Abstract
Nursing shortage is the significant problem that negatively affects patient care quality. Nurses overwork and cannot cope with their daily tasks, which causes severe problems in healthcare. The number of people needing medical help increases, and nursing becomes more complicated due to the spread of technology in hospitals. It means that qualified nurses have to study much to gain the required competencies, while healthcare needs more professionals at once. The impact of nursing shortage can result in severe burnout and stress and shapes the delivery of effective interventions to meet patient, family, and community needs. Therefore, it is a critical problem that requires a solution in the nearest future.
Introduction
Nurses constitute the core professionals who facilitate patient care services in healthcare settings. Their overall contribution is essential to the well-being of sick individuals and the country. Nursing is attracting many employment opportunities since the need to promote proper, quality healthcare practice is fundamental. However, despite the increasing number of physicians in the sector, the rising rate of provider turnover across the globe is alarming and proper intervention is required. A shortage of nurses and other practitioners will lower the quality-of-care services, thus leading to high morbidity, errors, and more deaths among patients.
Nurses are vital in providing patient care and ensuring public health, and the problem of a shortage of medical personnel is global. According to the World Health Organization (WHO) (2022), the world needs an additional 9 million specialists to achieve the Sustainable Development Goal of ensuring high-quality public health. People’s health depends on the number of nurses available and their training. At the same time, the situation worsened due to the crisis of the global pandemic COVID-19 – hospitals and their employees are overloaded, which creates tension and leads to fatigue, burnout, and desire to leave work (Kelly et al., 2021). Therefore, investing resources in medical personnel support, education, and decent working conditions is essential in increasing the number of nurses and keeping the existing specialists.
The nursing shortage is a complex problem involving many factors that affect possible solutions to this dilemma. Ethics and culture can play a significant role in solving this issue. In particular, the conditions of work in which the employer supports and promotes ethics and the diversity of cultures are more favorable for the staff and can increase their job satisfaction. As a result, ethics and culture can affect the retention of employees and their intention to leave the workplace. Improving the conditions of work for nurses, increasing the profession’s prestige by adequate payment, and popularizing this sphere are the possibilities of reducing medical staff shortages.
Discussion
Relevance of the Topic
Effective care delivery is necessary to enable individuals to overcome various health conditions that might hinder their productivity. Similarly, competent physicians must be available to deal with emerging diseases to ensure proper diagnosis and management. The nurse beginners will require experienced practitioners to guide them through technical practices, which might be a challenge provided such professionals are lacking in the facilities. The patient-nurse ratio will increase, leading to poor care delivery because the number of providers will be less than the population of patients. The paper’s purpose is to explore the limitation related to the decreasing number of providers and how the effect will shortly shape the nature of care provision. A decrease in the number of providers will imply a shortage of practitioners to attend to the needs of sick individuals, including the aging population (Shamsi & Peyravi, 2020). Understanding the negative impacts of limited physicians in healthcare facilities portrays the bigger picture of nurses’ role in healthcare practice. Among possible adverse outcomes are medical errors leading to health impairment or death (Spurlock, 2020). Similarly, patient satisfaction decreases because they do not receive providers’ attention due to scarce doctors.
Populations Affected by Nursing Shortage
The challenge of the nursing shortage becomes a severe problem when its impact on patient care is considered. Rosenberg (2019) shows that improving the issue in some health facilities in the United States can prevent deaths through improved nurse-to-patient ratios. Regardless of their practice state, specialty, or age, nurses struggle, and all need help. In the U.S., a study by the U.S. Bureau of Labor Statistics (BLS) established that only 12 percent of nurses are happy with their work (Nursing Shortage or Exodus, 2022). The same study revealed that over 35 percent of the nurses would continue working at their current positions only if changes in the nurse-to-patient ratio were improved (Nursing Shortage or Exodus, 2022). According to nurses, the main challenges they face are safer patient ratio assignments, safe staffing, and improved pay to maintain their working positions.
The issue of nurse shortage has been linked to nurses and physician burnout symptoms. The leading cause for such symptoms, as shown by Vuong (2020), is a nurse-to-patient ratio. None of the existing approaches to minimize burnout among nurses has been attributed to addressing staff ratios. Three dimensions of nurse burnout exist, including cynicism, emotional exhaustion, and low personal accomplishment sense, all of which can be controlled by managing the staffing ratio challenge (Vuong, 2020). Nurses need energy and time to effectively care for their patients, families, and the community. Moreover, rapport plays an equally important role in practical care realization, which, together with energy and time, translates to better care. Uninterrupted time, which results from the above, affords nurses more time with patients and their families (Tamata et al., 2021). However, due to nurse shortage, burnout makes it difficult for nurses to spend sufficient time with their patients.
