The Global Nursing Shortage and Strategies for Recruitment and Retention
The growing shortage of nurses is a global concern and an adverse impact on health systems around the world. Today shortages vary by type of nurse, geographic location, level of care, sector service and organization. Nursing recruitment and retention are recognized national and international priorities. The growth and sustainability of the nursing profession depends in the large part on the ability to recruit next generation. Understanding how these future nurses come to choose nursing as a career option is of critical importance to the profession and may be used to inform future recruitment and retention strategies (Price, 2008). The main causes of nursing shortages are inadequate workforce planning, and allocation mechanisms, under supply of new staff, poor recruitment, retention and return policies and ineffective use of available nursing resources through inappropriate skill mix and utilization, poor incentive structures and inadequate career support (Buchan & Aiken, 2008). The aim of this paper is to discuss the causes and solution of global nursing shortage.
Contributing factors for nursing shortage
The health care system is facing significant nursing shortage particularly in acute inpatient setting. On the demand side the number of inpatient, critical, labor-intensive patients has increased because of both aging population and medicine's success in keeping ill patients alive longer, thus requiring increased nursing hours to care for these patients. On the supply side some of the concerns include an aging nursing work force and a diminishing of new students entering in to the nursing profession due to broadening of job opportunities within and outside of health care (Upenieks, 2008; Chitty, 2005).
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The current nursing shortage results from a combination of external and internal factors. A major external factor is an increased demand for nurses because of the growth in total population and especially in the aging population. The main internal factor is the aging of the RN workforce itself. The aspects which contributing to the aging of the RN workforce is a decline in the total number of nursing school graduates, higher average age of recent graduates and the aging of the entire existing pool of licensed nurses (Chitty, 2005).The aging nursing workforce is causing concern with the average age of registered nurses, in the United States up from 45 in 2000 to 46.8 in 2004. According to the United States Department of Health Resources and services Administration report the country will be short of about one million nurses by the year 2020. In Canada 50% of the nurses employed today will retire within next 15 years (Carver & Candela, 2008).
An aging population, by 2050 there will be a greater number of older people than younger ones in the world. In the 25 European Union countries alone, half the population will be older than 50, with the proportion of the population 65 and older being twice as large as that younger than 15 years of age. Another increased demand is globalization and a growing private sector and public trust in nurses which increased demand for nurses as the primary entry point to health services (Oulton, 2006).
There is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes, which include increased mortality rates, adverse events after surgery, increased incidence of violence against staff, increased accident rates and patient injuries and increased cross infection rates (Buchan & Aiken, 2008). Nursing shortage is generally considered to be an imbalance between demand for employment and the available supply. In past shortages either an increasing demand or a decreasing supply was the main contributing factor. But today both factors contribute equally, a decreased supply cannot meet the increased demand. The factors for increased demand are shorter hospital stays and more complex diseases, resulting in increased activity of care, a shift
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From hospital to ambulatory, home and community care, new infectious diseases such as HIV/AIDS, tuberculosis and malaria ( Oulton, 2006, Haynes, Butcher & Boese, 2004).
Many new graduates never register to practice. In the United Kingdom one third of newly qualified nurses do not register and are lost to the profession (Oulton, 2006). In Australia 66% of new graduates reported and they leaving nursing during their first year of practice. The desire of practice seems to be frustrated by the realities of the work place (Oulton, 2006; Price, 2008).
In Eastern Mediterranean region, the gap between supply and demand of nursing work force is the geographic maldistribution between urban and rural settings and the imbalance in the number of different categories of professionals. In some countries where the ratio of health worker to population is high, the number of expatriate workers exceeds that of nationals. The percentage of national nurses in the six founder member countries of the Gulf Cooperation council ranges from 4% to 55%. Bahrain 55%, Kuwait 10%, Oman 52%, Qatar 8%, Saudi Arabia 27% and United Arab Emirates 4%.( WHO, 2008).
The shortage of qualified nurses and midwives, high workload, poor working environment, low job satisfaction and lack of nursing workforce plans seriously affect the quality of nursing and midwifery services in the region. Nursing directors and their staff need continuing support to become active participants in health and nursing policy-making and planning, including proper level of authority and sufficient resources, both financial and human to strengthen the roles of nurses and nursing services (WHO, 2008).
Nurse migration and retention is big challenge for national health systems and to initiatives to improve their performance. Several countries are suffering from severe shortage in the health workforce exacerbated by emigration. The mass migration of nurses to other countries has severely affected the health system. Primarily the migrant women from poor countries leaving their own dependent children and elderly relatives
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who lack in care. The burden of care in rich countries is now shouldered by poor women, who enable to the survival of their families in a global environment. The working conditions that include long working hours, few social benefits, poor pay and minimal training and support (Hirschfeld, 2009).
