Effective Strategies to Address Nursing Shortages

This article discusses the nursing shortage and proposes effective strategies to address it. The strategies include improving the work environment, involving nurses in decision making, improving retention strategies, and providing effective management and leadership support. The article provides evidence-based arguments for each strategy and recommends a comprehensive approach to addressing the nursing shortage.

Running head: Nursing Shortages 1
Nursing Shortages
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Table of Contents
1.0 Introduction........................................................................................................................3
1.1 Background Information...............................................................................................3
1.2 Thesis Statement.............................................................................................................4
2.0 Counter Argument.............................................................................................................5
3.0 Evidence for Argument......................................................................................................6
4.0 Other Counter Claims.......................................................................................................7
5.0 My argument......................................................................................................................8
5.1 Strategy One....................................................................................................................8
5.1.1 Involvement of Nurses in Decision making...........................................................8
5.2 Strategy Two...................................................................................................................9
5.2.1 Improving retention strategies...............................................................................9
5.3 Strategy Three..............................................................................................................10
5.3.1 Management and leadership support..................................................................10
Conclusion...............................................................................................................................11
Action plan..............................................................................................................................11
References...............................................................................................................................13

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1.0 Introduction
The nursing shortage is a critical matter that impacts not only Canada (Canadian Nurses
Association (n.d.) but also the global healthcare systems (World Health Organization, 2018).
It does also have an adverse effect on the quality of healthcare services to patients. Multiple
studies have been done on the possible causal effects of nursing shortage as well as
recommendations. Researchers have recommended the development of communication
programs as a way of curbing the increasing nursing shortage (Fillion, Truchon, &
L'Heureux, 2014). The Canadian Nurses Association (CAN) (n.d.) also proposed offering an
alternative model of nursing education and assessing the competencies of nursing graduates
among others. Despite the current efforts to fix the Canadian nursing shortage, the prevalence
of nursing shortage is still on the rise. The World Health Organization (2018) warned that if
the issue of nurse shortage is not adequately addressed on time, it is likely that by 2035 the
nursing shortage is to hit 12.9 million from the current 7.2 million.
Furthermore, the incidences of diseases in Canada have been reported to be on the increase
thus burdening the few nurses and making them to be ineffective in the delivery of quality
healthcare services (CAN, 2009). There is, therefore, need for an evidence-based proposal to
help curb the Canadian nursing shortage. The objective of this position paper is to
recommend an effective and workable strategy in addressing the nursing shortage. Other
proposals that have already been made in different literature will be examined and critiqued
and the arguments for the recommendations described in details. An action plan for the stated
proposal will also be provided.
1.1 Background Information
The trend of the shortage of nurses in Canada has become a concern of the department of
health. According to the CNA (n.d.) there was a shortage of 11,000 registered nurses in 2007.
However, if the matter is not adequately addressed and in time, it is projected that by 2022

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nursing shortage of full-time registered nurses will hit 60,000. The report attributes the
shortfall to unhealthy working conditions, high international migration, and low enrolment.
Mancino and Feeg (2014) asserted that nurses are tasked with demanding responsibilities to
care for patients with multiple chronic diseases such as obesity, acute myocardial infarction,
and diabetes.
Furthermore, it is expected that the number of people accessing healthcare services in Canada
to increase as a result of the reforms in the federal health insurance, consequently the demand
for nurses will also increase to provide healthcare services to people. The current nursing
shortage has already lead to considerable problems in the provision of safe and quality
healthcare services for patients (CAN, 2009). A workable strategy is promptly required to
address the current nursing shortage and the unprecedented increase in the future.
1.2 Thesis Statement
I believe that improving the nurse work environment is the most appropriate strategy to
address the problem of nursing shortage in Canada. This is because the nursing work
environment can attract or discourage people from pursuing any career in nursing. If nurses
perceive the healthcare field as being insecure, demoralizing and too much demanding they
are likely to leave the profession of nursing for other careers. Such an attitude will also affect
potential nursing students who are likely to develop negative perceptions of the nursing
profession thus shy away from enrolling to nursing schools. This will contribute to the
increasing nursing shortage. Poor nursing work environment also affects nurse job
satisfaction. Job dissatisfaction with the work settings as a result of factors such as
understaffing, increase in overtime, and workloads in hospitals and care homes discourages
potential nurses from venturing into the nursing profession. Furthermore, those currently
employed as nurses opt for early retirement.

