Abstract
Introduction. The shortage of nurses has become a major global health issue. It affects the quality of care services and leads to a potential delay in care services for veterans and military men.
Findings. The paper found that more than 85% of military health facilities are experiencing nurse shortages. Major factors contributing to the shortage of nurses were the competitive civilian nursing market, military-specific challenges, harsh military experience, and limited retention strategies.
Conclusion and recommendation. The shortage of nurses led to increased workloads for nurses, quality and patient safety issues, and delays in care services. Therefore, the paper recommended increased compensation, improved work balance, and high salaries for military men to increase job satisfaction and reduce high turnover rates.
Introduction
A shortage of military nurses is a major global health issue. It affects the quality of and access to care services for deployed soldiers and veterans. The Department of Veterans in the U.S. has complained of a lack of adequate services and personnel to care for war heroes. Veterans are exposed to risks to patient safety. The change is expected to escalate due to the anticipated decline of civilian nurses and the transition of military nurses to civilian nurses. According to Keita et al. (2022), the U.S. nursing shortage is expected to reach 260,000 registered nurses by 2025. The government is offering opportunities for military nurses to further their education. This would lead to a shift in the profession and the transition of military nurses to civilian nurses. Besides, barriers to licensed spouse-registered nurses have led to a more than 89% decline in the shortage of military nurses (Brannock & Bradford, 2021). Other factors contributing to the shortage of military nurses include military-specific challenges and a competitive civilian market. The military requires registered nurses to have specific requirements that discourage registered nurses from getting deployed. Besides, lack of job satisfaction, low monetary bonuses, poor recruitment strategies, and low retention strategies have escalated the turnover rates in military nursing services (Oh & Lee, 2021). The shortage leads to an increase in workload for remaining nurses and a potential delay in care services. Therefore, the defense department and military hospitals need to develop strategies to improve military nurse retention.
Findings
Shortages of Nurses in the Military
Why nurses are leaving veterans affairs hospitals?
The shortage of nurses in the military department has significantly increased in the past 50 years. Oh & Lee (2021) investigated why nurses are leaving military and veteran affairs hospitals. The authors used social exchange theory as the guiding theoretical model for the research. This theory involves individual military nurses weighing the cost and benefits of working in a veteran affairs hospital. According to this study, the aging veteran population with more than 65 years of experience has been complaining of a lack of effective services in military hospitals (Fasbender et al., 2019). This shortage of nurses in military hospitals has influenced the quality-of-care services in these hospitals.
This article is a quantitative study. It uses numerical data to analyze the findings of veteran nurses’ turnover rates. The authors used qualitative research methodology to investigate why the number of nurses in veteran hospitals has declined. It collected turnover rates from 118 veteran hospitals in the U.S. from 2015 to 2017. The 118 veteran hospitals were the sample size, representing all veteran hospitals in the U.S. The study found that job satisfaction, annual salaries, and patient mortality. influenced nurse turnover in military and veteran hospitals. These factors influenced the stress and job satisfaction of nurses, thus driving the high retention rates. Oh & Lee (2021) concluded that V.A. hospitals should develop proper work environment arrangements and implement programs that mitigate nurses’ stress levels and improve job satisfaction to reduce the high turnover rates.
Transitioning from military medics to registered nurses
The study reveals how military medics have transitioned to registered civilian nurses in the past few decades. Keita et al. (2022) used the labor market theoretical framework to explain how the demand for nurses in civilian nursing homes has led to a shortage of nurses in the military. According to the article, the government has organized training for military nurses by allowing them to pursue a bachelor of science in nursing. The program will transition them from military nurses to civilian nurses. Keita et al. (2022) used qualitative methods to investigate the research question. This made the study a qualitative study.
The authors used secondary research methodology to investigate issues leading to military nurses’ transition to civilian nurses. They used existing literature reviews to highlight why nurses are transitioning. Military nurses are transitioning to civilian nurses due to the expected shortage of civilian nurses. The U.S. nursing shortage is expected to reach 260,000 registered nurses by 2025. Therefore, the government has offered military nurses a BSC in nursing program to increase their competencies. This will allow military nurses to offer quality care services to civilian nursing hospitals. However, this will negatively affect the military nursing hospital. The authors concluded that the transition will lead to a shortage of military nurses in the long run.
Deployment experiences of military nurses
The study uses phenomenology theory as a lens or framework for the research. This theory is a qualitative approach that aims to understand the lived experiences of professionals. The authors use it to discuss the experiences of military nurses and their perceptions of their deployment journey. The theoretical framework explains how the military experience influences job satisfaction and high military nurse turnover rates. This study is qualitative since it used non-numerical data as the research findings.
