Nursing is a challenged and dynamic profession. Struggles and challenges have accompanied the development of nursing profession through the previous decades. Although nursing was started with unorganized and weakly defined beginning, our sisters and brothers didnââ‚¬â„¢t stop until nursing become respectful and recognized profession. Now in the twenty-first century, the most challengeable problem is nursing shortage which is considered a public concern because of its massive effect on the quality of care and on patient health and safety. The first nurse Nightingale’s concept was ’cause no harm to patients’. This was the foundation for the scope of practice for nurses. Any obstacles that may result in threaten patient safety should not be ignored. (Cherry & Jacob, 2002).
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Nursing shortage is an issue where the required number of nurses is much more than the supply. Nursing shortage has been reported as crisis due to its seriousness. In the moment of speaking there are 200000 vacant nursing positions worldwide and it is predicted to increase to one million or even more by 2020. 85% of hospitals have expressed concerns about nursing shortage and half of them have difficulties retaining and recruiting nurses. Moreover, the turnover rate among nurses is continuously rising. Recently it has reached 40% in some hospitals nationwide (Albro, 2008).
This assignment has been done as a requirement for contemporary nursing course; it will discuss the history, reasons and impact of nursing shortage. Explore the issue of recruiting foreign nurses and the issue of nursing shortage in the Middle East.
Experiencing shortage of nursing had started long time ago. Opening the first school in nursing in the US was the result of difficulty in finding adequate number and trained nurses to hand round in Civil war. After World War 2 the medical services that were provided had significantly changed resulting in huge increase in the number of hospitals and creating special care unit which generate the need for more nurses to serve. That time educational centres for nursing start to appear to educate and train nurses in order to overcome the shortage of nurses. Now the evidence shows that all countries worldwide suffer from nursing shortage and it is an international concern which needs to be highlighted and managed as soon as possible (Andrews & Dziegielewski, 2005).
In 1980s it was easy to identify the reasons behind nursing shortage: increase the number of hospitals, length of hospital stay and aging population. Although these reasons are true, this is not the whole picture. It is more complex than that
Nursing has experienced highest registering rate in 1960s-1970s. Because of new job opportunities opened in 1980s-1990s, smaller number of women registered. As a result of that, the average age of RN nowadays is 45 or more. Most of the middle aged nurses will reach retirement age between 2005-2010 (Abualrub, 2005).
Over the years nurses have developed concerns about their image in the society. Nursing has been differently described within the population as saints or sinner, admire or ignore, powerless or powerful. Can we say nursing shortage result from nursing image or nursing image result from nursing shortage? These two are highly related. Above that the education preparation for nurses differ 2 years associate degree, 3 years diploma and 4 years baccalaureate. These levels of education have made people not value nursing as a profession. Having a bachelor degree isn’t necessary when you can be qualified to work after 3 or 2 years. This leads to discourage people to enter nursing and undervalue it (Daly, Speedy& Jackson, 2003).
The reasons why nurses have the intention to leave nursing the career and why the turnover rate is increasing is mainly due to job dissatisfaction. Common reasons nationwide are over load, schedule changes, lack of appreciation and less family time. The nursing field doesn’t offer the chance for frustrated nurses to speak out and this nourishes the dissatisfaction feeling. Lack of satisfaction makes nursing not an attractive profession for young people. More than 50% of working nurses will not advice their children or sisters to enter nursing (Diana, 2005).
Linda, Clarke & Silber (2003) did a study that showed a strong relation between nursing education and patient mortality rate. Education plays a role in providing high quality care. 19% is the mortality rate in hospitals that have 60% of nurses with bachelor degree where it is higher in hospitals with only 20% nurses having bachelor.
Lack of nursing faculty that provide proper education for the demand of bachelor graduating nurses directly affect the nursing shortage leading to directly affect patient safety. Nursing institutions witness an increase of registration, American Association of Colleges of nursing state that 13% increase of enrolment rate between 2004-2005. This increase needs an increase in nursing schools and clinical settings to educate these students. If there is not enough nursing faculty the condition will be worse. According to AACN 2005 nursing schools have rejected 41683 qualified applications. The main reason was having not enough nursing faculty, clinical areas and preceptors to educate this number of students (Allen, 2008).
