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Global Nursing Shortage
Nursing provides a challenging yet rewarding career focused on the health and wellbeing of others. Nursing is a science and art which offers opportunities to promote and restore health, prevent illness and alleviate suffering in a skilled, professional manner. Nursing takes place wherever people are; in hospitals, the community, as well as urban, rural and remote settings. The health care industry is constantly changing and registered nurses are in high demand worldwide.
The world has entered a critical period for human resources for health. The scarcity of qualified health personnel, including nurses is being highlighted one of the biggest obstacles to improving the health and wellbeing of the global population. Nurses are the most significant component of the workforce. They represent the front line staff in most health system and their contribution is recognized as essential to delivering safe and effective care both preventive and curative. In the past nursing shortages was due to either high demand or low supply. But nowadays, both factors contribute in the shortages, as a" decreased supply cannot meet the increased demand"(Oulton, 2006, p.34S).
This paper aim is to identify the factors that shaped the global shortage of nurses and the strategies that contribute toward the solution of this issue.
History of nursing shortage
During World War I, the demand for nurses in the war greatly increased due to improved technology and creation of new weapons like the machine gun. The Army and Navy Nurse organization recruited to a great extent therefore the recruiting standards dropped and they began to except nurses straight out of nursing school. They were at such a deficit in nurses that they approved the entrance of black nurses. With all these accommodations there still remained an insufficient amount of nurses at war. Post war the number of nurses did decrease because the war events caused severe depression that led to give up nursing and lose of interest in this career among people (Joel, 1999).
After World War II, there was yet another shortage of nurses. This time the war presented new troubles; there were not enough nurses to work back in the US and over seas at war. The government's solution to this problem was to encourage young women to join the field of nursing by offering to pay their education and a give them money for school as long as they signed a contract that they were military and civilian nurses(Joel, 1999). At this point, there were great attempt taken to decrease nursing shortage. The government attempted to recruit inactive nurses back into nursing as a part time basis. They also began to accept married women into nursing, as the nursing was primarily for unmarried women since the Nightingale era. Nursing assistants were also being hired at hospitals to compensate for the lack of registered nurses(Joel, 1999). Since the 1980s, the US and several other countries has had a continuing decreasing supply of nurses. This shortage has been attributed to many factors that have similarities of post war experiences (Joel, 1999).
General picture of global nursing shortage
Rosekotter, Nardi and Oulton (2006) mentioned several statistics that were done by the International Council of Nurses [ICN] in years 2003 and 2004 and highlighted the serious of the problem that some people still are not aware of. For example, in Europe, Germany and Netherlands the shortage has reached 13000 nurses each and Switzerland is short by 3000 nurses. 18000 nurses quit public hospitals yearly in France whereas 50 percentages of the nurses hired today will retire the next fifteen years in Canada. In United States 126000 nurses are required. Africa overall is short of 600000 nurses; the situation there was aggravated by spread of AIDS which forced many nurses to migrate to developed countries looking for a better living condition.
At present, the GCC (Arabian Gulf countries) are unable to produce sufficient numbers of clinical staff to provide health care for their inhabitants due to rapidly growing and aging population. As a result of high growth rate (one of the highest in the world), the GCC population will reach almost double the size it is today by 2025 (World Health Report, 2006).
Global nursing shortage contributing factors
Oulton (2006) defines shortage as" an imbalance between demand for employment and the available supply"(p.34S). Today's health division encounters a tremendous challenge of providing high quality care within the increasing health care costs and limited resources. In particular, the disproportion in the supply and demand of health care human resources has been the highest concern for several decades (Kingma, 2001).
This because of many factors such as migration, aging, job dissatisfaction and shortage in nursing collages.
Chronic nursing shortages is aggravated by the migration of the nurses in seek of better working condition and quality of life (Oulton, 2007). "International nurse migration: moving from one country to another in the search of employment" (Kingma, 2001, p.205). In year 2000 almost 175 million people lived away from their birth countries mainly due to globalization. As a result, the highly skilled professionals including nurses lean to be the first to migrate and they form the majority (Kirk, 2007). Globalization is "the closer integration of countries and peoples of the world which has been bought about by the enormous reduction of cost of transportation and communication, and the breaking down of artificial barriers to the flow of goods, services, capital, knowledge and people across borders''( Kirk as cited in Stiglitz, 2002).
