Nursing Shortage: Literature Review

The nursing shortage is a highly important issue and a critical challenge for national health care because it is one of the main causes of poor quality of medical services. The ratio of nurses to patients continues to decline, and there has been a plethora of authors addressing this issue in a variety of medical fields. Researchers generally agree that the shortage is caused by an aging workforce and population, as well as a limited number of new nurses. The present review identifies and compares articles on nursing shortage and the question if adjusting nurse-patient ratios can improve patient outcomes in a set period of time.

Researchers set different goals to find solutions to the problem of nursing shortage or to mitigate its effects. Jarrar et al. explore the impact of patient-centeredness as a factor in the intervening process on “the relationship of nursing shortage on the quality of care and patient safety” (2018, p. 465). They conclude that optimal staffing levels will allow for a higher quality of care, and provide guidelines on how to maintain it with patient-centeredness as a facilitating factor. Nantsupawat et al. (2016) examine the relationship between work conditions, job dissatisfaction and burnout among nurses. Using a cross-sectional survey, they measure the degree of nurses’ job dissatisfaction and find out that those who work in hospitals with better environments are less likely to leave their jobs.

Weaver et al. (2018) investigate how pediatric home nursing shortage is reflected in the families with children that have complex medical conditions and receive palliative care. Their study reveals that such families “do not receive their allocated number of nursing hours”, showing a “40-hour average gap in-home nursing care coverage for children receiving palliative care per week per family” (Weaver et al., 2018, p.263). Zhang et al. (2017) focus on projecting and estimating future growth in nursing shortages, as well as comparing current data on the number of medical professionals to the results of their previous publication.

They break down registered nurse (RN) shortages into national, regional, and state levels (Zhang et al., 2017, p. 232). Using this model, they attempt to forecast the rates at which the shortage will grow in the period between 2015 and 2030 at all these levels. According to Zhang et al., 37 of 50 states in the USA will have “severe nursing shortages by 2030”, with the most significant ratios in New Mexico, Arizona, and California (2017, p. 234).

Sample population and methods differ insignificantly, with most researchers using cross-sectional studies to gather data. Jarrar et al. carried out a study, collecting information from 652 nurses working in 12 private hospitals (2018, p. 466). The sample population of the study by Weaver et al. included children and adolescents of a mean age of 7.44 years: “(range, 4 months to 19 years)” (2018, p. 263). The families of those children were offered to complete a survey, answering questions on home nursing services they received, their needs and the availability of home health nursing.

The study by Nantsupawat et al. used data collected from 1351 nurses with at least 2 years of experience in 43 inpatient units, randomly selected from all the hospitals in the country (2016, p. 93). In the study by Zhang et al., “RN population estimates were collected” in 7 age groups over the period from 2006 to 2015. These estimates were then used to create a metric of the RN shortage ratio, “defined as the difference between RN demand and RN supply per 100 000 people in each region” (Zhang et al. 2017, p. 232).

There are several limitations present in all four works discussed. Since the study by Nantsupawat et al. relied on self-report for measurements, participants may have inaccurately reported their working conditions and outcomes (2016, p. 95). Limitations to the study by Weaver et al. included a “small sample size and 1-site location at a freestanding children’s hospital in the Midwest (2018, p. 264).

Although the nursing shortage seems consistent across the United States, it can still have different outcomes in different parts of the country. The main limitation to the study by Jarrar et al. is the fact that it was “a cross-sectional, longitudinal survey” carried out in private hospitals only (2018, p. 471). The variables examined were limited as well, and the nurses were limited to assess “patient-centeredness and the outcomes of care” (Jarrar et al., 2018, p. 272). The main limitations to the study by Zhang et al. are assumptions made in their demand and supply models. One example is using “2015 national mean as the starting point” in their demand model, which states that “there was no shortage in 2015” (2017, p. 232).

Although the reduction in the shortage in the next 10 years was projected by Zhang et al., most researchers express growing concerns about the demands in health care (2017, p. 233). Claiming that these demands may not be met due to an insufficient number of registered nurses, they offer models and strategies that will allow channeling resources towards education and adequate maintenance of nurse-patient ratios. Further research may focus on investigating ways to retain nurses in the workforce, creating better work environments, as well as on ways to adjust nurse-patient ratios to meet the demands and minimize the shortage.


Jarrar, M., Rahman, H. A., Minai, M. S., AbuMadini, M. S., & Larbi, M. (2018). The function of patient‐centered care is mitigating the effect of nursing shortage on the outcomes of care. The International Journal of Health Planning and Management, 33(2), 464-473. Web.

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91-98. Web.

Weaver, M. S., Wichman, B., Bace, S., Schroeder, D., Vail, C., Wichman, C., & Macfadyen, A. (2018). Measuring the impact of the home health nursing shortage on family caregivers of children receiving palliative care. Journal of Hospice & Palliative Nursing, 20(3), 260-265. Web.

Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (2017). United States registered nurse workforce report card and shortage forecast: A revisit. American Journal of Medical Quality, 33(3), 229-236. Web.