refers to a situation where the demand for nurses is greater than the supply, as is currently the case in the United States and several other developed nations.
The amount of nursing responsibilities has increased and the patients are more ill than before. In addition, the average age of nurses increases while the number of applications to baccalaureate programs has decreased. Furthermore, new opportunities became available for the nursing practice, which further drains the number of nurses available for the acute care settings. Other factors that affect the nursing shortage are aging workforce, problems with retention, and difficulty recruiting young people into the field.
Studies have shown that the nursing shortage is an issue in developed countries today. Students need now apply to schools to become nurses because admission rates have increased. Several studies have been done to understand how nurses feel about their career
. About 5 years ago, sociologist Bryan Turner initially identified nurses’ most important complaints as subordination to the medical profession as well as over regulation, and difficult working conditions. Also, a report from the Commonwealth of Australia
identified some of the dissatisfaction as stemming from frequent schedule changes, overloads, shift work, lack of appreciation by superiors and colleagues, as well as lack of childcare
. Inadequate pay was identified as a lesser problem based on the report. Later, a study revealed that the dissatisfaction among nurses focused on conflicting expectations from nurses and managers due to regulation of cost, lack of opportunity to provide comprehensive nursing care, and disillusioned workforce
or “loss of confidence in, and frustration with, the healthcare system.” Limitations to comprehensive care were identified because nurses
are overloaded with the number of assigned patients
, massive paperwork for billing purposes, and short staffing to cut cost.
In the past 20 years administrative/government policies and practice has changed very little, cost-cutting is still the priority, patient loads uncontrolled, and nurses are rarely consulted when recommending changes. The major reason why nurses plan to leave the field, as stated by the First Consulting Group, is because of the working conditions. With the high turnover
rate, the nursing field does not have a chance to build up the already frustrated staff. Aside from the deteriorating working conditions, the real problem is “nursing’s failure to be attractive to the younger generation.” There’s a decline in interest among college students to consider nursing as a probable career
. More than half of currently working nurses
“would not recommend nursing to their own children” and a little less than a quarter would advise others to avoid this as a profession altogether.
Nursing shortage impact
Nursing shortage has the following effects:
- Increase nurses’ patient’s loads
- Increases the risk for error
- Increase risk of spreading infection to patients and staffs
- Increase risk for occupational injury
- Increased deaths
- Increase in nursing turnover
- Increase perception of unsafe working conditions, contributing to increase shortage, and hindering local or national recruitment efforts
- Increase the nurses chance of getting psychiatric help because of massive amounts of stress
The negative impact mentioned above intensifies with the nursing shortage in developing countries due to recruitment to work abroad to wealthier countries. For example, nurses from the Philippines and Africa are recruited to work for the United States and Europe.
Patching up the shortage
Nursing shortages can be consistent or intermittent depending on the current number of patient
attention. In order to respond to this fluctuating census, health care industries have utilized float pool nurses and agency nurses. Float pool nurses are nursing staffs employed by the hospital
to work in any unit within the organization. Agency nurses are employed by an independent staffing organization and have the opportunity to work in any hospitals
on a daily, weekly or contractual basis. Similar to other professionals
, both types of nurses
can only work within their licensed scope of practice, training, and certification.
Float pool nurses and agency nurses, as mentioned by First Consulting group, are currently used in response to the current shortage. Use of the said services increases the cost of healthcare, decreases specialty, and decreases the interest in long-term solutions to the shortage. On the other hand, international recruitment gives rise to concerns on clinical competencies, cultural sensitivity, and ethics in global recruitment. Foreign-trained recruitment has been touted as a "stop-gap", but is by no means a solution. In the United States nurses from Philippines, India, South Korea and China have been seen as prime recruiting grounds. However, the past several years have seen some unintended consequences of this aggressive recruitment, e.g., the 2006 nurse test selling scandal that was reported in the Philippines
A growing response to the nursing shortage is the advent of travel nursing a specialized sub-set of the staffing agency industry that has evolved to serve the needs of hospitals affected by the increasing nursing shortage. According to the Professional Association of Nurse Travelers, there are an estimated 25,500 Registered Nurse Travelersworking in the U.S. The number of LVN/LPN Nurse Travelers is not known.
Retention and recruitment
Retention and recruitment
are important responses to a long-term solution to the nursing shortage. Some of the reasons that contribute to retention of nursing in the healthcare field are addressed in different levels and are as follows. In spite of the discontent, nurses continue to practice. Also, there is a co-relation of high job satisfaction and significant education activities among nurses
. Other possible solutions is through incentives and funding coupled with employer and hospital regulatory approach to retain the current number of staff and could help avoid aggravating turnover.
