Chapter 8 Health Workforce, Health at a Glance: Asia/Pacific 2016: Measuring Progress towards Universal Health Coverage, Health at A Glance: Europe 2018 Availability of Nurses Section 11.7 OECD/EUROPEAN UNION 2018, Factbook 20152016: Economic, Environmental and Social Statistics Ratio of Nurses to Physicians: 2013 or Latest Available Year, Analysis of a global random stratified sample of nurse legislation, Levels of education offered in nursing and midwifery education in the WHO European region: multicountry baseline assessment, Nurses in Advanced Roles in Primary Care: Policy Levers for Implementation, OECD Health Working Papers, No. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, reprints@aacn.org. Firstly, 90% of nurses are women 2. Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention Global Policy Recommendations, Human resources for health in Southeast Asia: shortages, distributional challenges, and international trade in health services, Informing the scale-up of Kenyas nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production, Analysis of a government policy to address nursing shortage and nursing education quality, Texas nurse staffing trends before and after mandated nurse staffing committees, Factors associated with intended and effective settlement of nursing students and newly graduated nurses in a rural setting after graduation: a mixed-methods review, Factors influencing recruitment and retention of healthcare workers in rural and remote areas in developed and developing countries: an overview, Transnational nurse migration: future directions for medical anthropological research, Promoting retention of nurses: a meta-analytic examination of causes of nurse turnover, The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews, Policy Brief: Nurse Retention. A meta-analytic investigation of mediating mechanisms, Interventions to reduce adult nursing turnover: a systematic review of systematic reviews, 10.2174/1874434601711010108. The number of working nurses for . Nursing shortages have long vexed hospitals. Luxembourg, but at degree level in others, e.g. An umbrella systematic review considered interventions to reduce turnover rates of nurses (i.e. Legislation, regulation and assurance mechanisms of public and private health care providers to ensure clinical effective, safe services and working environments. These strategies include: Listening to nurses' concerns. Paul De Raeve, Secretary General of the European Federation of Nurses Associations provides insight into the EU's advanced practice nursing in long-term care. Find articles from nearly 70 trusted nursing journals, including AJN and Nursing2023. In recent years, there has been an overall rise in the number of seasoned nursing faculty retiring ( Evans, 2018 ). Exemplars of policy areas to address improved supply, retention and productivity of nurses. Natasha Williams, an emergency department nurse in New York City, said she felt like she was being pulled in too many directions at once. These constant interruptions may also lead to unsafe work environments.11. It's hard to overstate the importance of nurses in healthcare settings. Hospitals are under mounting pressure to reduce staff costs and turnover while simultaneously increasing their operating efficiency. Trying to understand why nurses leave and what retains nurses in their jobs has been a perennial question; the first Lancet Commission into shortages of nurses in the UK was published in 193339. 2009;16(1):11-7. doi: 10.1016/j.colegn.2008.12.004. It is estimated that the need for registered nurses (RNs) will skyrocket to 15%, more than double that of other occupations, in the next 8-10 years. AONL releases new nursing workforce strategies. With increasing specialization and recognition that nurses can perform autonomously and in advanced practice roles, nurse-led care has emerged. Nurses and other health care professionals are human. Reviews of evidence as to why nurses migrate to other countries also illustrate the multiplicity of factors in decision making38 including: Macro and meso level factors in the home country with the perceived converse in the country of destination: weak economy, political instability and/or civil unrest, unemployment of nurses, low status of nurses, poor working conditions, few opportunities for nurses for career progression. The figures in Table 1, however, mask some fundamental variations as to who counts as a nurse; not all countries have legislation to protect the title and education level of nurse9. Based on an AACN fact sheet, factors that contribute to the nursing shortage include: More than one million RNs reaching retirement age within 10 to 15 years. A systematic review investigating the decisions of newly qualified nurses taking up remote or rural posts found that at a personal level they had backgrounds of being educated in such areas and having family and/or spouses already in such areas. However, none of the reviews have rigorously assessed the