Ma et al. (2020) used a systematic and qualitative meta-synthesis methodology for the study. It focused on investigating military nurses’ preparation, deployment, and reintegration perceptions. The study did not have a particular sample size. However, it used data and experiences from licensed military nurses contracted to provide care services in military hospitals (Sadhaan et al., 2022). Most of the nurses’ experiences were harsh and difficult. Nurses were required to be on the frontlines with other military personnel to ensure they provided care services to deployed soldiers (Ma et al., 2022).
The article found that the deployment experience of nurses was harsh, and the transition from civilian to emergency military service was hard. The study also found that reintegration was not easy due to war-related issues and emotional challenges. Therefore, the deployment of military nurses to war zones was harsh and stressful. This resulted in high turnover rates and a shortage of military nurses.
Innovative Ways to Attract, Recruit, and Retain Personnel
Attracting, recruiting, and retaining nurses and care workers working in care homes
The shortage of nurses in the military significantly affects the delivery of care services for military men and veterans. Devi et al. (2020) highlights various ways civilian nursing homes use to attract, retain, and retain their staff. Military nursing homes may use similar strategies to attract and retain military nurses. The authors used social, motivational, and organizational culture theories to guide the research. These theories reflect how individual nurses weigh the cost and benefit of employment to determine whether to stay or leave the nursing profession. The study was qualitative. It focused on gathering non-numerical data such as documentation and existing literature reviews. This study enabled the author’s use of existing evidence to support the research question.
Devi et al. (2020) used qualitative research to gather the findings. They use existing literature findings to distinguish methods used to improve recruitment and retention programs. The evidence revealed that individual rewards such as feeling valued or training, relationships with colleagues and patients, and supportive work environments such as flexible working hours influenced the stay of nurses (Mallon et al., 2023). Devi et al. (2020) concluded that understanding how to attract or retain nurses could not be solved by a one-approach-fits-all solution. The nursing homes should provide individual rewards, room for stakeholder collaboration, supportive work arrangements, and better salaries. Therefore, military nursing homes should adopt similar arrangements to attract recruits and reduce turnover in military nursing services.
U.S. Army Medical Corps recruitment, job satisfaction, and retention
Marble et al. (2020) directly investigates the U.S. Army Medical Corps’ methods to recruit, attract, retain, and ensure job satisfaction. The authors use motivation and social exchange theories as the research foundations. The social exchange theory highlights how individual army medical corps members weigh the cost and benefits of working in military nursing homes, while the motivation theory reflects intrinsic and extrinsic factors influencing job satisfaction and commitment among military nurses. Marble et al. (2020) use these theories to identify and understand the current factors influencing job satisfaction, recruitment, and retention of U.S. military medical corps officers and the methods the military nursing departments should use to improve medical corps retention and recruitment.
Marble et al.’s (2020) research was qualitative. It used qualitative research methodology to gather the study findings. The research used an anonymous, voluntary questionnaire. The questionnaires were sent to army medical corps officers to gather responses on factors influencing their retention and job satisfaction. The responses gathered were tabulated and analyzed to show the results. The paper found that job satisfaction, retention, and recruitment among military nurses have been issues in the U.S. for the past 50 years (Dez et al., 2023). Limited medical students show interest in joining the U.S. Army Medical Corps; the satisfaction rate of the existing medical corps has been significantly low. This has increased the shift of the U.S. Army medical corps to the civilian nursing profession. Military nurses have also complained of low payments, limited monetary bonuses, and limited-service flexibility (House et al., 2022). Therefore, the authors concluded that the U.S. Department of Defense should focus on collecting individual medical corps officers’ opinions on the work arrangements and factors they feel should be improved. This would allow the Army Medical Department and Department of Defense to develop informed policies to improve job satisfaction, prevent turnover, and increase recruitment.
Job satisfaction and caring behavior among nurses in a military hospital
Putra et al. (2021) discuss the job satisfaction and caring behaviors of nurses in military hospitals. The study reveals how the job satisfaction of military nurses influences their commitment to offering care services to military patients and veterans. The theoretical lenses of the study are motivational theory and organizational culture theory. The authors use the motivation theory as a framework to explain why military nurses are demoralized to offer committed quality care services, while the organizational culture theory reveals organizational practices that influence military nurses’ job satisfaction and turnover rates. Caring for patients is the major role of medical nurses (Amelework & Sisay, 2019). However, factors such as organizational culture and motivations affect the ability and commitment of military nurses to offer quality care services.
