Nursing staff are the foundation of any healthcare system. History is a witness that nursing profession has been facing many problems since World War II. The shortage of the nursing staff is one of the biggest problems (Rivers, Tsai, & Munchus, 2005). The shortage of the skilled and educated nurses seems even more significant when there are many diseases being discovered every day and the sensitivity of the care has increased. The increased aging population has also contributed to the need for more nurses. Everyday, healthcare institutions are cutting back their expenses by reducing the number of registered nurses (RNs), or by replacing RNs with registered practical nurses (RPNs) or other less qualified staff, such as assistant nurses. The statistical data provided by Rivers and his fellow researchers (2005) reveal that by the year 2020 the shortage of nurses will be 0.4 million across the country. The scarcity of the qualified nursing staff would ultimately have a negative impact on the quality of care delivered to the patients. This paper will explore the economic explanation of the shortage of nurses, how it impacts the quality of care, and some suggestions to alleviate or to deal with the issue of the nursing shortage.
There are many reasons for the shortage of nurses, such as replacement of registered nurses by RPNs and assistant nurses because of financial crises, job dissatisfaction due to low wages, nursing workloads, working conditions, legal issues related to patients’ care, and aging workforce in healthcare (Rivers et al., 2005). Financial crises are the major contributors to the nursing shortage. These crises may lead to a never-ending chain of disasters in the healthcare sector and ultimately can have an appalling impact on patients’ outcomes. Healthcare institutions are cutting back their expenses by reducing the number of registered nurses on the floor (Sapountzi-Krepia, Lavdaniti, Psychogiou, Arsenos, Paralikas, Triantafylidou, & Georgiadou, 2008). This cutting down of nursing staff in the hospitals causes discouragement among students to choose nursing as a profession and the students assume there is a difficulty in finding jobs. This cutting down actually provides a starting point for the nursing shortage, which would leave a big gap between nursing demand and supply in the future (Sapountzi-Krepia et al., 2008).
The nursing profession is 94 % female dominant. In the past, more women used to choose nursing as a profession. However, this downsizing of the nursing staff has diverted women’s attention to choose a different profession. They find more job opportunities in other disciplines where pay is higher and working conditions are far better than hospitals. This shifting of the women’s choices from nursing to other industries has contributed to a nursing shortage (Rivers et al., 2005). Economists have shown a significant relationship between the nursing shortage and a low increase in nursing wages. This imbalance of wages is the foundation for job dissatisfaction among nursing staff, and as a result nurses leave the job; adding to the nursing shortage (Sapountzi-Krepia et al., 2008).
Due to financial crisis, healthcare institutions are hiring newly graduated nurses at lower remunerations and with fewer benefits, rather than keeping a senior nurse with higher wages. Nursing homes have already replaced RNs with RPNs, personal support workers (PSWs), and nursing assistants to meet their budget. Less qualified staff are performing more technical and skilled jobs. This increases disappointment among nurses and they leave the workforce; making the nursing shortage even worse (Duffield, Gardner, & Catling-Paull, 2008).
In addition to the shortage of nurses affecting the patients’ care, it has also caused many setbacks for nurses. Nurses have to be at the patients’ bed side; however, scarcity of nurses has made it impossible. In modern era of nursing, the patient to nurse ratio is affected; meaning more patients are assigned to a single nurse. High volumes of patients for a single nurse provide the basis for poor client care. Nurses get less time to be with their clients for nursing interventions, rather spending more time documenting and writing progress notes for a number of clients (Duffield et al., 2008). Due to this shortage of nurses, patients’ stays at the healthcare facilities are shorter which causes compromised patient care. More patients revisit hospitals with the recurrence of diseases that ultimately increases patients’ volume and their stay at the facility. The increased volume of patients would also affect the flow of new patients (Duffield et al., 2008).
The nursing shortage has directly impacted nurses in different ways. The increased patient to nurse ratio has caused an increased workload for nurses. The amplified burden could have an impact on nurses’ efficiency and may also affect the number of errors made in nursing interventions (Duffield et al., 2008). Another effect of the nursing shortage is lessening the distinction among nurse specialists and registered nurses. Nurse specialists are assigned the tasks that need to be carried out by registered nurses. The unequal and inappropriate distribution of tasks among these nurses has caused job dissatisfaction for nurse specialists (Duffield et al., 2008).
A collective effort from all directions is needed to overcome the issue of the nursing shortage. First of all, the nursing image needs to be clarified in the eyes of policy makers and the public by recognizing and valuing the nursing work (Duffield et al., 2008). Secondly, patients’ care and safety should never be compromised by reducing or replacing the number of skilled staff. Such interventions would bring back the lost image and worth of nurses in the eyes of students who choose nursing as their priority profession (Rivers et al., 2005). Rivers and his colleagues (2005) suggested that funding should be provided to nursing scholars to attract more students to join the nursing profession. They should be offered job security and reasonable earnings, along with gradual annual increments. Rivers et al. (2005) also recommended that nursing staff should be offered bonuses upon the completion of their contract. This would help in the retention of nurses in the facility and be a magnet for more nurses to come back to the nursing profession as a rewarding career (Rivers et al., 2005).
As far as distribution of the tasks is concerned, qualified nurses should be assigned tasks according to their skills and training. The tasks that do not need specific nursing skills should be allocated to other less skilled staff. There should be an appropriate patient to nurse ratio which would decrease the extra workload of nurses and provide job satisfaction to stay in the profession (Duffield et al., 2008).
In order to develop a healthy nation more healthcare staff, especially more nurses, are needed. Considerations should be made to increase the budget for healthcare each year to a handsome amount that would allow policy makers to hire more nurses. They should also hire clerical staff to reduce the extra burden of documentation off the nurses’ shoulders (Duffield et al., 2008). These changes would give nurses enough time to be with their clients and give authentic patient care which is unique to every patient. Nonetheless, the reasons for the shortage of nursing staff are quite clear and their solutions are suggested by scholars and critics. The questions of concern still remain, why public health and safety is compromised. The majority of patients are elderly, so how come healthcare does not get enough of a budget to meet patients’ needs for those who have contributed their lives to build this system?
Duffield, C., Gardner, G., & Catling-Paull, C. (2008). Nursing work and the use of nursing time. Journal of Clinical Nursing, 17, 3269-3274. doi: 10.1111/j.1365-2702.2008.02637.x
Rivers, P., Tsai, K., & Munchus, G. (2005). The financial impacts of the nursing shortage. Journal of Health Care Finance, 31(3), 52–64. Retrieved from http://cinahl.com/cgi-bin/refsvc?jid= 1011&accno=2009042296
Sapountzi-Krepia, D., Lavdaniti, M., Psychogiou, M., Arsenos, P., Paralikas, T., Triantafylidou, P., & Georgiadou, C. (2008). Nursing staff shortage and in-hospital informal care in an oncology hospital in Greece: The nursing staff’s perceptions. International Journal of Nursing Practice, 14, 256–263. doi: doi:10.1111/j.1440-172X.2008.00688.x
These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: firstname.lastname@example.org