Nursing and midwifery are fundamental to primary healthcare providers and are often the first and sometimes the only healthcare professions people need to experience quality in their initial evaluation. According to the World Health Organization (WHO) (2022), nurses and midwives are also responsible for initial care and treatment. They are part of the local community, meaning they have the mandate of sharing vulnerabilities, strengths, and culture. With this, nurses and midwives have a critical role in how effective interventions are shaped and delivered toward meeting patient, family, and community needs (WHO, 2022). For nurses and midwives to achieve the mentioned activities, they require adequate staffing, which becomes a challenge when the problem of nurse shortage comes into practice.
Statistical Issues Related to Nursing Shortage
The challenge of the nursing shortage negatively impacts a profession continuously acknowledged for its suffering, resilience, strength, and compassion, a universal issue. Based on the BLS, registered nurses’ employment was projected to by 9 percent between 2020 and 2030 (Rosenberg, 2019). Every year, the U.S. approximates that over 194,000 openings are available for registered nurses, on average, over the anticipated ten years (American Hospital Association, 2022). Nonetheless, the expectation was pre-Covid-19 and before the bedside mass exodus of clinical nurses, leading to a substantially lower number than the actual demand for nurses. The American Nurses Association (ANA) showed that the U.S. would need an additional 3.4 million nurses, a more than 20 percent increase in the existing registered nurses (AHA, 2022). In 2022, the ANA had projected an additional 1.13 million nurses, which means there is an ever-growing need to increase healthcare needs that help promote job growth in the U.S. (AHA, 2022). Moreover, the additional number of nurses means the U.S. must find alternative or effective measures to counter the impact of quality care resulting from the nursing shortage.
Several factors have been attributed to the nurse shortage issue, among them a declining number of student nurses enrolling in the nursing program alongside an increasing number of early retirement cases among practitioners. According to WHO (2022), the 27 million nurses and midwives around the globe account for approximately 50 percent of the workforce in the healthcare sector. However, despite the number, there is a universal health worker shortage, with the world requiring an additional nine million nurses and midwives by the end of 2030 (WHO, 2022). In addition to the critical role nurses play in health promotion, primary and community care provision, and disease prevention, they are responsible for emergency care settings, which is crucial for universal health coverage achievement (Tamata et al., 2021). However, the nurse shortage challenge impacts the realization of health for all. With the problem comes the need to ensure well-trained, educated, well-supported, and regulated nurses and midwives. Nurses and midwives receive remuneration and recognition through commensuration with the provided care quality and services.
Nurse shortage has been associated with leaving jobs, in addition to burnout. WHO (2022) anticipated a deficit of more than 7 million health workers globally starting 2020s, with the demand rising to more than 12.5 million by 2035. The shortage of nurses has resulted in the creation of negative impacts on both the nursing profession and patient health-related outcomes. The inadequacy in nurses’ supply is linked to the difficulty of improving health and fighting illnesses, which are causes of increased workload and a decline in nursing care quality (Rosenberg, 2019). The overwhelming nurse shortage has been linked to the intention to leave bedside clinical care due to unsafe staffing ratios. The outcome has been a never-ending nurse shortage cycle with the professionals facing unsafe staffing ratios.
In the U.S., the difficulty of dealing with nurse shortage is complicated by an increased workload in a limited resource environment. Source (2022) shows that in a pre-Covid-19 scenario, intensive care unit (ICU) nurses experienced either a 1:1 or 2:1; however, in a post-Covid-19 design, nurses experienced either a 3:1 or 4:1 patient-to-nurse ratio. The increased imbalance in the patient-to-nurse ratio has been attributed to exacerbated unsafe nursing practices and staff burnout. An increase in patient census, especially in post-Covid-19, is the reason patients are not benefiting from the delivered healthcare services. Furthermore, handling more than four patients at a time exposes nurses’ licenses. Nurses report the increased patient-to-nurse ratio as the main reason they no longer provide adequate care; instead, they are just running around carrying out tasks (AHA, 2022). The other reasons some nurses are leaving their practice constitute staffing ratio inadequacy, insufficient backup, inability to receive hazard pay during the pandemic, poor gain compared to experience, and failure to have breaks.
