Nursing shortage is considered as a major barrier that affects the nurses physical and psychological activities . It is a global crisis that is striking the world health care sector. Even though nursing shortage is an ancient issue, it continued to rise dramatically across the years. A nursing shortage is not just an organizational challenge or a topic for economic analysis; it has a major negative impact on health care. Failure to deal with a nursing shortage be it local, regional, national or global is likely to lead to failure to maintain or improve health care. (Buchan & calman, 2004, p.7).
This report aims to analyze the global nursing shortage with a focus on the UAE situation. Also, it discusses the contributing factors, the impact of this phenomenon on patients, nurses, and hospitals .finally it scatter the light on solutions and strategies for recruitment and retention of nurses.
Nurses make up the backbone of health sector, existence of vacuum and shortage among them will lead to a collapse of public health sector." Nursing shortage refers to a situation where the demand for nurses is greater than the supply"(Nursing Shortage, 2010). Since Florence Nightingale professionalized nursing in the 19th century, we have had cyclical nursing shortages, especially during times of war. In the past, whenever the demand for nurses exceeded the supply, more nurses were recruited and trained, and the shortages were quickly repaired (Seeking Sources, 2010).
Although nursing shortage is addressed as a global crisis, some countries suffer more than others. As Buchan & calman, (2004) stated" At country level, the reported nurse: population ratio varies in different countries from less than 10 nurses
Per 100,000 populations to more than 1,000 nurses per 100,000 a variation of more than one hundredfold". For example, in the united state the shortage of the full time equivalent registered nurse (RNs) is projected to range from 400,000 to 800,000 RNs by 2020. (Keenan & Kennedy, 2003). While the UAE is in desperate need for more nurses," There are approximately 23,000 nurses and midwives working across the seven emirates. An increase of 30 per cent would bring the number to almost 30,000". (Underwood, 2010). Moreover, wide spread phenomena between gulf countries, is the total dependence on foreign nurses as a work force. Even though 37% of the kingdom's nursing staff and expatriates, Bahrain employs more locals in the profession than any country in the region. For example, in the UAE 85%of nursing staff are recruited in from overseas and this figure is 95% in Qatar. (Oxford business group, 2009).
Nursing shortage factors are numerous and multifaceted. Part of these factors is: job dissatisfaction, aging population, aging RNs and nurse educator. As Elmobasher sate (2007) "The American Nurses Association (ANA) believes that a major contributing factor to the current and emerging nursing shortage is dissatisfaction with the work environment". As nursing is considered a very stressful job, which need a lot of physical and psychological effort. According to United States General Accounting Office (2001) the basic domains of job dissatisfaction are inadequate staffing, heavy workloads, and the increased use of overtime. Consequently, "41% current nurses are dissatisfied with their job"(Nunnelee & Jimmerson, 2005).
Another factor that is contributing in nursing shortage is the increased demand by the increased aging population. As Keenan & Kennedy (2003) reported" between 2000 and 2020, the population will grow by 18 percent (31 million) overall, but the over-65 population, with more health care needs, will grow by 54 percent (19 million people)" they added" Nurse educators are also aging, with consequent expected declines in available nursing faculty." Moreover, nurses are aging and most of them would start thinking about retirement without any substitute or replacement."22% plan to leave the profession in the next year" (Nunnelee & Jimmerson, 2005). According to the 2004 National Sample Survey of Registered Nurses released in February 2007 by the federal Division of Nursing, the average age of the RN population in March 2004 was 46.8 years of age, up from 45.2 in 2000. The RN population under the age of 30 dropped from 9.0% of the nursing population in 2000 to 8.0% in 2004(American Association of Colleges of Nursing, 2009).
In the past, women had few career potions, unlike these days where women are trying to explore their career options. The nation has experienced broad changes in social and employment patterns for women. Women born after the 1950s have more career options than their predecessors, and fewer have chosen to enter nursing (Keenan & Kennedy, 2003).
In the UAE context, the short staffing causes are more related to the culture. First of all is the nursing image which is governed by religious and cultural trends. The emirates view nursing as a maid ad undermines the nurse role. Their Islamic culture also reject nursing, as nurses have to deal with males ad have a direct contact with them. "There is a need to change the image of this important profession from just 'vaccination givers' to be part of the decision-making process."(Saberi, 2010).
