RUNNING HEAD: Nursing Shortage

Nursing Shortage

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Abstract

Nursing shortage refers to that situation wherein the demand for nurses exceeds the supply thereof. Usually, nursing shortage has been experience in various countries such as the United States, the United Kingdom and Australia. Nursing shortage occurs in the aforementioned countries in view of the following factors: (1) the ageing population, (2) the refusal of the people to enroll in schools that enter into nursing and (3) the increase in the turnover of nursing professionals. Apparently, these factors are even caused by other circumstances. Usually, people no longer enter the profession because of the negative perceptions of the society with respect thereto, the relatively low wages and the relatively stressful demands of being a registered nurse. The nursing shortage, however, resulted to a number of consequences to the delivery of health care services. Researchers suggest that such shortage compromises the quality of health care due to the increase in the margin of error. In this sense, studies have highlighted the need come up with various ways by which they could address the problem.

Nevertheless, most of the common strategies have failed to eliminate such shortage. Without a doubt this current situation may exacerbate in the following years should there be a failure to address the problem once and for all. 

This study aims to extensively analyze the issue of nursing shortage, focusing on the extent of such problem. More specifically, the current research also aims to look into the following: (1) the factors that affect the nursing shortage, (2) the common solutions proposed to eliminate this, (3) the failure of these solutions to address the problem of nursing shortage, and finally (4) the steps that must be undertaken to finally eliminate the problem.    

To achieve the goals of the study, the study conducted an extensive review of literatures published with respect to the matter at hand. The results of the study revealed a concurrence with the findings of previous researches with respect to the matter at hand. 

Introduction

          Nursing shortage commonly refers to the situation wherein the demand for employing nursing professionals exceeds the supply of the latter whether in a local, national and global levels (American Organization for Nurse Executives, 2000; Andrist,

Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Murray, 2002). More often than not, the nursing shortage is measured through the use of different approaches. One instance is the use of the nurse-to-patient ration, and the other is the nurse-to-population ratio (Buchan & Aiken, 2008; Bureau of Health Professions, 2004; Cherry, Cherry & Jacob, 2008). There are, however, also tendencies when nursing shortage is determined depending on the job openings available within the health care industry (American Organization for Nurse Executives,

2000; Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005; Oulton, 2006; Park, Murray & Delaney, 2006). 

          Various factors have been linked with respect to nursing shortage. Of course, as previously mentioned, one of the most common reasons behind the shortage is that the supply of nursing professionals (such as Registered Nurses) is not sufficient to meet the current demands. Other studies, on the other hand, revealed that the shortage of nurses is highly attributed to the turnover of such professionals (Andrist, Nicholas & Wolf, 2006; Cherry, Cherry & Jacob, 2008; Feldman, 2003; Kingma, 2002; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005; Park, Murray & Delaney, 2006). Statistics show that about 1 in 5 nurses have the tendency to quit their jobs within the first year (Bureau of Health Professions, 2004). Interestingly, it was likewise mentioned that the said turnover rates have been caused by the failure of health care institutions to devise various steps and initiatives by which they could ensure the retention of the nursing professionals (Andrist, Nicholas & Wolf, 2006; Lasaki, Cook & O’Brien, 2009). Due to their failure, the nurses do not feel that they have safety nests within their organizations (American Organization for Nurse Executives, 2000; Ellis & Hartley, 2004; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005). 

          Aside from the failure of health care institutions to provide training grounds for new nurses which in turn result in the latter’s decision to leave their current employment, nursing shortage is also attributed to the fact that the baby boomers are getting older (American Organization for Nurse Executives, 2000). Hence, a higher demand for nursing is inevitable (Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004; Feldman, 2003; Finkelman & Kenner, 2010;  Laschinger & Finegan, 2005). There are also nurses who do not perceive their careers positively which likewise contribute to the shortage of nursing professionals. According to sociologists, nurses would often complain about the status of their employment (Cherry, Cherry & Jacob, 2008; Park, Murray & Delaney, 2006). There are some who complain about their subordination to the members of the medical profession. In addition, nursing professionals also complain about the regulation that they must comply with before becoming registered nurses (Feldman, 2003; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005). 

          Other researchers however, also consider the following as the most common causes behind the nursing shortage (Buchan & Aiken, 2008; Carayon & Gurses, 2009;

Duvall & Andrews, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; McNesse-Smith, 2001; Murray, 2002): first, the inability of nursing schools to provide their graduates with the skills they need for their practice, the poor working conditions that are evident in the field of nursing, and of course, the aging nursing workforce (Lasaki, Cook & O’Brien, 2009; Feldman, 2003). 

          The employment of nurses from the developing countries such as the Philippines was one of the most common solutions to nursing shortage in the developed nations (Finkelman & Kenner, 2010; Laschinger & Finegan, 2005). Nevertheless, such solution cause nursing shortage in the countries of the third world (American Organization for Nurse Executives, 2000). Parenthetically, their employment in American and other developed countries’ hospitals would result in the shortage of nursing professionals in their own countries (Ellis & Hartley, 2004; Feldman, 2003; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005). 