However, despite the nurse shortage challenge, there is still hope for the profession. In the U.S., almost 70 percent of the practicing nurses still consider their work a great career, while another 64 percent still consider recruiting new nurses as a solution (Vuong, 2020). With the appropriate recruitment, the healthcare organizations can still salvage the profession to provide adequate healthcare and improve nurses working conditions. However, the starting point for this must be to address the systemic failures by healthcare institutions to invest in nurse protection measures from safety and health hazards.
Solutions
It is critical to induce change in the healthcare system to curb the increasing turnover. Studies indicate that most nurses quit their professions due to burnout problems. Introducing changes that lower exhaustion in such a scenario will save the situation. Properly analyzing different causes of the issues will make it easier to formulate a long-term solution to ensure the sustainability of practitioners for better and improved care services. Based on the resources and abilities of governments and healthcare organizations, achieving the goal of evoking change in the sector to curb the shortage is probable, provided the institutions commit to implementing solutions.
To overcome and reduce the nursing and physician challenges, several practices can be implemented by both the government and healthcare facilities. For instance, hospitals should formulate better ways to empower the practitioners by offering their services to patients. It will make them feel valued hence lowering the nursing turnover. Moreover, applying effective staffing ratios is essential in lowering the nurse-to-patient ratio leading to reduced workload necessary for low work-related pressure.
An integrated approach to improving working conditions, taking into account various factors that may affect the decision of employees to leave, will be more effective in solving the problem. One of the effective ways to cope with the nurse shortage is the retention of medical personnel. It is possible to achieve good results in nursing retention using a collaboration of professionals within teams that helps them to understand their expectations, to articulate problems and find possible solutions to them, and increase the number of nurses who continue working (Baik &Zierler, 2019). Using a structure-process-outcome (S-P-O) model, the researchers conducted an intervention to improve communication skills and enhance collaboration efficiency (Baik & Zierler, 2019). Their results demonstrated a significant increase in job satisfaction and a slight decrease in turnover, which can be used to reduce the shortage of medical personnel. Therefore, the connection between retention and job satisfaction does not receive sufficient attention in healthcare management, even though it can reduce staff turnover.
A combined approach to the policy-making, education, and economic sphere can solve the shortage of health workers. Drennan and Ross (2019) underline the significance of policy solutions and the allocation of resources in health care to address staff shortages. It is essential to support nurses financially by increasing their salaries and providing them with subsidies, including reduced costs for their children’s education. The combination of financial measures and improving the social status of nurses might contribute to the retention of nurses in the profession. Introducing policies on the state level that guarantee the protection of nurses at work and pursue their interests is also vital in coping with nurses’ shortages (Drennan & Ross, 2019). Thus, responding to the current lack of nurses should combine political, economic, and social factors.
Nurses’ burnout at work, which suggests severe fatigue, increased cynicism, and negative attitude, is an influential factor in staff turnover and shortages. A quantitative study by Kelly et al. (2021) includes a survey of nurses to identify the causes of burnout and its association with staff leaving the hospital. The results demonstrate that length of tenure, high daily workload, and patient death increase the likelihood of burnout, leading to staff turnover. Other factors in leaving the workplace included a higher degree of higher education and an employee’s intention to leave. Measures to reduce burnout, including promoting opportunities for work-life balance, minimizing the nurses’ workload, and providing recreation facilities for nurses, can become effective ways to reduce health care personnel shortage.
Working conditions, including organizational culture and atmosphere, significantly impact employees’ job satisfaction. Faramarzpour et al. (2021) conducted a survey using a questionnaire among 110 nurses to identify the correlation between the ethical climate at their workplace and the level of job satisfaction. The ethical environment affects decision-making, the relationships between employees of the organization, and their communication with patients and their families. Job satisfaction is associated with positive emotions that the employee experiences when assessing their working conditions. A survey by Faramarzpour et al. (2021) found a direct correlation between employees’ perceptions of the ethical climate and job satisfaction. Faramarzpour et al. (2021) revealed that the moral atmosphere is critical for all employees regardless of their demographic characteristics. Therefore, ethical working conditions are crucial to reducing the shortage of medical staff.