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Healthcare work environments have an impact on nurse retention. The nurse work
environment is one of the most demanding environment thus necessitating the need to focus
more on the effectiveness of the work environment in addressing the nursing shortage. For
example, an unhealthy work environment is characteristic of increased stress levels,
understaffing, overwork, and communication difficulties. These features are typical of the
current status of healthcare work environments which contribute to the nursing shortage.
Therefore, the most effective approach is to improve the work environment and not to focus
on enhancing each element because that would be like dealing with the symptoms of the
problem and not addressing the actual cause. It is for this reason that I strongly recommend
the improvement of the healthcare work environment as an effective strategy in addressing
the problem of nursing shortage.
2.0 Counter Argument
On the other hand, several arguments have been proposed as the most effective in addressing
the issue of the nursing shortage. The most common one is providing an innovative
academic-practice in nursing institutions so as to produce a constant supply of nurses that are
well –educated and ready to work (Fischer, 2016). The proponents of this strategy argue that
nursing shortage is as a result of a poor academic system that does not adequately prepare
nursing students for the actual experiences in the job market. The CNA (n.d.) indicates that
there is a need for an innovative model of education to substitute the traditional delivery
models for nursing education which do not use technology in the delivery and access of
education. The association contend that an innovative education model which incorporates
technology will increase access to education and multiple clinical experiences that makes the
nursing students “practice-ready.” However much this approach appears viable, it doesn’t
solve the primary cause for nursing shortage. It can be a long-term strategy but after the
major causes of the nursing shortage have adequately been addressed. Without addressing the

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problem of the healthcare work environment, the same nurses that will have been a product of
the new education model will still encounter the inherent factors in the work environment that
influence nurse shortages. As a result, they are also likely to quit the nursing profession.
3.0 Evidence for Argument
Studies have attributed nursing shortage to issues that surround organizational culture. The
study by Zhang et al. (2014) examined the association between work environments on the
nurse intention to leave. The authors found out that over 20% of the working nurses
experienced burnout, 45% of the nurses were not contented with their work in addition to
their salary. 5% of the nurses were intending to quit their jobs. Zhang et al. (2014) also found
out that nurses who worked in good work environments had minimal reports of burnout, job
dissatisfaction and the desire to quit in contrast to those working in poor settings. The
Nowrouzi, Giddens, Gohar, Schoenenberger, Bautista, & Casole (2016) carried out a
literature review to ascertain the quality of work life for registered nurses in the US. The
authors found out that job dissatisfaction as a result of nurse burnout increased the nurse
intention to quit their jobs thus raising the problem of nursing shortage. Furthermore, massive
cessation of nursing work in the US and Canada created a negative attitude among potential
nursing students thus further increasing nurse shortage. The literature review also found out
that in order to improve the quality of work life of nurses in the US, there is need for changes
in in the manner in which the novice nursing graduates are handled, provision of
opportunities for further learning, initiation of stress-reduction programs and the provision of
better financial compensation. A report by the Canadian Institute for Health Information
(CIHI) (2010) but on a similar topic indicated that most of Canadian nurses that were
involved in the study intended to leave the nursing profession. The factors that prompted
them to leave the job included the association between nurse and physician, lack of
involvement in hospital affairs, management and workload. Nantsupawat, Kunaviktikul,