evidence about the effect of nurse staffing on nurse outcomes through meta-analysis. I think customers expect safe and appropriate staffing in health care. 1). The second major gap is the evidence informing policy decisions about interventions that work to attract, equitably distribute, retain and sustain a nursing workforce against the requirements of any health care system. We are now in danger of losing valuable staff due to unsafe work environments and lack of appreciation. A transformational strategy for nurse retention, effectiveness, and extra effort. Creating an innovation infrastructure in academic nursing. Accounting in large part for replacing those retirees as well as other factors, the BLS estimates 1.1 million new RNs will be needed to prevent a shortage. Harnessing the full power and promise of nurses and the nursing profession depends on . Human Resources for Health Observer Series No 20. Overlaying these gaps in knowledge there is an issue, common across many countries as noted by WHO2, that the profession of nursing has not been valued and given the policy attention congruent with its scale. www.ncbi.nlm.nih.gov/pmc/articles/PMC5725565/, Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study, The Author(s) 2019. An inadequate staffing budget can lead only to poor outcomes. This situation can be incredibly stressful for the nurses and extremely unsafe for the patients. individual, job characteristics, organizational characteristics and the wider labour market) on actual leaving rates of RNs or on any subgroups, such as those with caring responsibilities41. This scoping review investigated: what is Search for other works by this author on: Year in review: reflections on nursing in 2021 with an eye to the future, NIHCM Newsletter. Most of the evidence reported was at the individual level; high levels of stress and burnout, job dissatisfaction and low commitment was associated with intention to leave. Even where there are evaluations of implementation of policy actions to address shortages, such as the WHO strategy for remote and rural areas, these focus on the medical profession not nurses45. The WHO calls for greater investment in all human resources for health and advocates for policy attention across the system of production, regulation and employment2. If 1 extra patient per nurse on a medical/surgical unit can affect mortality, imagine the implications of adding 1 or 2 patients to the assignment of an ICU nurse. Dr Bourgault can be reached at. National Library of Medicine Demand for nurses is increasing in all countries. A recent umbrella review of systematic reviews investigating the determinants of nurse turnover (leaving their jobs) in high-income countries reported that most studies focused on individual factors influencing intention to leave, i.e. Meeusen V, Ouellette S, Horton B, et al. RN Shortages Negatively Impact Patient Safety Am J Nurs. Retention of experienced staff nurses is paramount as the nursing profession enters another shortage era, which leads to impact on patient safety and quality of care. For example, the Netherlands has had less than 1% foreign-trained nurses in its workforce consistently over the past 15years while others such as the UK, Australia and New Zealand have consistently had over 14% in the same period5. We turn now to consider the evidence for action to solve the shortages and mal-distribution. 16 Results from the analysis formed the basis of the discussion and our concluding remarks . Empirical Quality Results Evidence of solid processes and structures can positively impact the nursing staff, the organization as a whole and the systems of care 5. Ono T, Lafortune G, Schoenstein M. Health workforce planning in OECD countries: a review of 26 projection models from 18 countries. However, the extent of the demand for nurses is country and time specific. The shortage of registered nurses in the U.S. could reach as high as 500,000 by 2025 according to a report released in March 2008 by Dr. Peter Buerhaus of Vanderbilt University School of Nursing, Dr. Douglas Staiger of Dartmouth University, and Dr. David Auerbach of the Congressional Budget Office. There are six proven strategies to increase nurse retention. Author Karen Rosenberg PMID: 30801322 DOI: 10.1097/01.NAJ.0000554040.98991.23 Abstract Guided by the PESTEL framework theory, the purpose of this case study was to explore strategies healthcare leaders use to overcome a nursing shortage. United States Bureau of Labour Statistics. Frameworks to guide RN salary scales and benefits linked to career progression. Contingency, followed by crisis capacity strategies, augment conventional strategies and are meant to be considered and implemented sequentially (i.e., implementing contingency strategies before crisis strategies). Good human resource management policies and practice. Countries with similar GDP levels per capita show much higher figures: Japan stands at 11.3, New Zealand at 10.2, and France at 10.5 [2]. For example, a patient