Culture is another factor influencing the problem of nursing shortages. Pressley et al. (2022) report that countries seek to solve needs and hire nurses from other nations. However, employers pay little attention to the new worker’s adaptation and support, which may affect the decision to stay or quit the job. The authors conducted a systematic literature review that examined the experience of migrant nurses from various countries of origin (Pressley et al., 2022). Since such employees leave their native culture and must adapt to a society that is entirely new for them, support and acceptance play an essential role (Pressley et al., 2022). Racism and discrimination are significant barriers to adaptation to a new place and can cause a decision to leave work. Therefore, the recruitment of nurses from other countries, their transformation, and the cultural factor of their retention are critical in coping with nurse shortages. Supporting migrant nurses in their adjustment requires measures and policies to be taken at various levels, such as government and health care institutions, to help these workers. Adopting a culture of diverse employees will make the workplace more ethical and help reduce the shortage of specialists.
The work of nurses is complex and carries significant health risks to employees, which also affects their shortage. Tei-Tominaga and Nakanishi (2018) surveyed nurses to investigate how honorable and favorable conditions can reduce the chances of injury and psychological stress. The researchers found that risks increase due to individual and job characteristics, workflow organization, and security programs (Tei-Tominaga & Nakanishi, 2018). Tei-Tominaga and Nakanishi (2018) determined that an ethical work environment can reduce risks and make conditions more favorable, contributing to lowering nurse shortages. At the same time, unfavorable working conditions and personnel turnover can also lead to a requirement for compensation from the employer (Tei-Tominaga & Nakanishi, 2018). The solution to this problem is establishing an ethical workplace environment because the workplace atmosphere is essential in health care settings for employee retention. Moral support can therefore be a critical factor in reducing the shortage of medical staff.
Nurses provide the necessary help in patient care and play an essential role in supporting public health. Therefore, their shortage is critical and creates health care problems. As the literature shows, there are many reasons for the lack of staff. In particular, work difficulties make a substantial load and lead to overwork and burnout. These manifestations have worsened due to the current coronavirus crisis. To solve the problem, an integrated approach and changes in the working conditions, education of employees, and policies regarding health care are needed. Measures to reduce staff shortages should aim at retention, improving job satisfaction, preventing burnout, and other aspects. However, there are still areas of controversy and gaps in the discussion of the problem requiring more research.
The findings of the paper have shown that due to nurse shortage, nurses experience burnout and are struggling with the patient-to-nurse ratio, which impacts their intention to leave. The challenge has been made worse with the pandemic demanding healthcare institutions invest in nurse protection. For this reason, there is a vital need to improve the working conditions of nurses, increase their satisfaction with their job, and attract new employees to healthcare. The research demonstrates that ethics and culture are essential in addressing nursing shortages. The ethical climate in the medical institution reduces risks to employees’ physical and mental health and contributes to increased job satisfaction.
Consequently, improved working conditions lessen staff turnover and help to reduce the shortage of nurses. The cultural aspect, in turn, is becoming increasingly important as employers attract nurses from other countries. Such employees need support in adapting to new cultural conditions. However, they face discrimination, which becomes a significant barrier to retention. Respect for other cultures and ethics are critical parts of a supportive work environment, reducing the nursing shortage.
Nursing research indicates that ethics and culture are vital to dealing with increasing nursing shortages. The ethical climate in the medical institution reduces risks to employees’ physical and mental health and contributes to increased job satisfaction. The cultural aspect is becoming increasingly important as employers attract nurses from other countries. Such employees need support in adapting to new cultural conditions. However, they face discrimination, which becomes a significant barrier to retention. Money, politics, and power determine a medical institution’s capacity to attract and retain nursing staff. It is essential to consider the aging population affects nurses’ population significantly as they would have more retirees to deal with and a minor team. Expatriation and respect for other people’s cultures are essential to deal with the impending nursing shortage crisis.
Conclusion
The situation in public health aggravates for numerous reasons, and the shortage of professional nurses is one of these issues. There is a global need for nurses because the number of people who need professional medical help increases, the population is aging, and this tendency will preserve during the following decades. In addition, nursing has become a technologically complex work due to the progress in public healthcare, and specialists need the education to cope with the tasks required by this specialization. At the same time, there is a significant shortage of nurses due to comparatively small payment for this work, excessive workload, and low prestige of the profession in society. In other words, the professional nurse needs to study almost as much as the physician, but receives a lower salary, has more work, suffers from stress, and does not receive public recognition for their actions. It allows us to assume that nurses are not economically, socially, and culturally protected, which leads to their shortage.