          The problem with respect to nursing shortage must be immediately addressed, various researchers recommend (Ellis & Hartley, 2004; Finkelman & Kenner, 2010; Goodin, 2003; Murray, 2002). According to the different studies conducted in relation to the subject matter at hand, nursing shortages usually result in the following negative consequences: first, the tendency to result in increased workloads for the patients (Finkelman & Kenner, 2010; Goodin, 2003; Murray, 2002); second, increased risk for error which in turn  negatively affects the safety of the patients (Duvall & Andrews, 2010; Murray, 2002); third, the increased risk in terms of spreading infection to the patients and to the members of the staff (Laschinger & Finegan,2005); fourth, increased risk for occupational injury (Ellis & Hartley, 2004; Feldman, 2003; Lasaki, Cook & O’Brien, 2009); fifth, higher rates of turnover for the nursing profession which the results in the acquisition of greater costs for the employer and the entire health care system

(Lasaki, Cook & O’Brien, 2009; Murray, 2002); and lastly, its tendency to contribute to the acquisition of negative perception related to the working conditions of nurses which also further contributes to the shortage (Cherry, Cherry & Jacob, 2008; Feldman, 2003; Lasaki, Cook & O’Brien, 2009; Park, Murray & Delaney, 2006).  

The Problem

          Undeniably, nursing shortage poses negative effects to the health care industry. As previously mentioned, the shortage in the number of nursing professionals affects the manner by which services are rendered in the health care industry (Andrist, Nicholas & Wolf, 2006; Feldman, 2003). In fact, researchers mentioned that the safety of the patients is compromised in view of the nursing shortage (American Organization for Nurse Executives, 2000). Parenthetically, nursing shortage negatively affects the workload of the professionals within healthcare institutions (Carayon & Gurses, 2009;

Duvall & Andrews, 2010; Ellis & Hartley, 2004; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Consequently, the increase in such workload would contribute to burnout which in turn could compromise the delivery of the services to the patients (Lasaki, Cook & O’Brien, 2009). In this regard, it is of paramount importance by which the members of the health care industry could address the aforementioned problem

(Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004; Feldman, 2003; Laschinger & Finegan, 2005). 

          This research attempts to explore the issue of nursing shortage, including the various factors that contribute to the said problem. In addition thereto, this study also attempts to provide various ways by which the problem in relation to the nursing shortage may be addressed. 

Literature Review

          The exploration of the topic at hand entails the effective analysis of literature published with respect to nursing shortage, focusing on the extent of nursing shortage, the factors that affect the current problem, the current methods undertaken in order to solve the problem, the current flaws in the said system, the further steps that must be undertaken in order to solve the issue at hand, and finally, the recommendations to once and for all address the issue relating to nursing shortage.

The Nursing Shortage Problem: A Statistical Overview

          The problem with respect to the shortage of nursing professionals is not merely confined with a particular territory (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Park, Murray & Delaney, 2006). Instead, the nursing shortage problem is felt throughout the entire world. Nevertheless, it has been mentioned that nursing shortage originated amongst the countries in the first world

(Cherry, Cherry & Jacob, 2008; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005). The nursing shortage problem had a great effect on the United States of America. According to one agency in the country, the National Council of State Boards of Nursing, the portion of the population which enrolls in nursing courses has been relatively increasing. In fact, the percentage in the enrolment in such schools has also resulted to the increase in the number of nursing professionals in the country (Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004). Unfortunately, however, such increase has failed to keep with the overall population growth in the United States of America. In this sense, various researches show that nursing shortage has been largely attributed to the inability of the current nursing supply to meet the present demands of the patients (Buchan & Aiken, 2008; Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008). The aforementioned statistics with respect to shortage is expected to increase over time, thereby widening the gap between the supply and demand for nursing professionals (Buchan & Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Ellis & Hartley, 2004; Laschinger & Finegan, 2005). 

          Data released by the government of the United States of America reveal that nursing shortage in the country continues to increase every five years (American

Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Cherry, Cherry & Jacob, 2008). For instance, in 2000, nursing shortage was merely 6% (Bureau of Health Professions, 2004). In 2005, however, such figure increased by 4%, revealing the nursing shortage rate at 10%. Subsequently, in 2010, nursing shortage rates further increased to 17% (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Park, Murray & Delaney, 2006). Hence, the government projects that nursing shortage would eventually climb to 27% in 2015; and in 2020, would reach 36% (Bureau of Health Professions, 2004; Laschinger & Finegan, 2005). 

          Other researchers, on the other hand, point out the fact that the percentage of nursing shortage varies from one state to another. In fact, certain states do not immediately experience shortage (American Organization for Nurse Executives, 2000). At times, the graduation rates of such states even reveal a surplus of nursing professionals (Buchan & Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005; Murray, 2002).

