Nursing Shortage Leading in a Complex Evolving Environment

Leading in a Complex, Evolving Environment
Introduction
Nurse leaders of today face a wide range of challenges in the execution of their mandate. It is important to note, from the onset, that to be able to effectively address some these challenges, today’s nurse leaders ought to have a unique set of skills and capabilities that enable then to navigate the said challenges so as to ensure that patient care is not adversely affected. This text concerns itself with nursing shortage as one of the main challenges in care delivery facing nursing leadership today. In so doing, it will not only assess the impact nursing shortage has on patient care, but also some of the options that ought to be taken into consideration in seeking to rein in the challenge.
Discussion
Throughout history, the United States has had periods of nursing shortages as well as surpluses – with this cyclical nature of nurse staffing impacting the healthcare system in various formats. Currently, the U.S. is in a state of what could arguably be referred to as serious nursing shortage. As a matter of fact, in the words of Masters (2018), at present, “the nursing shortage is real; the long-term pipeline numbers are alarming” (187). With regard to the said long-term pipeline numbers, it is important to note that as Haddad and Toney-Butler (2018) point out, data from the World Health Organization (WHO) indicates that “estimates of upwards of one million additional nurses will be needed by 2020.” There are no guarantees that this is a target that can be met. This is more so the case given that as Haddad and Toney-Butler (2018) further observe, through 2020, it is expected that available registered nurse jobs will vastly outnumber available jobs for any other profession. With this in mind, and given the current state of affairs, the relevance of formulating and implementing viable strategies to address the concern of nursing shortage cannot be overstated. Seo and Spetz (2013) are of the opinion that “during periods of nursing shortage, hospital managers have difficulty recruiting and retaining nurses…” (219). This could adversely impact the delivery of care.
When it comes to what exactly is fuelling the nursing shortage in the U.S., there are various factors that have been highlighted in the past. Some of the more prominent ones in this case include an aging population, an aging workforce, and nurse burnout (Haddad and Toney-Butler, 2018). When it comes to an aging population, the authors are of the opinion that on the whole, we have an aging population. More specifically, the baby boomer generation is being ushered into an age that demands enhanced medical attention. According to Grant (as cited in Haddad and Toney-Butler, 2018), “currently, the United States has the highest number of Americans over the age of 65 than any other time in history.” With this in mind, there is bound to be an increased need for medical and health services by this population – effectively straining the available healthcare workforce. Next, when it comes to an aging workforce, it is important to note that we also have an aging nursing workforce with registered nurses over the age of 50 numbering close to a million. According to Grant (as cited in Haddad and Toney-Butler, 2018), this effectively means that we have a third of the current workforce facing retirement. The impact has already started being felt at nurse faculty which according to Cooley and DeGagne (as cited in Haddad and Toney-Butler, 2018) “is experiencing a shortage, and this leads to enrollment limitations, limiting the number of nurses that a nursing school can generate.” Lastly, with regard to nurse burnout, it should be noted that there are nurses who come to the realization that the profession is not their calling upon graduating and working for a few months – after which as a consequences of the challenges of the profession, they suffer burnout and exit the profession (Haddad and Toney-Butler, 2018).
Nurse shortage, as it has been pointed out elsewhere in this text, does adversely affect the delivery of care. When the demand for healthcare services cannot be sufficiently met as a result of inadequate staffing, patients are likely to be turned away from healthcare facilities. Even when attended to (or admitted), the delivery of quality care is likely to be compromised by the fact that the available nurses are not only overscheduled but also overworked. As a matter of fact, as Cherry and Jacob (2018) point out, stressed-out and tired nurses are likely to make costly mistakes in the delivery of care thus compromising outcomes. Nurse leaders in such a case may have to contend with a dissatisfied workforce that is demotivated by the seemingly unmanageable workload that is not only mentally, but also physically exhausting.