The study by Putra et al. (2021) was quantitative. It used numerical data to evaluate the military nurses’ perspectives on factors influencing their commitment and satisfaction. The authors used quantitative research methodology to gather and analyze the findings. They used self-assessment questionnaires, which were distributed from August to December 2019 (Vujanić et al., 2020). The target population of the study was the military nurses in Indonesia. Putra et al. (2021) used a sample size of 121 military nurses in Malang military hospital, Indonesia. The sample size was used to represent the entire population of military nurses in Indonesia. The data was collected using the Job Satisfaction Survey (JSS) and analyzed using rank-scoreman and multiple linear regression.
The authors revealed that job satisfaction positively correlated with caring behaviors and retention rates (p = 0.003; r = 0.266) (Putra et al., 2021). Job satisfaction was influenced by work arrangements, coworkers’ relationships, contingent rewards, and supervision. The research realized that salary, promotion, and monetary benefits had an insignificant impact on the nurse’s retention and caring behaviors (Amelework & Sisay, 2019). Therefore, military nursing homes should provide effective nursing supervision, offer contingent rewards, empower nurses, and ensure an effective collaboration program to improve military nurse retention and job satisfaction.
Comparisons Between Military and Civilian Nurses’ Salaries and Benefits
Comparing the compensation of U.S. military physicians and civilian physicians in residency training and beyond
The authors use human capital theory and labor market theory as frameworks for the study. The human capital theory suggests that individuals are likely to be more committed when receiving high salaries and benefits. On the other hand, the labor market theory examines how salaries and compensation influence the supply and demand of nurses. Civilian and military nurses differ in terms of salaries and education. The civilian nurses have a professional degree in nursing, while the military nurses have an academic level below a bachelor of science in nursing (Congressional et al., 2019). The salaries for military nurses vary based on rank in the military. The study was quantitative since it used quantifiable and numerical military pay data from the Department of Defense.
Stortz et al. (2021) used a secondary research methodology. The research obtained military nurses’ pay data from existing military websites. The authors extracted the salary data from the 1018 Defense Finance and Accounting Services website. The Medscape 2018 resident salaries report obtained the civilian nurse’s data. Stortz et al. (2021) found that military physicians earned 53% more than civilian nurses. Military residents were paid $88,694 with additional benefits like housing allowance, subsistence allowance, and annual incentive pay, among others. Conversely, civilian nurses were paid $57,000, which is relatively lower than that of military nurses (NALP, 2019). However, civilian nurses received higher benefits, such as housing allowances, education, training, and work-life balance, than military nurses.
Job satisfaction among nurses and physicians in an Army hospital
The authors used social exchange and motivation theories to frame the research. The theories reflect individual military cost-benefit evaluations of employment for civilian nurses. They show factors motivating or demoralizing civilian or military nurses to continue working in their respective nursing homes. According to the study, civilian nurses had several better benefits or compensations than military nurses (Lu et al., 2019). This has contributed to low retention rates in the military medical corps.
The article is a quantitative paper. House et al. (2022) use numerical data to evaluate the factors motivating military nurses to stay in military hospitals. The authors used quantitative and primary research methodologies to conduct the research. They used two open-ended questions that were distributed to a sample size of 286 military nurses and physicians. House et al. (2022) found that military nurses complained of a greater lack of job satisfaction than civilian nurses. Inadequate staffing, low monetary bonuses, and work schedule conflicts influenced a lack of satisfaction. Therefore, military hospitals should develop policies that offer reasonable work-life balance and monetary bonuses and compensations, like in civilian nursing homes, to increase the retention and job satisfaction of military nurses.
Trends in Recruiting Military Nurses
Barriers to licensure for military spouse registered nurses
The authors use labor market theory to explain how barriers to licensure for military spouse registered nurses will affect the number of military medical corps. According to Brannock & Bradford (2021), by 2030, one million registered nurses in the U.S. are expected to retire. This would increase the nurse shortage in the U.S., thus reducing the number of in-care services. Military nurses are expected to face similar challenges by 2030, and the policies they are implementing will escalate the shortage (Arnold, 2022). According to the article, more than 89% of registered nurses with spouses did not relicense due to the barrier restricting them from registering for military nursing service.