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Nantsupawat, Wichaikhum, Thienthong, and Poghosyan (2017) explored the association
between work settings and job satisfaction, and nurse’ intention to leave. The authors found
out that better work environment led to significant job satisfaction with no desire to quit. The
study recommends focusing on the work environment as an effective strategy to increase
nurse job satisfaction, retention, and reduce nurse shortages. Therefore, based on these
evidence-based studies, it is clear that the factors that lead to nursing shortage are associated
with the work environment cultures and not the incapacity of the nurses in providing quality
services due to traditional ineffective education model.
4.0 Other Counter Claims
Other researchers have also postulated various strategies to deal with the problem of nurse
shortage. Westphal, Marnocha, and Chapin (2016) suggested the use of appropriate
recruitment and retention strategies as an indication of a caring attitude in the nursing
profession and that will draw many people to the job. The authors noted that there were
variations in job satisfaction between full-time and part-time nurses, an aspect they attributed
to lack of job motivators. Ebrahimi, Hassankhani, Negarandeh, Azizi, and Gillespie (2016)
conducted a qualitative study to ascertain the hindrances to supporting new graduate nurses in
work. The authors found out that a lack of desire to seek for support, weaknesses in the
leadership, poor communication, individual characteristics, and cultural hindrances were
some of the barriers that prevented the provision of effective support to new nursing
graduates. The study recommended the use of effective communication as a strategy in
developing healthy relationships between nurses and management thus increasing retention.
The study by Mehdaova (2017) explored the strategies utilised by the management to address
nursing shortage using the PESTEL framework. Data analysis suggested five
recommendations for dealing with nurse shortage namely development of communication
programs, improving workers’ engagement, providing an improved work environment,

Nursing Shortages 8
investing more in nursing education and designing new policies and regulations to enhance
the healthcare system.
All these factors such as improving communication, appropriate recruitment, and retention
strategies, improving employee engagement, etc. are different elements of the work
environment (Hendricks & Cope, 2013) and therefore addressing each of them separately will
not solve the entire problem. Additionally, dealing with pieces of a more significant problem
instead of dealing with it in its entirety will increase the cost burden on the healthcare system
which is already burdened by nursing shortage. However, it should be observed that different
workplace settings may be affected by different factors and the management should address
the pertinent issues based on the situation. Therefore, creating a sustainable work
environment for nurses will address most of the factors that cause nursing shortages.
5.0 My argument
Based on a critical literature review of proposed strategies, improving the healthcare work
environment is the most effective recommendation for dealing with nurse shortage. The
following are the effective strategies that can be implemented to improve work environments
towards addressing the problem of nurse shortage worldwide.
5.1 Strategy One
5.1.1 Involvement of Nurses in Decision making
The involvement of nurses in decision making on matters that affect them will ensure that
their issues are addressed to the hospital management. Nurses undergo different kinds of
experiences while on their routine duties which may not necessarily reach the administration.
Furthermore, the engagement of nurses in decision making will create awareness to the
hospital administration of the challenges that nurse’s face. This will ensure that any decisions
made on behalf of nurses are aimed at meeting their needs on a priority basis, thus increasing
employee engagement. This will also develop trust in the management. As a result, the nurses

Nursing Shortages 9
will feel happy with their workplace and work and would like to stay. Van Bogaert, Wouters,
Willems, Mondelaers, and Clarke (2013) found out that the involvement of employees in
decision making improves their work commitment which is positively linked to the desire to
stay in the profession. According to Hayes, Douglas, and Bonner (2015), nurses that satisfied
with their work will be more committed to their work and the organization. Maurits, de Veer,
van der Hoek, and Francke (2015) also suggested that retaining employees in the nursing
industry can be achieved by improving staff independence by designing policies that promote
their engagement. Once the nurses are contented with their work, they will be more
committed and with no intention to quit their profession.
5.2 Strategy Two
5.2.1 Improving retention strategies
Retention of nurses has been the most daunting task for the stakeholders in the healthcare
industry. Retention strategies such as better compensation, remuneration and fringe benefits,
and professional development have been found to be the primary retention strategies. If
nurses are well compensated for their work, they will retain their work and will not desire to
quit. This will also act as an attraction for potential nurses to join the profession. Professional
development of employee nurses is an effective strategy in improving the technical skills of
nurses and increasing job satisfaction. This also will enhance the quality of healthcare
services offered to patients. Professional development is an indication to the employee that
the management is interested in the needs of the employee thus increasing job satisfaction
and reducing the desire to leave the profession.
Studies have shown that nurses in countries with more competitive salary rarely leave the
profession and have a lower nurse shortage. On the other hand, nurses in countries with low
salary scales tend to migrate even internationally to the states that offer better payment
(Haskins, Phakathi, Grant, & Horwood, 2017). The CAN (n.d.) recommends reducing

