The Global Nursing shortage
The priority of nursing is helping and providing caring services for the patients so, how they can provide proper care if benefits , work conditions and salaries of the nurses were the last concern for most hospitals and the registered nurses are underpaid and underappreciated. This papers are prepared to outline the nursing shortage. Now a days, there is acute shortage in registered nurses world wide and if this issue not resolved the situation will become worse. The nursing shortage emerged in late 1990s. At that time the government and private payers cut registered nursing position (RN) as cost-cutting initiative (cost based model to a cost manage model). They replaced the registered nurses by unlicensed assistive personal with lower cost. As a result the number of nursing education became less. The unlicensed assistive failed due to increase patients acuities and medical errors. So, the demand for registered nurses dramatically increased. In united state they are expecting the nursing shortage to grow to 29 per cent in 2020. Baccalaureate-prepared nurses have a positive impact on lowering mortality rates. A research team led by Dr. Ann E.Tourangeau from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada, studied 46,993 patients admitted to hospital with heart attacks, stroke, pneumonia and blood poisoning. The authors found that: "Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients." Tourangeau; Doran; Hall; Pallas; et al; (2007).
What the public thinks about nurses and what they see or read in the media made the situation worse. Most of people think twice before allowing their children to enter the nursing field. At the same time the public is hearing about the stress nurses experience and the shortage. This make many people feeling unsafe to leave their family in hospitals or to joined nursing field. The media is giving bad image about nursing. There are many stories in the newspaper about nursing errors that injured or killed patients. In addition to that most of the nurses are females and like other female professions the public undervalues nursing. Another market that needs to be pursued is males. If men were to enter nursing at the same rate as women, shortages would not be a concern. In order to influence men to enter the nursing profession, society and the media must eliminate barriers and stigmas facing men who may choose this career. Adrist; Nicholes & Wolf. (2006).
In 2004 and 2005, registered nurses identified the top four reasons for nursing shortage salary and benefits issues, more career options for women, undesirable work hours and negative work environment. (Buerhaus et al; 2006) as cited in (Allen; 2008). One of the main reason for nursing shortage is faculty shortage. The nursing schools were unable to accommodate the flow of applicants. Nursing schools turned away 41,683 qualified applicants in 2005 in US due to faculty shortage. The reason for faculty shortage include increased age of the current faculty, increases in faculty retirements, less compensation for academic teaching than position in clinical areas for master's holders nurses. (Allen; 2008). Kowalski; Dalley & Weigand (2006) made a randomized study on 129 nurse educators teaching from 61 schools of nursing to determine what influencing retirement plans. The factor influencing retirement plan as mentioned in the study were work place issues , personal and family health and the most important factor was financial security. The faculty members who were secured financially retired earlier. Another factor is that most of the new graduate nurses are encouraged to immediately start clinical work instead of encouraging them to continue education.
Furthermore, low level of job satisfaction are widespread among nurses. Sochalski; (2002) as cited in Andrews& Dziegielewski; (2005) said that "one every three staff nurses expressed low satisfaction with her or his job". Some of the factors that lead to low satisfaction include feeling overloaded due to unrealistic workload, relations with co-workers, scheduling, mandatory overtime, senior managers who are successful in increasing job stress which lead more RNs to burnout fast or retire early or quit nursing and also hospital administrators who lack responsiveness to nurses' concern which result in a lot of nurses resigning. Andrews& Dziegielewski; (2005)
On 22 of March 2010, the National newspaper published about the new council that took place in Dubai to address UAE nursing shortage. The new Nursing and Midwifery Council said that the low salary, low status and limited career progression are factors influencing the shortage. They that UAE needs to increase the number of nurses by 25 to 30 per cent. In UAE everything from salaries to code of conduct and scopes of practice different across the emirates this is due to the three bodies responsible for licensing nurses who works in the seven emirates. The council said that there are 23,000 nurses and midwifery working in the different emirates. If they increase 30 per cent this will increase the number to 30,000. Dr Fatima al Rifai, the director of the federal department of nursing at the Ministry of Health and secretary of the new council, said the shortage of nurses and midwives was compounded in the UAE by the perceived low status of the profession. "A lack of unified regulation also affects the identity and image of nurses and midwives," she said. "It is very important that we develop national scopes of practice and we believe we will be able to do this. By 2015 we would like to have a new system where nurses and midwives only need to register with one agency and will all meet the same minimum standard." Underwood; (2010, March). There are different licensing rules in Abu Dhabi, Dubai and the northern Emirates which are the three bodies of licensing in UAE. Requirements about educational qualifications, experience and primary source verification differ depending on which body - Health Authority-Abu Dhabi, Dubai Health Authority or the Ministry of Health is licensing the nurse or midwife. The council plans to increase nursing and midwifery education and to encourage nurses to take up specialist like neonatal and intensive care. They also planning to provide accredited courses to ensure the quality of training. Also the want to change the public image of nursing by making it more professional and desirable so more local will choose nursing as a career option. Underwood; (2010, March).
