Nursing Shortage

Jordan University of Science and Technology

Faculty of Nursing

Analysis Barrier Paper: Nursing Shortage

Prepared by:

Ashraf Al-Smadi

Advised by:

Dr. Yaseen Hayajneh

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Abstract

The objective of this analysis barrier paper is to elucidate the significance of

nursing shortage as one of the most managerial issues today. This barrier is described

and investigates the effects of nursing shortage on nurses’ satisfaction, and patient’s

care is clarified, by the end of this paper we can conclude that nursing shortage is one

of the most significance barriers which impact on nursing actions and quality of

nursing services.

Many studies revealed that inadequate workplace social support among nurses,

affects negatively on nurses job satisfaction, job performance, and the quality of

nursing services, also it may lead to nurses’ burnout and turnover, which make nurses’

shortage problem more exaggerated (AbuAlrub, 2007, Mrayyan 2005, AbuAlrub,

2004, AbuAlrub, 2006). Implications for nursing administration and the proposed

solutions or strategies for this barrier that may develop as a result of nursing shortage

also were discussed.

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Nursing Shortage

Introduction and Significance:

Nursing shortage is considered as a major barrier that affects the nurses’

productivity, efficiently, affectivity, and competency of nursing care services and their

commitments to the healthcare organization that they work for.

Nursing shortage is one of the barriers that need awareness and intervention from

all health care parties (AbuAlrub, 2007). Nursing practice problems; including the

nursing shortages, is not stable as it matches with the locally and globally increasing

changes in healthcare (Mrayyan, 2007). Although nurses provide 24 hours a day of

patients care; without a sufficient number of nurses to staff hospitals, patient care will

suffer (AbuAlrub, 2007).

Healthcare organizations should worry about the pleasure or satisfaction of their

consumers and be trained and learn how to maintain or retain a sufficient number of

nurses to maintain a quality of nursing care. Locally, in Jordan like globally, the

decline in the number of nurses is a result of slow salary increases for nurses; fewer

women are selecting nursing careers, a decrease in the number of nursing faculty

(AbuAlrub, 2007). Goodin (2003) reported on research that has found four main

factors contributing to the nursing shortage in the USA. These factors are the

declining enrollment in nursing schools, poor public image of nursing, the aging RN

workforce population and the changing work climate.

In addition, nursing shortage is a universal barrier that most of the countries

suffered from; there are many factors or causes that may lead to nursing shortage such

as lack of work place social support, job stress, and job dissatisfaction (AbuAlrub,

2004). And many countries experience a shortage of nurses that is predicted to get

worse (Langan J.C & Kao, C.C., 2007). Bednash (2000) pointed out that the future of

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health care in the United States is becoming increasingly dependent on an adequate

supply of RNs. It is estimated that there will be a 20% shortage in RNs available to

fill needed positions by the year 2020 (Buerhaus et al, 2000).

Consequently, the present nursing shortages within American health care sectors.

A survey released in the fall of 2001 revealed that one in seven hospitals surveyed had

a severe nursing shortage with more than 20% of the RN positions vacant, and an

average hospital vacancy rate of 13% for RNs. The survey also illustrated that RN

vacancy rates have increased over 60% of the hospitals surveyed since 1999 (First

Consulting Group, Fall 2001). Understanding the causes, implications, and solutions

to this significance barrier of quality of nursing services is an important initial step in

solving the nursing shortage and assuring continuity of quality of patient care

services.

From my perspective as a nursing management student, the nursing shortage

implies in my career and education. In the Jordan like elsewhere in the world, nursing

shortage is one of the most challenges that the nursing administrators confronted.

Unfortunately, few studies discussed and analyzed the causes of nursing shortage in

Jordan and affect on quality of nursing services.

Definition of Nursing Shortage:

The shortage of registered nurses is not a new phenomenon; nursing shortage is

defined as the inadequate number of qualified nurses to meet the projected demand

for nursing care within healthcare settings (American Association of Colleges of

Nursing, 2003). In addition, World Health Organization (2006) defined nursing

shortage as a situation where the demand for nurses is greater than the supply. More

precisely, shortages presented when employers responded too slowly to the decreased

supply of nurses by increasing wages (Newschaffer and Schoenman 1990).