From a systems perspective, there are various options that could be explored in an attempt to rein in the problem of nursing shortage in the U.S. One such option would involve both policy and institutional interventions that seek to provide solutions to concerns identified in the supply side – i.e. with regard to recruitment and retention. By fixing the supply side, patients are likely to access better healthcare services (with regard to quality and convenience) as a result of well-staffed facilities. The entities/interests to be taken into consideration include, but they are not limited to, healthcare institutions and the government. The interventions would essentially be seeking to not only enhance the recruitment of new nurses, but also improve retention of nurses in the workforce. One of the institutional interventions that have been suggested in the past has got to do with “encouraging nurse leaders to be actively involved and supportive of nursing staff…” (Cherry and Jacob, 2018. p. 207). This has the impact of enhancing staff morale and motivation – thus helping with retention efforts. Policy interventions could seek to broaden the recruitment base. According to Cherry and Jacob (2018), there are countries that have succeeded in this endeavor by way of ensuring that pathways into nursing are opened “for a broader range of recruits, including mature entrants, entrants from ethnic minorities, and entrants who have vocational qualifications or work-based experience to compensate for fewer conventional academic qualifications” (212). Policy interventions, could also seek to ensure that the profession has adequate opportunities for professional development as this would attract more persons to nursing.
There are various traits that nurse leaders ought to possess so as to effectively address nursing shortages via the proposed institutional solution proposed above. As per the trait theory of leadership, this means that nurse leaders ought to possess some qualities associated with leadership or that mark a leader. This particular theory of leadership, it should be noted, is founded on the assumption that there are “distinguishing characteristics of successful leaders…” (Stanley, 2016, p. 30). To be able to ‘be actively involved and supportive of nursing staff’, nurse leaders ought to have superior communication and relationship management skills and have sound knowledge of healthcare environment. As an effective communicator and relationship manager, the nurse leader would be able to effectively moderate relations and diffuse tensions in the workplace setting for improved working relations. By having sound knowledge of the healthcare environment, the nurse leader would be able to offer meaningful guidance by way of making the relevant presentations in diverse settings so as to further enhance the capabilities of nurses and thus improve their motivation and satisfaction levels. Both traits would be instrumental in enhancing retention.
In the final analysis, it should be noted that the relevance of resolving the issue of nurse shortage cannot be overstated. This is more so the case given that as Haddad and Toney-Butler, 2018 have clearly stated in their study, “nurses are a critical part of healthcare and make up the largest section of the health profession.” The nursing shortage situation is likely to worsen if not addressed as a matter of urgency. As it has been pointed out elsewhere in this text, by the year 2020, the U.S. healthcare system will demand at least 1 million additional nurses so as to be able to effectively and efficiently address the needs of patients. It is therefore clear that if the situation is not rectified soon enough, almost every aspect of the delivery of healthcare will be adversely affected. As it has been pointed out elsewhere in this text, overscheduled or overstretched nurses are more likely to make errors and mistakes – thus effectively compromising the quality and safety of care. Care facilities are also likely to lose out on business when they are unable to accommodate the demand for healthcare as a consequence of inadequate staffing levels.
Conclusion
Solutions that address the supply side of the nursing shortage equation are likely to be more effective in the long-term. This is more so the case given the main factors at play in relation to the said shortage. The role nurse leader empowering behaviors play in the entire setup cannot be overstated.
References
Cherry, B. & Jacob, S.R. (2018). Contemporary Nursing: Issues, Trends, & Management (8th ed.). St. Louis, Missouri: Elsevier Health Sciences.
Haddad, L.M. & Toney-Butler, T.J. (2018). Nursing, Shortage. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/
Masters, K. (2018). Role Development Professional Nursing Practice (5th ed.). Burlington, MA: Jones & Bartlett Learning.
Seo, S. & Spetz, J. (2013). Demand for Temporary Agency Nurses and Nursing Shortages. INQUIRY: The Journal of Health Care, 50(3), 216-228.
Stanley, D. (Ed.). (2016). Clinical Leadership in Nursing and Healthcare: Values into Action (2nd ed.). Hoboken, NJ: John Wiley & Sons.