who is intubated and ventilated may be scared and anxious. Policies must be in place to help safely manage nurse-to-patient ratios. Having a weak voice and influence in national and international health workforce policy development has inevitable consequences, which in this context means that fewer levers are available to address shortages and action is slow. Mar 01, 2023 - 02:34 PM. The UConn School of Nursing and the UConn School of Social Work (SSW) have been awarded more than $6 million through the new CT Health Horizons program to address statewide shortages in social work and nursing.. Strategic partnership arrangements in place between regulators, education providers and health care organizations to ensure quality assurance. For over a decade, nephrology nurses, including those with dialysis expertise, have been in short supply, reflecting a broader nursing shortage in the United States., By 2030, experts project a national deficit of more than 900,000 nurses, largely attributed to a growing elderly population and limitations in nursing school capacity., Vacancies Geneva, International Council of Nurses, Nursing education challenges and solutions in sub Saharan Africa: an integrative review, The Nursing Workforce: Past Trends, Future Developments, Evaluated strategies to increase attraction and retention of health workers in remote and rural areas, How does human resource management influence organizational outcomes? So do their patients, AONL to NYT Op-Ed: nurses, not legislators, should decide appropriate nurse staffing, Think tank drives solutions to address nurse staffing crisis, Nurses dont need platitudes. Hopefully, by the time you read this editorial, many nurses will have joined ANAs initiative to send a strong message to state representatives in Congress.20 The ANA letter states that its time for Congress and the Administration to take concrete steps towards finally addressing the nursing shortage to ensure that we have a robust workforce now and in the future.20 Nurses can personalize their message to describe the difficult work situations they have been enduring. Addressing nurse shortages requires a data informed, country specific model of the routes of supply and demand. The Nursing Shortage Isn't Just InconvenientIt's Dangerous. Seven categories emerged including: nurse: patient ratios; reasons for nursing shortage; effects of nursing shortage; adverse patient outcomes; intrinsic and extrinsic motivation; recruitment and retention strategies; and motivation to work. However, this could be considered the minimum requirement for benchmarking rather than proactively modelling the future demand for nurses, the availability and supply of nurses and planning to meet the gap or shortfall. This situation can be difficult to manage even if all 3 patients remain stable. Equality and diversity policies setting workplace opportunity standards. The BLS projects a 6% job growth for registered nurses between 2021 and 2031, which is on par with the 6% projection the BLS gives for the average profession. This scenario is common in critical care and can involve a large amount of nursing time to assess the cause, alert other health care providers, determine the appropriate interventions, and perform or assist with diagnostic testing and/or interventions to monitor and stabilize the patient. Anyone who has worked at the bedside in critical care knows these high staffing ratios are a recipe for failure.8,9 Nurses cannot provide optimal care if they are assigned to too many patients. While the nurse is busy stabilizing this patient, who is looking after the other 2 patients? 1 - 3 During the Omicron wave, the US Department of Health and Human Services has reported critical staffing shortages in 24% of US hospitals, 4 and military medical personnel have been deployed to assist hospitals in at Increasing diversity and representation in nursing. Data compiled from four OECD sources 5,8. In contrast, there are those definitions of shortages that flow from staff planning projections. plans rather than actual leaving41. Trpanier A, Gagnon MP, Mbemba GI, et al. Policies addressing the participation and retention of nurses in the labour market. Congress must help end the nursing shortage crisis, Presidents Column: The Future of Nursing Starts Now, 2022 American Association of Critical-Care Nurses, This site uses cookies. In 2021, U.S. nursing schools turned away more than 91,000 qualified applicants due to a lack of faculty, education space, and resources. 