Nursing Shortages 10
international in-migration by half. Furthermore, the organization proposed professional
development as a strategy of addressing competency weaknesses of new graduate nurses.
Weidner, Graham, Smith, Aitken, and Odell (2012) found out that nurse retention in Canada
would be achieved through the improvement of workplace conditions.
El-Jardali et al. (2013) note that extrinsic rewards such as unpaid leave and bonuses are some
ways of fostering professional development. Bush (2016) found out that nurses are willing to
stay at the workplaces and in the nursing profession as long as they feel they are part of a
professional learning society where there are opportunities for professional development.
Ulrich, Lavandero, Woods, and Early (2014) proposed the reduction in nurse turnover by
investing in nurse managers and the career development of nurses. This strategy is also
characteristic of a successful organization in the nursing industry.
5.3 Strategy Three
5.3.1 Management and leadership support
The leadership in the healthcare sector have the duty of managing and retaining healthcare
providers. Hospital management can offer support by reducing workload through the
employment of adequate and competent staff, who can deliver quality health care (Mudallal,
Othman, & Al Hassan, 2017). Supportive leadership is those that are approachable and do not
bully junior staff when approached. This will ensure that the workplace environment is safe
for nurses and therefore increasing nursing retention (Hayward, Bungay, Wolff, &
MacDonald, 2016). Studies have also indicated that nursing leadership determine
organizational culture and thus workplace conditions. A corporate culture that is employee-
centered will create a conducive environment in which healthcare workers take risks, work
without supervision, are receptive to change and provide mutual support and have confidence
in the management (Tomey, 2009).

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Yamaguchia, Inoue, Harada, and Oikeo (2016) observed that the unavailability of nurse
leaders to undertake immediate supervision within a unit led to procrastination in solving
issues that affected nurses leading to low retention among nurses. Employees who are
supported at work by the management are committed to the organization and have no
intention to leave (Rajacich, Kane, Williston, & Cameron, 2013).
Conclusion
The objective of this paper was to recommend the most appropriate strategy for addressing
the problem of global nursing shortage. The nursing shortage has been in existence for long,
and a lot of investment regarding research and strategy has been incurred. But still, shortages
in nurses continue to increase with the increase in population and the burden of disease. This
positional paper recommends the improvement of the healthcare work environment as the
most effective approach to addressing the problem of nursing shortages. This is because most
of the factors that contribute to nursing shortages are elements of the work environment and
therefore improving the work environment will be one way of addressing at once, most of the
pertinent issues associated to nursing shortages. Workplace conditions can be improved by
involving nurses in decision making, enhancing retention strategies, and through management
and leadership support.
Action plan
Action Plan: Curbing Nursing Shortage through Improving Workplace Environment
Action Objective Responsible
Involvement of
nurses in decision
making
- Improving Workplace
Environment:
*Addressing workplace issues
promptly
*The nursing supervisors,
*Representatives of nurses
*Hospital administration

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*Establish close link between
management and nurses
*Improve nurse job satisfaction
Improving on
retention strategies
- Improving Workplace
Environment:
*Through better compensation
and fringe benefits
*Professional Development
*Management
*Stakeholders
Management and
leadership support
- Improving Workplace
Environment:
*Employment of enough and
competent staff
*Through the provision of
immediate supervision within
units
*Through prompt solving nurse
issues
*Management and leadership

Nursing Shortages 13
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