          The nursing shortage in the United States of America is likewise experienced in the United Kingdom of Great Britain. In this regard, the number of nurses in the United

States of America has remarkably decreased that in the 1990s (Laschinger & Finegan,

2005; McNesse-Smith, 2001; Murray, 2002). Similarly, as in the case of the United States, the population that demands health care continues to increase remarkably. As such, it is evident that the supply of nursing professionals in the country continues to be significantly disproportionate to those that demand health care services (Buchan &

Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Goodin, 2003; Laschinger & Finegan, 2005; McNesse-Smith, 2001; Murray, 2002).

          Aside from the United States of America and the United Kingdom, developing countries in Asia and Africa, such as the Philippines have also experienced nursing shortages (Laschinger & Finegan, 2005; McNesse-Smith, 2001; Murray, 2002; Park, Murray & Delaney, 2006). Nursing professionals in the third world countries have decided to migrate to the first world in the hopes of seeking better employment, taking advantage of the nursing shortage therein (Carayon & Gurses, 2009; Duvall & Andrews, 2010; McNesse-Smith, 2001). However, in view of the number of nursing professionals that migrate to other countries, developing nations have then experienced a deficit with respect to the nurse to patient ratio (Andrist, Nicholas & Wolf, 2006; Lasaki, Cook & O’Brien, 2009).

Because of the various consequences associated with the problem of nursing shortage, a number of steps have been undertaken to somehow reduce the problem

(American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006;

Park, Murray & Delaney, 2006). Apparently, one of the most common solutions presented is resorting to immigration to employ more nursing professionals (Andrist, Nicholas & Wolf, 2006; Bureau of Health Professionals, 2004). Of all the members of the developed world, the United States of America, the United Kingdom of Great Britain and Australia received the most number of nurses from other countries (Buchan & Aiken, 2008; Ellis & Hartley, 2004; Laschinger & Finegan, 2005). Aside from these three, the Kingdom of Saudi Arabia also received a large share as regards immigrant nurses to address the issue relating to nursing shortage (American Organization for

Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Ellis & Hartley, 2004; McNesse-Smith, 2001; Murray, 2002). 

          Sending their nurses to developed countries has consequently contributed to nursing shortage within their respective countries (American Organization for Nurse

Executives, 2000; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Lasaki, Cook & O’Brien, 2009). As expected, sending nursing professionals into developed countries creates shortage in their own countries (American Organization for Nurse Executives, 2000). In this sense, it is evident that nursing shortage is a problem experienced not only by the developed countries but also of the developing countries. Hence, nursing shortage is a global problem (Bureau of Health Professions, 2004; Lasaki, Cook & O’Brien, 2009). 

Negative Effects of Nursing Shortages

          Nursing shortage affect the entire world, regardless of whether they belong to the first and third world (American Organization for Nurse Executives, 2000). In fact, the existence of nursing shortages has negatively affected health care practices in the United States, the United Kingdom and the other third world countries (American Organization for Nurse Executives, 2000). It is because of this that a number of studies have already conducted in order to determine the most common negative effects of nursing shortages (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Park, Murray & Delaney, 2006). As previously mentioned, nursing shortages have negatively affected the manner by which health care institutions deliver their services to the general public (American Organization for Nurse Executives,

2000 Carayon & Gurses, 2009; Duvall & Andrews, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005; Murray, 2002). The failure of clinics and hospitals to meet the current demands for nurses prevents them from rendering effective services to their client. Nursing shortage increases the workload of those who are currently employed. In this regard, those nursing professionals currently employed in various health care professionals have suffered from burn out and other stressful conditions related to their duties (Buchan & Aiken, 2008; Carayon & Gurses, 2009;

Duvall & Andrews, 2010; Laschinger & Finegan, 2005; McNesse-Smith, 2001; Murray, 2002). Verily, such situation further contributes to nursing shortage as most of the nursing professionals as most of them tend to leave their present jobs. In connection with these, various studies have been conducted in the hopes of further analyzing the negative effects of nursing shortages (American Organization for Nurse Executives, 2000; Buchan & Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Goodin, 2003; Finkelman & Kenner, 2010; Laschinger & Finegan, 2005; McNesse-

Smith, 2001; Murray, 2002). 

          Carayon and Gurses (2009) looked into how nursing shortage affected the workload of the nursing professionals and the effects thereof on the safety of the patients. According to the study conducted, the problem related to nursing shortage has contributed to the existence of another major problem in the health care industry, that is, the heavy workload of professional nurses in health care institutions (Carayon & Gurses, 2009). According to the study conducted by these two authors, nursing professionals are now experiencing heavier workload because of the following factors: (1) the increasing demand for nurses, (2) the shortage as to the supply for nurses, (3) reduced staff members, and lastly, (4) the reduction in the number of the patients’ length of stay (Carayon & Gurses, 2009). It is because of this, however, that a number of scholars have likewise deemed it important to address the issue related to nursing workload as the same also affects the delivery of services into health care institutions. 