2003 Winter;8(2):64-71. This then flags the next gapthe evidence to base the planning decisions on. 59, No. The https:// ensures that you are connecting to the England NHS Digital General Practice Workforce. Only peer-reviewed articles were included and all papers were read thoroughly. Praxmarer-Fernandes S, Maier CB, Oikarainen A, et al. However, many health care systems have other developments beyond minimum targets that create demand for nurses but few have undertaken nurse staffing planning projections at a national level. Even in countries where there have been active programmes to increase the recruitment of men, such as the US, less than 10% are male 16. Only 5 of 31 high-income OECD member countries have modelled their demand for and supply of nurses to 2025. There is some evidence that many RNs (like many physicians) in high-income countries consider that they are not working to the full scope of their training and are undertaking work that could be undertaken by others44. JBI Database System Rev Implement Rep. 2015 Oct;13(10):21-9. doi: 10.11124/jbisrir-2015-2380. Positive working environments are those that not only ensure the nurses well-being but sustain or increase their motivation in their work. The review excluded literature concerned with midwives and nurse-midwifes. And there's a good chance you've probably experienced the effects of it yourselftoo many patients, not enough hands. Ministre des Solidarits et de la Sant. to increase RN productivity (for example, working to the full extent of their license, task shifting to assistants, using technologies and community health workers) as well as to produce more and retain more RNs. There was also evidence that nurse manager leadership styles that were perceived as encouraging work group cohesion were also effective in reducing turnover47. You often hear terms like 'it was harder in my day' 'I was left in charge as a . More than half of current RNs are over the age of 50. The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. RNs are in high demand, with projected job growth of 12% from 2018 to 2028. The types of factors influential in this decision making include: Individual: skills and interests, career plans, caring/family responsibilities, financial responsibilities. Attracting and retaining RNs (and other types of specialties and levels) to work as clinical educators of nurses in training. This is not a new term to be used in conjunction with nursing with many reports describing bullying and intimidation from staff (both qualified nurses and care assistants) to students while on placements. 2022 Nov 19;14(11):e31664. At the time of writing, there is a global WHO-sponsored campaign called Nursing Now (201820) (https://www.nursingnow.org/) that supports country-specific campaigns and activities to raise the profile of the nursing profession, develop leaders for governments and to make change at a systems level. Some patients may not receive all of the necessary elements of evidence-based care, and some patient needs will not be attended to. Bookshelf Global demographic changes have led to a systematic increase in the elderly population and a decreasing number of births, which have impacted health policy and healthcare systems in various countries. Data Sources US Bureau of Labor Statistics 19, Australian Health Workforce20, NHS Digital England21, Japan Nursing Association22, Ministre des Solidarits et de la Sant23. The demographic profile, status, education, career options and remuneration levels for these two professions are very different and assumptions that evidence from one professionally is automatically applicable and relevant to the other is contestable and at worst misleading. The aging nursing workforce has long been a major contributor to the nursing faculty shortage ( Poronsky et al., 2012 ). Nursing retention and turnover impacts health care on many facets; pressures are increasing to provide quality care in a cost-effective manner to a satisfied patient with an engaged staff as defined by the Quadruple Aim. Many nurses are angry and leaving the profession early. For example, at the national level, nursing workforce data is often incomplete and based on historical activity rather than projections. Prepandemic research identified 2 major reasons for understaffing of nursing care: (1) poor workplace conditions and (2) inadequate staffing models and flexibility.17 Dr Linda Aiken, a top researcher on nursing workforce issues, blames inadequate staffing on lack of government legislation, especially at the state level17; she believes that states can assist by mandating staffing ratios. These include: California New Jersey South Carolina Alaska Texas Even before 2020, there were statewide initiatives to address the shortage of bedside nurses and nurse educators. It has taken a significant mental-health toll on nurses and resulted in some quitting their jobs. Burnout is a large problem in social professions, especially in health care worldwide [] and is consistently associated with nurses intention to leave their profession [].Burnout is a state of emotional, physical, and mental exhaustion caused by a long-term mismatch of the demands associated with the job and the resources of the worker [].One of the causes for the alarming increase in nursing . The number of employed nurses in each state compared to its population creates a healthcare deficit. Registered nurse (RN) academic levels also vary; for example, in Europe RN education is at diploma level in seven countries, e.g. