Nursing Shortage and Its Effects on Healthcare

Despite the recent advances in nursing, including the introduction of the latest technology, the redesign of some of the nursing practices, and the incorporation of the latest tools into the provision of nursing services, the quality of the latter is quite unstable due to the shortage of nursing specialists. The reconsideration of the current time management approaches, as well as the promotion of personal and professional responsibility in nurses does not trigger major alterations, which is an obvious reason for concern. Therefore, the areas of the human resource approaches adopted in the contemporary nursing setting, the quality of the corresponding services, and the means of addressing the issue, can be considered the scope of the problem. The significance of the issue in question to nurses and nursing staff is obvious: by considering the existing solutions to the problem, one will be able to develop the strategy that will allow for both a major improvement in the nursing services quality and the rearrangement of nurses roles and responsibilities. Thus, it is crucial for nursing staff to be aware of the issue. The quality of the healthcare delivery and the efficacy of the nursing staffs performance are the key dependent variables, whereas the nursing shortage and its increasing rates are the essential independent variables. Among the rest of the independent variables, the time management strategies, the recovery rates among the patients, nurses stress rates and satisfaction rates in nurses will be considered as well. Before the study is conducted, some of the terms that have been or will be used need definition and further clarification. The full list of terms and their definitions is provided below.

Nursing shortage is the lack of nursing specialists within the environment of a certain healthcare facility or community that is supported by one or more healthcare facilities (Morgan & Lynn, 2009).

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Burnout/Compassion fatigue is the state of psychological exhaustion, which occurs after a nurse becomes overly engaged with the wellbeing of the patient or is assigned with an unrealistic amount of work and, therefore, is incapable of experiencing an emotional connection with the patient anymore. As a result, the nurse ceases to be empathetic with the patient; moreover, the quality of the nurses work may drop significantly (Brunetto et al., 2013).

Social Exchange Theory is a set of sociological and psychological concepts that allow understanding the significance of change and stability (Flinkman, Leino-Kilpi & Salantera, 2010).

Organizational commitment is the understanding of ones professional responsibilities and duties, as well as complete compliance with these duties and the existing code of ethics (Brunetto et al., 2013).

Perceived organizational support is an HRM approach, which presupposes a very delicate treatment of the staff and concern about the employees physical and emotional wellbeing, as well as an overall positive treatment of the nurses (Brunetto et al., 2013).

Career mobility is either a downward or an upward change in the position assumed (Flinkman et al., 2010).

Personnel turnover is the average tenure of the nursing staff within an organization.

Much to the credit of the researchers addressing the issue, the current state of knowledge on the subject is quite impressive. The problem of the nursing shortage, including the reasons for the phenomenon to occur, the implications of nursing shortage for the reality of healthcare and the provision of the services of the required quality, the correlation between nursing shorting and staff satisfaction, and, eventually, the link between nursing shortage and the quality of the healthcare services have been researched extensively over the past few years. Nevertheless, the problem still remains unresolved due to the lack of a proper strategy, which could help address the issue of nursing shortage.

Literature Review
Nursing shortage as is currently understood has been caused by a number of factors. In developed countries, particularly, in Europe and the United States, the shortage occurs partly due to increasing demand for nurses complicated by undersupply. Increasing demand for nursing services is related to the ageing population in these countries. The effects of ageing on nursing services are twofold. The ageing population has more healthcare needs. In order to meet the needs of this population it is important to increase the nursing workforce alongside other healthcare disciplines. Second, ageing removes a significant portion of nurses from the workforce. The supply of qualified nurses has been steadily declining in a number of countries. For instance, it was estimated that by the end of the first decade of this century, demand for nurses in the United States of America would outstrip supply.

