Abstract
Nurses play a significant role in health care because they are the intermediaries between patients and professional physicians and doctors. The nursing shortage is a significant problem that has led to reduced chances of achieving global health care objectives, especially in healthcare-associated infections and diseases. Health care leaders have continued to experience challenges in nursing recruitment and retaining processes due to economic factors such as a reduced supply of professional nurses and reduced institutional funding. This essay will examine the issue of a nursing shortage, parties involved, market forces influencing the issue, demand and supply of nursing, influence of the affordable care act, and how improvements can be made. Due to the nursing shortage, the nursing field has been clouded with low-quality care and reduced patient safety, which leads to the negative patient and organizational outcomes.
Introduction
Population health and universal coverage, and equitable access to quality care are dependent on having a vibrant workforce in health care facilities. The global demand for health care providers is expected to rise in the US, and demand for RNs is expected to surge to meet the needs of patients. The new RNs are needed to replace that elderly workforce and meet the growing demands of people searching for health care. The challenge that faces the nursing field is that there have been shortages in the workforce. The current workforce is overwhelmed by the rising demands which need their services. Nurses comprise half of the global workforce, and shortages are a significant concern in the healthcare sector. The shortage of nurses in the world is a topic of interest across the medical field, and it is prudent to address the issue and come up with solutions to policy and resource allocation.
Literature Review
The nursing shortage is a critical issue because it leads to a negative patient and organizational outcomes. In the US, it is projected that nursing supply will experience up to 1million shortages regarding registered nurse jobs by 2025, and demand is projected to increase, influencing employment rates to have a 19% increase (Mehdaova, 2017). This growth in nursing employment rate will be higher than the average growth experienced in other occupations.
There has been a growing demand for nurses to cater to increased chronic health conditions such as dementia, obesity, diabetes, and arthritis. Additionally, the demand for nurses is growing due to the increased number of people who can access health care services due to the affordable health care act. The federal government has continued to improve health care access through health insurance reforms, which have enhanced the capacity of patients to pay hospital bills without pressuring health care facilities budgets. Nurses are needed to satisfy the demand to enhance fast patient discharge to improve health care outcomes.
The aging population is increasing rapidly, which has led to increased numbers of nursing homes. Baby boomers have increased in number, with most ranging in the 65-year-old and above gap, making them legible for Medicare. Aged people may prefer staying at home or in nursing homes, and they need to be cared for. The continued increase of baby boomers into Medicare will impact the program’s sustainability. Meeting the health care needs of the aging population will increase the pressure of health care spending due to increased recruitment of nurses, setting up facilities, and retaining nurses.
This health care pressure is likely to affect nurses’ attitudes, self-perception, competence, and performance. Practicing nurses will have to improve their attitudes and collaborate towards effective performance for improved patient and organizational outcomes. Nurse Managers are required to have an understanding of expense to revenue ratio and other metrics that influence operational performance. Nurse leaders need to guide the processes of change to make recruiting, retaining, and performance efficient.
Nurses are also aging, and the US currently experiences increased retirement of nurses due to old age. In 2013, a report by the National Council of State Boards of Nursing stated that 55% of the registered nurses in the US were above 50 (Snavely 2016). Even though many graduates are presumed to replace the retired nurses, it is not sure that the fresh graduates will fill the gap. Even if the fresh graduates replace the retired nurses, there still is a deficit of nursing professionals considering most retired nurses add up to the growing number of aging individuals in need of nursing care.
The economic perspective of nursing shortage demonstrates that supply factors drive the issue. The issue is complex because it cannot be solved in the short term due to the dynamics of having to educate thousands of individuals while the demands are steadily increasing. Addressing past economic problems has entailed relocation coverage, sign-on bonuses, and new premium packages. These solutions can only temporarily address some of the factors associated with the nursing shortage, such as job satisfaction. The solutions can only redistribute nursing supply based on the merits of priorities. Creating a more sustainable nursing supply requires long-term strategic planning. Some nurses have quit their jobs due to lack of job satisfaction, poor working conditions, and flawed work relations. Resolving such fundamental issues is the starting point of dealing with the nursing shortage. Nurses need to be valued, given a voice, provided with advanced training, and paid good salaries.
Discussion
Nursing shortage from an economic perspective
Nursing shortage draws from the economic factor of reduced supply amidst a sharp increase in health care demand. Based on economic principles, the nursing shortage is detrimental because it leads to ineffective and inefficient use of limited health care resources. Based on their professional positions as supplementary and complementary to physicians and doctors, nurses can provide less costly health care. The production process in health care requires the input of nurses to improve the utilization of resources to achieve reduced service costs. Nurses are involved in administration, policymaking, education, and research, and clinical practice. Therefore, nursing shortage reduces the ability of the health care sector to provide quality care, ensure equitable resource distribution, and integrate nursing-specific performance and quality of care measurement.
