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Nurses are the main professional and primary component of the staff in most health systems, and their contribution is recognized as essential in meeting these development goals and delivering safe and effective care. For many countries, one of the most problematic current human resource challenges is a shortage of nurses (Seifert, 2000).Nursing shortage is not just an organizational challenge or a topic for economic analysis; it has a major negative impact on health care. Failure to deal with a nursing shortage - be it local, regional, national or global - is likely to lead to failure to maintain or improve health care (Johnson, 2000). This paper will discuss the global nursing shortage and strategies for recruitment and retention. Causes of the current nursing shortage will be described, as well as, possible solutions to this shortage and identify potential or actual outcomes of the nursing shortage. In addition, nursing shortage in UAE will be explained.
Overview of nursing shortage
Andris, Nicholas, and Wolf, (2006) defined nursing shortage as "a situation where the demand for nurses is greater than the supply, as is currently the case in the United States and several other developed nations." (p.147).The nation's nursing shortage is projected to worsen significantly over the next two decades if current trends continue (Department of Health and Human Services, 2000).The report, titled Projected Supply, Demand, and Shortages of Registered Nursessays that" the shortage will deepen because increasing numbers of nurses are retiring while too few are entering the profession". The national supply of registered nurses in 2000 was estimated at 1.89 million, while the demand was estimated at 2 million, for a shortage of 110,000, or 6 percent. In previous decades, nursing shortages in many countries have been a cyclical phenomenon, usually as a result of increasing demand outstripping static or more slowly growing supply of nurses. At the beginning of this new millennium, the situation is more serious. Driven by growing and ageing populations, demand for health care and for nurses continues to grow, whilst the supply of available nurses has actually fallen in some developed and developing countries(Buchan, 2002). Shortages may not relate only to clinical nurses; in some countries there is a critical shortage of nurse tutors and educators, which will constrain any attempts to increase the numbers of educated nurses(Goodin, 2003).
Reasons for nursing shortage
On the other hand, the amount of nursing responsibilities has increased and it may be possible to argue that the patients are more ill as a result. In addition, the average age of nurses' increases while the number of applications to baccalaureate programs has decreased (Stone, Clarke, Cimiotti, & Correa-de-Araujo, 2004)furthermore, new opportunities became available for the nursing practice, which further drains the number of nurses available for the acute care settings.
Defining professional identity, of course, is not straight forward. It invites thorny questions of what it means to be a nurse and the strength of nursing's claim to be a profession. In the nursing literature as a whole there are many concerns about nursing's lack of recognition and the possible reasons for this (Wieck, 2003). Several studies have been done to understand how nurses feel about their career. About 5 years agoThupayagale, &Dithole, (2005) identified that nursing has for many years struggled with an inner hunger, a deep need for professional congruency and effectiveness. The perception by many people, except those aligned to nursing, see nursing as an inferior and inadequate undertaking to be regarded as a profession.While Anderson, (2000, p. 53) marks it as a 'doing' culture that 'values or at least tolerates being oppressed'. Salvage (2006, p. 260) argues that nursing perceived as 'dirty work' for 'softies'. Forsyth, & McKenzie, (2006) identified some of the dissatisfaction as stemming from frequent schedule changes, overloads, shift work, lack of appreciation by superiors and colleagues, as well as lack of childcare. Inadequate pay was identified as a lesser problem. A comprehensive literature review done by Hayes, Pallas, Duffield, Shamian, Buchan, Hughes, et al (2006) concluded that the dissatisfaction among nurses focused on conflicting expectations from nurses and managers due to regulation of cost, lack of opportunity to provide comprehensive nursing care, and disillusioned workforce or loss of confidence in, and frustration with, the healthcare system.In addition, limitations to comprehensive care were identified because nurses are overloaded with the number of assigned patients, massive paperwork for billing purposes, and short staffing to cut cost are the major reasons for nurses job dissatisfaction.