The recruitment of registered nurses by a facility and then the retention of those RNs are major challenges in today's nursing shortage. In order to solve the nursing shortage there is should be effective recruitment and retention. Recruitment refer to continuously attracting new students into the nursing profession. How? By providing positive image or role model of nursing, making nursing education more efficient or to higher academic, increasing salary, improving financial aid. So this made the recruitment of RNs expensive for any facility. Jones;( 2005) made study about the cost of nurse turnover. He estimated a total cost of between $62,100 and $67,100 to replace a single RN. When vacancy rates reach high single or double digits, the cost to the facility is significant and its likely impact on other resources such as workload, overtime, nurse replacements, etc. will be significant. An additional cost not often discussed is the human costs of turnover and subsequent recruitment on the nursing staff. While a position is empty, the workload of the missing nurse should be absorbed into others' workload. If a new nurse be hired, the nursing staff usually does a good deal of orientation of the new employee to the particular unit and its culture. Temporary employees also require additional work by staff RNs since they have to provide support to the temporary employees in becoming familiarized. Retention is also a major challenge since once an RN is recruited and hired, the facility wants to retain that employee. Many factors play into the retention of any single nurse. Such things as feeling they have autonomy over their professional practice decisions, they are a part of decision making at the unit level, they have reasonable workloads, they receive continuing education, they have flexible scheduling, they receive competitive pay, etc. All of that effect the RN's decision to stay or leave their place of employment. Jones; (2005).
Finally, Nursing shortages can be consistent or intermittent depending on the current number of patients needing medical attention. In order to provide high quality of patient care, reduce risk for error, patients injury or death they should develop effective strategies of recruitment and retention to overcome the acute shortage in registered nurses also its important to change the image of nursing in the community so, more young people will enter the nursing field. Another important issue is to find solution for the faculty shortage. Solutions should be developed in several areas: education, health care systems, policy and regulations, and image as mentioned before. This shortage is not exclusively a nursing issue, but will require a collaborative effort among nursing leaders, practitioners, health care executives, government, and the media.
- Adrist, L, C; Nicholes, P, K& Wolf. (2006). A History of NURSING IDEAS. Canada. Jones and Bartlett Publishers.
- Allen, L. (2008). The Nursing Shortage Continues As Faculty Shortage Grows. Journal of NURSING ECONOMICS.
- Andrews, D, R & Dzieglewski, S. (2005). The nurse manager: job satisfaction, the nursing shortage and retention. Journal of Nursing Management.
- Jones, CB. (2005). The costs of nurse turnover, part 2. Journal of Nursing Administration.
- Kowalski, S.D., Dalley, K., & Weigand, T. (2006). When will faculty retire? ;Factors influencing retirement decisions of nurse educators. Journal of Nursing Education.
- Underwood, M; (2010, March). New council to address UAE nursing shortage. National newspaper.
- Tourangeau, A,E; Doran,D,M; Hall,L,M; Pallas,L,O; Pringle,D; Jack V& Lisa A. Cranley. (2007). Impact of hospital nursing care on 30-day mortality for acute medical patients. Journal of Advanced Nursing.