Education Level and Nursing Staffing Shortages: A Research Proposal

Introduction

What causes staffing shortages in the field of nursing? Staffing shortages can be the result of many variables — turnover, unmet demand for services due to a lack of registered nurses, overwork (nurses calling in sick), and so on. Buchan (2002) identified the problem of staffing shortages in nursing as having an underlying cause in the nature of the health system itself as well as a social one: "Nursing in many countries continues to be undervalued as women's work, and nurses are given only limited access to resources to make them effective in their jobs and careers" (p. 751). This is especially true in countries like Saudi Arabia, where nursing is viewed as women's work but is not valued highly by society — though it is recognized as being highly needed (Alyami & Watson, 2014).

To address the issue of staffing shortages, the Institute of Medicine (IOM, 2012) has called for more nurses to achieve a higher level of education so that they can be better prepared to handle the demands of the real-world nursing environment. The idea is that the more educated a nurse is, the more prepared the nurse will be for the experiences routinely faced in the industry, and the less likely turnover and absenteeism are to result. The question remains, however: Is there reason to believe, based on the IOM's proposal, that the higher the level of education a nurse attains, the more likely that nurse will be to commit to nursing for the long haul? In other words, can the problem of staffing shortages be solved by requiring all registered nurses to obtain a four-year or six-or-more-year degree (Bachelor's, Master's, or Doctoral)?

Problem and Purpose Statement

The problem this study intends to address is staffing shortages in the field of nursing. Staffing shortages lead to obstacles in the delivery of quality care to patients (Baydoun, Dumit & Daouk-Oyry, 2016). This problem is not confined to any one region but is a global phenomenon (Buchan, 2002; AbuAlRub, El-Jardali, Jamal & Al-Rub, 2016; Zboril-Benson, 2016; Walker, 2017). While Buchan (2002) charges that the problem is institutional and social, the IOM (2012) asserts that if nurses obtained a higher level of education, they would be more likely to handle the pressures and complex problems associated with nursing in today's health care industry, where patients often present with a complex array of issues.

The purpose of this study is to test the hypothesis that higher levels of education obtained by nurses are predictive of staying power in the nursing field. It proposes to evaluate whether there is a significant predictive relationship between the level of education obtained by nurses and the amount of time they dedicate to working as nurses. The study will measure nurses' level of education and compare it to how many days they call in sick or take off for personal reasons, and how many months and years they have worked in the field without interruptions beyond routine or scheduled vacation.

Review of Literature

The research question this study specifically intends to address is: Does obtaining a higher level of education predict staying power in the field of nursing? The sub-question is: Is more education the solution to staffing shortages in nursing?

According to Baydoun et al. (2016), staffing shortages disrupt health care service and make it harder for providers to offer the kind of quality care that patients expect and require. The more frequently nurses call in sick or do not show up for work, the more costly it is for the organizations that employ them. Not only does the organization have to find a way to cover the shift — sometimes by paying other nurses overtime — it risks overworking the short-handed staff already present, which can lead to further turnover and the need to hire and train additional nurses. Baydoun et al. (2016) conducted a qualitative descriptive study, collecting information from a governmental academic hospital in Lebanon and interviewing 20 nurse managers at the facility. Content analysis was used to analyze the data, which showed that staff shortages were routinely caused by one of three factors, or some combination of them: (1) work-related issues, (2) individual issues, and (3) organizational issues. These issues did not correlate in any explicit way with the level of education the nurse had received, which indicates that there may be more to the problem of staffing shortages than education alone can solve.

The study by Zboril-Benson (2016) also focuses on absenteeism and why it is occurring in the nursing industry. The researcher notes, as do Baydoun et al. (2016), that absenteeism is a costly factor for organizations and one that must be substantially reduced in order for facilities to maintain high standards of patient care. The problem is that organizations are unable to address the issue for lack of understanding why it occurs in the first place. Zboril-Benson (2016) notes that there is "relatively little cumulative knowledge regarding its determinants" and that her approach was designed to establish a better understanding of why staffing shortages occurred (p. 89). To that end, Zboril-Benson (2016) conducted a quantitative, non-experimental study examining why 2,000 front-line nurses in Canada called in or did not show up to work. What the researcher found was that an astonishing 450 respondents admitted to seriously considering quitting the nursing field because of overwork and stress. Moreover, the researcher found that the less job satisfaction there was among nurses, the more likely absenteeism was to occur. In other words, negative workplace environments created a feedback loop in which staffing shortages fueled a worsening of the workplace environment by generating more stress and compelling more nurses to want to quit. The researcher did not examine the correlation between education levels and commitment to the nursing profession within the context of staffing shortages, but rather focused on social complaints connected to the problem.

The study by AbuAlRub et al. (2016) looked at the connections between workplace environment, job satisfaction among nurses, and nurses' intention to stay in the profession. It also examined the predictive power of nurses' intention to stay within the context of staffing shortages. The researchers used a descriptive correlational method to obtain data from 330 nurses working in Jordanian hospitals. The study's findings showed a significant link between job satisfaction and the workplace environment. Logistic regression analysis was used to identify the predictive power of the variables of housing, job satisfaction, and workplace environment — each demonstrating predictive ability. The researchers concluded that in order to stop staffing shortages, health care organizations must cultivate a better workplace culture and environment where nurses feel good about their work and find satisfaction in their roles. Without these qualities in place, health care facilities are likely to continue experiencing staffing shortages that are never adequately addressed. The study made no indication that education levels were a factor in nurses' intention to stay in the profession or to remain at the organization.

The study by Walker (2017) identified a number of factors related to the staffing problem in nursing. Walker (2017) viewed an aging population and an aging workforce as contributing factors, along with a lack of specialty or higher-level education. Mobility within the nursing industry and a shortage of nurse educators were also cited. Walker's (2017) study thus identified two education-related factors that may impact staffing: a lack of higher education among nurses, and a lack of teachers available to provide instruction. In other words, the shortage is not restricted to the nursing industry alone — it also touches, and is touched by, a lack of nurse educators in the educational sector. The problem that Walker (2017) sees in her qualitative assessment is that there is too little connection between the workplace environment where practitioners work and the educational environment where researchers and academics operate. The real-world experience of the nursing field must be better integrated into education so that nurses can be better prepared for the future.

Aboshaiqah (2016) examines the problem of nursing shortages in Saudi Arabia by conducting a systematic review of relevant literature from 1993 to 2013 — a twenty-year period. The researcher found that the main factors in the shortage problem were related to a poor public perception of the vital role nurses play in society. Nurses did not feel strongly appreciated or valued, and thus staffing shortages resulted in part because relatively few people aspired to the profession. Aboshaiqah (2016) concluded that the best way to solve the problem — like the IOM (2012) — would be to advocate for more education and to instill better values in nursing students, as well as to cultivate broader public respect for nursing and improve the overall culture in which nurses are situated.

Taken together, these studies show that many variables may impact the problem of staffing shortages in nursing. Some, like Walker (2017) and Aboshaiqah (2016), identified education as a factor, which supports the IOM's (2012) argument that more education is needed to help address the challenges nurses face and to overcome staffing shortages. The other studies pointed to social, personal, or workplace factors that resulted in nurses experiencing stress or low job satisfaction and therefore desiring to leave the profession.