Analysis on Contemporary Issue of Nursing Shortage: Healthcare

This paper provides a critical analysis of the contemporary issue of nursing shortages, examining the factors contributing to this global concern. It defines the nursing shortage, highlighting that the demand for registered nurses exceeds the supply, and provides statistics on the situation. The paper delves into the causes, including an aging workforce, burnout, and inadequate nursing education, and explores the impacts on healthcare services and patient safety. It also includes a clinical experience reflection. The paper concludes by discussing potential solutions, such as improving workforce environments, encouraging gender diversity, and managing nursing schools and hospital culture effectively. Finally, it discusses the need to reposition the profession and retain RNs.

Running Head: ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE
Analysis on Contemporary Issue of Nursing Shortage
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Table of Contents
1. Introduction…………………………………………………………………………
3
2. Brief Overview……………………………………………………………….
……..3
2.1. Causes of Nursing Shortage…………………………………….………..….…
4
2.1.1. Aging Workforce & Population.…………………………….……..…..
….4
2.1.2. Burnt Out & Inadequate Nursing Education.………..……………...…..…
5
2.1.3. Hospital Acuity & Staffing Ratio…………………………………...….
….6
2.2. Why Address Nursing Shortage…………………………………………..
…....6
2.2.1. Impact on Health Care Services & Patient Safety…………………………
7
2.3. Clinical Experience & Reflection………………………………………………
8
2.4. Solving the Nursing Shortage………………………………………….………9
2.4.1. Immigration………………………………………………………...….….9

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 3
2.4.2. Improving Gender Diversity & Incorporating Leadership Change……….9
2.4.3. Management of Nursing Schools & Hospital Culture……………………
10
2.4.4. Repositioning the Profession & Retention of
RNs……………………….11
3. Conclusion…………………………………………………………………………12
4. References…………………………………………………………………………13

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1. Introduction
The following paper aims to put forward a critical analysis of one of the most vital
contemporary issues in nursing, i.e. shortage of nurses. The nursing shortage is defined as the
situation where the demand for Registered nurses (RNs) or other nursing professionals
exceeds the supply (Peters, 2018). The various criteria to measure this are nurse-to population
ratio, nurse-to-patient ratio, and the number of nursing job openings, indicating that nurse
demand is not meeting the supply. Nursing shortage is observed in developed nations like
Canada too and is a significant concern globally. According to a pan-Canadian statistics
survey conducted by Canadian Institute for Health Information (CIHI), in 2018, even though
Canada has observed an increase in the annual growth rate of registered nurses with 303,146
RNs, the growth rate is minimal, i.e. mere 0.71%, and pose a great apprehension for the
nursing shortage. The paper will analyse this concern and present the facts and statistics
along with the leading causes of the nursing shortage. The significant causes of nursing
shortages are workplace condition, job dissatisfaction, work-life balance and burnt out.
Moreover, the paper includes a short clinical story, delivering a real-life experience in the
same area of concern. The following sections of this paper will mention the impact of nursing
shortage on healthcare industries, and patient safety, be it locally or globally. The latter part
of the paper will discuss in great detail the few measures that can be taken to solve the
nursing shortage issue. These measures include improving workforce environment,
educational faculties, encouraging admission of male nurses, and few others.
2. Brief Overview
The nursing shortage is one of the most vital concerns in nursing, globally. Nurses
have a substantial role in the healthcare system as they form up the most extensive section of
the health-related profession. CIHI (Canadian Institute for Health Information), in their