          Carayon and Gurses (2009) mentioned that the increase in nursing workload negatively affects the safety of the patients under the care of health care institution. Undeniably, the increase in the nursing workload threatens patient safety because of the fact that it contributes to burnout and other job related stress (Carayon & Gurses, 2009). Parenthetically, the stress experienced by nursing professionals within their health care institutions would prevent them from performing their jobs in an effective manner (Carayon & Gurses, 2009). In addition thereto, Carayon and Gurses (2009) also supported the proposition that the increase in the workload of the nursing professionals could further contribute to the shortage in the supply of the former (Carayon & Gurses, 2009). Indeed, increase in nursing workload contributes to a reduced satisfaction to the job. In fact, nurses who experience stress and burnout within their institutions are more likely to look for other opportunities (Carayon & Gurses, 2009). Therefore, the high nursing workload if not addressed would only merely contribute to the problem of nursing shortage.

          The results presented in the study of Carayon and Gurses (2009) merely echoed what has been contained in the research of Buchan and Aiken (2008). This study mentions that nursing shortages indeed pose a lot of problem to the society in general, more specifically to the members of the health care industry (Buchan & Aiken, 2008). According to Buchan and Aiken, 2008), it is important to address the issue related to nursing shortage because it negatively affects the manner by which institutions of health deliver their services. Without a doubt, nursing shortage fail to take patient safety into consideration. In the same manner, because there are more patients to attend to, the quality of the services given suffers because of the shortage with regard to the number of nursing professionals (Buchan & Aiken, 2008).

          Ellis (2008) also focused on the effects of nursing shortage on the manner by which health care institutions affect the health care services in various countries. According to Ellis (2008) the serious problem with respect to nursing shortage has negatively affected the manner by which the health care institutions deliver services to the patients. For instance, the nursing shortage affected the work environment (Ellis, 2008). Because of the absence of sufficient nursing professionals to attend to the needs of the patients, work patterns have changed overtime. Hence, they suffer from lengthened shifts and more overtimes (Elliis, 2008). It is because of that nurses experience fatigue which in turn affects their performance (Ellis, 2008). Also, the fatigue experienced by the nursing professionals prevents them from performing their jobs effectively. Consequently, the margin for error becomes greater thereby negatively affecting the quality of health care (Ellis, 2008). 

          It is therefore because of this that the nursing shortage must be addressed in order to prevent the deterioration in the quality of the nursing profession. Hence, addressing nursing shortage would allow health care professionals in rendering effective health care services (Ellis, 2008).

          Bradley and Pennbridge (2003) also concurred with what has been previously mentioned. Previous studies mentioned that nursing shortages increase the workload of nursing professionals. Because of this, the stress and burn out that they experience prevent them from rendering their jobs effectively (Bradley & Pennbridge, 2003). These stressful conditions then prevent them from minimizing risks and errors in the manner by which they perform their duties. In this sense, Bradley and Pennrbidge (2003) mention the importance of also addressing the nursing shortage in order to prevent the deterioration in the quality of health care. 

          Undeniably, the problem of nursing shortage is not a problem by itself. The nursing shortage issue affects the entire society, more significantly, the health care industry. Interestingly, previous studies have determined how nursing shortage negatively affects the manner by which health care services are delivered (Bradley & Pennbridge, 2003). Undeniably, nursing shortages increase the workload of the nursing professionals. In this regard, they suffer from constant stress and burnout thereby negatively affecting the manner by which they perform their jobs. Essentially, this also increases their chances of committing error in the performance of their jobs (Ellis, 2008).

Factors that Contribute to Nursing Shortage

          As mentioned, the extent of the problem regarding nursing shortage has caused a number of researches to be conducted in order to determine the various factors that contribute to such problem. McNessse-Smith (2001) was one of the authors who looked into the existence of the different factors that contribute to the nursing shortage. According to such researcher, it is of paramount importance for health care professionals to consider finding solutions to the nursing shortage problems as the latter continue to threaten various health care organizations (McNesse-Smith, 2001). However, in determining the right solutions to this problem, it is important to understand the root causes thereof (McNesse-Smith, 2001). The author then seeks to look into the perceptions of thirty staff nurses regarding the factors that contribute to the development of their commitment or to what causes the absence thereof. 

McNesse-Smith (2001), enumerates the following as the most common factors behind the commitment of the nurses to their organizations: (1) personal factors, (2) the existence of various opportunities to help them learn, (3) satisfaction with their jobs, (4) the existence of plans for their retirement, (5) the presence of various monetary benefits, (6) care given to patients, (7) nature and characteristics of their colleagues, (8) other cultural factors, and (9) security with respect to their current jobs. On the other hand, however, the opposite of these factors have resulted to the lack of commitment on the part of the nursing professionals (McNesse-Smith, 2001). Apparently, the failure of the health care organizations to retain nursing professionals has been largely attributed to the failure thereof to comply with their personal needs (McNesse-Smith, 2001). The failure to achieve a certain degree of satisfaction with respect to their jobs as a result of inadequate benefits, lack of learning, ineffective patient care situations and poor relations with coworkers significantly affect the lack of commitment on their part (McNesse-Smith, 2001).

