Health care system in action

Global nursing shortage 9

Global nursing shortage: strategies for recruitment and retention

Nurses are the most visible examples of health care system in action. But, as is rightly said by Williams (2009) "a fiercely competitive job market has now replaced this phenomenon" (p.10). There is no scarcity of reports concerning experience with nursing shortages. This problem is not new and is a constant threat to nursing profession (Donelan, Buerhaus, Desroches, Diltus & Dutwin, 2008). The nursing shortage is viewed as both a supply and demand problem (Heinz, 2004). Several approaches have been implemented in various ages of global nursing shortage. Just as there is no simple description of the nursing shortage; it is difficult to isolate single factors or solutions to this problem. This paper aims to discuss the global and UAE nursing shortage, the historical background, the causes for it, the statistical nursing shortage data, and the measures designed to address this shortage, which includes strategies for recruitment and retention of nurses.

Historical background

"Although there are recurring reports of manpower shortages in many other professional fields, nursing seems to enjoy the dubious distinction of continually suffering from this condition". (Spohn, as cited in Fox & Abrahamson, 2009, p.235). Though this quote sounds to fit in contemporary nursing dialog, it was written 50 years ago. Using the professional standard definition, ''a shortage is when there are not as many nurses as needed to provide a certain level of quality'' (Fox & Abrahamson, 2009, p.236). Whereas, in economic terms, ''a nursing shortage exists when there are not enough nurses to fill open and budgeted position'' (Fox & Abrahamson, 2009, p.236).The vital and inevitable reason behind starting the first nursing schools in United States, was the difficulty in finding adequately trained nurses, to serve during the Civil War. On the other hand, with the advances in medical care and introduction of specialty care, during the World War II, in combination with the increase in the number of hospitals, lead to the nursing shortage during this period (Fox & Abrahamson, 2009). Thus, 'The Nurse Training Act' of 1964, made the Federal funds available for the first time to increase the supply of nurses. These funds closely followed cyclic shortages in each decade since then (Fox & Abrahamson, 2009).The shortages in 1970's & late 1980's were fueled by the nurses' dissatisfaction with working condition and lack of professional autonomy (Goodin, 2003). In 1990's, the classic economic model- as the demand for health care increased, the system accommodated by providing more nurses; was interfered by the insurance companies and the Federal government's policy to change from cost-based to cost-managed model. This led to, reduce demand for nurses. But, the 'Health Professions Education Partnership Act'1998 reauthorized 'The Nurse Training Act' of 1964 in response to the increased demand for highly trained nurses(Andrews & Dziengielewski, 2005). In UAE, the dependency on expatriate nurses, has been and remains, significant since 1960's, when mostly, nurses from the Indian subcontinent started to work in this region. The total number of Emirati nationals working as nurses is only 3% (El-Haddad, 2006). At any stage and at any region mentioned at a given time, in the history of nursing shortage, the impact of the nursing shortage has its effects directly on the patient outcomes.


The nursing shortage in Canada was predicted to reach 78,000 RN's by 2011 and potentially 113,000 by 2016 (Cash, Daines, Doyle, & Tettenborn, 2009).The nursing workforce analysts indicate a nursing shortage of 260,000, by 2025, in United States (Rudel, Moulton & Arneson, 2009). By 2020, California alone is expected to require an additional 116,600 RN's to care for its residents (Gamely, 2009). The study done by Rajapaksa and Rothstein in 2009, to study the factors influencing men and women to leave nursing, showed that, 4.5 % and 4 %, of men and women respectively, dropped out of nursing within 4 years from graduation. Andrews & Dziengielewski (2005) also found that vacancy rates also vary as per the specialty care area, with the highest rates in medical-surgical care (16.3%), critical care (15.5%) and emergency care (15.2%). The demand for nursing services will exceed the supply by nearly 30% in 2020 (Andrews & Dziengielewski, 2005). As mentioned above, only 3% of UAE nursing work force is currently nationals, which explains UAE's dependency on expatriate nurses, who leave the country after few years leading to nursing shortage in the UAE (El-Haddad, 2006).

