Nursing Shortage in America

A summary of the issue and the middle-range theory that could be used
There has been a disturbing trend of both surplus and shortage of nurses at different times throughout the healthcare workforce history in the US. There was a nursing shortage in the early parts of 2000s (Snavely, 2016). While there is already a moratorium regarding nursing shortage at the moment, the situation is likely to worsen in future because of a number of factors. The first cause is that since there is a recovery from the 2008/2009 recession in process, there is a likelihood that nurses who picked up their tools and went to work during the recession will revert to their statuses before the recession. It was estimated that 120 000 Registered Nurses will leave the nursing profession by the year 2015 (Auerbach, Buerhaus & Staiger, 2015). Such an eventuality will lead to the nursing situation as was a decade earlier.
There are 3 million nurses in the US. This is the largest part of the workforce in the healthcare sector. Nursing also happens to be one of the occupations that show the fastest growth in the US. Interestingly, even with such admirable growth, the demand for nursing still outshines supply. It is estimated that there will be 1.2 million job vacancies for Registered nurses between 2014 and 2022 (Grant, 2016). It has also been estimated that the shortage of nurses will double any shortage ever experienced since Medicare and Medicaid, by the year 2025(Cox, Willis & Coustasse, 2014).
The current nursing shortage could make use of Jean Watson’s Theory of Human Caring for a solution. The theory could work by handling the patient from a holistic perspective. It implies paying attention to the patient’s wellness of the mind, body and spirit. Such care has the potential to expedite the healing process (Watson & Foster, 2003). According to Watson, the model incorporates both scientific and art based techniques. It is an approach that incorporates useful aspects of art, humanities, spirituality, science and medicine for the mind, spirit and body, to supplement nursing.
Describe a borrowed theory that could be applied to the problem. Is this borrowed theory appropriate to your identified problem?
Maslow’s theory of hierarchical needs is motivational. It is based on a pyramid representation of human needs in which the needs at the base are regarded more urgent than the ones that come on the higher tier. According to Maslow (1943, 1954), some needs overshadow others. The most basic and urgent need is the one for survival, physically. Inevitably, such a need is the one that first motivates human behavior. Once such a need is satisfied, the next one up the pyramid arises and pushes us to act; and so on, until the highest need at the apex of the pyramid is satisfied.
Figure 1. Maslow's Hierarchy of needs (adopted from Maslow, 1954)
Considering the implication of the theory, emphasis by an employee on the needs at the lower level of the pyramid, i.e. physiological needs and security is understandable. Someone just starting off in their career will focus more on the adequacy of wages and security nuances such as a safe environment to work from. Everyone wants to earn a handsome salary to cater for personal needs and those of our family (Maslow, 1987). If an employee’s lower level needs are not adequately met, they are likely to decide based on the compensation, stability and safety concerns. An employee will seek to satisfy the needs at the base of the pyramid by whatever means, if such needs are not met by the employer.
A brief history of the borrowed theory's origins
Abraham Maslow is an acclaimed psychologist because of his theory that suggests that human behavior is inspired by urge to satisfy five basic needs. The needs are hierarchical in nature. Maslow states that humans seek to satisfy the needs at the lowest level of the pyramid before they do the same for the ones that com immediately after, and, sequentially, all five in the end (Maslow, 1943; Maslow, 1954).
Maslow, after looking at the work of Erich Fromm, came to believe that the push to self actualization is encoded in the human psyche. That need arises when all the other needs have been fulfilled. The need for creativity and self actualization suffices once the needs for food, security, love and recognition are fulfilled. Maslow successfully combines ideas brought forth by other psychologists before him, including those by BF Skinner and Sigmund Freud. The latter two focused more on the basic human instincts. He also borrowed from work by Jung and Fromm, who pointed out that the need for attention is equally urgent (Maslow, 1987).
The most important contribution by Maslow in psychology is the “hierarchy of needs” theory. As he sought to understand what motivates human behavior and the search for happiness, he came up with a list of basic needs that a human being has to fulfill for their optimum health psychologically. It is through the interviews and research that he conducted that he developed the pyramid of needs.
A discussion of how the borrowed theory has been previously applied
Maslows theory has been used by nurses in their patient care practices. A person’s need must be met at individual level; if they are to be satisfied, and feel attended to. Nurses have used Maslow’s theory of needs to determine plans for care and admitting the existence of concerns from patients (Jackson et al., 2014). Palliative care medicine and standard hospices are examples of nursing institutions that have used Maslow’s theory to enhance patient care. These institutions emphasize the need for managing symptoms of the disease, pain and the disease in a holistic approach.
Nurses working in healthcare institutions should start with identifying the type, intensity and quality of healthcare that a patient needs, and proceed to protect the patients under their charge. The nurses infer the patient needs that should be met first, and confirm the setting required for the various patients (Shao & Hsu, 2017). Nurses usually, can tell the care that a patient is missing, by evaluating the patient’s communication. Such body postures as slouching can mean a patient’s need for respect. Crossing arms may suggest that a patient feels unsafe.
Consequently, nurses are enabled to adjust their behavior so as to demonstrate that they acknowledge such needs. One of the ways is through transparency. They can be open about the procedures they follow to carry out treatments or deal with the patients. Bonding with the patient is an important aspect for nurses. Patients who have stayed in care centers for a long time gain a lot from such bonding. They can joke and laugh with the caregivers as they enjoy each other’s personalities (Shao & Hsu, 2017).
