This paper examines the global nursing shortage as a critical public health and policy issue. It defines the nursing shortage in terms of supply and demand, identifying key causes such as insufficient nursing education capacity, aging nursing workforces, poor working conditions, high turnover rates, and the brain drain from developing nations. The paper also outlines major effects of the shortage, including increased rates of morbidity and mortality, healthcare disparities, and declining patient satisfaction. Regional statistics from the United States, Europe, and Africa illustrate the scale of the problem. The paper concludes with recommendations for prevention, including expanding nursing education programs, improving organizational culture, and incentivizing nurses to work in underserved areas.
Even the most advanced healthcare systems in the world are short on nursing staff. As a result, existing nurses are working longer hours under high duress and are more prone to making errors or experiencing workplace violence and abuse. Patients are dying from preventable causes or becoming ill due to insufficient nursing care. If nothing is done soon to mitigate the nursing shortage, the entire globe could witness major crises in healthcare delivery.
Nurses have recently made inroads to improve the role and status of the profession, but much more needs to be done. The burgeoning patient population implies ever-increasing demand for qualified nursing staff, yet there is no comprehensive plan in place to ensure that enough nurses will be staffed at the healthcare institutions or in the communities where they are needed most. Nursing education programs at the level of higher education are overburdened, and even qualified students eager to enter the healthcare professions are turned down daily due to a lack of teaching faculty. The nursing shortage has reached a critical point, requiring effective policy intervention.
A nursing shortage refers to an insufficient number of nursing professionals — in other words, a staff shortage within the nursing field. Nursing is an incredibly broad and diverse field, encompassing a wide range of specializations within clinical practice. In addition to clinical roles, nurses can work in education to prepare the next generation of nursing professionals. A nursing shortage may refer to any specific situation in which there are fewer nurses than are required to meet current or projected patient demands.
Nursing shortages generally occur in specific geographic regions. Areas that are especially vulnerable include those in which the patient population is growing while the nursing workforce is shrinking. Currently, nursing shortages have become chronic issues around the world, though they affect some areas more severely than others.
As demand for healthcare services rises, there is a corresponding need for more nursing staff. Ironically, improvements in quality of care worldwide have contributed to the nursing shortage. Better healthcare services mean increased longevity, which in turn leads to growing demands for nurses throughout the course of a patient's lifetime. Similarly, as wealth accumulates globally, demand for healthcare services rises among populations that, even a generation ago, could not access or afford such services.
The simplest way to describe the nursing shortage is through basic economics: supply and demand. Currently, the demand for nurses far outweighs the supply in the labor pool. Despite the fact that many nurses are willing to relocate for work, chronic nursing shortages persist in some areas because the number of nurses entering the profession cannot keep pace with the rising population and the increased demand for healthcare services.
In the United States and other wealthy nations, the population has been aging rapidly. This demographic shift has further increased the demand for nurses, but nursing schools cannot keep pace. Nursing education is therefore a primary driver of the shortage. Even though the United States, Canada, Great Britain, Australia, and other countries have quality nursing education programs, there are only so many schools and only so many teaching faculty within those schools.
Until nursing education programs expand substantially, the shortage is likely to continue. The population continues to grow and to age, and with greater numbers of seniors seeking treatment for both acute and chronic conditions, demand for nurses will keep increasing.
Globalization also leads to increasing demand for nurses worldwide. Unfortunately, nurses from developing countries have strong financial incentives to relocate to nations where they will receive higher pay and greater opportunities for career advancement. Filling nursing staff shortages in developed nations comes at the cost of depleting the labor pool in developing countries.
The nature of healthcare service delivery has also been changing, contributing to the current shortage. More and more people are relying on ambulatory care services and are using nurses rather than physicians as their primary point of entry into the healthcare system (Oulton, 2006). If more and more people expect to see a nurse right away, the shortage is likely to worsen until meaningful steps are taken to increase the number of nurses in the labor pool.
