Nursing Shortage Literature Review

By Author: Sherry Roberts
Total Articles: 99
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Nursing shortage remains to be a significant problem in the health care sector since it affects the quality of health services offered to the patients. In essence, the challenges faced by patients due to the issue of nursing shortage are compounded when the ratio of the patient-to-nurse ratio is lower than the internationally set value. As such, it is necessary to address the problem of nursing shortage as discussed in this section of the dissertation. The literature review provided is an analysis of recent studies conducted on the nursing shortage.
The American Association of Colleges of Nursing (AACN) (2014) projected that the U.S would experience a shortage of Registered Nurses as Baby Boomers continue to age and the demand for health care increases. Nursing schools are struggling to expand their capacities in meeting the increased demand for care. AACN continues to seek for resources to shape legislation, identify strategies, and create collaborations to deal with the shortage.
According to a study conducted by Macken and Hyrkas in (2014), there have various studies on the issue of job satisfaction of the nurses ...
... working in the United States. Other studies have focused on the economic measures that are crucial to reducing the nursing jobs in Iceland and the high rates of burnout in nurses in China. Nurses suffer from increased workload and working hours that subject them to fatigue and in turn affecting their job satisfaction. The law of supply and demand also works for the nurses in which where the demand for health care services is high; there ought to be a high supply of nurses deployed in those areas though it is not the case in many parts of the world. Across the world health care systems, nurses in regions such as United States, Iceland, and China among other countries suffer from increased patient population, but their numbers are not increased proportionally. There is low nurse retention when they are understaffed due to burnouts and fatigue in the workplace.
In a different study, MacLean et al. (2014) conducted a study that focused on the scale, causes, and implications of the primary care nursing shortage and obtained important findings. The demand for health care continues to rise, and many people lack access to primary care services. It is important to understand the major causes of primary care shortage both in the United States and beyond and the key solutions to the issue. The authors reviewed the US and international primary health care literature and its application in the countries with different levels of health care infrastructure. The causes of the deficits in health care infrastructure were also examined, and the findings revealed important strategies to maximize primary care workforce. The issues of consideration in dealing with the challenges encountered when seeking primary health care include the use of technology, task shifting, inter-professional teams, and consistent data to build workforce strategies. It is important that the global nursing workforce is increased to avert the shortage experienced in providing primary health care services which many people lack access to.
Snavely (2016) reported the findings of data watch, which was a brief economic analysis of the looming nursing shortage in the United States. The nation already suffers from nursing shortage, but there are indicators that it is likely to experience a severe nursing shortage in the coming few years. Several economic issues affect the U.S nursing workforce at present and in the future. There is a high likelihood of an imbalance between the nursing supply and demand, which has significant economic consequences within the United States. The nursing workforce has stabilized over the past few years, but the anticipation of a nursing shortage in the coming years has unlikely consequences to the country’s health care system as well as the economy. Nursing shortage makes it challenging for many U.S citizens to gain access to quality health care that affects their well-being. In effect, there is reduced productivity in their workplaces and to a large extent affects economic growth.
Lartey, Cummings, and Profetto-McGrath (2014) conducted a systematic review of the literature on the interventions that promote the retention of experienced registered nurses in health care settings. The study intended to review the report of the effectiveness of strategies for the retention of experienced registered nurses. Nurses have noticed that a significant share of nursing shortage will affect health care cost, job satisfaction, and quality of patient health care services. The retention of the experienced nurses helps to address the shortage, facilitate the transfer of knowledge and provide quality care to the patients. The systematic review analysis involves a review of twelve studies focusing on the interventions that enhance the retention of the experienced registered nurses in care facilities. Most of the studies reported an improved retention due to the intervention. The aspects of working together as a team and enacting strategies such as mentorship, leadership, enhanced job satisfaction and high retention results. The interventions promoting the retention of experienced registered nurses are necessary for health care. Nurse leaders should be informed of the ways that help to retain nurses and maintain quality health care. There should be programs that target the retention of nurses as measures of increasing the nursing shortage and the effects on quality of care.