To assist the healthcare field, congress annually approves a budget for the year through the Nurse Reinvestment Act passed in 2002. Previously in 2004 and 2005, 141.9 million and 205 million were approved in each fiscal year, respectively. The funding is distributed to advance nursing education, scholarships
, grants, diversity programs
, loan repayment programs, nursing faculty programs, and comprehensive geriatric
Efforts of some states to address the nursing shortage in United States
focused on the nursing working conditions. Currently, mandatory overtime for nurses is prohibited in nine states, hospital accountability to implement valid staffing plans in seven states, and only one state implement the minimum staffing ratio.
In terms of recruitment
, suggestions were made in order make nursing attractive as a profession. One of these suggestions was presenting Nursing as a unique discipline, making it an attractive field for the young people. As mentioned in retention, incentives and funding to recruitment effort can contribute to the solution.
Many hospitals believe retention is more important than recruitment. They feel that if you treat an employee well, they will be your best recruiters. Word of mouth goes far.
Market philosophy and Impacts on healthcare
Australian nursing researchers, John Buchanan and Gillian Considine described hospitals
as “being run like a business” with “issues of patient care… of secondary importance.” Emotional support, education, encouragement and counseling are integral to the everyday nursing practice. However, these practices are not easily quantified and considered by managers as unjustified cost for the patients
, who are also viewed as consumers
. Therefore, only clinical responsibilities, such as medication
administration, dressing changes, foley catheter
insertions, and anything that involves tangible supplies, are quantified and incorporated into the organizational budget and plan of care for the consumers
US nursing shortage
population is projected to grow at least 18% over two decades in the 21st century, while the population
of those sixty-five and older is expected to increase three times that rate. The current shortfall of nurses
is projected at over 1 million by the year 2020.
Professional and related occupations are expected to rapidly increase between years 2000 – 2012. The demand for healthcare practitioners and technical occupations will increase and projected to have 1.7 million job openings with in this time period. In this group, the demand for registered nurses is the highest. Registered nurses are predicted to have a total of 1,101 openings due to growth during this 10 year period. In a 2001 American Hospital Association survey, 715 hospitals
reported that 126,000 nursing positions were unfilled.
However, other research findings report a projection of opposite trend. Although the demand for nurses continues to increase, the rate of employment has slowed down since 1994 because hospitals
were incorporating more less-skilled nursing personnel to substitute for nurses
. With the decrease in employment, the earnings for nurses
also decreased. Wage
leveled as it relates to inflation between 1990 and 1994.
Comparing the data released by the Bureau of Health Professions, the projections of shortage in within two years have increased.
US: Supply versus Demand Projections for FTE Registered Nurses
|| Percent |
|| -6% |
|| -7% |
|| -12% |
|| -20% |
|| -28.8% |
Source: Data from the Bureau of Health Professions (2002)
US: Supply versus Demand Projections for FTE Registered Nurses
|| Percent |
|| -6% |
|| -10% |
|| -17% |
|| -27% |
|| -36% |
Source: Data from the Bureau of Health Professions. (2004).
Global shortage and recruitment
The nursing shortage is in global scale according to the International Council of Nurses
needed to fill 7000 nursing positions in year 2002, England
needs to fill 22,000 positions in year 2000, and Canada
will need about 10,000 nursing graduates by year 2011.
In the United States
has been practiced for 50 years. Philippines
supplied most of its nurses
to the United States
and other countries. Overall, the total number of foreign graduate nurses
continues to increase to 14% between 1998 and 2003.
Source: Data from the World Health Organization (2006).
U.S. healthcare facilities pushes to “ease restrictions” on the immigration law to increase the number of recruited foreign nurses. On the other hand, this recruitment practice is only a temporary solution and does not fully address the nursing shortage as mentioned by American Nursing Association (ANA).
Impact of global recruitment
Countries that send their nurses abroad experience a shortage and strain their own healthcare system. In South Africa
, accelerated recruitment
by developed countries such as United States
, United Kingdom
is putting more strain in the healthcare system due to prevalence of diseases
, such as AIDS
, and limited resources. Similar to the U.S., nurses
who leave the organization are a financial disadvantage due to the need to fund recruiting and retraining of new nurses into the system. Also, every nurse
that leaves the country in South Africa
is an annual loss of $184,000, related to the financial and economical impact of the nursing shortage. The following table represents the number of nurses per 100,000-population in South African Countries.
| Number of South African Countries
|| Number of nurses per 100,000 population |
|| 100 |
|| 50 |
|| 20 |
|| Less than 10 |
In addition, physicians in the Philippines have shifted to the nursing field for export opportunities.
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.