Brannock & Bradford’s (2021) study was quantitative research. The authors gathered and analyzed numerical data to come up with the findings. They used mixed methods that consisted of primary and secondary data. Brannock & Bradford (2021) used surveys and 14-semester structured in-depth interviews to gather information from military spouses. The study used 191 military-registered nurses’ spouses as the sample size to represent the entire U.S. military spouse population. The research found that more than 35% of the surveyed registered nurses were considering leaving the field of military nursing due to licensing issues. Therefore, the barrier to licensing military spouse nurses has significantly contributed to the low number of military nurses.
From civilian service to military service: What led policymakers to remove nursing care from field units of the Israeli Defense Force (IDF) and return it later?
The author used labor market theory as the theoretical framework guiding the research. This framework examines the supply and demand of the labor market. The study uses the theory to reflect how civilian nurses are recruited to military nursing homes to increase the number of military nurses. Segev (2020) examines how the Israeli defense force has experienced a shortage of nurses since 1948. The Israeli defense force closed all the military hospitals in 1949, and the medical corps lost its purpose in the military. However, in 2018, the medical corps decided to integrate the military nurse into the military by compulsory recruiting civilian nurses (Segev, 2023).
The study was a qualitative one. The research used non-numerical data as findings for the study. The research methodology used was secondary and qualitative. Segev (2020) based the study on an analysis of documents from IDF archives, current news articles, and the Israeli parliamentary archive to answer the research questions. The study found that for almost 70 years, Israeli military nurses had no purpose (Segev, 2023). Their major work was to offer care services to civilian nursing homes. This increased the shortage of military nurses in Israel. Therefore, the government reinstated the military medical corps officers to military care services and deployed normal civilian nurses to military nursing homes to increase the number of military nurses.
Conclusion and Recommendations
A shortage of military nurses poses a significant threat to the well-being of the military and veterans. Reports show that there are high vacancy rates among military nurses due to high turnovers. About 85% of military healthcare facilities experience shortages of nurses. The shortage has increased the workload of the nurses and reduced the quality and patients’ safety. A shortage of nurses has led to potential delays in care services. This has put most veterans at risk of poor health. The literature review found that the shortage is mainly due to limited retention strategies for the military medical corps. Most of the army medical corps complained of low pay and compensation and poor work-life balance. The civilian nurses also received higher salaries, benefits, and work-life balance options. Therefore, most military nurses were willing, when given options, to transition to civilian nursing services. The harsh experience confessions by military nurses have demoralized civilian nurses who would want to be deployed in military services. Shortages of nurses have increased poor care service complaints from military members and veterans. Therefore, there is a need for the development of effective military nurse retention and recruitment strategies.
The paper recommends the Departments of Health and Defense employ the following strategies to deal with the shortage of nurses: First, increase the compensation and benefits of the military medical corps. Military nurses should be offered competitive salaries, bonuses, and benefit packages to retain them. This will also limit the transition of military nurses to civilian nursing services. Besides, the defense department should increase military nurses’ work-life balance. The Army Medical Corps should be allowed to have a flexible work schedule. This would attract young and talented registered nurses to join the military nursing services.
References
Amelework, N., & Sisay, G. (2019, December 18). Factors associated with nurses’ perception about nurse caring behaviors (case at hospitals of Harar Town, Eastern Ethiopia). Int J Heal Nursing Med, 1, 21-9. https://www.semanticscholar.org/paper/Perception-of-caring-behavior-and-associated-among-Assefa-Getahun/b27f16607018fa10d12fac5a799695266d78f0d2
Arnold, C. (2022, December). The Information Architecture of Military Spouse Architect Licensing. Soar.suny.edu. https://soar.suny.edu/handle/20.500.12648/10437
