Nursing Shortage: Causes and Effects

Introduction

Nurses are the most prominent professional group in the world and an essential workforce tasked with providing quality care to improve health outcomes for communities, people, and families. The World Health Organization estimates that 29 million nurses, 3.9 million in the United States, are currently providing care around the world (Ross & Drennan, 2019). However, the healthcare industry’s primary challenge today is the scarcity of nurses, which has compromised the provision of quality care and the ability to attain global health coverage. The demand for professional nurses is projected to grow by 9% from the end of the Coronavirus pandemic until 2030 (Lopez et al., 2022). Research proposes that issues like high turnover have caused a shortage of nurses and can have severe consequences on providing quality care.

Background

Currently, there is a shortage of nurses worldwide, and people in need of adequate care are suffering the most. The World Health Organization estimates that an added 6 million nurses are wanted to cater entirely to the current world population, and the demand will hit 13 million by 2035 (Ross & Drennan, 2019). The shortage affects about one billion people, especially women and children (Ross & Drennan, 2019). The importance of nurses in the healthcare system has been brought to light and reinforced by the coronavirus pandemic. However, staff managers have noted that COVID-19 is causing mental health problems and clinical burnout and are worried the problems will intensify. The scarcity of these health workers has negatively affected patients’ health and increased the challenge of eradicating diseases (Ross & Drennan, 2019). In turn, nurses are faced with increased responsibilities and fatigue that causes the quality of care to decline, threatening patient safety.

Method

A systemic review of credible sources was conducted to acquire information regarding the causes and effects of the shortage of nurses. The research considered all kinds of studies (mixed method, quantitative, and qualitative) to obtain relevant information regarding nurses in all health facilities (Tamata & Mohammadnezhad, 2022). A comprehensive analysis of the effects of the nursing shortage of nurses is also given, along with recommendations for the necessary actions and involvement.

Results

Data from the Bureau of Labour Statistics affirms that the United States health industry alone has lost over 100,000 nurses since the start of COVID-19. However, other causes of nurses shortage have existed and still proceed to affect the healthcare industry. They include an aging workforce, an aging population, nurse burnout, the COVID-19 pandemic, and staff turnover (Ross & Drennan, 2019). Marć et al. (2019) state that the impact of nursing scarcity is the decline in quality of care and poor management of diseases that could increase the death rate of patients. Solutions like better funding for nursing programs could mitigate the shortage of nurses.

Causes of Nursing Shortage

COVID-19 Pandemic

The Coronavirus pandemic intensified the scarcity of nurses by overwhelming the staff during the peak seasons. The high mortality rate among COVID-19 patients resulted in low morale for new nursing program applicants (Lopez et al., 2022). The US alone is experiencing a shortage of 100,000 employees, expected to double by 2030 (Lopez et al., 2022). Nurses cannot train and help healthcare systems without sufficient faculty due to the high patient numbers needing care.

Aging Population

The current global population is aging, and so is their need for increased care. More than at any time in history, the United States currently has many citizens over the age of 65, an increase of 75% since 2011 (Marć et al., 2019). The issue is that older individuals do not have one illness to cater to. More often, they have numerous comorbidities and diagnoses that need them to seek medical care (Marć et al., 2019). Overall, people are living longer but need constant use of healthcare services. In addition, most terminal illnesses are currently survivable, and treating them is straining the workforce.

Aging Work Force

The aging workforce constitutes about a third of the registered nurses and will likely retire in the next decade. Over one million registered nurses worldwide are over 50 years old (Tamata & Mohammadnezhad, 2022). Nurse faculty are among the aging workforce, providing unique training issues. Shortage in the nurse faculty results in enrolment limitation, lowering the number of nurses graduating (Tamata & Mohammadnezhad, 2022). Limited and declining faculty also means that when there are fewer students, the quality of the classes and the program also decrease.

Nurse Burnout

Some people only realize that nursing is not what they expected after graduating and entering the workforce. Those who decide to stay soon realize that the job can cause burnout and stress. It is evident that after COVID-19 worsened, about 47% of the nursing population left (Turale & Nantsupawat, 2021). However, burnout was not only caused by the pandemic as the turnover rate is still at about 20% high (Turale & Nantsupawat, 2021). The turnover is fuelled by the extra demanding work and poor staffing levels. The consequence is high patient ratios, which worsens the crisis by leaving the remaining nurses to cater to more patients.

