Global Nursing Shortage: Causes, Stress, and Solutions

Background and Current Reality

The shortage of nursing staff in the workforce has become a global crisis. Numerous research articles and books have been written on the subject from around the world, all identifying causal factors and possible solutions. As far back as 2002, "90 nurses' organizations, representing 69 countries and every geographic region of the world, reported shortages in their countries" (Clark & Clark, 2003). Moreover, the United States has been drawing many immigrant nurses into the profession as a result of higher pay, further depleting the numbers in other countries such as "Oceania, Africa, Central America (including the Caribbean), and central and eastern Europe" (Clark & Clark, 2003).

Although nursing shortages have been reported periodically over the past 60 years (Spetz, 2005), the labor force has generally been able to gradually correct itself over time. However, the current shortage has been underway for several years and is not expected to reach the height of its crisis until around 2020. By that year, the United States alone was predicted to need 300,000 to 500,000 additional nurses, meaning that "graduation rates must rise by 50% to meet the increased demand and make up for impending retirements" (Manthey, 2008).

Something must be done to correct the nursing shortage before patient care is seriously undermined. Already, "reduced nurse staffing levels have been linked to poorer outcomes for hospital patients, when compared with higher levels of nurse staffing" (Hogan et al., 2007). These negative outcomes include increased lengths of stay, higher infection rates, drug administration errors, accidents, and even deaths (Hogan et al., 2007).

Nursing shortages are also associated with higher rates of staff turnover, which not only negatively affect patient care but lead to increased hospital costs such as "advertising, interviewing, temporary replacement, and terminal payouts" (Hogan et al., 2007). Furthermore, when nurses are already overwhelmed with responsibilities, it is especially difficult for them to take new recruits under their wing and provide proper training. Highly educated and experienced RNs are being effectively replaced by LPNs and CNAs who are unable to provide the same level of care. Many people do not realize that the nursing education required to become an RN is in many ways as challenging as medical school, and on-the-job demands are arguably more strenuous than those for physicians (Perkins, 2010).

In the recent past, many hospitals were able to offer pay raises to lure more nurses into the profession. However, with the entire nation facing economic pressure and health care costs escalating rapidly, pay raises are unlikely to be a practical long-term solution. This paper attempts to uncover the true root of the crisis and offer practical, long-term solutions.

Causal Factors

While the obvious answer to the question of why there is a shortage is "an aging population"—with too many nurses retiring and too many older people needing health care—current literature suggests the problem runs deeper. And while the obvious remedy is to increase pay, current research shows little correlation between high pay and job satisfaction among nurses.

In one study published in 2002, Cowin found that pay was the "most commonly raised theme" brought up by nurses with respect to job satisfaction (Perkins, 2010). However, other studies do not show that raising pay levels lowers or prevents attrition rates (Hogan et al., 2007). This contradiction may be due to the fact that it was not feasible to reinterview nurses who desired higher pay after they received a raise, making it difficult for researchers to determine whether higher pay truly improved job satisfaction. In fact, a thorough review of the literature in 2007 led one researcher to conclude that "results showed the strongest association between job satisfaction and job-related stress, indicating that nurses who perceive more stress experience less job satisfaction. A further result from the study showed that there is an insignificant relationship between current salary class and current job satisfaction" (Hogan et al., 2007).

With the Baby Boomer generation nearing retirement age and facing their own health concerns, the number of nurses retiring is increasing just as the numbers needed in hospitals are rising. One study in Australia, where a similar crisis exists, found that the "average age of a registered nurse working in Queensland Health in 2005 is 42 years of age, with 47% of the workforce over 46 years of age and around 20% of nurses over 56 years of age" (Hogan et al., 2007). While economic conditions may not allow all nurses to retire as early as they would like, many will still reduce to part-time status when they reach retirement age.

Despite an aging population, however, the primary reason for the nursing shortage has more to do with a lack of young people entering the profession (Spetz, 2005). The reasons for this lack of interest or perseverance in nurses' training are discussed in the following sections.

Even amid difficulties in today's job market, nurses' roles are always changing and expanding. For highly educated and experienced RNs—precisely those hospitals need to retain—new opportunities are emerging to lure them away from routine work. These often more lucrative and less stressful subfields include "prevention, education, ambulatory care, industry, and law" (Lee, 2002). Furthermore, many Baby Boomer nurses entered the profession because it was one of the few fields widely open to women at the time. In the 1990s, ironically, downsizing initiatives actually deterred some students from entering the nursing profession out of fear of not finding employment upon graduation (Quinn, 2002). But even today, with so many options offering higher pay, less stress, and "more desirable work schedules," women who once might have chosen nursing are now pursuing business, medical, law, and technical fields, among others (Lee, 2002).