Brannock, M. K., & Bradford, N. A. (2021, January 1). Barriers to licensure for military spouse registered nurses. Journal of Nursing Regulation, 11(4), 4–14. https://doi.org/10.1016/s2155-8256(20)30170-8
Congressional Research Service. (2019, December). Federal support for graduate medical education: an overview – R44376. https://crsreports.congress.gov/product/pdf/R/R44376
Devi, R., Goodman, C., Dalkin, S., Bate, A., Wright, J., Jones, L., & Spilsbury, K. (2020, July 1). Attracting, recruiting and retaining nurses and care workers working in care homes: the need for a nuanced understanding informed by evidence and theory. Age and Ageing, 50(1), 65–67. https://doi.org/10.1093/ageing/afaa109
Dı́ezF. V., Pedro César Martínez-Morán, & Maite Aurrekoetxea-Casaus. (2023, August 08). The learning process to become a military leader: born, background and lifelong learning. Frontiers in Education, 8. https://doi.org/10.3389/feduc.2023.1140905
Fasbender, U., Van der Heijden, B. I. J. M., & Grimshaw, S. (2019, October 11). Job satisfaction, job stress and nurses’ turnover intentions: The moderating roles of on-the-job and off-the-job embeddedness. Journal of Advanced Nursing, 75(2), 327–337. https://doi.org/10.1111/jan.13842
House, S., Crandell, J., Miller, M., & Stucky, C. (2022, July 9). The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital. Nursing Forum. https://doi.org/10.1111/nuf.12777
House, S., Wilmoth, M., & Stucky, C. (2022, July 5). Job satisfaction among nurses and physicians in an Army hospital: A content analysis. Nursing Outlook. https://doi.org/10.1016/j.outlook.2022.03.012
Keita, M. D., Diaz, V., Miller, A., Olenick, M., & Simon, S. (2022, December 18). Transitioning from military medics to registered nurses. Journal of Multidisciplinary Healthcare, 495. https://doi.org/10.2147/JMDH.S93254
Lu, H., Zhao, Y., & While, A. (2019, June). Job satisfaction among hospital nurses: A literature review. International Journal of Nursing Studies, 94(1), 21–31. https://doi.org/10.1016/j.ijnurstu.2019.01.011
Ma, H., Huang, J., Deng, Y., Zhang, Y., Lu, F., Yang, Y., & Luo, Y. (2020, April 18). Deployment experiences of military nurses: A systematic review and qualitative meta‐synthesis. Journal of Nursing Management, 29(5), 869–877. https://doi.org/10.1111/jonm.13201
Ma, H., Zhu, X., Zhang, S., Huang, J., Lu, Y., & Luo, Y. (2022, April 18). Development and validation of professional competency scale for military nurses: an instrument design study. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-00867-5
Mallon, A., Mitchell, G., Carter, G., Francis McLaughlin, D., Linden, M., & Brown Wilson, C. (2023, December). Exploring Resilience in Care Home Nurses: An Online Survey. In Healthcare (Vol. 11, No. 24, p. 3120). MDPI. https://www.mdpi.com/2227-9032/11/24/3120
Marble, W. S., Cox, E. D., Hundertmark, J. A., Goymerac, P. J., Murray, C. K., & Soderdahl, D. W. (2020, September 18). U.S. Army medical corps recruitment, job satisfaction, and retention: historical perspectives and current issues. Military Medicine, 185(9-10). https://doi.org/10.1093/milmed/usaa094
NALP. (2019, December). National Association for Law Placement. Findings on first-year salaries from the 2019 Associate Salary Survey. https://www.nalp.org/0619research
Oh, D., & Lee, K.-H. (2021, June 10). Why Nurses Are Leaving Veterans Affairs Hospitals? Armed Forces & Society, 0095327X2110238. https://doi.org/10.1177/0095327×211023851
Putra, K. R., Andayani, T., & Ningrum, E. H. (2021, April 14). Job satisfaction and caring behavior among nurses in a military hospital: A cross-sectional study. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2212
Sadhaan, A., Brown, M., & McLaughlin, D. (2022, October 29). Registered Nurses’ Views and Experiences of Delivering Care in War and Conflict Areas: A Systematic Review. Healthcare, 10(11), 2168. https://doi.org/10.3390/healthcare10112168
Segev, R. (2020, December). From civilian service to military service: what led policy-makers to remove nursing care from field units of the Israeli defense force (IDF) and return it later? Israel Journal of Health Policy Research, 9(1). https://doi.org/10.1186/s13584-019-0360-2
Segev, R. (2023, March 1). The Shaping of Military Nursing in Israel: 1947–1958. Nashim: A Journal of Jewish Women’s Studies & Gender Issues, 42(1), 148–174. https://muse.jhu.edu/pub/3/article/907308/summary
Stortz, S. K., Foglia, L. M., Thagard, A. S., Staat, B., & Lutgendorf, M. A. (2021). Comparing compensation of U.S. military physicians and civilian physicians in residency training and beyond. Cureus. https://doi.org/10.7759/cureus.12931
Vujanić, J., Prlić, N., & Lovrić, R. (2020, July 21). Nurses’ Self-Assessment of Caring Behaviors in Nurse–Patient Interactions: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 17(14), 5255. https://doi.org/10.3390/ijerph17145255
write