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 5
survey conducted in 2018 across Canada, found out that out of all the health care
professionals, 48% were regulated nurses (registered nurses + nurse practitioners). This
accounted for 431,769 regulated nurses in the year 2018. However, these statistics are not
justified with the fact that Canada faces nursing shortages. There are several reasons for
which the nurses choose to leave their profession, and this can mean a negative impact on the
healthcare industry. Nursing shortage is directly proportional to the lower nurse-to-patient
ratio, which possesses a severe impact on patient safety issues (Källberg, Ehrenberg, Florin,
Östergren & Göransson, 2017).
2.1. Causes of Nursing Shortage
Even though history has witnessed a shortage of nurses, the present development of
nursing shortages is distinctively serious. High number of professional, as well as patient
complaints, has discouraged the younger generation, keeping them away from entering into
this profession. The nursing shortage is worldwide, and other causes such as growing
demand, lower enrollment, burnt out are mentioned below in detail.
2.1.1. Aging Workforce & Population
A growing economy means people will get rid of financial troubles to get better health
care management. This will directly result in more demand for registered nurses in
specialized areas. The demand-supply gets limited due to low enrollment numbers of younger
generation nurses. The average age of the registered nurse globally is more than 50 years,
approximating around one million nurses of this age. This means that over the next 10-15
years, over one-third of the workforce will be retired, creating a vast supply gap. The overall
quality of the nursing classes and enrollment limitations is not adequate to fill such large
supply gap. Baby Boom generation (people taking birth between 1946 to 1964) are now in
great need of health services as they are getting old The last of the baby boomers will enter

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 6
the age of retirement in the year 2029. This will lead to a higher demand of the nurse
workforce as the aging population usually undergoes a multitude of diagnosis with more than
one morbidity (Auerbach, Buerhaus, & Staiger, 2017). Moreover, with more considerable
advancement in the treatment of terminal diseases, the process is being elongated, leading to
nurses addressing the patient for longer-term and a strained workforce.
2.1.2. Burnt Out & Inadequate Nursing Education
According to Maslach and Leiter (2016), the Burnout theory defines burnout as a
sustained response to chronic interpersonal and emotional stressors on the job. The six factors
that cause a mismatch between the job and the person, ultimately leading to burnout are
workload, fairness, lack of control, reward, values and community. Nursing has increased
demand with scarce resources, which leads to a more significant workload on the available
nurses. Absence of fairness in an organization may lead to discrimination. Less involvement
in the organizational activities leads to lack of control, which makes the person feel
undervalued. Building motivation and shaping behavior can be achieved with positive
rewards. Going against someone’s value generates a feeling of stress and cynicism.
Community breakdown leads to workplace bullying, no teamwork and unresolved conflicts.
All these significant factors often lead to burnt out in nurses, which forces them to leave their
profession for some other jobs. In a survey of 1000 nurses conducted by Nursing Times, it
was revealed that eight out of ten nurses are under more burden and stress than they were a
year ago. Short-staffed team leads to pressure build-up among other remaining nurses who
then have to overtime to ensure proper care to patients. The nurses get exhausted after their
shift and looking at the average age statistics of the nurses; exhaustion more often leads to
termination of jobs. One of the primary reason that the average age of the nursing population
is around 50 years is that there is a significant decrease in nursing educators. Large groups of
educators are retiring, and the younger generation shows very less enthusiasm in entering

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 7
educative roles. One of the reasons for this can be the late-career development potential in
such a role. Moreover, researches have shown that there is a significant salary gap between
employees in nursing education and nurses in the clinical profession (Eslamian, Moeini &
Soleimani, 2015). This demoralizes the younger generation of nurses to take up such roles.
2.1.3. Hospital Acuity & Staffing Ratio
Insights from hospitals have shown that rapid increase in technology involvement in
average patient’s care plan. Rapid assessment, treatment and discharge of an average patient
are now possible with technology, which leaves with higher demand for specialized nurses
with more exceptional skills. Specialty wards are facing a massive shortage of experienced
nurses, and the issue is getting intense. The female to male nurse ratio in Canada is 12:1
("Nurses in Canada by gender share 2006-2016 | Statista", 2019). This is an altogether
different issue and is a factor causing a nursing shortage. Female nurses usually take a pause
or altogether leave the nursing profession in their childbearing years. This is affected by other
factors such as greater workload, which has a negative impact on the work-life balance, and
the female nurses are bound to leave their jobs to take care of the family. Collectively looking
at this issue and then the female to male nurse ratio, it can be determined that this poor
staffing ratio majorly affects nursing shortage. Moreover, men nurses face many barriers and
get demotivated as the nursing profession is hugely dominated by females (Twomey, &
Meadus, 2016).
2.2. Why Address Nursing Shortage
Inconsistency in nursing faculty often leads to severe problems in the healthcare
industry. Exhausted nurses doing overtime do not address to the patient attentively and miss
crucial details that lead to patient safety issues. In addition, health care providers with nursing
shortage are unable to take admissions of patients to their full potential. It is high time that

