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Staffing Shortage: Clinical Management Issue
The United Kingdom is facing a serious nursing shortage that seems destined to get much worse before it gets better (Rothcock, 2000). Clinical managers are finding it increasingly difficult to find qualified, experienced nurses and much interest is being given as to how to hire and retain nurses for hospital facilities.
It is important to understand why a nursing shortage exists. The nursing shortage is basically a product of supply and demand (Rothcock, 2000). The majority of nurses today are over the age of 30. The average practicing nurse is in his or her mid-40s. These nurses will begin to reach retirement age (65) around 2010, leading the nursing retirement wave, and half of the nurse workforce will be eligible to retire over the next two to three decades. In addition, numbers show that nursing school enrollments have been dropping. In a nutshell, this means that the supply of nurses remains low while demand remains high.
In order to determine how to rectify this clinical management issue, it is important to figure out what nurses want and how to make them feel rewarded, needed, and satisfied in their positions (Rothcock, 2000). Novice nurses must feel that they can really make a difference to their patients and maintain control over their personal lives. With those goals in mind, clinical manager can use various strategies to recruit and retain nurses.
The escalating crisis in the recruitment of nurses in the United Kingdom threatens to undermine doctors' ability to deliver high standards of clinical care on hospital wards, reported the BMA after a survey of nurses confirmed the shortage of nurses.
Dr Peter Hawker, chairman of the BMA's Central Consultants and Specialists Committee, argued that unless the government and clinical manager made substantial efforts to combat the current nursing recruitment crisis, standards of care on hospital wards would dramatically decline. "We are able to do more complex procedures with collaboration between highly skilled nurses and doctors. If one part of the team is weak because of numbers, then the whole team is weak. You can have the brightest and keenest doctors in the world, but you are wasting your time if you haven't got skilled nursing backup," said Hawker.
Research suggests that the current nursing shortage is the product of numerous trends including (Gerson and Oliver, 2004):
steep population growth in several areas;
a diminishing pipeline of new nursing students;
a decline in nurses' earnings relative to other career options; an aging nursing workforce; low job satisfaction; poor working condition; and an aging population that requires health care services.
These issues are increasing as the majority of nurses are retiring and job opportunities within health care are growing (Gerson and Oliver, 2004). Typical solutions to address past nursing shortages include wage increases and recruiting nurses from other countries, including Canada, English-speaking Caribbean and African countries, India and the Philippines. Due to the complex causes of the current shortage, however, experts note that these short-term solutions will have little impact.
In addition to attracting new nurses, it is important to retain existing ones and convincing those who have left nursing careers to reenter the workforce (Gerson and Oliver, 2004). In terms of clinical management, improving workplace conditions and improving the education and professional development of nurses are primary retention strategies. High levels of job dissatisfaction in relation to scheduling, unrealistic workloads, mandatory overtime, and management's lack of responsiveness to nurses' concerns are the cause of high turnover and early retirement among nurses.
Clinical managers should provide incentives for nurses to stay (Rothcock, 2000). The most effective strategy for battling the nursing shortage is keeping nurses satisfied. They should have as many reasons as possible to stay and as few reasons as possible to leave. According to a small study in the May issue of Nursing Management, the top five reasons nurses stay in their positions are (Rothcock, 2000):
co-worker communication and support; job satisfaction; schedule and shift satisfaction; opportunities for diverse clinical experiences and challenges; and salary.
The reasons nurses leave include (Rothcock, 2000):
low salary; poor benefits; inadequate recognition, respect, or input into practice; schedule and shift dissatisfaction; and other career opportunities.
If a clinical setting offers high job satisfaction, if managers encourage and value nurses' suggestions and implement them whenever possible, if the culture is warm and employees are encouraged to grow, nurses will be more likely to stay (Rothcock, 2000).
Strategies to combat the UK nursing shortage do not revolve entirely around attracting and training more nurses, says Chris Mullen, Project Director for the Greater Manchester Workforce Confederation (Mullen, 2003). The approach is broader and more inclusive. It focuses instead on re-focusing the skills of health care professionals on the needs of the service rather than the interests of individual professions. The Greater Manchester Workforce Confederation has developed an innovative approach to attracting more nurses into the service and into new ways of working, in an effort to resolve this staffing crisis.
According to Mullen, the workforce shortage in the NHS is the result of a combination of factors, including decreases in training places in the 1980s and 1990s, poor workforce planning, an aging workforce, the requirements of the European Working Time Directives and changes to local population profiles (Mullen, 2003). "Studies by the RCN have also found that nurses are concerned about increasing workloads, high vacancy levels, lack of empowerment and dissatisfaction with pay. Lack of support for caring responsibilities, bullying and violence at work have also been cited."
In addition, clinical managers should recruit only the best When employee turnover is experienced, many managers make the mistake of hiring a "warm body" to fill positions, not realizing how important it is to hire the most talented, most qualified nurses possible. They will ultimately contribute more to the organization (Rothcock, 2000).
To find nurses with these capabilities, the following suggestions can be helpful (Rothcock, 2000):
Do not insist on one or two years of industry experience. Instead, focus on recruiting the best and brightest person you can find, regardless of his or her experience level.
Invite nursing students for a clinical rotation.
Offer growth opportunities by developing a clinical career ladder.
Half of all nurses consider leaving their jobs due to poor pay, one survey suggests (BBC News, 2002).
The findings published by the trade union reveal that one-fourth of all nurses need a second job to help them make ends meet. In addition, many nurses suggested the pressure of working in the NHS was having a damaging effect on their health and personal relationships.
Pete Low, Unison's head of nursing, said the findings showed that UK nurses are under pressure (BBC News, 2002). "Our survey shows that long hours and increasing workloads are clearly taking their toll on nurses, and sadly this will have a knock-on effect on patient care. We cannot rely on overseas nurses to keep plugging the gaps, when there is a world-wide shortage of trained staff."
Low advises that a significant pay increase is necessary to stop many nurses from leaving the NHS (BBC News, 2002). "The Pay Review Body must act now to stop nurses simply slipping away. We cannot afford to lose more trained nurses through poor pay and unrealistic workloads. With over 40% of nurses due to retire in the next 10 years, there is no time to lose."
Other changes, such as introducing innovative family friendly working practices, could also have a major impact on improving the existing situation (BBC News, 2002). "It is disappointing that so little seems to be happening to implement family friendly policies throughout the NHS." Said Low. "It is clear that many nurses work for agencies because they can choose when they work and what hours they work. This is not surprising when you consider that the vast majority of nurses…[continue]
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