This paper examines the persistent and worsening nursing shortage in the United States and proposes a dual-theory framework to address it. It introduces Jean Watson's Theory of Human Caring as a middle-range nursing theory focused on holistic patient wellness, and Maslow's Hierarchy of Needs as a borrowed motivational theory with established applications in healthcare settings. The paper traces Maslow's theoretical origins, reviews prior applications of his hierarchy in nursing and ICU care, and then applies both theories in tandem to the staffing crisis. The integrated approach argues that meeting nurses' physiological, safety, social, and esteem needs — while cultivating a caring organizational culture — can improve recruitment, commitment, and long-term retention in the profession.
There has been a disturbing trend of both surplus and shortage of nurses at different points throughout the history of the US healthcare workforce. A significant nursing shortage emerged in the early 2000s (Snavely, 2016). While there is currently a moratorium of sorts on the acute shortage, the situation is likely to worsen in the future due to several factors. First, as recovery from the 2008–2009 recession continues, nurses who returned to full-time work during that period may revert to their pre-recession employment statuses. It was estimated that 120,000 Registered Nurses would leave the profession by 2015 (Auerbach, Buerhaus & Staiger, 2015), an eventuality that risks recreating the shortage conditions of a decade earlier.
There are approximately 3 million nurses in the United States — the largest segment of the healthcare workforce. Nursing is also one of the fastest-growing occupations in the country. Even so, demand continues to outpace supply. It is estimated that there will be 1.2 million job vacancies for Registered Nurses between 2014 and 2022 (Grant, 2016). Furthermore, the nursing shortage is projected to double any shortage previously experienced since the establishment of Medicare and Medicaid, by the year 2025 (Cox, Willis & Coustasse, 2014).
The current nursing shortage could draw on Jean Watson's Theory of Human Caring for a solution. The theory addresses patients from a holistic perspective, paying attention to the wellness of the mind, body, and spirit. Such comprehensive care has the potential to expedite the healing process (Watson & Foster, 2003). According to Watson, the model incorporates both scientific and art-based techniques — an approach that integrates useful aspects of art, humanities, spirituality, science, and medicine to supplement nursing practice and support the whole person.
Maslow's theory of hierarchical needs is a motivational framework represented as a pyramid in which needs at the base are considered more urgent than those at higher tiers. According to Maslow (1943, 1954), certain needs overshadow others. The most basic and urgent need is physical survival. That need is, inevitably, the first to motivate human behavior. Once it is satisfied, the next level of the pyramid becomes the driving force, and so on until the highest need — self-actualization at the apex — is reached.
Considering the implications of this theory, an employee's emphasis on lower-level needs — such as physiological requirements and security — is entirely understandable. Someone just beginning their career will focus more on the adequacy of wages and safety considerations, such as a secure work environment. Everyone wants to earn a sufficient salary to meet personal and family needs (Maslow, 1987). If an employee's lower-level needs are not adequately met, their decisions will be driven by concerns about compensation, stability, and safety. An employee will seek to satisfy the foundational needs of the pyramid by whatever means necessary if those needs are not met by the employer.
Abraham Maslow is a prominent psychologist known for his theory that human behavior is driven by the desire to satisfy five basic needs arranged in a hierarchy. Maslow argues that humans seek to fulfill the needs at the lowest level before progressing to the next, and so on sequentially through all five levels (Maslow, 1943; Maslow, 1954).
After studying the work of Erich Fromm, Maslow came to believe that the drive toward self-actualization is encoded in the human psyche, emerging only after all other needs have been satisfied. The need for creativity and self-actualization arises once the needs for food, security, love, and recognition are fulfilled. Maslow successfully synthesized ideas from earlier psychologists, including B.F. Skinner and Sigmund Freud — both of whom focused primarily on basic human instincts — as well as Carl Jung and Erich Fromm, who emphasized that the need for attention and belonging is equally urgent (Maslow, 1987).
Maslow's most important contribution to psychology is precisely this "hierarchy of needs." As he sought to understand what motivates human behavior and the pursuit of happiness, he compiled a list of basic needs that a human being must fulfill for optimal psychological health. It was through interviews and systematic research that he developed the pyramid structure that has since become one of the most widely referenced frameworks in psychology and organizational behavior.
"Maslow used in patient care and ICU settings"
"Motivating nurses through hierarchical needs"
"Dual-theory framework for retention and culture"
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