High turnover rates within the nursing profession are another reason for the diminished labor supply. Burnout, stress, experiences with violence or abuse, low pay, and limited power within healthcare organizations are only a few of the reasons why nurses have a relatively high turnover rate. High turnover means fewer nurses available to meet patient needs, creating a vicious cycle: as hospitals and clinics lose key nursing staff, the remaining nurses shoulder the burden and work too long and too hard. The resulting burnout leads to even more vacancies.
Causes of the nursing shortage are linked to both supply and demand. Supply-side issues begin with an insufficient number of slots in nurse education programs. Nurse education begins with undergraduate (baccalaureate) degrees and continues into advanced degree programs such as Master's and PhD programs. The Registered Nurse and the Licensed Nurse Practitioner are only two of many professional designations for nurses in the United States. Advanced practitioners can also specialize in areas such as pediatrics or gerontology.
Even though quality higher education programs for nurses exist around the world, there is a shortage of teaching staff. Nursing faculty at most colleges and universities have dwindled in number, due both to aging and to issues such as low pay relative to clinical positions in the field (Allen, 2008). As a result, few nurses with advanced degrees are motivated to enter the teaching profession, preferring the higher status and higher pay that clinical employment offers (Allen, 2008).
An aging nursing workforce is also contributing to the shortage in some regions. Canada has been especially affected by this age-related supply problem. Approximately half of all Canadian nurses are expected to retire within the next 15 years, yet there are currently not enough new graduates available to fill their vacancies (Oulton, 2006).
Another supply-side cause is related to working conditions within the clinical setting. Nursing shortages are in part traceable to poor working conditions and relatively low pay, which fuel high turnover rates. Turnover can be attributed to several factors, including burnout. Violence on the job is also a major issue: research shows that nurses are among the most vulnerable professionals to both verbal and physical abuse (Haddad & Toney-Butler, 2019).
Organizational culture in healthcare also contributes to high turnover. According to Laschinger & Finegan (2005), lack of trust and lack of respect are key reasons for high employee turnover among nurses. Burnout and job strain lead to absenteeism and further turnover, which compounds the nursing shortage. Notably, burnout and job strain are also effects of the nursing shortage itself, since the high demands placed on existing nursing staff create a self-reinforcing cycle.
Demand-side causes include changes in population demographics and in how the healthcare system functions within society. Growing populations generally mean increased demand for healthcare services, and an aging population amplifies this demand even further due to the elevated risk for chronic and acute conditions. An aging population is in one sense a sign that the healthcare system is doing its job well — but it also means that more and more people will require care over longer periods of time.
Demand for nurses is also increasing in new areas and among new populations. People in developing countries are demanding improvements to healthcare services more than ever before, but nursing shortages in the developing world are typically even worse than in wealthy nations due to the brain drain phenomenon (Oulton, 2006). Trained nursing staff leaves developing nations to seek higher pay elsewhere, thereby worsening the shortage in their home countries.
Because nurses have become more highly trained and specialized, patients are demanding to see nurses more than ever before. Increased demand has not yet produced a corresponding increase in the supply of trained and licensed nursing professionals. It is not that hospitals are unwilling to hire new staff — on the contrary, many healthcare institutions would readily hire more nurses but cannot find enough qualified candidates to fill open positions. Until nursing schools can graduate more people and until job placement more accurately reflects the needs of the population, the shortage is likely to continue.
"Impact on patient outcomes, mortality, and healthcare equity"
"WHO, U.S., European, and African vacancy data"
"Policy recommendations to expand supply and improve retention"
If it is not addressed immediately, the global nursing shortage could cause major humanitarian and public health crises. Natural disasters, terrorist attacks, and disease outbreaks all require massive numbers of qualified healthcare professionals. Nurses work on the front lines to help people in their most vulnerable moments. Eliminating the nursing shortage is therefore a pressing public policy issue that demands urgent, coordinated action from governments, educational institutions, and healthcare organizations worldwide.
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