The existence of various factors that contribute to the problem of nursing shortage was likewise underscored in the study conducted by Murray (2002). In the said study, Murray (2002) recognized the gravity of the nursing shortage problem. According to her, the failure to come up with viable solutions would result in the continuance of the problem, even until 2020 (Murray, 2002). Indeed, the creation of viable solutions to the nursing shortage must take various factors into consideration, including the factors that contribute to the problem (Murray, 2002). Thus, the author enumerates the following as the most common reasons behind the shortage of nursing professionals: (1) the increase in the age of those currently employed as nursing professionals, (2) decrease in enrollment in nursing schools, (3) the existence of various work opportunities for women, (4) changes in relation to the healthcare delivery system, (5) burn out experienced by nurses at work, and lastly, (6) the tendency of the public to misunderstand what the nurses do (Murray, 2002).

 Nevertheless, there are also other factors in the social and economic aspects that also contribute to the problem of nursing shortage, Murray (2002) pointed out. According to her, one of the most common problems is the aging population. Hence, more and more people are in need of nurses to take care of them (Murray, 2002). On the other hand, increased technology also renders nursing services obsolete. Aside from this, the increase in the movement related to health and wellness also affects the problem related to the employment of nursing professionals in institutions of health care (Murray, 2002). In addition to the aforementioned, Murray (2002) also discovered that the preference of people for high paid jobs also prevent them from entering the nursing profession (Murray, 2002).

Murray (2002) believes that the problem related to nursing shortage could continue on until 2020. Hence, it is of paramount importance for the members of such profession to take an active part with respect to the formation of a strategic plan in order to eliminate such problem. Nevertheless, such strategic plan must also focus on the elimination of the previously mentioned factors that contribute to the current problem at hand (Murray, 2002).

Duvall and Andrews (2010), in their study entitled “Using a structured review of the literature to identify key factors associated with the current nursing shortage,” also offered an extensive discussion of the various factors that contribute to the formation of the problem. According to these two authors, one of the salient reasons behind the shortage of nursing professionals is the fact that nurses nowadays are aging and are at the brink of retirement (Duvall & Andrews, 2010). Consequently, the people graduating from nursing are deemed insufficient to meet the current demands in the profession (Duvall & Andrews, 2010). Duvall and Andrews (2010) also highlighted the importance of analyzing the different factors that contribute to nursing shortage. Similar to previous researchers, these two also maintained the importance of taking these factors into consideration in devising solutions aimed towards the elimination of the problems related to nursing shortage (Duvall & Andrews, 2010). Duvall and Andrews (2010) discovered that one of the main reasons behind the shortage of nursing professionals is the failure of the health care institutions to ensure the retention of their employees. Undeniably, a wide range of factors exist as to why these institutions fail to retain their nurses. One of the most common reasons behind the high turnover rate is attributed to the management issues present in the hospital institutions. Aside from this, nurses tend to suffer from their jobs because of its design, the stress they encounter in relation thereto and the physical demands (Duvall & Andrews, 2010). Also, it was discovered that the failure of the hospitals to care for the career of their new nurses also contribute to the increase in the number of professionals who leave that particular field (Duvall & Andrews, 2010). 

The study conducted by Goodin (2003) focused on the issue of nursing shortage in the United States of America. The study primarily aims to review current literature in order to understand the different reasons behind the nursing shortage in the United States. Just like the other studies previously reviewed, Goodin’s study (2003) acknowledged the importance of understanding these factors in crafting solutions to the problem so that the latter may be effectively addressed. Undoubtedly, nursing shortage occurs due to the cyclical nature for the demand for nursing professionals (Goodin, 2003). In fact, shortages and surpluses of registered nurses have been evident throughout the entire history of the United States. Nevertheless, Goodwin (2003) discovered that the problem relative to nursing shortage has exacerbated in recent times. Such exacerbation, according to the author has been brought about by the existence of factors that undeniably offers a new perspective to the otherwise age old problem (Goodin, 2003). Thus, in finding solutions to the problem, it is important to consider these new factors as the solutions previously used may no longer applicable nowadays (Goodin, 2003).

To achieve the goals of the study, the researcher conducted an integrative literature review of published studies and articles related to nursing shortage in the United States of America (Goodin, 2003). The literature review revealed four areas that are considered as the factors that contribute to the issue of nursing shortage in the United States of America: (1) the ageing workforce of registered nurses, (2) the significant decrease in the number of enrollees in the different nursing schools, (3) the work climate, and lastly, (4) the negative image associated to nursing (Goodin, 2003). Indeed, the four factors have long contributed to nursing shortage in the country. It is thus important that these factors be addressed in order to eliminate the different problems associated with the shortage of nursing professionals (Goodin, 2003). More specifically, Goodin (2003) also recommends the promulgation of appropriate legislation to correct the current problem regarding the shortage of nursing professionals. 