Nurse Turnover

Lack of social support and vision in the healthcare sector is among the leading causes of high turnover and a shortage of nurses in the healthcare system. In addition, many nurses have also complained of minimal job satisfaction and work overload as significant causes of leaving their jobs (Tamata & Mohammadnezhad, 2022). Other causes of high turnover include poor salaries and a lack of bonuses for extra shifts (Tamata & Mohammadnezhad, 2022). Finally, limitations caused by new technology and declining health conditions caused older nurses to leave their jobs before retirement age.

Effect of Nursing Shortage on Health Care

Besides financial costs, the patient suffers the most regarding the quality of care they receive from the scarcity of nurses. A direct link exists between the shortage of nurses and patient mortality (Buerhaus, 2021). Each time a full-time nurse is hired to cater to about 1,000 patients, the risk of death declines by 4.3% (Buerhaus, 2021). However, each time a nurse quits, there is a 2% to 7% increase in deaths.

Secondly, the issue of overcrowding in healthcare facilities results from the need for more nurses. Overcrowding in the emergency department can result in poor performance of medical procedures, more extended hospitalization, disability, or death (Spurlock, 2020). In addition, physicians are more likely to commit errors due to overcrowding. About a quarter of those who died during the COVID-19 pandemic was waiting for consultation for hours because of overcrowding.

Thirdly, the job of the existing nurses increases when there is a shortage of nurses. It leads to an increase in medical errors and medication errors. Errors can include a poor or wrong prescription for a specific patient or illness, leading to fatal outcomes (Buerhaus, 2021). Worryingly, medical errors can also be caused by insufficient training due to the scarcity of qualified educators and insufficient infrastructure.

Solutions to the Shortage of Nurses

Healthcare Institutions should Hire Additional Nurses

When there is an increase in hospital admissions, healthcare facilities should hire seasonal nurses temporarily. They can contract international nurses for about three years to enable more retention and stability at the unit level (Buerhaus, 2021). These international nurses can slowly transition into permanent and full-time department roles when their contracts expire. Healthcare facilities should also consider other cheaper solutions like internal recruitment, temporary to permanent work, and flex shifts.

Hospitals should Empower Nurses

Healthcare institutions must be innovative when meeting the nurses’ needs while offering the safest and best patient care. Nurses who work in a motivating and empowering environment have high sustainability in the workforce (Tamata & Mohammadnezhad, 2022). When staffing ratio verdicts considering acuity levels and high volume are empowered through autonomy, there will be less burnout and desire to quit the job (Tamata & Mohammadnezhad, 2022). Most healthcare organizations have adopted Magnet certification that offers high-level nursing courses and superior quality, safety, and patient satisfaction.

The Aging Population Need Technology Training

Technological advances like Electronic Medical Records (EMR) can influence the nurses’ decision to stay in the workforce. Most of the older nurses are struggling with technology and retiring from the profession early (Spurlock, 2020). They should be provided with better training to have more opportunities for growth in the profession (Spurlock, 2020). Such professional development establishes loyalty and minimizes the issue of high nurse turnover in the healthcare industry.

Conclusion

The scarcity of nurses is among the barriers to providing quality healthcare and attaining universal health coverage. The aging workforce, burnout, and high turnover are among the leading causes of the nursing shortage. The shortage of nurses has increased the workload on the current workforce leading to mental health problems and a decline in the quality of care that threatens patient safety. However, a broad strategy comprising long-term and immediate approaches can ensure that patients do not suffer because of the scarcity of nurses.

References

Buerhaus, P. I. (2021). Current nursing shortages could have long-lasting consequences: Time to change our present course. Nursing Economics, 39(5), 247-250. Web.

Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International Nursing Review, 66(1), 9-16.

Ross, F., & Drennan, V. M. (2019). Global nurse shortages: The facts, the impact and action for change. British Medical Bulletin, 130(1), 25-37.

Spurlock Jr, D. (2020). The nursing shortage and the future of nursing education is in our hands. Journal of Nursing Education, 59(6), 303-304.

Tamata, A. T., & Mohammadnezhad, M. (2023). A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing Open, 10(3), 1247-1257.

Turale, S., & Nantsupawat, A. (2021). Clinician mental health, nursing shortages and the COVID‐19 pandemic: Crises within crises. International Nursing Review, 68(1), 12-14.

Lopez, V., Anderson, J., West, S., & Cleary, M. (2022). Does the COVID-19 pandemic further impact nursing shortages? Issues in Mental Health Nursing, 43(3), 293-295.