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the nursing shortage is addressed globally, and appropriate steps are taken to eliminate the
shortage of nurses. One other reason why nursing shortage needs to be addressed globally is
the image of the nurses. Owing to adverse complications and the impact of shortages, patients
are having poor perceptions of the nurses. Following sections of the paper will deal with the
impact of the nursing shortage issue on healthcare systems and patient safety.
2.2.1. Impact on Health Care Services & Patient Safety
Registered nurses comprise the largest section of all healthcare professionals.
However, Canada and many other nations are facing nursing shortages, and the healthcare
system is suffering for the same. Hospitals and other healthcare providers are compelled to
make their available nurses do overtime with greater workload. Moreover, with the nursing
shortage, many health care organizations fail to admit patients to their full capacity. Older
nurses have the largest proportion among the registered nurses, and they are unable to take
any extra workload, then they already have. Shortage of nurses in specific departments has
led healthcare authorities to shift nurses to other departments, which they are not accustomed
to. Such cases are often the root cause of nursing failures and are a potential hazard to patient
safety. Moreover, with increased nursing turnover, health care systems are facing a rapid
increase in the cost of employment. Nursing shortage pushes the remaining of the nurses to
greater workload, resulting in job dissatisfaction, fatigue and stress. Nurses in this type of
stressful condition are more prone to making errors and medical mistakes. Patient safety takes
a hit with the nursing shortage, and reports have concluded that this leads to increased
mortality rates (Rosseter, 2014). Medication errors are increased when the nurses are forced
to move to specialty wards, which are out of their expertise. Patient quality can suffer
severely, and many other unfortunate incidents have occurred due to the nursing shortage.
Patient safety is compromised, and the risks such as spreading of infection, adverse

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outcomes, occupational injury and patient workload are increased significantly due to nursing
shortages.
2.3. Clinical Experience & Reflection
During my nursing training in a health care organization, I experienced many small
incidents, which were the result of a nursing shortage. Our team was working in the medical-
surgical emergency ward and often addressed to emergency cases. The team was of specialty
nurses who were trained explicitly for emergency cases and post-treatment patient care.
Nurses in this department were generally exhausted with daily work, as the emergency ward
required their priority attention. The emergency ward required a total of twenty-two nurses
for proper care and management of patient safety. However, due to stress and workload, over
a period of three months, six nurses left the profession for better opportunities. This led to a
severe shortage as the team was left with only 16 nurses out of twenty-two required. The
authorities decided to call for four additional nurses from other departments to meet up the
requirements a little. It was, after this decision, that complications and medication errors
alarmingly increased. One of the four additional nurses was asked to overtime and looked
after a critical patient who just got operated for injuries. The patient had an elevated heart rate
of 130 beats/minute, lower blood pressure of 50/40, and was getting treatment for a
hypovolemic type of shock. However, the new nurse, who joined post-operation, was
unaware of all these and got very little time to revise patient report and history among the
entire huddle. She gave the wrong medication, which complicated the patient health to very
critical. It happened that after this incident, the patient’s health got worse, and doctors were
unable to save his life. The organization had to face a lot of criticism from the patient’s
family as they were told that the patient was recovering positively and was out of danger. I
believe that the nurse who administered the wrong medication is not to be blamed entirely for
this misshapen. The entire incident was the result of a broader issue of the nursing shortage.