In recent years after the beginning of the pandemic of COVID-19, the nurses experienced many hardships due to the increasing number of patients, risks connected with contamination, constant stress, and fatigue. These factors lead to the burnout of many nurses and influence their decision to change their specialization. There is no need to say that the public healthcare sphere has suffered from this situation significantly, and society needs to cope with the nurse shortage.
The investigation shows that the approach to finding solutions to the problem of nurses shortage should be complex. Providing nurses with social support, financial benefits, educational opportunities, and decent work conditions is critical. There is also a vital need to give the nurses psychological support at the workplace to ensure that the working environment is favorable.
Even though completing these goals might seem complicated and time-consuming, it is essential to start implementing these changes gradually. For instance, it is possible to start by implementing the changes on the level of the particular hospital, making the environment more supportive and enhancing team-building strategies. Precise attention to the work of the nurses who recently immigrated from other countries and have to adjust to the local reality is among the aims the hospital should pursue. Moreover, the nurses should work according to a balanced schedule that does not allow them to overwork for a long time because it leads to constant stress, fatigue, and burnout. These factors are among the most widespread causes of the desire of professional nurses to quit their work or change their specialization. In other words, it is critical for managers in the hospital to remember that nurses are humans, not robots, which means that they should have the opportunity for rest and recreation.
It is also crucial to implement positive changes in the legislative system and nurses’ economic support to make work conditions more attractive for people. Among these measures are the nurse’s legal protection and the healthcare specialist’s ability to seek help in case of violation of their rights. In many cases, the nurses are vulnerable at the workplace because of the aggression from patients or their relatives, which aggravates their burnout and makes them quit their work. Additional payments for the services the nurses provide to patients should be paid on a decent level to popularize the profession and attract more people. It allows us to conclude that the measures to increase the popularity of the nursing profession that will help to cope with the shortage of specialists should be complex.
References
American Hospital Association. (2022). AHA letter re: Challenges facing America’s health perceptions on the factors affecting nursing shortage in the Republic of Vanuatu hospitals: A qualitative study. Plus One, 16, 5.
Baik, D., & Zierler, B. (2019). RN job satisfaction and retention after an interprofessional team intervention. Western Journal of Nursing Research, 41(4), 615–630.
Care Workforce as the U.S. Enters the Third Year of COVID-19 Pandemic | AHA. American Hospital Association.
Drennan, V. M., & Ross, F. (2019). Global nurse shortages: The facts, the impact and action for change. British Medical Bulletin, 130(1), 25-37.
Faramarzpour, M., Farokhzadian, J., Tirgari, B., Shahrbabaki, P. M., Borhani, F., & Rafati, F. (2021). Nurses’ perceptions of hospital ethical climate and their job satisfaction. Ethics, Medicine and Public Health, 18, 1-8.
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing Shortage. StatPearls Publishing LLC.
Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96–102.
MacDonald, I. (2017). The financial impact of the nationwide nursing shortage: Hospitals pay billions to recruit and retain nurses. Fierce Healthcare.
Pressley, C., Newton, D., Garside, J., Simkhada, P., & Simkhada, B. (2022). Global migration and factors that support acculturation and retention of international nurses: A systematic review. International Journal of Nursing Studies Advances, 4, 1-16.
Rosenberg, K. (2019). RN Shortages Negatively Impact Patient Safety. The American Journal of Nursing, 119, 3, 51.
Shamsi, A., & Peyravi, H. (2020). Nursing shortage, a different challenge in Iran: A systematic review. Medical journal of the Islamic Republic of Iran, 34, 8. Web.
Spurlock Jr, D. (2020). The nursing shortage and the future of nursing education are in our hands. Journal of Nursing Education, 59(6), 303-304.
Tamata, A. T., Mohammadnezhad, M., Tamani, L., & Rajiah, K. (2021). Registered nurses.
Tei-Tominaga, M., & Nakanishi, M. (2018). The influence of supportive and ethical work environments on work-related accidents, injuries, and severe psychological distress among hospital nurses. International Journal of Environmental Research and Public Health, 15(2), 1-13.
Vuong, L. (2020). Staffing Ratios and Burnout. The American Journal of Nursing, 120, 5, 13.
World Health Organization. (2022). Nursing and midwifery.