Morgan and Lyn (2009) observe that dissatisfaction is a major cause of exit from both practice and the profession. They further claim that satisfaction and quality of care are positively related. The study seeks to describe the relationship between job satisfaction and nursing shortage. The results indicate that there are two dimensions of satisfaction in nursing. The intrinsic dimension refers to the satisfaction that nurses get after attending to patients. It includes comforting patients, making a difference in nursing, educating patients, as well as promoting patient advocacy, professional pride, autonomy, mentoring, respect for nursing, and professional boundary maintenance. The nurses, who were interviewed, put a strong emphasis on the reward systems inherent in the profession. For example, 95% of the responses identified making a difference in a patients life as an important aspect of their work (Morgan & Lynn, 2009). Fifty five percent of the respondents found comforting patients rewarding. Autonomy was cited as one of the factors that can contribute to the general satisfaction rates. Nurses desire more autonomy when discharging their duties. Other factors that influenced satisfaction of the respondents are considered extrinsic in nature. The external factors are not inherent in the profession itself; they , relationship with coworkers and mangers, career opportunities, and resource adequacy. Work relationship contributes a great deal to satisfaction or dissatisfaction. Adequacy of resources appears to be the most important factor among these. Availability of resources influences both time and the amount of energy that nurses put into their work. Resource deficient setting puts a great physical and mental strain on the nurses. While adequate financial compensation is important to nurses, it is not nearly the most important aspect of the profession.

Workplace relationships influence nurse recruitment and retention (Brunetto et al, 2013). Workplace relationships have a profound effect on nursing turnover. Intention to quit is exacerbated by strained workplace relationship. The aspects of workplace relationships important to nurses include supervisornurse relationships, teamwork, perceived organizational support, employee engagement, well-being, organizational commitment, and turnover intention.

Well-being is among the most important predictors of intention to quit. Nurses emphasize their well-being at the workplace. The nurses, who think that their well-being is not being catered to, quit either work or the profession altogether. On the other hand, those, who feel that their well-being is being catered for are likely to remain in the profession. It is, therefore, important for managers to consider nurses well-being when making major institutional decisions. This is important because hiring new staff is expensive and time-consuming In addition, nurses play an important role in the society. It is important to retain nurses because of the prevailing mismatch between supply and demand. Nurses are in short supply in most parts of the world. Attending to this need ensures that nurse turnover is kept at a manageable level.

The results indicate that nursing turnover is correlated to organizational support. The organizational support availed to nurses varies with the organization. Nurses, who receive adequate support, are likely to remain in the institution. The findings also indicate that the relationship between supervisors and the nurses varies based on the state, in which the nursing procedures are observed. In Australia, for instance, the supervisors played an important mediating role between the organization and the nurse. However, in the United States supervisors do not play an important role in mediation between the nurses and their organization. In those countries that the supervisor plays an important mediating role, the level of nurse satisfaction is thought to be higher. Even with the regional differences in mind, organizational support is a predictor of nurse turnover. Therefore, the way, in which an organization decides to extend its support, is important. Organizational support is associated with the promotion of staffs well-being. Well-being appears to be the key factor defining the rates of turnover and retention.

Effective workplace relationships are beneficial to both the organization and the employees. The benefits that the employees may derive from include improved access to resources and the establishment of useful networks. Effective workplace relationships may also improve adverse patient outcomes. This may occur because the employees can when they have effective relationships. However, the findings also indicate that effective workplace relationships are not associated with better outcomes in all settings.

Flinkman, Leino-Kilpi & Salantera (2010) found in their review of literature that a number of factors influence intention to leave the profession. They observe that, though many previous studies focus on intention to leave, few examine the core causes of this feeling. Accordingly, the problem appears to persist because the reasons for intention to leave the profession are not known. If the reasons were known, perhaps it would be possible to formulate mitigation measures. The variables that influence decision to quit include demography, work-related constraints, and individual constraints. The percentage of nurses intending to leave the profession is not constant across the studies. However, there is a correlation between the number of those, who quit, and the proportion of those, who intend to quit. In general, nursing shortage has been acknowledged in most parts of the world. It is further recognized that the shortage is affecting the quality of care. The shortage is associates with poor outcomes. This problem is compounded by the fact most countries need more nurses. Therefore, it can be said that as new nurses enter the profession those with experience are leaving. Research needs to focus on the factors leading nurses to leave the profession. A thorough analysis of those, who actually quit, will offer insight into the reasons for their choice. It has been observed that male nurses and younger nurses tend to transit to higher education. The quality of data in previous studies varies owing to the limitations. Most studies are quantitative in nature. The quality of the studies is also complicated by sampling methods used. Most rely on convenience samples; in addition, most surveys use small samples.

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