Smith (2010) also explored the issue of nursing shortage in the United States of America. The problem with respect to nursing shortage in the United States has indeed affected the entire society as the numbers of professionals who can attend to patients have remarkably dropped (Smith, 2010). Nevertheless, nursing shortage is not only evident with regard to the patient to nurse ration. Instead, it is also determined from the skills that the nurses possess (Smith, 2010) According to Smith (2010), research shows that nursing shortage becomes evident in the sense that some nursing professionals do not possess the standards needed in practice. In the study, Smith (2010) aimed to look into the various factors that contribute to the nursing shortage problem.

          To achieve the said objective, the researcher conducted various interviews amongst clinicians and practitioners within the nursing profession (Smith, 2010). The said interviews were supported by the extensive review of literature with respect to the matter at hand (Smith, 2010). Generally, the following factors were pointed to as the main reasons behind the shortage of nursing professionals: (1) the aging workforce, (2) the absence of educational capacity and faculty, and lastly, (3) the negative images associated to the practice of nursing (Smith, 2010). In this regard, Smith (2010) deems it of paramount importance to address these previously mentioned problems in order to reduce the shortage of nursing professionals.

          Without a doubt, the studies reviewed mentioned various factors in relation to the existence of a shortage in the nursing profession. While the studies revealed various factors that affect nursing shortage, four common themes are evident with respect thereto; these are the following: (1) the aging workforce, (2) the lack of training and education of nursing professionals, (3) the increase in the number of the segment of the population who demands health care, and finally, (4) the negative perception developed in relation to the nursing profession (Duvall & Andrews, 2003; Finkelman & Kenner, 2010; Goodin, 2003; McNesse-Smith, 2001; Murray, 2002; Smith, 2010). 

The abovementioned studies focused on the different factors that contribute to the problem related to the shortage of nursing professionals, as gleaned from experiences in the different parts of the world, but primarily focusing on the developed countries (Park, Murray & Delaney, 2006). Undeniably, the factors that contribute to the problem of nursing shortage in the third world countries are significantly different from the aforementioned. As such, there are also various studies which have been conducted in the hopes of determining the factors behind the nursing shortage in these countries (Park, Murray & Delaney, 2006).

In Oulton (2006), the problem of global nursing shortage was extensively discussed. In the said study, Oulton (2006) attributed the existence of the global nursing shortage to the same factors earlier mentioned. Undeniably, members of the first world countries have experienced nursing shortage in view of the factors earlier discussed. Consequently, most of the developed countries tend to recruit nursing professionals from the third world countries in order to ensure that demand for nursing professionals are met (Oulton, 2006; Park, Murray & Delaney, 2006). Kingma (2002) then mentioned that the aforementioned contributes to the brain drain experienced by the countries who are actually supplying nursing professionals to the developed countries. 

Having established this, it is evident that the problem with respect to nursing shortage has been experience not only in the United States and the other members of the developed world. Instead, such problem has become evident in globally. 

Addressing the Nursing Shortage Problem

          Having established the serious problems arise in view of the nursing shortage, various efforts have already been undertaken in order to address the said problem (Andrist, Nicholas & Wolf, 2006). Various strategies have already been promulgated in the hopes of addressing the nursing shortage problem (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Perhaps, one of the most common methods adopted by developed countries such as the United States of America, the United Kingdom and Australia was to look for the nursing professionals in other countries (American Organization for Nurse Executives, 2000; Lasaki, Cook & O’Brien, 2009). In fact, migration into these countries by nursing professionals from developing countries in Asia and Africa has become relatively important in order to supply the former with the nursing professionals that they need in order to address the needs of the patients

(American Organization for Nurse Executives, 2000; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Nevertheless, this solution has not been considered effective in the elimination of the said problem. In fact, aside from eliminating nursing shortage, it further contributes to the problem in such a way that the number of nurses in the developing countries is likewise reduced. Generally, strategies aimed towards the elimination of the nursing shortage problem are isolated towards the following: first, the recruitment of the future workforce; and second, adopting various steps in order to retain the current members of the workforce (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). 

          Recruitment of the future workforce it that is deemed of paramount importance in addressing the problem with respect to the shortage of nursing professionals (Finkelman & Kenner, 2010). Various researches, as earlier mentioned, revealed that the shortage of nursing professionals has been largely attributed to the failure to recruit more nurses nowadays (American Organization for Nurse Executives, 2000; Lasaki, Cook & O’Brien, 2009; Park, Murray & Delaney, 2006). Generally, such failure has been brought about by the negative perceptions thrown towards the nursing profession, the workload therein and the stress encountered in relation to the duties thereof (Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010). In this regard, less and less students nowadays enter in schools that specialize in nursing. Furthermore, it was also because of these factors that it has been relatively difficult to recruit people to enter into the field. As a result thereof, it is of paramount importance that these difficulties be addressed to recruit the members of the workforce (Lasaki, Cook & O’Brien, 2009; Park, Murray & Delaney, 2006).

