further nursing shortages (Mehdaova, 2017).
Furthermore, there is a need to employ about 203,000 registered nurses annually up to 2026 to fill positions of retired and fill new positions (American Association of Colleges of Nursing (AACN), 2019). ACNN (2019) further projects that approximately 1 million nurses would have retired by 2030, thus affecting the patient care settings and organizations that depend on registered nurses’ knowledge and expertise. This paper will give a detailed description of the contributing factors to the nursing shortage.
Factors Contributing to the Nursing Shortage
The nursing profession continues to face shortages due to several reasons including high turnover, lack of potential educators, and unequal distribution of the workforce. However, the nursing shortage causes are diverse (Haddad, Annamaraju, and Toney-Butler, 2020). The following are some of the documented factors contributing to the nursing shortage across the globe.
There is an increase in the number of older adults who require a lot of medical attention, including care for chronic diseases and geriatric care (Haddad, Annamaraju, and Toney-Butler, 2020). A report issued by the US Census Bureau found that by 2050, the number of people in the United States aged 65 and above will be over 80 million, double the population in 2012 (AACN, 2019).
Increase in the Number of Nurse Retirees
Just like the population that the nurses take care of, nurses are also aging. There are over 1 million nurses in the United States who are over 50 years of age. In the next 10 to 15 years, this population will be going to retirement. Of this aging workforce, most nurses are nurses in the teaching profession, thus putting a strain on the training resources for more nurses. There is a shortage in the nursing faculty, limiting the number of enrollments, and reducing the number of trained nurses released to the professional world (Haddad et al., 2020).
In 2015, the “Science Daily” released a report indicating that over 40% of the registered nurses were more than 50 decades and projected that more than 80,000 nurses would be retiring by 2020 (AACN, 2019). When more nurses retire, and there are few to fill the positions, the healthcare system faces many challenges.
When nurses graduate, and they enter into the professional and practicing world, some of them come to realize that the work is not what they expected and decide to quit. Some work for a short while and experience the pressure that comes with the work, hence decide to leave (Haddad et al., 2020). A study conducted in various countries, including Finland, Belgium, Spain, and England, on the nurses’ job satisfaction and outcome found that an adequate number of nurses to take care of patients contributes to better nurses and patients’ results.
Family and New Career Prospects
The fact that the nursing career is constituted mainly of women contributes to the nursing shortage. During childbearing, just like any other profession, nurses go for maternity leave, or some decide to leave the work and try out different things and jobs. Whether they choose to go on vacation and come back or quit altogether, they reduce nursing practitioners (Haddad et al., 2020).
Violence and Abuse in the Healthcare Setting
Nurses are more prone to violence and abuse, especially those that work in the psychiatric and emergency departments. Such treatment kills the morale to work and contributes to emotional or physical strain. Between 2008 and 2009, a study in Poland on healthcare professionals revealed that nurses represent a group that is more exposed to aggression and abuse in the workplace.
The most commonly verbal abuse was being spoken to by a patient in a loud voice. The inpatient nurses suffer more abuse than outpatient nurses (Haddad et al., 2020). Across the globe, between 5% and 40% of healthcare workers are exposed to a form of violence (Buchan and Aiken, 2015). These violence and abuse cases contribute to the nursing shortage because most of the nurses decide to quit their work.
Effects of Nursing Shortage
The nursing shortage affects patient care, the nursing profession, and organizations negatively. Failure to deal with or handle nursing shortages will contribute to decreased healthcare services (Buchan and Aiken, 2015). Health care facilities and organizations are at risk of making economic and reputational losses. If patients cannot receive the care they anticipated, they will stop coming to the healthcare facility, causing the facility to make losses financially.
Furthermore, there are more consequences for patients because some might die due to a lack of care. Many scientific studies associate adequate nursing staff with safe patient outcomes and care. A survey conducted in 2014 by Linda Aiken and her colleagues reported that an increase in a nurse’s workload by one patient increases death by 7% within 30 days of admission.
The research also found that growth in the number of nurses by 10% reduces the death of patients by 7%. On the same note, another study conducted in 2013 revealed higher chances of readmissions if a registered nurse is left to handle over four patients (AACN, 2019). Therefore, the nursing shortage is a risk factor for patient readmissions and deaths. Also, when there are shortages in nurses, those in the workforce are forced to work for long hours, stressing, resulting in injury, fatigue, and dissatisfaction with the work.