Kirk (2007) describe nursing migration as a "brain circulation" as they move out of the their national nursing workforce, in search of achieving their personal goal (learning apportunities) and better living conditions. Rosenkotter, Nardi and Kkirk (2007) mention that the high stress environment with increasing the work load, mandatory over time with low salaries and unsafe work setting due to spread of infectious diseases such as AIDS and an increase in the violence rate against heath worker push the nurses to leave their countries for good.
The aging of the nursing workforce has contributed to the global nursing shortage. Nurses leave hospital settings as they age and leaving the workforce entirely after age fifty (Sorrel,2010). In Canada fifteen percentages of nurses employed today will retire within the next fifteen years (Oulton, 2006). In 2000 one in three nurses was younger than forty years of age and the current percentage of nurses age between forty and forty nine is 35% (Whitehead, Weiss & Tappen, 2007). In the other hand, by 2050 there will be greater numbers of older people than younger ones worldwide (Oulton, 2007).With Aging population comes many long term health conditions such as cancer, Alzheimer's, HIV, COPD and drug abuse (World Health Report, 2006) raises the pressure on the health care workers, so more nurses are needed to care for those with long term conditions (Kirk, 2007). In addition, Improvements in the life expectation over the past 25 years have left the GCC with growing number of elderly people requiring care (World Health Report, 2006).
Unfavorable work environment such as , heavy workloads, increased mandatory overtimes, lack of appreciation , inadequate support stuff, families commitment, pregnancies, little payment, lack of power, high stress, and violence against health workers lead to quit nursing (Whitehead, Weiss, Tappen & Oulton, 2007; Jamieson, 2009). When the nurses have the choice, they will choose to go where they are respected, rewarded for their job and given personal and professional development opportunities (Oulton, 2007).
Reduction in nursing faculty
In United States by the year of 2003; 15,944 of qualified applicants were rejected from BSN programs due to lack of nurse faculty, clinical sites, classes and inadequate funds. Beside that 54.4 percentages of teacher will leave the faculties because of low salaries next few years while 1000 vacant positions are waiting to be filled at the present (Rosekotter, Nardi Whitehead, Weiss & Tappen, , 2007). In the GCC, international academic institutions are needed to set up the health care facilities and many health care providers are needed to meet further demand (World Health Report, 2006).
Impact of nursing shortage
The shortage has very bad effects on health care systems, patients and health workers. As a result, reduced quality of care, poorer patient outcomes, reduced job satisfaction, high staff
resigning rates, and increased care costs. In the United States and Canada some studies revealed that the patient risks and mortality rate increased with the nursing personnel scarcity (Oulton, 2007).
Buerhaus, Donelan, Desroche and Hess (2009) summarized the impact of the nursing shortage on patients, health care workers and health care sittings as delayed response to pages or calls, increased staff communication problems, increased patient complaints about nursing care, reduced number of available beds, patient wait for long time for surgery or test, delayed discharges, increased workload on physicians and discontinued patient care programs.
Retention and recruitment
Nurses tend to migrate to developing countries to gain work experiences and to search for better living opportunities. Mother countries should retain the nurses that they already have to reduce the cost of new nurse's recruitment. As well as, to encourage their emigrant nurses to return back to their home with privileges such as good salaries, acceptable work environment, educational continuing programs and supportive services, to share the knowledge that they gained in return (Nicolas, 2006). The governments of the small countries need to initiate an agreement with the government of the great recruiting countries to stop draining their nurses, e.g. South Africa and the UK (Kingma, 2001). Governments are trying to reduce nurses' shortages by putting successful retention interventions such as an increase in the salary, initiation of programs that aim to create professional developing pathway and introduction of competencies programs for educators and employers to help them to return in to nursing after long time being out of the practice (Jamieson & Taua, 2009). The retention of nurses encourages and facilitates the recruitment of future nursing professionals (Oulton, 2006)
In addition, the governments offer nursing educational exchange programs in which students sign an agreement to serve a number of years after graduation (Kingma, 2001; Sorrel, 2010).
As a conclusion, nursing shortages are not just a problem for nursing. They are a health system problem, which undermines health system effectiveness and requires urgent solutions. Without effective and sustained interventions, global nursing shortages will persist, destroying the attempts to improve care outcomes and the health of nation. Private providers can help to make nursing and other medical professions more attractive to local students by creating professionally and financially rewarding carrier paths.