How to Address the Nursing Shortage

¶ … Leadership and Management The issue at hand is nursing turnover and nursing shortage. There are many areas of the country where there are chronic nursing shortages. Using a situation like this can be an effective means of illustrating the differences between management and leadership. A manager is seen as someone who is mainly an administrator -- someone who allocates resources in the organization. Leadership relates specifically to the human elements, such as motivation, engagement, vision, organizational culture and buy-in.

In essence, where management is a function, leadership pertains to relationships (Maccoby, 2000). Thus, both management and leadership can provide responses to the problems of nurse shortage and turnover, but those approaches will differ from one another, differences relating to the differences between management and leadership. A manager will look to resource-based strategies for dealing with the issue. A manager can, for example, improve the capability of the organization to attract and retain nurses.

That might mean increasing the spending on nurses -- higher salaries, better benefits, and these can be benchmarked against other companies in the region. The result is that if the organization offers more, it can attract more talent, better talent, and it is more likely to retain that talent. A manager thus deploys more resources to solving the problem in order to improve the organizational outcomes. This is a mitigation strategy, but there are other strategies as well, such as adaptation strategies.

An adaptation strategy would be to assume that for whatever reason there is little that the organization can do about the shortages and turnover, and structure its operations around this reality. So perhaps the most complex tasks can go to those employees who do have a long tenure, saving simpler tasks for the less-experienced nurses. Staffing levels can be adjusted so that the negative effects of shortages are spread out across the work week in order to minimize the negative impacts on performance.

Better training programs can increase the capabilities of the existing workers, so that they are more efficient. Such training would in particular increase the capabilities of all the new workers. In many instances, adaptation strategies are necessary because the nursing shortage is global in nature, and it also relates to the rise in demand for health care -- hospital managers are only one part of the tactical solution (Nevidjon & Erickson, 2001) The leadership solution is going to be relationship-based by its nature.

One of the perspectives is that a good leader can allow an organization to separate itself from the pack with respect to its ability to build a high quality nursing workforce. The better the leadership, the more the organization can insulate itself from the overall nursing shortage. One strategy, as advocated by Laschinger & Finegan (2005) is to increase empowerment of the existing workforce. This can be an effective means of building a better workforce, through training and developing strong relations.

Empowerment is usually well-received by nurses, who often have a high level of capability. Knowing that you are empowered, and have the support of your leadership, can be a powerful means of compelling someone not only to perform at a higher level, but to remain with their current organization. Empowerment means that opportunities elsewhere will ultimately be less attractive, and it will also mean that the talents and skill sets of the existence workforce will be maximized.

The two approaches are also different in terms of how they tap into motivation. The managerial approaches tend to tap into lower level motivations -- they focus on things like pay and benefits and working conditions. However, when the organizations in an area generally have similar characteristics and resources, there may not be much difference between what they can offer. The approach that I would choose is the leadership approach. The main reason is that this is an area where results can be achieved at a relatively low cost.

It provides a very positive working environment. Further, not every organization can match such a positive, empowering environment. Other organizations also have money, and can offer benefits, so in that sense all that really happens is that the organization gets into a bidding war for nursing talent. This is not necessarily bad but it does result in increased costs, which in the current environment can mean that profitability is reduced. Furthermore, many people get into nursing not as much for the money as for personal reasons.

It is a challenging career, but one ultimately rooted in helping people. Empowering nurses feeds into those sort of higher-order motivations. People are more motivated by an empowering environment where they can genuinely make a difference than they are by money -- at least the best people are motivated in this way. Furthermore, an empowered workforce ends up being more efficient, so this sort of empowerment actually lowers organizational costs over time. So the choice ends up.