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 10
The organization was ignorant in solving the issue with proper actions and failed. However,
after looking at the global nursing shortage statistics, a broader judgment relieves the
organization from the blame.
2.4. Solving the Nursing Shortage
There are many ways to address the nursing shortage; most of them are general, along
with a few region-specific measures. According to the Canadian Nurses Association (CNA),
by the year 2022, Canada will witness a shortage of over 60,000 nurses (Health Human
Resources, 2019). With constant failures in nursing employment along with decades of
budget cuts, the Canadian health care system and hospitals are on the verge of facing a lack
of nursing professionals (("Nursing: Supply and Demand through 2020", 2019). Without
proper measures taken in the right direction, Canadian healthcare services could take a severe
hit, mostly quality-wise. Following sections of the paper will discuss a few strategies and
measures that can help address the issue of nursing shortage in Canada and the rest of the
world.
2.4.1. Immigration
Nursing shortage can be fulfilled with the immigration of nurses from other nations.
Foreign nurses coming to Canada with the help of various immigration programs can be
crucial in improving and maintaining strict health standards in Canada. Foreign nurses are
given the provision of being permanent residents in Canada and practice nursing anywhere in
the country. There are three major programs that foreign nurses can primarily take advantage
of and practice nursing in Canada. These programs are Federal Skilled Worker (FSW) in
Express Entry, Quebec Skilled Worker (QSW) program and Nova Scotia Nominee Program.
The nurses should have a valid certificate and have to sit for NCLEX (National Council

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 11
Licensure Examination), post which, they will be determined of nursing credentials and get
authorization to work.
2.4.2. Improving Gender Diversity & Incorporating Leadership Change
Recruiting more men in the nursing profession is one of the simplest ways to solve
the nursing shortage. Lack of male nurse educators and mentors are two barriers, which
determines the low number of male nurses in the clinical part of the profession. Fear of
suspect touch when addressing female patients is another barrier that needs to be addressed.
Men usually feel unwelcomed in the clinical setting of the nursing profession, and only when
all of the above points are taken care of, there can be an increase in the number of male
nurses. CIHI reported a significant positive breakthrough in gender diversity with the reports
of male nurses accounting for 32% of the growth in regulated nurse numbers in 2017-2018.
Leadership has a vital role to play in encouraging the nurses and removing the stress of their
heads. For new graduate nurses, personal and organizational identity is essential, and this can
be fostered by authentic leadership. Positive leadership boosts the confidence in the
employees, enabling them to handle work-related challenges more smoothly. If the concerns
of nurses are heard and acted upon appropriately by the leaders, then job-satisfaction will
take a hike and retain a greater number of nurses. Thus, authentic leadership subsequently
leads to positive workplace mentality among the nurses.
2.4.3. Management of Nursing Schools & Hospital Culture
Baby boomers and the nursing shortage are very much co-related. Older nurses are
more in demand for the faculty because of their clinical experience. Nevertheless, this also
means that soon, the aging workforce will retire. Checking the present career pipeline system,
the nursing schools need to ensure that a greater number of students are being engaged to
clinical experience in the profession as soon as possible (Fang & Bednash, 2014). Greater

ANALYSIS ON CONTEMPORARY ISSUE OF NURSING SHORTAGE 12
investment in nursing education can help overcome the nursing shortage by increasing the
number of potential applicants. Financial incentives and rewards are one of the best short-
term implementations that can help to maintain a steady number of nurses in any
organization. Incentives, bonuses and rewards encourage the nurses to stick to their
profession. However, such measures merely help in increasing the nurse’s population and is a
temporary fix, which comes at a considerable cost for the organization. Improving hospital
culture, even though it is elusive, can help in improving the nursing shortage issue.
Transparency in administration ensures that every employee is part of the decision making
the process by delivering core information of the finances and other aspects to everyone in
the hospital. Proper appreciation is a critical part of the culture, which fuels the employees
and make them stay positive. Proper communication set up is necessary to establish an
enticing culture. This helps the employees to convey their problems to the administration, and
the latter will make sure it is resolved in the best way possible. Leadership qualities among
the authorities of the health care system is another factor determining the nursing shortage.
Hospitals should ensure that leaders listen to the nurses and revert positively, creating a
positive work environment for the nurses. The less the nurses will feel stressed; excellent will
be the retention statistics.
2.4.4. Repositioning the Profession & Retention of RNs
Even though nurses constitute the major portions of the health care professionals
numbers, nursing is undermined. The young need to be acknowledged about the versatility of
the profession, which includes critical-thinking, customer service, decision-making and
learning technology. Nurses of every educational level need to be encouraged to pursue
higher education. Increasing the workload of nurses, results in burnt out, which eventually
results in the nurses leaving the profession. Developing evaluation systems and implementing
strategies that promote retention is one way to cease nursing shortage. The six factors of the