On the other hand, the image of male nurses needs to be corrected. "Currently, male nurses account for only 5.7% of all nurses. If men were to enter nursing at the same rate as women, shortages would not be a concern"(Nursing Shortage, 2006).
Another factor that had a dramatic impact on nursing shortage is wages. Nurses as any other professionals look or better salaries and more benefits, as a result nurses immigrate for a better salary. an average monthly salary of a nurse in Dubai is anything between Dh2,000 and Dh9,000, in Saudi Arabia it is between 12,000 and 18,000 Saudi riyals (Dh11,750-Dh17,600) and in the USA it is about $4,500 (Dh16,500). In the UK the lowest-grade starting salary for a nurse is £13,000 a year (Dh8, 000 a month). (Gupta, 2007).
Unfortunately, nursing shortage has negative impact on Innocent victims.
A 2007 Health and Human Services report, prepared by the Minnesota Evidence-based Practice Center, concluded, "Higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in
Surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay." (Anderson, 2007). On the contrary, Keenan & Kennedy (2003) reported that" A study published in October 2002 found that an increase of each additional patient per nurse (within a range of four to eight patients) was associated with a 7 percent increase in the odds of dying within 30 days of admission and a7 percent increase in the odds of death following complications such as shock or pneumonia. This the ugly effect of nursing shortage on patient, which will extend and reach nurses.
Nurses struggle each day to over come the nursing shortage and to do the job following the standers. The challenge has taken a physical toll, causing nurses to develop chronic back pain and repetitive stress injuries. It's taken a psychological toll, making them feel harried and overwhelmed. The study says 41 percent of nurses are dissatisfied with their jobs and 43 percent suffer from burnout. In addition, 75 percent of nurses believe the quality of care at their hospitals is declining, and 40 percent would not feel comfortable having a family member cared for at their facility, according to a 2001 survey by the Washington, D.C.-based American Nurses Association. (Ginty, 2004). Furthermore, nursing shortage could deeply affect nurses" Increase the nurses' chance of getting psychiatric help because of massive amounts of stress""(Nursing Shortage, 2010).
Also hospitals suffer from the short nurse staffing and they try hard to reduce this phenomena and to attract RNs .Nursing shortage (2010) stated that" In an American Hospital Association study, the cost to replace one nurse in the U. S. was estimated at around $30,000 - $64,000. This amount is likely related to the cost of recruiting and training nurses into the organization. Hiring foreign nurses is more financially taxing compared to hiring domestic-graduate nurses; however, facilities save money in a long run because foreign nurses have a contractual obligation to complete their term.
United Arab Emirates has started to implement strategies to alleviate nursing shortage. For example, according to nazzal (2008) reported that Ras Al Khaimah nursing student is approved to recruitment by the minister of health. He also added that" the newly appointed nurses will be distributed among the emirate's hospitals and medical centres according to their needs. He said medical services offered in the emirate are expected to improve with the appointment of these graduates."
Another strategy is listen to the nurses demand and satisfy them. "Jamal Nagi, Director of Human Resources at Dohms, who is preparing the final stages of implementing new HR policies for nurses, said: "Dohms will introduce new pay packages for nurses from August this year and we will also provide them with better accommodation and introduce more training initiatives.''(Gupta, 2007).
Finally, the strategies should contain a solution for the nursing education seats ,taking in consideration it is one of the nursing shortage causes in UAE . With 23,459 nurses in the UAE, out of which only four per cent are Emirati, the Ministry of Health (MoH) is in talks with educational institutes to introduce a Bachelor of Science (BS) degree in nursing across all UAE universities in the next five years. The MoH currently offers a BS degree in nursing for both Emiratis and expatriates in only three higher institutes, the Fatima College, Ras Al Khaimah University and Sharjah University (El Shammaa., 2010).
In conclusion, nursing shortage is a wide world crisis. It should attract the health care organizations to address this crisis and implement strategies to over come it. there are many factor that lead to nursing shortage like: low wages, nursing image, and job satisfaction.UAE suffer from nursing shortage because of the cultural nursing image that caused locals to never thing of nursing as a career. nursing shortage has dramatic impact on patient safety, nurses and hospitals . UAE followed strategies to alleviate nursing shortage.
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