          One of the many solutions adopted to recruit members of the future workforce is to increase the budget allocated for nursing education (Lasaki, Cook & O’Brien, 2009; Park, Murray & Delaney, 2006). More specifically, these funds must be addressed towards the improvement of the faculty as well as the facilities that the students shall use in relation thereto (Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009 Park, Murray & Delaney, 2006). Aside from this, it is important for the members of the health care profession to devise ways by which they could subsidize training. Undeniably, promoting subsidized training could increase the number of registered nurses (Andrist, Nicholas & Wolf, 2006; Park, Murray & Delaney, 2006). In the same manner, the nursing profession may be also increased through the development of training programs in the other fields of nursing such as information and technology systems, management and the like (Finkelman & Kenner, 2010).

          The recruitment of future members of the nursing workforce also entails the devotion of resources towards increasing wages for the nursing professionals (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010). This particular approach is considered of paramount importance in order to recruit more potential employees in the field. It is also of paramount importance that members of the minorities be recruited to further boost the number of those who are willing to enter the nursing profession (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). 

          Aside from merely adopting strategies by which the number of nurses may be increased, it is also essential that strategies be adopted to also retain registered nurses in the workforce. As previously mentioned, nurses leave their current workplace because of the inability of health care professionals to devise ways by which the status of the registered nurses therein could be improved (American Organization for Nurse Executives, 2000; Finkelman & Kenner, 2010). In fact, most of the nurses leave their work because of the heavy workload (American Organization for Nurse Executives, 2000; Park, Murray & Delaney, 2006). As such, it is of paramount importance that the policies within health care institutions be promulgated to avoid turnover and guarantee retention (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006). 

Recommendations

          Nursing shortage has undeniably affected the manner by which health care industries in the United States and throughout the rest of the world operate (American

Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Nursing shortage exists whenever the demand for nursing professionals is higher than the supply thereof. Because of this, the shortage causes the quality of health care services to deteriorate. Parenthetically, it also increases the margin of error for those who are currently employed therein (American

Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). In this regard, as it has been repeatedly mentioned in this paper, it is essential that various strategies be adopted to address the situation at hand. However, it is of utmost significance that the problem be addressed by considering the new factors that have affected the development thereof. Indeed, as mentioned by various researchers (American Organization for Nurse Executives, 2000;

Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien,

2009), the nursing shortage problem, while an age old problem has evolved over time. Hence, it is necessary that the factors that contribute to the problem be addressed through the adoption of modern means.

Summary

Once again, nursing shortage has pervaded the entire health care industry, regardless of where it is located. In fact, it has severely affected the developed countries such as the United States of America, the United Kingdom and Australia. In the same manner, the problem even extends to the members of the third world. The problem with respect to nursing shortage is commonly described as that the situation wherein the demand for employing nursing professionals exceeds the supply of the latter whether in a local, national and global levels (American Organization for Nurse

Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Murray, 2002). More often than not, the nursing shortage is measured through the use of different approaches. One instance is the use of the nurse-to-patient ration, and the other is the nurse-to-population ratio (Buchan & Aiken, 2008; Bureau of Health Professions, 2004; Cherry, Cherry & Jacob, 2008). There are, however, also tendencies when nursing shortage is determined depending on the job openings available within the health care industry (American Organization for Nurse

Executives, 2000; Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004; Lasaki, Cook &

O’Brien, 2009; Laschinger & Finegan, 2005; Oulton, 2006; Park, Murray & Delaney, 2006). In this regard, the issue with respect to nursing shortage has long been explored in a number of studies. Most of the studies conducted usually focused on the extent of the problem, the most common factors that affect the current problem, the solutions employed to address the same, the failure thereof to effectively eliminate nursing shortages and lastly, the various recommendations to address the current problem. 

          Without a doubt, the attention given to nursing shortages have been brought about by the number of problems associated thereto. Previous studies showed that nursing shortage poses negative effects to the health care industry (Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004; Feldman, 2003; Laschinger & Finegan, 2005). In fact, many studies have mentioned that the shortage in the number of nursing professionals affects the manner by which services are rendered in the health care industry (Andrist, Nicholas & Wolf, 2006; Feldman, 2003). Apparently, the nursing shortage highly affects the manner by which the services in the health care industry are affected. Nursing shortages increase the workload of the current employees employed in the field in a sense that most of the nurses feel burnt out and othr job related stress (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006;

Finkelman & Kenner, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Murray, 2002). As such, the quality of services are compromised and the margin of error increases (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Murray, 2002). In fact, researchers mentioned that the safety of the patients is compromised in view of the nursing shortage (American Organization for Nurse Executives, 2000). Parenthetically, nursing shortage negatively affects the workload of the professionals within healthcare institutions (Carayon & Gurses, 2009; Duvall & Andrews, 2010; Ellis & Hartley, 2004; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Undoubtedly, the increase in such workload would contribute to burnout which in turn could once agian compromise the delivery of the services to the patients (Lasaki, Cook & O’Brien, 2009). In this regard, it is of paramount importance by which the members of the health care industry could address the aforementioned problem (Carayon & Gurses, 2009;

Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004; Feldman, 2003; Laschinger & Finegan, 2005). 