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Literature Review:

The healthcare system in Jordan is composed of 29 governmental hospitals, 56

private hospitals, 2 large university-affiliated teaching hospitals, and many primary

care clinics which are directed by The United Nations Relief and Works Agency

(Mrayyan, 2007). Many Jordanian nurses leave to work in Gulf countries, in Canada,

and in the United States because of the higher salaries offered there, therefore;

creating a nursing shortage locally and many Jordanian nurses have left the nursing

profession because of burnout and a non supportive work environment (AbuAlrub,

2007). Worldwide, there have been many changes in hospital settings including

nursing shortage which leads to an increased workload, dissatisfied nurses and a

tendency to leave the service, which in turn reflects negatively on quality of nursing

services and patients’ outcomes (Mrayyan, 2007). Meanwhile; World Health

Organization (2003) declared that the most critical issue facing health care systems is

the shortage of the people who make them work.

The impacts of nursing shortage on quality of nursing services and patients care

was considered broadly in western literature; but there are absent studies that

discussed the relationship between nursing shortage and quality of patients outcome

in Jordan. Only one study discussed this barrier in Jordan, specifically, nursing

shortage in Jordan has carried out by AbuAlrub, which titled “Nursing Shortage in

Jordan: What is the Solution?” The study explored factors that affected nursing

shortage in Jordan, and ended up with solutions to manage these factors.

Factors were categorized as: organizational, social, cultural, and economical

factors. Beginning with the organizational factors; the decline in the number of nurses

was a result of slow salary increases for nurses, fewer women were selecting nursing

careers, a decrease in the number of nursing faculties, and unattractive work

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conditions. The social factors that affect nursing shortage include the both of a low

salary of nurses is one of the major reasons for nurse's dissatisfaction and turn over

and nursing is still seen as a woman’s job and involving unclean duties. In the other

hand the cultural factors includes families' rejection of a nursing profession for their

daughters because of night shifts, and married nurses would leave their jobs, if their

husbands can afford a good living, to focus on their maternal and spousal roles. Other

factors effect nursing shortage was economical factors which manifested by small

number of nursing schools compaired to large population in Jordan, minimal budget

and funds to support education, and less high degree faculties of nursing in Jordan.

The study findings emphasize the causes of nursing shortage and proposed five

strategies to deal with the nursing shortage in Jordan. In addition, the researcher

concluded that nurse researchers, clinicians, educators, and administrators need to

work collaboratively to actively deal with the issue of nursing shortage and work

conditions need to be improved, so that nurses can feel more satisfied and more

committed to their profession.

Nursing shortage among Jordanian hospitals was discussed partially in the study

which conducted by Mrayyan (2007), which titled “Nursing practice problems in

private hospitals in Jordan: Students’ perspectives”. Was described nursing shortage in

three Jordanian private hospitals, and explored causes of the nursing shortage and

proposed solutions.

Nursing practice problems was studied through evaluation of student work in the

"nursing leadership and management" course. Students (n=62) were assigned in 8

groups; each consisted of 4–6 students. Each group had to select a practice problem,

identify its causes, and propose some practical solutions. Practice problems included:

nursing shortage, job dissatisfaction, burnout, and turnover.

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The results of this study revealed that the main causes of nursing shortage in

Jordan were: low salaries, poor working conditions, non-supportive nursing

administration, burnout, workload, mandatory overtime, and the decrease in nursing

supply. And the major causes of job dissatisfaction included lack of job advancement

opportunities, long hours of work, poor physical working conditions, heavy workload,

and low payment as a causes which also contributing to nursing shortage (Mrayyan

2007).

The study findings emphasize the causes of nursing practice problems in

Jordanian private hospitals and proposed solutions from student's perspective to deal

with these problems. In addition, the researcher concluded the nurse leaders,

healthcare administrators, policy-makers, employers, and all nurses must work

actively to ensure quality practice environments. Nursing shortage influence patients

in many ways such as patients’ satisfaction and patients care.

Other study intended to partially solving the nursing shortage was conducted by

Langan which titled "Exploring Incentives for RN's to return to practice: a Partial

Solution to the Nursing Shortage", the purposes of this study is to illustrate the

reasons why nurses who maintained their RN licenses left the practice of nursing, also

to examine the type of work environment and resources needed to motivate

unemployed RNs to return to practice, and type of skill sets for the inactive RNs to

feel secure to return to active practice.

A descriptive research design was conducted between 2003/2004. A screening

questionnaire, containing demographics, respondents’ current work status, the practice

setting where they had ever worked, reasons why they may never have worked in a

position requiring an RN license, and the conditions to return to practice.

