Nursing Shortage: An Open Systems Approach to Solutions
This paper examines the nursing shortage through the lens of open systems theory, drawing on Meyer and O'Brien-Pallas's (2010) nursing services delivery framework. It analyzes the problem across key systems components — inputs, throughput, output, and feedback cycles — to identify both institutional and systemic causes, including nursing faculty shortages, horizontal violence, burnout, and unfavorable staffing ratios. The paper proposes a change plan combining micro-level workplace improvements (fair scheduling, anti-bullying orientation) with macro-level strategies (supporting nursing education, institutional collaboration with universities). Evidence from the American Association of Colleges of Nursing (AACN) and peer-reviewed research is used to ground the recommendations in professional standards and data.
- Introduction: A Systemic View of the Nursing Shortage: Systemic perspective needed beyond individual staffing fixes
- The Problem: Nursing Shortage: Institutional shortage, ratios, burnout, and horizontal violence
- Open Systems Concepts: Problems and Solutions: Inputs, throughput, output, and feedback applied to staffing
- Change Plan: Micro and macro strategies for reducing the shortage
- Professional, Mission, and Values-Based Nursing Standards: AACN standards, education data, and patient safety evidence
- Conclusion: Open systems solutions aligned with institutional mission
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What makes this paper effective
- It consistently grounds practical institutional recommendations in a named theoretical framework (Meyer & O'Brien-Pallas's open systems model), giving the argument academic coherence rather than relying on common sense alone.
- It moves deliberately from problem diagnosis to solution, applying each systems component (inputs, throughput, output, feedback) to a concrete aspect of the nursing shortage — a disciplined analytical structure.
- It integrates authoritative external evidence from the AACN and peer-reviewed journals to validate claims about staffing ratios, infection rates, and educational gaps.
Key academic technique demonstrated
The paper demonstrates framework-driven analysis: rather than listing problems and solutions loosely, the author maps each issue onto a specific element of open systems theory. This technique shows the reader exactly how the theoretical model earns its explanatory value and makes the change recommendations feel logically derived rather than arbitrary.
Structure breakdown
The paper opens by framing the broader systemic problem and critiquing individualistic staffing fixes. It then identifies the nursing shortage within the author's own institution before systematically applying open systems concepts (inputs, throughput, output, negative feedback) to diagnose causes and propose solutions. A focused change plan follows, distinguishing micro from macro interventions. The paper concludes by anchoring recommendations in professional standards set by the AACN and aligning them with institutional mission and values.
Introduction: A Systemic View of the Nursing Shortage
According to Meyer and O'Brien-Pallas (2010), addressing organizational problems such as staff shortages demands a systemic perspective, one that integrates "clinical, organizational, financial, and outcome variables from a nursing perspective" (p. 2829). All too often, staffing is addressed only from an individual, closed-systems perspective. For example, nurses are encouraged to join an organization through an introductory bonus, or to remain through a retention bonus. This approach merely skims the surface of the problem, which is rooted in deeper and more systemic issues within the healthcare system — including a shortage of nursing faculty, high levels of nursing burnout, and low levels of administrative support for nursing staff.
The Problem: Nursing Shortage
Within many institutions, there is a clear nursing shortage. Nurses are being forced to care for patients at higher caregiver-to-patient ratios, even though research has shown this results in higher rates of medical errors due to nursing fatigue. There is also the issue of horizontal violence — nurses bullying other nurses — which can be exacerbated by the tensions that accompany understaffing.
Viewing this problem through an open systems perspective of inputs, throughput, output, cycles of events, and negative feedback, as described by Meyer and O'Brien-Pallas (2010), can be useful. Inputs, in the case of a human relations issue, take the form of both patients and nurses, and can also include institutional personnel outside the immediate care environment. Addressing input-related problems by increasing staff numbers is critical, though the other elements of open systems theory must likewise be addressed.
Open Systems Concepts: Problems and Solutions
According to the American Association of Colleges of Nursing (AACN) (2017), "faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for professional registered nurses continues to grow" (para. 1). Nursing schools are turning away qualified applicants simply because there is not an adequate number of faculty to educate all students who wish to enter the profession. Without expanding the available roster of openings to educate new nurses, the prospects for improving the shortage remain dim. On an institutional level, organizations can make it easier for practicing nurses to teach at affiliated hospitals. They can also offer tuition reimbursement to reduce the financial burden of study and support advancement to baccalaureate-level preparation, in exchange for an agreement to remain at the institution for a specified period. These remedies target the input of human resources more holistically.
Throughput, in relation to the nursing shortage, encompasses services and interventions. New nurses may be driven away by fatigue, overwork, and horizontal violence triggered by poor working conditions. Institutions can meaningfully address this dimension by establishing fair, clearly defined policies about mandatory overtime and holiday scheduling — reducing the most burdensome scheduling practices. Organizations can also conduct systematic reviews of nursing services and interventions to identify which are most taxing for staff. Output, or patient volume, must likewise be managed with close attention to the human factors and stressors of nursing. For example, during peak periods in an intensive care unit, nurses may be assigned more than one unstable patient simultaneously — a situation that increases both stress and the likelihood of errors.
Viewing the shortage as a product of wider systemic cycles helps explain why the problem cannot be resolved overnight. More aggressive recruitment of new nurses from nearby campuses is important, as is communicating clearly to experienced nurses who engage in bullying that such behavior is unacceptable. Constructive negative feedback is often necessary to initiate change, since people are rarely motivated to change without a sense of urgency. When negative feedback is delivered — such as through performance reviews — it must be grounded in measurable data, including patient satisfaction scores or staff retention rates, to be credible and actionable.
Conclusion
It is commensurate with the mission of healthcare institutions to promote patient welfare and safety. The imperative to control costs also makes lowering readmission rates a serious institutional priority. Upholding the mental and physical welfare of staff and compensating nurses fairly are likewise essential goals. An open systems approach means working with surrounding universities to enable nurses to engage in productive relationships — serving as fairly compensated adjunct faculty to increase enrollment of qualified applicants and receiving support for continuing their own education. It also means instituting fair staffing policies so nurses are not forced to suppress professional concerns or endure excessive fatigue in order to provide the care their patients deserve. Finally, it means cultivating a supportive workplace culture where nurses receive fair and unbiased performance reviews and are oriented to appropriate behavioral expectations toward colleagues as well as patients.
References
Meyer, R. M., & O'Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017742/
Nursing faculty shortage. (2017). American Association of Colleges of Nursing (AACN). Retrieved from http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Faculty-Shortage
Nursing shortage fact sheet. (2017). American Association of Colleges of Nursing (AACN). Retrieved from http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
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