Staffing shortages in nursing are a consequence of poor nurse retention and nurse satisfaction. Being a nurse requires a lot of dedication, patience, and ability to keep updated in a constantly evolving world. When hospitals and other medical facilities have staffing shortages or shortages in qualified nurses, the healthcare delivery of that particular place dwindles. Nurses are the backbone of any healthcare facility. Especially in recent times, nurses provide prescriptions, treatment protocols, and diagnosis when doctors are away or busy. This literature review is meant to explain such a phenomena and how it relates directly to nurse satisfaction and nursing retention. From here, the connection crosses over to nursing care and healthcare delivery as standards of practice. Things like arrhythmias will be viewed to understand how nursing shortages attribute to lower quality of care. Utilizing Polk's theory of Resilience, this review will allow a look into performance improvement concerns and practice through a particular lens.

Nursing Shortages and its Repercussions on Patient Care

In an article analyzing the turnout rate of oncology nurses, the study believed nurses within the oncology department of a chosen hospital expressed job dissatisfaction due to stress and burnout. "…it appears that oncology RNs who worked in substandard staffing units often express job dissatisfaction, stress and burnout, which prompt them to seek new employment out of the oncology specialty" (Toh, Ang & Devi, 2012, p. 126). Nursing is a demanding field that requires constant attention to detail and no mistakes. With nurses taking on the role of doctors and caregivers, it may sometimes be too much for a person to handle. Organizations hiring nurses for patient care must understand the toll being a nurse entails. They have to develop better retention strategies to keep quality nurses from leaving.

Recruitment also plays a vital role. "This entails a pressing need for organisations to ensure sufficient staffing in oncology/haematology settings, in order to ensure that quality patient care is provided" (Toh, Ang & Devi, 2012, p. 126). Quality nurses must be found on a regular basis to ensure hospitals retain an adequate number of staff to avoid placing too much burden on any single nurse. The stress that the nurses in the study experienced came directly from a large workload and overextending themselves in their job duties. Departments like oncology demand extra from nurses in that most of the patients assigned to the oncology department are chronically ill and/or terminal. These things must be taken into consideration when applying strategies to improve nurse retention.

Chronic illness is a big issue for nursing. Nurses must deal on a daily basis with chronically ill patients. Chronically ill patients make up a large portion of nursing care and make the role of nursing that much more vital for quality health care as doctors are often too busy to handle individual cases consistently, letting nurses take over with prescription refills, referrals and so outpatient care protocols. Another study dealing with palliative care clinics, speaks of the negative consequences of staffing shortage with some practices having staffing shortages that resulted in longer wait times for new patient appointments and 24/7 care. "Eleven practices noted a staffing shortage and 8 had a wait time of a week or more for a new patient appointment. Only 12 practices provide 24/7 coverage" (Smith et al., 2013, p. 661).

When patients must wait for care especially in the palliative care clinic setting, this means the quality of patient care suffers. A staffing shortage in this scenario greatly affects how patients perceive and receive healthcare. This study provides data on active clinics and the negative effects of a nurse shortage. Funding is often another reason why staffing shortages in healthcare facilities exist. Besides nurse dissatisfaction rates, funding also adds to the nursing shortage epidemic. "Most practices described starting because inpatient palliative providers perceived poor quality outpatient care in the outpatient setting. The most common challenges included: funding for staffing and being overwhelmed with referrals" (Smith et al., 2013, p. 661).

Attempts at Reducing Need for Nurses

Solutions for Nurse Shortages

In a study performed this year, researchers attempted to see if nurse aides could provide the same quality care as nurses. The results were mixed.

The 76% RNs group made fewer medication errors than the 100% RNs group; the 76% and 92% RNs groups had a higher rate of urinary tract infections; the 92% RNs group had a lower rate of bloodstream infections; the 76% RNs group had a lower rate of ventilator weaning; and the 76% and 92% RNs groups incurred higher nursing costs."

Although nurse aids contributed...

The main problem of nursing shortages revolves around lack of job satisfaction brought on by heavy caseloads. Researchers attribute heavy caseloads to staffing shortages that are caused by lack of funding. If nurse aids do not provide a decrease in expenses then they are not useful in decreasing staffing shortages.
In order for hospitals to avoid such a risk, hospitals and other healthcare facilities must train and employ their own nurse aides and nurses revolving around education materials and adequate training to avoid the expense seen in the study. "Use of different nursing staffing models that substitute nurse aides for RNs may negatively affect patient safety and quality of care and increase nursing costs." (Yang, Hung & Chen, 2015, p. 1). Proper training avoids additional expenses because less mistakes are made. Furthermore, nurses and nurse aides learn to use less materials when they know which standards of practice are effective for each case.

Everything in the healthcare world revolves around effective use of resources. Quality care from the patient perspective means fast wait times, fast referrals, and minimum healthcare expense. With proper training nurses and nurse-aids may be able to diagnose, treat, and help patients in a faster time allowing for more patients per day and higher profits. However if medical staff are not properly trained, this may result in misuse of resources by adding unnecessary exams and tests, and mishandling of patient records and issues, resulting in more appointments and wasted time assessing and interacting with patients. Everything must be examined when looking at the nursing shortage dilemma.

In a prospective observational study, Wise et al., compared mortality and length of stay or (LOS) of medical ICU patients. Either hospitalists or intensivists led the teams caring for them. The results showed intensivist-led teams produced better results showing that nurses in these areas are most needed when it came to mortality and LOS. "Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team."(Wise et al., 2011, p. 183). Although nurse shortages run through several areas within nursing, the hardest hit and the most needed are in critical areas like palliative care, ICU, and oncology. These areas require the most from nurses in order to provide high quality patient care.

The results from a quantitative study demonstrated a strong correlation between nursing group outcomes and job satisfaction. "Moderately strong and strong significant correlations (P < 0.003) were found between job satisfaction and nursing group outcome attainment capability (intrinsic satisfaction r = 0.800; extrinsic satisfaction r = 0.650; total satisfaction r = 0.770)" (GIANFERMI & BUCHHOLZ, 2011, p. 1012). As earlier mentioned, nurses in the previously detailed studies expressed dissatisfaction from handling referrals and heavy caseloads. Nursing administrators play a part in how much work and training a nurse receives or handles throughout any given day. If in order to improve job satisfaction, some of the workload must be lessened, the nurse administrator must then strategize to develop ways for nurses to handle less referrals and focus more on patient care.

The study continues to explain that fulfilling goals can also provide relief and higher rates of job satisfaction for nurses and nurse administrators. "To increase job satisfaction, it is important that nurse administrators have the power to achieve their professional goals" (GIANFERMI & BUCHHOLZ, 2011, p. 1012). When nurses and nurse administrators attain their daily or weekly goals, this may improve morale and motivation. Therefore, assigning goals that are not too hard to achieve, but also challenge the nurse or nurse administrator may be applicable. Job satisfaction comes from a complex set of actions and reactions. Studies like these help to shed light on what hospitals and other medical facilities may use in order to improve job satisfaction and improve nurse retention rates.

There are other ways to optimize job responsibilities and improve or alleviate nurse shortage. Cross-training is one such model explored by researchers to see if it is effective for nurse workforce planning. In the end, operating at minimum cost while not sacrificing quality of care remains the favorable outcome for any tested model. Cross-training offers benefits such as reduction in costs as well as maintenance of quality care standards.

We demonstrate the benefits of cross-training in terms of a reduction in the total number of nurses required to satisfy demand across multiple departments as…