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The questionnaire was sent to 1,004 randomly selected from RNs in Missouri to

determine who were licensed but not practicing. Fifty-two full questionnaires were

mailed and 33 (63%) were returned. Qualitative data gathered by required narrative

responses from the nurses concerning skill sets that they feel were required before

they return to practice, the reasons why they choose not to practice nursing, and the

most compelling factors that motivate them to return to practice.

Over 30% of the inactive nurses left the practice of nursing as a result of

workload, 12-hour shifts, no enough time for patients, paperwork, and new

technologies. The work environment needed to motivate RNs to return to practice

were: 42.4% indicate money, 21.2% to improve working conditions, 9.1% need

security factors such as RN refresher courses and health insurance, 9.1% need

policies, and only 3% indicate need of improved interpersonal relations. The skills

required most often by RNs to feel confident to return to practice were: medication

and medication calculation, a need to review basic skills, intravenous insertion, site

maintenance, entire refresher course, work with a preceptor, team concepts, physical

assessment, and ACLS (Langan, 2007).

The study findings described the reasons of why RN's left the practice of nursing,

the needs of inactive RN's to return to practice and mentioned some factors that seem

to enhance the retention of nurses such as: recognition for achievement, an

appreciation for the work itself, responsibility or autonomy, and opportunities for

personal growth and advancement.

In an integrated literature review regarding nursing shortage, Nursing-sensitive

quality indicators have been defined as patient outcome measures that are most

affected by nursing care. The American nursing association (ANA) has identified ten

nursing-sensitive quality indictors, which include measures of staffing, clinical

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outcomes, and patient satisfaction. The staffing measures are skill mix, and total

nursing care hours provided by patient day. Patient satisfaction measures include

satisfaction with pain management, educational information, and nursing care in

general. Nurse staff satisfaction is also included as a nursing-sensitive quality

outcome indicator. Therefore, the quality of all these indicators not achieved perfectly

if hospitals have insufficient number of qualified nurses (Patricia W. Stone, 2002).

Many studies revealed that inadequate workplace social support among nurses,

affects negatively on nurses job satisfaction, job performance, and the quality of

nursing services, also it may lead to nurses’ burnout and turnover, which make nurses’

shortage problem more exaggerated (AbuAlrub, 2007, Mrayyan 2005, AbuAlrub,

2004, AbuAlrub, 2006).

Impact of Nursing Shortage on Quality of Patients Care:

From the findings of previous studies, we can conclude the impacts of nursing

shortage on quality of nursing services and patients’ care outcome. Nursing shortage

affect negatively on quality of patients’ care outcome. When the health care facilities

have inadequate number of qualified nurses, the nurses will have workload, the nurses

level of stress will be increase and the nurses becomes more likely to be dissatisfied

with their job, so the delivered nursing care services will be insufficient and

inappropriate in some situations. On the long time of this condition the opportunity of

burnout, absenteeism and turnover will be result, so it is more likely to force the

nurses to leave their profession in their healthcare organizations which that

contributing to release nursing shortage problem.

But when the healthcare organizations have a sufficient number of qualified

nurses, the nurses will deliver nursing care services in productivity, efficiently, and

affectively ways and nurses will become more capable in performing their duties. So

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they will deliver high quality level of healthcare to their patients, with diminishing of

medical error occurring.

In addition, the nurse-patient relationship will be collapse as a result of nursing

shortage which creates stress, dissatisfaction, and emotional exhaustion. So it’s more

likely to develop patient's dissatisfaction with health care services in general, and

nursing services specially. At this situation, the patients are more likely to seek for

health care services in another healthcare organization, which affect the possibility of

organization stability and thriving.

Implication for Nursing Management:

The findings of the previous studies that investigated nursing shortages and its

impacts on quality of nursing services and patients outcomes; point out many

implications for nursing administration.

Competent patient care and assuring quality, is the cornerstone of nursing practice.

The nurse healthcare administrators, leaders, policy-makers, employers, and all nurses

must work actively to solve this problem and combine their efforts in nursing

administration, education, and practice to overcome nursing shortage. Jordanian

nurses should focus on increasing autonomy, decreasing patient–nurse ratio,

increasing salaries and benefits, increasing the number of nurses, and creating a

positive practice environment which will make the nursing services more productive.

In additions, qualitative studies should be conducted to explore in-depth

understanding of current nursing shortage.

Nursing executives are expected to benefit from the role of increase number of

nurses among healthcare organizations in enhancing nurses care outcome, which will

affect positively in the quality of nursing care services and the satisfaction of both

nurses and consumers. Sufficient number of qualified Jordanian nurses among

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healthcare sectors is predicted to reduce the level of workload, which will improve job

satisfaction, and enhancing nurses’ efficiency and retain.