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R19-en.pdf?ua=1&ua=1, https://www.who.int/hrh/resources/pub_globstrathrh-2030/en/, https://www.who.int/hrh/resources/health-observer17/en/, https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en#page160, https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2018_health_glance_eur-2018-en, https://read.oecd-ilibrary.org/economics/oecd-factbook-2015-2016/ratio-of-nurses-to-physicians_factbook-2015-graph199-en#page1, http://www.euro.who.int/__data/assets/pdf_file/0008/348416/PUBLIC_HEALTH_PANORAMA_SEPTEMBER_RUS.pdf#page=64, https://www.bls.gov/oes/current/oes291151.htm, https://www.census.gov/library/working-papers/2013/acs/2013_Landivar_02.html, https://www.gov.uk/government/news/nhs-pledges-action-to-eliminate-ethnicity-pay-gap, http://www.data.drees.sante.gouv.fr/TableViewer/tableView.aspx?ReportId=3704, https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-3, http://www.health.gov.au/internet/main/publishing.nsf/Content/hwa-archived-publications, https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/final-30-september-2018-experimental-statistics, https://www.nurse.or.jp/jna/english/statistics/index.html, http://dx.doi.org/10.1787/5k44t787zcwb-en, https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/nhs-vacancy-statistics-england---february-2015---march-2018-provisional-experimental-statistics, https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-k-shortage-occupation-list, https://immi.homeaffairs.gov.au/visas/working-in-australia/skill-occupation-list, https://www.uscis.gov/working-united-states/temporary-workers/h-1c-registered-nurse/h-1c-registered-nurse-working-health-professional-shortage-area-determined-department-labor, https://www.who.int/hrh/resources/health-observer20/en/, https://www.who.int/hrh/retention/guidelines/en/, http://www.human-resources-health.com/content/12/1/47, https://doi.org/10.1016/S0140-6736(00)98375-2, https://www.icn.ch/news/new-policy-brief-nurse-retention-released, http://www.oecd.org/health/health-systems/Nursing-workforce-February2016.pdf, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, Ambulatory healthcare services/community health services, Nursing home and residential care facilities. The nursing organization uses evidence-based practices and research when implementing clinical and operational processes. 7. Innumerable literature reviews on the subject in the intervening years demonstrate the interlocking range of factors at individual, organizational and the broader socio-economic level40. This review has demonstrated that that the nature and size of the professionally qualified nurse workforce is shaped by the societal context of individual countriespolitical choices that influence decisions about resource allocation to health systems, demographics (labour market pressures on working age, particularly of women), image of nursing and its positional power in relation to medicine, demands for care/health and social inequalities. Thinking and educational time is valuable. Location: urban, sub-urban, rural, proximity to family and/or other services such as schools for children. In late January 2022, the incidence of Omicron in US communities is beginning to fall, yet many hospital systems remain burdened by unprecedented high patient volumes and COVID-19related deaths. The answer is Yes! Definitions of shortages in workforce are policy contingent and vary between health care systems. The two measures are aimed at helping heal the state's . Recent reports suggest that nurses are leaving the bedside owing to COVID-19 at a time when multiple states are reporting a severe nursing shortage. Advanced practice roles are those in which RNs, with additional training, undertake diagnostic and treatment roles traditionally the domain of the doctors. Subsequent analysis has identified multiple reasons for this failure including: insufficient infrastructure for clinical education, weak regulation of education standards and few posts to apply for, see for example the review from Sub-Saharan African countries43. Federal government websites often end in .gov or .mil. 29-1151 Nurse Anesthetists, Ghana Association of Certified Registered Anesthetist, Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature, Men in Nursing Occupations: American Community Survey Highlight Report, Department of Health and Social Care (England), NHS Pledges Action to Eliminate Ethnicity Pay Gap, Ministre des Solidarits et de la Sant (France), Data DRES TABLEAU 1. For Permissions, please email: journals.permissions@oup.com, This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, Children and bioethics: clarifying consent and assent in medical and research settings, Micro RNA in meniscal ailments: current concepts, Implementing brief and low-intensity psychological interventions for children and young people with internalizing disorders: a rapid realist review. 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