Causes for nursing shortage

The foremost reason for the nursing shortage in the present era is that, the retirees and aging nurses leaving the workforce are not being replaced in adequate numbers with newly trained and younger nurses (Fox & Abrahamson, 2009). The present average age of employed RN is 43.3 years, with nurses less than 30 years contributing to only 10 % (Fox & Abrahamson, 2009). This can be attributed to expansion of educational options and professional opportunity for women and also due to shortage in the nursing faculty (Fox & Abrahamson, 2009; Rajapaksa & Rothstein, 2009). Nurses who have left the profession often cite poor work environment coupled with poor compensation for the services rendered as the primary motivation to leave nursing (Fox & Abrahamson, 2009; Rajapaksa & Rothstein, 2009; Upenieks, 2005). The current nursing work environment with their heavy workloads is stressful for even the most seasoned nurses, resulting in higher levels of burnout and absenteeism. Laschinger, Finegan, & Wilk, 2009, cite that 66% of new graduates were experiencing severe burnout due to negative work place condition. Physical problems of the back, feet, knees and wrists along with the interruption of the circadian rhythm, as well as the mental stress due to the nature of the job and newer technologies being introduced, encourages many to change the profession (Fox & Abrahamson, 2009). In a study by Hart, as cited in Andrews & Dziengielewski, (2005); 68 % of nurses reported low morale in the work place, of which 81% were planning to change profession. Nurses, who were largely female, did not have the political and financial resources of their male counterparts in medicine and administration, which disabled them to exercise the strategies to gain autonomy over education and clinical practice (Andrews & Dziengielewski, 2005). In UAE, the nursing shortage is mainly attributed to the dependant role of women and the low status of women and nursing profession in the society. The variations in basic nursing program and lack of educational resources in Arabic, which is the national language, are the other reasons identified (El-Haddad, 2006).

Strategies for recruitment and retention of nurses

The nursing shortage can be effectively managed in the long run by the recruitment and retention of nurses. The process of recruitment starts from the high school education, facilitated with the help of high school guidance counselors, who can influence student perceptions of nursing as their career (Rudel, Moulton & Arneson, 2009). Various studies have emphasized the need for academic and professional development of students by the nursing faculty, clinical nurse specialist and clinical resource nurses for creating and maintaining professionals in nursing (Ganley & Sheets, 2009; Laschinger, Finegan & Wilk, 2009; Cooper, 2009; & Price, 2009). The five elements of supportive professional practice environment which include adequate staffing, strong nursing leadership, staff decisional involvement, shared governance and effective nurse-other health care profession collaboration, is necessary to enhance positive work environment to retain nurses (Laschinger, Finegan & Wilk, 2009; Andrews & Dziengielewski, 2005). Andrews and Dziengielewski, (2005), equates autonomy to independence and control over one's practice and defines 'professional jurisdiction as the autonomy and authority to act independently (p.288). Success to achieve this professional jurisdiction is postulated to increase the number of individuals seeking nursing as a career. What the public thinks about nurses generally and what they specifically read or see in the media shape the current image of nurses. Nurse executives can be helpful by starting an organizational campaign to educate their staff about how to communicate in social and community settings. Magnet hospital prevention model can help the nurse executives in finding ways to attract and retain nurses (Upenieks, 2005). The government and management can be of greatest help in these turbulent period of nursing shortage by offering tuition reimbursement and scholarship programs for nurses and financial incentives during employment, like increasing salary, providing nurses with annual bonus, and by being advocate for better identification of registered nursing services within insurance and reimbursement system (Rajapaksa & Rothstein, 2009; Upenieks, 2005; Goodin, 2003). The establishment of Emirates Nursing Association in 2001 is a powerful indicator of Emiratization of nursing, which can help to tackle nursing shortage in UAE (El-Haddad, 2006).


In conclusion, it is obvious that the current global nursing shortage is not being ignored as is evident by various researches done in this field. In the short-term fiscal and marketing strategies may help. Ultimately, it is the long-term solution of making the profession a desirable career choice that is essential. It is critical that the nurses strive to empower themselves, improve the public image of nursing; and communicate, to form partnership with their employers, nursing association, lawmakers and other influential key players (Goodin, 2003). The good news is that nursing is one of the fastest growing professions, thus offering strong career for today's youth. With shortages, budget cuts, and retention issues, there is no better time than the present to justify the obvious need for greater numbers of skilled professionals at the bedside (Heinz, 2004). With a strong united voice, nursing may be able to use the nursing shortage to build up the strong foundation for the betterment of the future of the profession.


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