NURSING SHORTAGE IN THE HOSPITAL

Nursing Shortage in the Hospital

Alodia Farichai
University of Pelita Harapan

Author note
Alodia Farichai, International Executive Master of Management and Master of Hospital
Management, University of Pelita Harapan
This paper was for the final scholarly work of patient care management and nurse
administration module
Correspondence concerning this paper should be addressed to Alodia Farichai, Kemang
Selatan VIII, Gg. Kembang Buntu No.2, South Jakarta, Indonesia. Contact:
alodia.farichai@gmail.com

NURSING SHORTAGE IN THE HOSPITAL

Abstract

The health care field is a demanding one, which is why it's so difficult to not only find
great nurses, but also hold on to them for the long haul. The nursing shortage is causing
staffing problems and delays in care in hospitals. There are many factors causing the
shortage: an aging nursing workforce, declining numbers of people seeking nursing careers;
dissatisfaction with work environments; more competitive wages in other professions;
alternative career choices for women; an aging population that requires more health care.
Hospitals across the nation are experiencing difficulties recruiting and retaining
nurses.Without a sufficient number of nurses, patient care and safety may become
compromised. As competition and expenses increase, hospital executives must prepare
administrators to effectively lead during a time of transformational change in our healthcare
system.
Keywords: nursing shortage, hospitals, retention, recruitment

NURSING SHORTAGE IN THE HOSPITAL

Nursing Shortage in the Hospital

Introduction
The health care field is a demanding one, which is why it's so difficult to not only find
great nurses, but also hold on to them for the long haul. Due to increasing stress from the
nursing shortage, health care organizations across the globe including Indonesia are feeling
pressure to quickly improve their recruitment and retention techniques. Evidences correlating
nurse staff levels to quality of care are proving that the nursing shortage is directly effecting
patients. As a result, there is a growing realization that the supply of appropriately prepared
nurses is inadequate to meet the needs of a diverse population - and that this shortfall will
grow more serious over the next 20 years.
According to the American Association of Colleges of Nursing (2010), the United
States is projected to have a nursing shortage that is expected to increase as the baby-boom
generation age and the need for health care grows. With this problem looming, the
importance of nurse shortage in the hospital setting becomes substantial.
As competition and expenses increase, hospital executives must prepare
administrators to effectively lead during a time of transformational change in our healthcare
system. Hospitals across the nation are experiencing difficulties recruiting and retaining
nurses. Low budgets and a highly competitive market have become barriers for attracting new
nurses.
Without a sufficient number of nurses, patient care and safety may become
compromised, while nurses themselves may be overwhelmed, distressed, and dissatisfied.
High patient-to-nurse ratios have been shown to lead to frustration and job burnout, which is
linked to higher turnover. An inadequately staffed nursing force has been found to play a
negative role in patient outcomes. In contrast, studies have demonstrated that hospitals with
low nurse turnover have the lowest rates of risk-adjusted mortality and severity-adjusted
length of stay.

NURSING SHORTAGE IN THE HOSPITAL

Statement of the Problem

What: The nursing shortage threatens the stability and quality of the health care system
When: Hospitals are feeling the shortage now.
Why: There are multitude of factors contributing to the shortage. Cause include an aging
nursing workforce, declining numbers of people seeking nursing careers; dissatisfaction with
work environments; more competitive wages in other professions; alternative career choices
for women; an aging population that requires more health care.
Who: The greatest concern is the shortage of Registered Nurses. However, there are also
shortages of Licensed Practical Nurses, Certified Nursing Assistants and nurse educators.
Where: The shortages are most severe in hospitals.
Causes of the Nursing Shortage
The attractiveness of health careers has diminished significantly.
Perceptions of the healthcare field as insecure and low tech, shift week 24 hours/7 day
per week demands. and as offering less psychic reward (i.e., in hospitals, shorter lengths of
stay limit nurses ability to form strong relationships with patients and their families)
Other career options.
As new opportunities have opened up for young women and stresses have been added
to the profession, many are opting to choose other careers besides nursing. Women and men
are weighing their interests with a career choice that will bring them worthy compensation as
well as enhancing their quality of life. Unfortunately, nursing is currently falling short on
both of these. Nursing is still largely considered a womens career. Women are now pursuing
many competitive, attractive and lucrative careers that were impossible to achieve thirty years
ago, so fewer women are entering the nursing professionand men still shy away from the
field. Only 6% of nurses are male and that number doesnt show signs of growing.
The nursing workforce is aging.

