Causes and Solutions to Global Nursing Shortage.

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Causes and Solutions to Global Nursing Shortage.

Introduction

The growing shortage of nurses is a global concern and has 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 depend in the large part on the ability to recruit the 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, undersupply 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).

Contributing factors to nursing shortage

The health care system is facing a significant nursing shortage, particularly in acute inpatient settings. On the demand side, the number of inpatient, critical, labor-intensive patients has increased because of both the 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 workforce and a diminishing of new students entering the nursing profession due to the 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 the total population and especially in the aging population. The main internal factor is the aging of the RN workforce itself. The aspects which contribute to the aging of the RN workforce are a decline in the total number of nursing school graduates, the 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 the next 15 years (Carver & Candela, 2008).

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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 the 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). The nursing shortage is generally considered to be an imbalance between the 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 that they leave nursing during their first year of practice. The desire for practice seems to be frustrated by the realities of the work place (Oulton, 2006; Price, 2008).

In the Eastern Mediterranean region, the gap between the supply and demand of the 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 workers 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 the United Arab Emirates 4%.( WHO, 2008).

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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 a 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 a big challenge for national health systems and initiatives to improve their performance. Several countries are suffering from a 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 the survival of their families in a global environment. The working conditions 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 of nursing faculty members. They include providing guidance from more experienced faculty members for professional development, networking and increasing the self esteem of newer members, fostering socialization, encouraging flexibility, conducting orientation and providing support, facilitating collaboration, allowing for mistakes, co-ordinating teaching assignments, and growing your own and offer rewards.

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Causes And Solutions To Global Nursing Shortage.WHO Regional Committee for the Eastern Mediterranean (2008) emphasized that positive practice environments are 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.

Conclusion

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 developing countries. The retention of nurses encourages and facilitates the recruitment of future nurses. There is a need to review and update the current strategy for nursing development for scaling up nursing, creating a positive practice environment, developing strong committed nursing leadership, and advocating for new roles.

Causes And Solutions To Global Nursing Shortage.Recruitment and retention of a competent, motivated nursing workforce is critical to a well-functioning health system. Achieving 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 and 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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Causes And Solutions To Global Nursing Shortage.

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