Running head: NURSING SHORTGE ISSUES 1

Nursing Shortage Issues

Kayo Estes

NURS 211

Nursing Shortage Issues

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Cherry and Jacob (2014) argued that periods of long term nursing shortages have been

one of the complex issues in health care. This paper will support their argument demonstrating

that there have been shortages in the past, that there are current shortages, and that it is predicted

that there will be future nursing shortages as well. It will also be shown that having a shortage of

nurses creates ethical dilemmas for the nursing profession and the patients for whom they care.

This discussion will finally address the role of the nurse in improving client centered care in the

face of a reduced nursing force.

Nursing Shortage Confirmations

According to Rich and Nugent (2010), the nursing population is getting older and many

older nurses will retire in the next 10 to 15 years (p. 228-229). With older nurses retiring, there

would need to be younger nurses being graduated into the workforce in adequate numbers to

replace those older retiring nurses. To look at an older, but representative, statistic created back

in 2004, 83.2 % of Registered Nurses (RNs) were then working in their professions. Of that 83.2

%, only 8.1 % were under the age of thirty. A casual look at this statistic shows that the 8.1 % of

RNs under thirty who represent approximately ten years of RNs being graduated into the

workforce cannot replace the 75.1 % of RNs working after age thirty in the approximate forty

working years before their retirement (Rich & Nugent, 2010).

It is well understood that as the population ages the individual health care needs increase.

The baby boomer generation is moving into old age adding to the numbers in need of additional

health care. Because of technological advances, increased trends toward preventive care, and

an aging US population, the demand for nurses is expected to grow 23 % by 2016 (Rich &

Nugent, 2010, p. 229). But as the demand for nurses grows, the Health Resources and Services
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Administration suggested, the availability of new graduates to meet the projected demand is

decreasing (as cited in Duvall & Andrews, 2010, p. 310).

Ethical Issues of a Nursing Shortage

The shortage of nurses affects both the quality of patient care and the lives and working

environment of the nurses themselves. Regarding patient care, Needleman et al. noted that when

hospital staffing has a shortage of nurses, there are more reported cases of pneumonia,

gastrointestinal bleeding, urinary tract infections, and the length of patients hospital stay is

increased (as cited in Duvall & Andrews, 2010, p. 313). American Nurses Association (2011)

mentioned that nursing shortage is related to increased risks of patient complications and

mortality rates. Specifically, patients mortality risk was up 2 % while a shift was being staffed

by fewer than the recommended number of nurses. In addition, the mortality of patients

expanded by 4 % when the patient was in an environment of lots of discharges, admissions, and

transfers when all occurring during a single shift.

Such shortages affect the nurses themselves. Buerhaus et al. reported that, when polled,

most RNs (79 %) felt that the quality of care was significantly impacted when there was a

nursing shortage. This loss of quality was most evident in the ability to keep the patient/nurse

environment safe, to be able to find complications early, and to get to spend quality nurse to

patient time (as cited in Duvall & Andrews, 2010, p. 313).

Aiken et al. demonstrated how the nursing shortage also has a cascading effect on its own

problem of to few nurses (as cited in Duvall & Andrews, 2010, p. 313). When even one patient

is added to a nurses patient load, it was found there was a 23% increase in burnout and a 15%

increase in job dissatisfaction. So, the condition of to few nurses even caused more nurses to

leave the nursing workforce, exacerbating the already difficult problem of nursing shortage.
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The Role of the Professional Nurse in Nursing Shortage Situations

Certainly, patients are the center of health care. To enhance patient centered care as it

relates to the issues of nursing shortage that were discussed above, what would the professional

nurse be able to do?

Zolnierek and Steckel (2010) argued nurses are the final contact point with the patient in

a line of forwarded information and directives. This position ensures that the nurse will be the

one to actualize all mistakes and misinformation that may have been picked up in this

communication line. So, this position is most critical in that, here, the nurse can screen out and

protect against misinformation and/or mistaken directives being actually performed on the

patient. In taking this role seriously, the nurse must first be skilled at identifying the areas of

concern and quickly identifying the specific problem. By having this skill, the nurse makes an

opportunity to effectively correct the possible error and to enhance the safety of the patient.

Obviously, during periods of nursing shortages, these skills are most important. Zolnierek and

Steckel (2010) also suggested a commitment to a culture of safety and a positive nursing

practice environment is the most important strategy in the health care organization (p. 264).

Alternative staffing like using more licensed vocational nurses and respiratory therapist,

floating staff, mobilizing managers and other nondirect care nurses, and controlling demand are

helpful examples of organizational strategies to effectively preserve a safe environment for the

patient (Zolnierek & Steckel, 2010).

Conclusion

There are many factors that cause nursing shortage. Some of them are the aging nursing

population, the aging baby boomer population, and decrease in new nursing students. Nursing

shortage directly affects nurses in their work environment by having each nurse assume more
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responsibility and greater workload. The result is burnout causing them to leave the workplace.

Of course, the issues affect the quality of patient care increasing risks of complications and

mortality. The issues are serious and complicated, and have been for a long period. From

understanding and analyzing the issues, effective strategies and ideas could be developed to

enhance patient centered care. In any work environment, the professional nurse must understand

the responsibility of providing patients the highest quality of care.

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References

American Nurses Association. (2011, June). Understanding the nursing shortage and what it

means for patients. Retrieved from http://www.nursingworld.org/

Cherry, B., & Jacob, S. R. (2014). Contemporary nursing: issues, trends, & management.

St. Louis, MO: Elsevier

Duvall, J. J., & Andrews, D. R. (2010). Using a structured review of the literature to identify

key factors associated with the current nursing shortage. Journal of Professional

Nursing, 26 (5), 309-317. doi:10.1016/j.profnurs.2010.02.002

Rich, K. L., & Nugent, K. E. (2010). A United States perspective on the challenges in nursing

education. Nurse Education Today, 30, 228-232. doi:10.1016/j.nedt.2009.10.015

Zolnierek, C. D., & Steckel, C. M. (2010). Negotiating safety when staffing falls short. Critical

Care Nursing Clinics of North America, 22 (2), 261-269.

http://dx.doi.org/10.1016/j.ccell.2010.03.014
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