A study was conducted to discover and reveal how nursing as a profession and the working conditions are portrayed in Swedish media narratives on the shortage of nurses. According to Blomberg and Stier (2016), the media is a platform where stakeholders air their views on the health care sector and the situation for nurses in which the debate on the shortage of nurses is also a part. There has been a various analysis of the media narratives about nurses and their working conditions which have also been published in Swedish newspapers. In most of the Swedish media platforms, nurses are portrayed as good, and concerned health managers and politicians are not taking realistic actions to address the problem. The accused groups justify themselves through partial acceptance of or displacing of responsibility. Shortage of nurses is termed as a social problem and a threat to the safety of patients. The metaphorical expressions used to describe the problem include inevitable, beyond control, and collegial problem as replaceable. Nurses and patients are at times dehumanized with no one taking responsibility. The media has a significant role in emphasizing the extent of the problem of the nursing shortage and the possible solutions to it. There can also be alternative narratives to report on the nursing shortage and seeing for sustainable solutions.
There can be interventions to improve the recruitment and retention of nurses in clinical settings as reported in a survey and workshop to assess the existing practice and future priorities. As reported by Bower et al. (2014), many clinical trials face challenges in recruitment and retention in spite of having a significant investment in infrastructure. There has been an insufficient focus on the development and testing of recruitment and retention interventions. Various interventions can be used to improve the recruitment and retention strategies in clinical settings. The methods used for encouraging recruitment and retention are categorized as patient contact, convenience, maintaining systems, incentives, resources and human factors. The major categories of the interventions were grouped as training the staff in the site, communication with patients, and use of incentives. There have been significant resources invested in trials, but recruitment is a major challenge that affects nurse retention and shortage.
The U.S nursing shortage and the high turnover problem is considered as the American epidemic. According to an article by Cox, Willis, and Coustasse (2014), nursing shortages are on the rise and has become a challenge due to the aging baby-boomer population that tends to increase turnover throughout the region. The demand for nurses is on the rise and hence necessary to determine the major causes of the problem as essential for health care provider. The cost of health care is also on a rising trend due to the high turnover rates of nurses. The root causes of the problem include an aging population of nurses, patient demographics, insufficient staffing, lack of experience, nursing schools, and salary challenges. The factors are linked to increased turnover and shortages in the health care sector. An evaluation of the issue revealed that negative job satisfaction results to turnover and overall nursing shortage in the U.S.
Abhicharttibutra, Kunaviktikul, Turale, Wichaikhum, and Srisuphan (2017) provides an analysis of a government policy in addressing the nursing shortage and quality of education. The policy making processes of Thailand government in increasing the capacity and promoting nursing education quality was examined. What is considered as critical is the role of policy modification that incorporated implementing the first international doctorate in English in Thailand. Other interventions include policy implementation, recruiting the right people, and producing more nurses. The move ensures that there is an adequate supply of nurses within the country to serve the entire patient population.
In a different study, Adriaenssens, De Gucht, and Maes examined the causes and consequences of occupational stress in emergency nurses in 2015. The factors examined included the influence of the changes in work and organizational characteristics on job satisfaction, work engagement, emotional imbalance, turnover, and distress in the emergency room nurses. Organizational and job characteristics are the major predictors of stress-health outcomes. Many of the emergency room nurses are exposed to stressful work events and unpredictable work conditions. The turnover rates during the study were high, and the changes in job demand, control, and the social support was a key predictor of job satisfaction, work engagement, and exhaustion (Adriaenssens, De Gucht & Maes, 2015). The differences in reward and work agreements predicted the results of work engagement and the intention to leave the workforce. The work-related interventions are crucial in improving the occupational health in the emergency room nurses. Hence, the focus should be reducing job demands, increasing job control, promoting social support, and having an appropriate reward system. Nurse managers ought to be aware of the causes and effects of occupational stress especially for the emergency room nurses and have preventive interventions.

References
Abhicharttibutra, K., Kunaviktikul, W., Turale, S., Wichaikhum, O.-A., & Srisuphan, W. (2017). Analysis of a government policy to address nursing shortage and nursing education quality: International Nursing Review, 64(1), 22-32 doi:10.1111/inr.12257
Adriaenssens, J., De Gucht, V., & Maes, S. (2015). Causes and consequences of occupational stress in emergency nurses, a longitudinal study: Journal of Nursing Management, 23(3), 346-358 doi:10.1111/jonm.12138
American Association of Colleges of Nursing [AACN] (2014). Nursing shortage fact sheet. Washington, D.C.: American Association of Colleges of Nursing,
Blomberg, H. & Stier, J. (2016). Metaphorical expressions used in Swedish conditions: Journal of Advanced Nursing, 72(2), 382–395. doi: 10.1111/jan.12839
Bower, P., Brueton, V., Gamble, C., Treweek, S., Smith, C. T., Young, B., & Williamson, P. (2014) Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities: Trials, 15399 doi: 10.1186/1745-6215-15-399

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