Evidence-Based Solutions to Nursing Shortage
To address the nursing shortage issue at the moment and the future, several stakeholders, need to take part in the process and implement long-term and sustainable solutions (Buchan and Aiken, 2015). Below are some of the evidence-based answers to addressing the nursing shortage.
Investing in People
Organizations, including healthcare facilities and nursing schools, need to support leadership among nurses at all levels, from nurses still in college to executives in the nursing field. When initiatives and programs come together to invest in nurses, they increase the chances of having more nurses that will take different roles in the health care system. For example, The Robert Wood Johnson Foundation (RWJF) established the “Fellowship in Nursing Policy and Philanthropy” (Hassmiller and Cozine, 2016), which allows nurse leaders to take part in projects at the foundation and at the Rutgers University in a move to establish health policies.
Furthermore, the foundation has a fellowship program that sponsors midcareer nurses to understand their healthcare system’s role. Such programs increase the morale to work and professionalism in the field. Additionally, in 2014, the University of Wisconsin (UW) donated over $3 million to the Nurses for Wisconsin Initiative. The money is to help pay for the education of future nurses who agree to take up teaching jobs after graduation.
Forming Strategic Partnerships
Partnerships are necessary for addressing the nursing shortage. Nursing schools are creating strategic alliances and sourcing for external funding to help support and expand students’ capacity. A good example is the University of Minnesota, which included a partnership with the Minnesota VA Health Care System to increase students enrolled in a bachelor’s degree in nursing.
Furthermore, the VA donated over $5 million to the university to employ more nursing faculty and have more students joining the faculty (AACN, 2019). Therefore, partnerships are critical when it comes to dealing with the nursing shortage.
Dealing with Demand Side Challenges
The nursing shortage not only means the numbers but also focuses on the healthcare resources available in countries and how nurses use their skills effectively. Therefore, to have sustainable solutions to the nursing shortage, there is a need to focus on the demand side. Health care is a labor-intensive system, and the nursing resources in place must effectively become part of daily use.
Invest in Research
More research is needed to measure, explore, and define the relationship between nursing care and patient outcomes. This research will help determine why new nurses leave hospitals after a short while of working and help identify sustainable strategies to keep nurses within the workforce. For example, the RWJF launched a program in 2015 called “Interdisciplinary Nursing Quality Research Initiative” (Hassmiller and Cozine, 2016) that support teams of nurses and other researchers to collect evidence on the association between nursing care and the quality of patient care.
Dealing with Staffing Ratios
The healthcare system needs to come with the appropriate patient to nurse ratio. Having an adequate number of nurses will promote nurse retention, job satisfaction, reduce medical errors, and increase patients’ satisfaction. Therefore, health care organizations need to have ways to ensure that nurses recruit other nurses regularly, and there is a plan on how to fill the positions of retired nurses (Haddad et al., 2020).
The nursing shortage is affecting the healthcare system across the globe. Millions of nurses are retiring while others are quitting their profession, thus contributing to a decreased workforce. Furthermore, the nursing shortage is attributed to the increase in the aging population who need more medical attention, need to take care of family and explore other career paths, and the healthcare profession’s culture.
Stakeholders, including organizations and institutions, need to invest in nursing to help curb the shortage now and the future. Some solutions include investing in research, ensuring that more nurses are hired, forming partnerships that support the nursing profession, and having ways of dealing with the increase in demand for nursing services. These solutions will come in handy and ensure that the future has more nurses than anticipated.
American Association of Colleges of Nursing (AACN). (2019). Nursing Shortage. Retrieved April 23, 2020, from https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
Buchan, J. & Aiken, L. (2015). Solving Nursing Shortages: A Common Priority. Journal of Clinical Nursing. 17(24): 3262-3268
Haddad, L. M., Annamaraju, P. & Toney-Butler, T. J. (2020). Nursing Shortage. Retrieved April 23, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK493175/
Hassmiller, S. B. & Cozine, M. (2016). Addressing the Nurse Shortage to Improve the Quality of Patient Care. Health Affairs. 25(1)
Mehdaova, E. (2017). Strategies to Overcome the Nursing Shortage. Walden Dissertations and Doctoral Studies. Pg. 1-130. Retrieved April 23, 2020, from https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=5933&context=dissertations