If the nursing fraternity adopts Maslow’s Theory of Hierarchical Needs, it could dramatically change the culture in critical healthcare. This could happen through the creation of interdisciplinary teams of healthcare givers who embrace the strategy of addressing the higher order needs linked to the survival of the patient. Such teams made of clinicians, doctors, social workers and therapists would engage the patient and their family in discussing the shift to the holistic patient care approach (Jackson et al., 2014). Emphasizing that there is still a life after the ICU experience may encourage patients to cope with their state. Such focus will be helpful while the patients travel the road of better awareness of the psychological, cognitive and physical disturbances that set in after discharge. Such disturbances seem to be independent from the illness and hospitalization experience but they aren’t.
A discussion of the application of the borrowed theory to the identified problem. How would you practice change by incorporating this theory?
Attaining the objectives of health in a given population in healthcare is determined by the availability and provision of efficient quality services. The most important input, arguably, in a production process that is unique such as health service provision is the availability of healthcare staff in numbers that can effectively respond to the patient needs in a timely fashion. The staffing dynamic bears a strong implication on the performance of the healthcare system (Hughes, 2017). Most countries experience an imbalance that threatens the capacity of their healthcare systems to attain health objectives because of the lack of clear policies of human resource management. The healthcare sector comes with a workforce that possesses some unique characteristics that cannot be wished away. Motivating the healthcare staff can go a long way in overcoming the challenges that they face in the system. The shortage of nurses is exerting pressure on every healthcare facility. Sufficient staffing is the key to quality healthcare provision. It also slows down the burnout process and will help to maintain serving nurses in the sector for longer. There are a range of factors that influence whether nurses resign or remain in their service. They include supervision issues, job satisfaction and the general work environment (Hughes, 2017). Nurses can be encouraged and motivated using Maslow’s Theory. It can also make the profession attractive to new entrants. The physiological needs of the nurses must be met. Nurses should be provided with sufficient rest and proper housing. Safety spans across resource security, family, employment and health. From the point of view of nursing, psychological and physical needs exist, and need consideration. When nurses are promoted, their self esteem will be boosted. They will feel wanted and important to society.
A discussion of how application of both the borrowed theory and the middle-range theory can be integrated to create the most appropriate solution to the identified problem
There will be an integration and application of both Maslow’s and Watson’s theories to address the concern about the shortage of nurses. Nursing leadership has to take charge in the implementation of the theories. Watson’s theory requires the leadership of nurses and that of the hospital’s (Watson & Foster, 2003);
· Supporting the show of both negative and positive feelings and recognizing them as the link with the inner self and that of the patient
· Cultivating the spiritual practices and the self that goes beyond one’s ego and opens to other people in a sensitive way and with compassion
· Creating and maintaining a caring and trusting relationship
· Exercise kindness, love and equanimity in the context of the consciousness of caring
· Attending to spiritual dimensions, and aspects of one’s health; caring for the soul of both the care giver and the one being cared for
· Exploring productive and cautious use of the self as a way of the process of caring and pursuing the art of caring and healing
Maslow’s theory should help in caring for the needs of the nurses as they arise; up and down the professional ranks. The psychological needs of new nurses should be sufficiently attended to. Adequate salaries based on their qualification and aimed at meeting their expectations are especially important. The next level calls for fulfilling their need for safety. These needs are both physiological and psychological in nature. A physical environment that is safe including provision of a god shelter and caring for the psychological insecurities is needed. Nurses need love too. They need to feel the sense of belonging. Once such cares are attended to, nurses will want to remain in their profession for longer. They will feel safe too. When nurses know where they belong compared to others and how such people relate to them and with them, they feel secure and identify with a form of structure (Hughes, 2017). The last step is to help the nurses to realize their need for self actualization. The latter can be achieved through awards, promotions, salary increments, awards and benefits.
When the two theories are applied, the nursing profession will regain its fading glory. It will attract more people to pursue the profession, encourage existing nurses to work while committed, and help retain nurses in the practice for longer.


References
Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2015). Will the RN workforce weather the retirement of the baby boomers? Medical Care, 53(10), 850-856.
Cox, P., Willis, W. K., & Coustasse, A. (2014). The American epidemic: The US nursing shortage and turnover problem.
Grant, R. (2016). The US is running out of nurses. The Atlantic.
Hughes, V. (2017). Leadership Strategies to Promote Nurse Retention. Sci J Nurs Pract. 1(1): 001-005.
Jackson, J. C., Santoro, M. J., Ely, T. M., Boehm, L., Kiehl, A. L., Anderson, L. S., & Ely, E. W. (2014). Improving Patient Care Through the Prism of Psychology: application of Maslow’s Hierarchy to Sedation, Delirium and Early Mobility in the ICU. Journal of Critical Care, 29(3), 438–444.
Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review, 50(4), 370-96.
Maslow, A. H. (1954). Motivation and personality. New York: Harper and Row.
Maslow, A.H. (1987). Motivation and Personality. (3rd ed.). New York, NY: Harper & Row.
Shao, L. M., & Hsu, T. H. (2017). Applying Maslow's Hierarchy of Needs Theory to Assist a Colon Cancer Patient to Cope with Chemotherapeutic Process. Tzu Chi Nursing Journal, 16(4).
Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economics, 34(2), 98.
Watson, J., & Foster, R. (2003). The Attending Nurse Caring Model®: integrating theory, evidence and advanced caring–healing therapeutics for transforming professional practice. Journal of clinical nursing, 12(3), 360-365.