NURSING SHORTAGE IN THE HOSPITAL

The average age of registered nurses has also increased dramatically in the past two decades
and now is 45,within the coming decade 40% of nurses will be over age 50, less able to
perform the heavy lifting or work the long hours required and nearing retirement.
Declining Nursing School Enrollments and Nurse Educators
Reductions in nursing program enrollments narrow the pipeline of young people
entering the nursing profession. Clinicians who have paid their dues in front-line work,
academic study, research and teaching are now reaching retirement age. With few teachers,
there are fewer openings for students.
Bad working conditions
Dissatisfaction with the work environments due to factors such as inadequate staffing,
heavy workloads and increased use of overtime in hospitals and nursing homes steers young
peoplesinterest away from entering the nursing profession and moves those in the profession
toward early retirement. Job dissatisfaction amongst nurses is three to four times higher than
for other professions. High patient-to-nurse ratios have been shown to lead to frustration and
job burnout, which is linked to higher turnover.
Wages
Still another factor affecting the nursing shortage is wages. While nursing wages have
increased dramatically over the past decade, they still lag behind other professionals with
equal training. For most nurses working in non-hospital settings, the typical wage is not
enough to support an average familys needs. Even many hospital-based nurses, where wages
have risen the most in recent years, find it difficult to sustain themselves financially.
Retaining nurses is difficult.
Thirty percent of nurses under 30 years old leave nursing within 3 years of practice.
Increased demand as a result of population aging.
The population is aging and needs more health professionals to meet its increasing
health care needs. Hospitalized patients are sicker and need more specialized care, and the
need for care in other settings, such as nursing homes, is increasing.

NURSING SHORTAGE IN THE HOSPITAL

Reccomendations and Strategies

Retention - create an internal environment to retain more staff. To retain valued staff, the
facilitys leadership must create a working environment that:
Introducing greater flexibility into work environment structure and scheduling
programs;
Rewards accomplishment
Implementing appropriate salary, attractive compensation and benefit programs. Base
compensation on education and work-related skills in addition to years of service.
Use hiring practices that encourage retention and discourage quick fix approaches
that may lower morale among current employees.
Ensuring adequate nurse staffing. Achieve staffing levels that will provide optimal
patient outcomes, staff satisfaction and organizational objectives through the
development of appropriate models of care. The models should define the roles of
technical and support staff and their responsibilities and delineate scopes of nursing
practice with corresponding competencies.
Respect: recognize and treat nurses as professionals. Develop collaborative practice
initiatives among nurses, physicians and other disciplines to develop mutual respect.
Insist on work environments free of fear and intimidation. Empower nursing staff as
leaders; give them an active role in the decision-making process
Establish effective mentoring programs for new nursing graduates. Establish
mentoring programs for aspiring nurse leaders; offer mentors to new nurse managers.
Supporting the role of nursing leadership. The nurse managers position description
should emphasize retention of staff at the front line of care delivery. Concurrent with
providing nurse managers the tools to retain staff, nurse managers must also clearly
understand their responsibility and accountability for nurse retention.
Recruitment
Initiate formal recruitment programs that will encourage individuals to pursue nursing
and other health-related careers. Place an emphasis on encouraging schoolaged and
college-bound students to consider health careers.
Launch a media campaign to: increase awareness about the nursing shortage,
highlight the positive aspects of careers in nursing, call attention to the programs in
place to help students pursue nursing degrees. Targeted audiences could include

NURSING SHORTAGE IN THE HOSPITAL

guidance counselors, school nurses, scout leaders, and others. Practicing nurses could
help deliver the message.
Create scholarships and loan repayments for nurse education to: allow more needbased students to pursue nursing careers, make pursuing a nursing education attractive
more attractive to more people, increase the size and expand the diversity of the
nursing workforce
Conclusion
In order to for nursing to survive and thrive, the cyclical swings of the nursing
shortage must be addressed. While solutions to this problem will be discussed more fully in
other articles, the author would offer the following thoughts. As already stated, failure to
address the work environment will make any strategies to address overall nursing workforce
planning and the nursing shortage very difficult.

NURSING SHORTAGE IN THE HOSPITAL

References

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Fact Sheet (9-09.DOC). USA: AACN. Retrieved July 1, 2016 from:
http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf
International Council of Nurses (1999). Nurse retention, transfer and migration. Retrieved
July 1, 2016 from the World Wide Web: www.icn.ch/psretention.htm
Grant, Rebecca. (2016, February 3). The U.S. Is Running Out of Nurses. Retrieved July 1,
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