Implication of Shortage
No doubt nursing shortage will have a negative impact on health care system. Nursing shortage forces hospitals to impose mandatory and unsafe overtime on nurses, increase responsibilities and workload and create floating nurse. All these contribute to job dissatisfaction and decrease quality care (Goodin, 2003).
Linda, Clarke & Silber (2003) conducted study to show the relation between nurse work load and mortality rate. 50% of hospitals worldwide have 5:1 patient to nurse ratio. The study shows if the ratio is 6:1 or more, the risk for patient death will be 14%. If it is more than 8, the risk will be 31%.
The number of medical errors is rising in a dangerous rate. One of the associated factors is nursing shortage. Study done by health resources and services shows a strong relation between number of staff and medication errors. These errors may have undesirable effect on patient health (Goodin, 2003)
Not enough staff intensifies the level of stress of nurses. Overtimes, increase responsibilities and emotional stress promotes increase staff absenteeism, impair decision making ability and increase level of turnover. More than 75% of RNs believe that their job quality delivered to patient is strongly affected by the shortage. Three from four nurses feel is frustrating, discouraging and disappointment when you unable to provide proper nursing care, just because of there is not enough nurses in the floor. (Revira, 2009).
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As a remedy for nursing shortage health care societies have started to hire foreign nurses. Phenomena of hiring foreign nurses has been introduced and practiced for almost 50 years (Leavitt, Mason & chaffee, 2007). Recruiting foreign nurses is specifically problematic as a technique to resolve this shortage simply for two reasons. First, the shortage is global issue; means the country which sent her nurses abroad intensified the shortage within its health care system. Second, hiring foreign nurses cost much more than hiring home graduate. This related to the coast of recruiting and training them into the organization (Cherry & Jacob, 2002).
Recruitment and retaining RNs
Nursing associations are constantly working in order to recruit nurses as much as they can. Recruitment strategies should focus on attracting young nurses. Efforts should be maximized to spread the awareness among school aged students in order to make them consider nursing as a career or a profession (Yoho, Timpanaro & Fowler, 2006)..
Retention of professional nurses have helped the organization to overcome the shortage. To retain experienced nurses organizations should consider staff needs, In response to that, magnet hospitals were created. Hospitals which they focus in developing proper retention strategies, mainly by enhance nurses’ autonomy and support decision making ability. Magnet program aim to increase job satisfaction, decrease turnover and promote encouraging environment. Now magnet considered the most effective programme in US for retaining and recruiting nurses ( Valerie, & Dreachslin, 2007)
Nursing shortage in the Arab world
The image of nursing as a profession in the Arab world is significantly improving. The status of nursing will be addressed from three dimensions: practice, education and image. Nursing education in the Arab world causes a lot of confusion due to the different educational levels. The minimum accepted educational degrees to enter the profession can be associated degree (2 years) or diploma degree (3 years) while in the US the bachelor is the minimum accepted degree. Moreover, some countries don’t offer bachelor degree where other countries have recently started bachelor program like UAE. Arab world also tend to recruit foreign nurses especially gulf countries to overcome the shortage. Nursing image plays a big role in promoting the shortage in the Arab world. Most of the population doesn’t prefer their sisters or daughters to choose nursing as a profession (Shukri, 2005).
Nursing shortage is an international problem which needs to be solved urgently. All the reasons and impacts of nursing shortage are now internationally known and it can’t be ignored any more. There are many reasons that could lead to this problem, few of them were addressed: Age, nursing image, job satisfaction and faculty shortage. Leaders of nursing in practice and in academia should work to gather to develops plans enhance the growth of nursing staff. Impacts of nursing shortage can’t be denied because it has a dangerous effect on patients’ health and on nurses. The practice of hiring foreign nurses doesn’t help in solving nursing shortage. Recruiting and retaining strategies should be carefully studied in order to increase the number of working nurses. The shortage in the Arab world is a noticeable problem in which a lot of efforts need to be done in many areas to overcome this shortage.
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