A recent study on the migration of Lebanese nurses to the GCC countries because of high nurse to patient ratios, autonomy in decision making, working in a supportive environment, being valued by other health professionals, career development, salary levels, equality with other professional careers, a permanent position, commitment to excellent nursing care, employer education support, safe working environment and programme for recognition of excellence (WHO, 2008)
Recommendations for nursing shortage
The nurses should be respected, rewarded for their competencies and problem-solving skills, challenged appropriately and given opportunities for personal and professional development. Creating those conditions need not be costly and will go a long way to resolving the nursing shortage (Oulton, 2006). Recruitment and retention of nurses are equally important. Recruiting employees gets someone there to do the job and retaining them prevents the necessity of trying to recruit and train new people on a continuing basis. The managers and health workers to increase their understanding of sensitivity to cultural differences in the work place (Carver & Candela, 2008; Upenieks, 2008).
Hessler and Ritchie (2005) developed a list of suggestions that may benefit nursing schools that are hiring new generations nursing faculty members. They include, providing guidance from more experienced faculty members for professional development, networking and increasing the self esteem of newer members, foster socialization, encourage flexibility, conduct orientation and provide support, facilitate collaboration, allow for mistakes, co-ordinate teaching assignments, grow your own and offer rewards.
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WHO Regional Committee for the Eastern Mediterranean (2008) emphasized that positive practice environments characterized by policies that enhance recruitment and retention of the nursing workforce, strategies for continuous professional development, adequate employee compensation, recognition programmes, sufficient equipment and supplies, support and respect and safe working environment. Determining staffing levels using workforce planning tools and models has a positive impact on the working conditions of nurses. Poor staffing patterns and skill mix have a negative impact and need to be addressed.
A nursing shortage is not just an organizational challenge; it has a major negative impact on health care. Failure to deal with a nursing shortage is it national or global will lead to failure of health care. Retaining nurses in active practice is key to resolving the present nursing crisis in the developing countries. The retention of nurses encourages and facilitates the recruitment of future nurses. There is need to review and update the current strategy for nursing development for scaling up nursing, creating positive practice environment, developing strong committed nursing leadership and advocating for new roles. Recruitment and retention of a competent, motivated nursing workforce is critical to a well functional health system. To achieve allocation of adequate resources to the nursing services is important. Lack of understanding of the complexities involved in comprehensive nursing care and fulfilling this role is vital for nurse's job satisfaction constitutes a critical mismatch of interests that needs to be urgently addressed if the current worldwide shortage of nurses is to be tackled. Professionals have a momentum building opportunity and the obligation to make the workplace safe and attractive to current and future health professionals so that ultimately it is the patients and families across the globe who benefit.
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- Buchan, J. & Aiken, L. (2008). Solving nursing shortages: A common priority [Electronic Version]. Journal of Clinical Nursing, 17, 3262-3268.
- Carver, L. & Candela, L. (2008). Attaining organizational commitment across different generation of nurses [Electronic Version]. Journal of Nursing Management, 16, 984-991.
- Chitty, K.K. (2005). Professional Nursing Concept & Challenges. (4th Ed.) pp 97-100 United States: Elsevier Saunders.
- Haynes, L., Butcher, H., & Boese, T. (2004). Nursing in contemporary society: Issues, Trends, and Transition in to practice. New Jersey: Pearson Prentice Hall.
- Hessler, K. & Ritchie, H. (2006). Recruitment and Retention of Novice Faculty [Electronic Version]. Journal of Education, 45 (5), 150-154.
- Hirschfeld, M. J. (2008). Profession And Society Accepting Responsibility for Long- Term Care- A Paradox in times of a Global nursing shortage? [Electronic Version]. Journal of Nursing Scholarship, 41 (1), 104-111.
- Oulton, J. A. (2006). The Global Nursing Shortage: An overview of Issues and Actions [Electronic Version]. Policy, Politics & Nursing Practice Supplement, 7 (3), 34-39.
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- Price, S. L. (2008). Becoming a nurse; a meta- study of early professional socialization and career choice in nursing [Electronic Version]. Journal of Advanced Nursing, 11-19.
- Upenieks, V. (2006). Recruitment and Retention strategies: A Magnet Hospital Prevention Model (Electronic Version). Nursing Economics, 21 (1), 7-13.
- World Health Organization. Regional Office for the Eastern Mediterranean (2008). Promoting nursing and midwifery development in the Eastern Mediterranean Region, 55-6(b). Regional Committee for the Eastern Mediterranean.