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

1

|

Page

Nursing Shortage

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 patients 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.

2

|

Page

Nursing Shortage

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 of3

|

Page

Nursing Shortage

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).4

|

Page

Nursing Shortage

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

5

|

Page

Nursing Shortage

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 womans 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 46 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.

6

|

Page

Nursing Shortage

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.

7

|

Page

Nursing Shortage

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

8

|

Page

Nursing Shortage

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. So9

|

Page

Nursing Shortage

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 its 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 patientnurse 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 among10

|

Page

Nursing Shortage

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 publics awareness about the incredible role of this profession; and focusing on higher education by providing scholarships to pursue Master and PhDs degrees. Consequently, to overcome nursing shortage, the Jordanian nurses should focus on decreasing patientnurse ratio, increasing autonomy, increasing salaries, rewards & benefits, and increasing the number of nurses within Jordanian hospitals.

11

|

Page

Nursing Shortage

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 nurses 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.

12

|

Page

Nursing Shortage

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 Americas 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. Langan J.C & Kao, C.C. (2007). Exploring Incentives for RNs to Return to Practice: 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.

13

|

Page

Nursing Shortage

Mrayyan, M.T. (2007). Nursing practice problems in private hospitals in Jordan: Students perspectives. Nurse Education in Practice 7, 8287. Newschaffer and Schoenman (1990). From wwww. www.trpi.org. Patricia W. Stone, (2002). Nursing Shortage and Nursing Sensitive Outcomes. Applied Nursing Research, Vol. 15, No. 2, pp 115-116. World Health Organization, (2003). The world health report 2003: Shaping the future. World Health Organization, (2006). From www.who.int/hac/events/2006/nursing shortage.

14

|

Page