Nursing shortage impacts
A recent study which was conducted by (Buerhaus, Donelan, Ulrich, Norman, Desroches, &Dittus. 2007) of the nursing shortage shows that views on the shortage's effects on hospital patient care vary widely. The researchers analyzed the results of three national surveys of registered nurses, physicians, and hospital executives. The results of the study show that the nursing shortage has negatively impacted communication, nurse-patient relationships and timeliness of care and overall efficiency. The study further shows that there are broad differences among various health care professionals regarding approaches to improving patient care safety.
According to this study showed that nursing shortage has the following effects. First, it increases nurses` patient loads which Increases the risk for errors. Besides, it increases risk of spreading infection to patients and staffs. Finally, it Increases risk for occupational injury which might lead to Increased deaths.Consequently, it affects the nurses' life and career. As was explained in a study was conducted by (Aiken, Clarke, Sloane, Sochalski, & Silber,October, 2002) that an Increase in nursing turnover, Increase perception of unsafe working conditions, contributing to increase shortage, and hindering local or national recruitment efforts, as well as, Increase the nurses chance of getting psychiatric help because of massive amounts of stress.
Retention & Recruitment
Research indicates that nurses might be attracted to and retained at their work because of opportunities to developprofessionally, to gain autonomy and to participate in decision-making, whilst being fairly rewarded. Workplace factors can be critical both in encouraging retention to decrease the nursing turnover and recruitment (Atencio, Cohen, &Gorenberg, 2003;Stone, Tourangeau, Duffield, Hughes, Jones, O'Brien-Pallas, et al. (2003).Kishi, (2004) defined retention as "the strategies focus on both retaining current nurses and encouraging those who have left nursing careers to reenter the workforce." As well as recruitment as defined by University of Texas Health Science Center at San Antonio (2005) as" the ability to continuously attract individuals into the nursing workforce, in order to increase the supply of nurses." There is some evidence that a participative management style, flexible employment opportunities and access to continuing professional development can improve the retention of nursing staff as well as patient care (ANCC, 2003).Many of these issues are addressed in the "magnet hospital" model, which has developed over the last 20 years. It highlights the benefits of a systematic approach to staff involvement in improvements in nurse recruitment or retention and in improved health outcomes (Kramer, Schmalenberg, 2004).
The Magnet hospital
Magnet hospital principle focuses on three main points according to the several studies which was conducted topresent and establish the main characteristics of the magnet hospitals to limit the nursing turnovers and encourage nursing recruitment and retention. Upenieks, (2005) discussed that first the administration should be Participatory and with supportive management style, Well-prepared with qualified nurse executives and with adequate nursestaffing. Second Aiken, Havens, & Sloane, (2000) insisted that the professional practice should Emphasis on teaching responsibilities of staff and Professional autonomy and responsibility. Finally, the Professional Development which is according to Trossman,(2002) will be accomplished by planned orientation of staff,Emphasis on service/continuing education, Competency-based clinical ladders and Management development. Not all hospitals are suffering a labor shortage. Some "magnet hospitals" are out-competing their market with low turnover and high staff morale. These magnet institutions promote their nursing staffs' job satisfaction, both professionally and personally (Kramer, 2006).
UAE "needs 7,000 more nurses"
In the United Arab Emirates (UAE), where Emirati nationals constitute an average of 3% of the total number of nurses working in Ministry of Health (MOH) facilities, the dependency on foreign nurses has been, and remains, significant. There are about 23,000 nurses and midwives across the UAE, well short of the 30,000 who are needed (FDON 2003). Indeed, Emirati nurses with Diplomas in nursing are now encouraged and supported by the UAE government to enroll in BSN bridging programs, available in the country and abroad (Al-Rifai, & van der Merwe, 2002). However, despite all the efforts to nationalize the nursing workforce, the reduced numbers of nationals in the nursing profession remain a reality in the UAE. Several factors may be contributing, in varying degrees, to this predicament. To better understand some of these factors, one may need to step back and examine the socio-economic factors as well as the cultural customs that have, over the years, shaped the UAE and its people(El-hadad, 2006).
The persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a misdistribution of nurses. Nurses are expressing job dissatisfaction, experiencing moral distress, and wondering about their inability to provide quality patient care. Recommendations for possible action include re-envisioning the profession of nursing, empowering nurses, providing support, and restructuring the work environment.
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