Proposed Solutions:

To manage nursing shortage among Jordanian healthcare organizations, there are

many proposed strategies that the nursing administrators can build up. Nursing

administration should adopt comprehensive strategies to deal with nursing shortage in

Jordan. Some of these strategies to work out these problems were mentioned as: to

conduct studies and disseminate the results concerning work factors by nurse

researchers, to unite active political leadership by the Jordanian nursing higher

council and the nursing associations in Jordan, to start believing in the incredible role

that nurses play in the health care system by nurses, to allocate funds from the annual

budget for expanding nursing schools to increase the number of graduate students by

the government, and to expand funds for nursing education scholarships in countries

with advanced nursing education levels by nursing leaders (AbuAlrub, 2007).

In addition, Mrayyan (2007) proposed some solutions from student's perspective

to manage nursing shortage in Jordan such as creating a positive practice environment

to provide high quality of nursing care and decrease the level of burnout and turnover

among nurses and will help in nurses’ retention. And use of media to help to polish

the image of nursing and increase the public’s awareness about the incredible role of

this profession; and focusing on higher education by providing scholarships to pursue

Master and PhD’s degrees. Consequently, to overcome nursing shortage, the

Jordanian nurses should focus on decreasing patient–nurse ratio, increasing autonomy,

increasing salaries, rewards & benefits, and increasing the number of nurses within

Jordanian hospitals.

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As a final point, orientation and training programs are recommended to be

implemented by Jordanian nursing stakeholders and Jordanian nursing policy makers

to enhance the communication and collaboration among Jordanian nurses, and to

assure that the Jordanian nurses are familiar and oriented with the obtainable

resources, equipment, skills, and procedures that are required to achieve their job

duties, and attaining the desired level of nursing services for patients.

Conclusion

Nursing shortage is one of the most significant barriers of quality of nursing care

and patient's outcome that the nursing administrators faced today. The present of

nursing shortage may lead to nurse’s stress, anxiety, burnout, and turnover.

The studies revealed that nursing satisfaction and job performance were adversely

affected when the number of qualified nurse was insufficient to meet patients need

and the quality of patients’ care will also adversely affected as a result of nurses

stress, dissatisfaction.

Nurse researchers, educators, clinicians, and administrators need to work together

to actively deal with the issue of nursing shortage. All of the health care provider must

be work collaboratively to improve the nurse practice environment, to ensure quality

of practice environment for the reason that when the nurse practice environment

improved, nurses can feel more satisfied and more committed to their profession and

will reduce rate of the burnout and turnover in all health care sectors.

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References

American Association of Colleges of Nursing, 2003. Nursing Shortage Facts Sheet.

AbuAlRub, R. (2004). Job Stress, Job Performance, and Social Support Among

Hospital Nurses, Journal of Nursing Scholarship, 36 (1): 73-78.

AbuAlRub, R. (2006). Replication and Examination of Research Data on Job Stress

and Coworker Social Support with Internet and Traditional Samples,

Journal of Nursing Scholarship, 38 (2): 200-204.

AbuAlRub, R. (2007). Nursing Shortage in Jordan: What is the Solution, Journal of

Nursing Scholarship, 23 (2): 117-120.

Bednash G, (2000). The decreasing supply of registered nurses: inevitable future or

call to action. JAMA, 283; 2985-2987.

Buerhaus P, Staiger D, Auerbach D (2000). Implications of an aging registered nurse

workforce. JAMA 283:2948– 2954.

First Consulting Group: The Healthcare Workforce Shortage and Its Implications for

America’s Hospitals. Long Beach, CA, First Consulting Group, Fall 2001.

Goodin H, (2003).The Nursing Shortage in the United States of America: an tegrative

review of the literature. Journal of Advance Nursing 43:335– 350.

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A Partial Solution to the Nursing Shortage. Journal of Professional

Nursing, 22 (1); 13-20.

Mrayyan, M. (2005). Nurse Job Satisfaction and Retention: Comparing Public to

Private Hospitals in Jordan, Journal of Nursing Management, 13: 40-50.

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Mrayyan, M.T. (2007). Nursing practice problems in private hospitals in Jordan:

Students’ perspectives. Nurse Education in Practice 7, 82–87.

Newschaffer and Schoenman (1990). From wwww. www.trpi.org.

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