          Once again, the problem of the nursing shortage has been felt throughout the entire world. In this regard, the issue as regards the shortage of nursing professionals is not merely confined with a particular territory (American Organization for Nurse

Executives, 2000; Andrist, Nicholas & Wolf, 2006; Park, Murray & Delaney, 2006). Instead, the nursing shortage problem is felt throughout the entire world. Nevertheless, it has been mentioned that nursing shortage originated amongst the countries in the first world (Cherry, Cherry & Jacob, 2008; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009; Laschinger & Finegan, 2005). The nursing shortage problem had a great effect on the United States of America. According to one agency in the country, the National Council of State Boards of Nursing, the portion of the population which enrolls in nursing courses has been relatively increasing. In fact, the percentage in the enrolment in such schools has also resulted to the increase in the number of nursing professionals in the country (Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008; Ellis & Hartley, 2004). Unfortunately, however, such increase has failed to keep with the overall population growth in the United States of America. In this sense, various researches show that nursing shortage has been largely attributed to the inability of the current nursing supply to meet the present demands of the patients (Buchan & Aiken, 2008; Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008). The aforementioned statistics with respect to shortage is expected to increase over time, thereby widening the gap between the supply and demand for nursing professionals (American

Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Buchan & Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Ellis & Hartley, 2004; Laschinger & Finegan, 2005). 

          Researchers also reveal various statistics that show the extent of the problem. In the United States alone, the extent of the problem is remarkably vast (American

Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Buchan &

Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Ellis & Hartley, 2004; Laschinger & Finegan, 2005). As earlier mentioned, data released by the government of the United States of America reveal that nursing shortage in the country continues to increase every five years (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Cherry, Cherry & Jacob, 2008). For instance, in 2000, nursing shortage was merely 6% (Bureau of Health Professions, 2004). In 2005, however, such figure increased by 4%, revealing the nursing shortage rate at 10%. Subsequently, in 2010, nursing shortage rates further increased to 17%. Hence, the government projects that nursing shortage would eventually climb to 27% in 2015; and in 2020, would reach 36% (Bureau of Health Professions, 2004; Laschinger & Finegan, 2005). 

Because of the extent of the problem of nursing shortage, researchers and scholars have deemed it of paramount importance to devise ways by which the problem could be addressed (Buchan & Aiken, 2008; Carayon & Gurses, 2009; Duvall & Andrews, 2010; Ellis & Hartley, 2004; Laschinger & Finegan, 2005). In fact, a number of scholars and researchers have already proposed different solutions by which the present situation may be addressed. In fact, in the earlier parts of this current research, it was mentioned that various strategies have already been promulgated in the hopes of addressing the nursing shortage problem (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Perhaps, one of the most common methods adopted by developed countries such as the United States of America, the United Kingdom and Australia was to look for the nursing professionals in other countries (American Organization for Nurse Executives, 2000; Lasaki, Cook & O’Brien, 2009). 

Different suggestions have been made to address the current problem. Perhaps, one of the most common ways was to look into other sources of nursing professionals, such as those in the developing countries who are in search of greener pastures

(American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). Unfortunately, however, most of the strategies devised in relation thereto have not solved the problem at hand. It is because of this, that previous studies mentioned the need to take the factors that affect the problem into consideration in order to effectively address the nursing shortage. Also, one of the most common methods was to suggest various ways by ways by which nurses may be recruited (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009)). This includes the adoption of strategies in order to increase the enrolment of students in schools that specialize in nursing. At the same time, these strategies also involve the training and development measures by which they could effectively prepare the nursing professionals for work in health care institutions (American Organization for

Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Finkelman & Kenner, 2010; Lasaki, Cook & O’Brien, 2009). In addition thereto, there are also various strategies that are aimed towards the retention of the nursing professionals in their current working environment. 

Conclusions

          The results obtained from this current study undeniably reveals that the entire world is suffering from the problems brought about by the nursing shortage (American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006; Buchan &

Aiken, 2008; Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008; Finkelman & Kenner, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Murray, 2002). In fact, such nursing shortage has affected the delivery of health care services in the United States as well as in other countries throughout the world. As repeatedly mentioned in this

paper as well as in the various studies previously published, nursing shortage has tremendously increased the workload of those currently employed in the profession

(American Organization for Nurse Executives, 2000; Andrist, Nicholas & Wolf, 2006;

Buchan & Aiken, 2008; Carayon & Gurses, 2009; Cherry, Cherry & Jacob, 2008;

Finkelman & Kenner, 2010; Goodin, 2003; Lasaki, Cook & O’Brien, 2009; Murray, 2002). Because of this, most nurses tend to compromise the quality of the services rendered by the health care institutions as their efficiency reduces and the margin of error increases. It is in this regard that various methods be adopted to provide solutions to the problem. However, it is essential that it transcends to the most common methods adopted beforehand. Evidently, the new proposals to the manner by which nursing shortage must be addressed must take the factors that affect the latter into consideration.  

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