Major Parties Involved in Nursing Shortage
The major parties involving in the nursing shortage are the government and the employers. The government is a significant party in nursing shortage in addressing policies related to the supply of nurses, such as the nursing subsidies. The US government began a nursing subsidies program under the Nurse Student Loan Program, which has continued ever since. However, no significant changes have been made to the policy to ensure that the prevailing state of nursing subsidies is enhanced to suit the current nursing care demand. Nursing subsidies help nurses navigate the normal challenging labor market clouded with depressing compensation and wages below reasonable market value.
The nursing shortage does not just happen in the market economies, but it is created by the actions of the government and employers, which entail tampering with nursing supply and retaining mechanisms. The shortage of supply in the free market economies is, in this perspective, expected. Employers, including hospitals, pay nurses to meet organizational demands, increasing overtime and nursing shortage. Employers compete to retain nurses by increasing compensation rates and wages to attract and retain more nurses. When the shortage of nursing supply persists, wages continue to increase due to increased demand until a level is reached where nursing wages are competitive, just like other enviable occupations. This way, individuals get attracted to undertaking nursing courses and get into service. However, with the rapid demographic changes of aging populations, increased rate of chronic diseases such as obesity and diabetes, and increased healthcare-associated infections, the demand may never be fully met.
Market Forces that have an Impact on Nursing Shortage
The market forces of supply and demand have been at play in influencing nursing shortage and surplus in various instances. However, due to the increased need for quality health care, increased number of patients with health insurance increased infections and diseases, and an increase in the aging population, the force of demand is higher. The increase in health care demands has led to nursing shortage because the supply of registered nurses is affected by a factor such as reduced funding for nursing education and economic recessions. Therefore, instances of nursing surplus are rare even though there are years when nursing recruitment rates increase, but they cannot match the demand in the health care industry.
Economic recession is a factor that influences the supplies of nurses. During the onset of economic recession, nurses working part-time and nurses not working tend to find full-time jobs for financial security. Employers are usually ready to hire more nurses, which brings the supply and demand at equilibrium even though public institutions and may have limited ability to retain their workforce. However, when an economic recession ends, the nurses tend to leave their full-time jobs to continue with their pre-recession status. Therefore, the economic recession creates instability of nursing supply, which ends up causing a nursing shortage. The effects of nursing shortage can be a long term such as downsized workforce.
When nursing policymakers do not understand the market trends and the dynamism of a free market economy, they may make bad policies such as downsizing. Reversing such policies is expensive and time-consuming, and difficult. After an economic recession, if downsizing had been effected, the cost of attracting, recruiting, and retaining nurses is usually higher than cost saving in the short term. Effective nursing management supports its nursing workforce during economic downturns and motivates them by creating conducive working conditions to retain them.
Influence of Affordable Care Act on Nursing Shortage
The ACA has made access to health care access, which has increased the number of people who can access health care in the US. ACA covers many health problems, including chronic diseases such as dementia. The health cover has enlightened people about preventative health care, which has led to the development of health culture. These changes have increased the demand for quality health care and intervention practices to prevent health-associated infections and diseases. The ACA has led to the shift of focus on patient and organizational outcomes, pressuring nurses to provide adequate health care. The increased demand for health care services has opened the public’s eye to the nursing shortage issue. There is a growing demand for APNs and NPs for the health care sector to deal with complex emerging issues such as HCAIs and provide improved care.
The introduction of the ACA was done when the US was already experiencing a nursing shortage. What ACA did was increase the number of people eligible for health care access. It has made the nursing profession rise in preference among non-nurses. According to the US Bureau of Labor Statistics, the profession is projected to grow by 16% up to 2024 (Thompson 2017). The average salary for RNs is projected to have a steady increase since the introduction of ACA. According to the ANA, more RN jobs will be availed in the US by 2022, and employment opportunities for nurses will grow by 15% towards 2026 (Haddad et al. 2020). Even though the increased demand is favorable for RNs seeking employment, it may present negative outcomes.
The nursing shortage has led to long working hours for practicing nurses due to a high patient-to-nurse ratio. Cases of burnout reduced patient safety, and poor quality of health care are some of the negative consequences of increased demand and low supply of nurses. The ACA came along with incentives of making nursing education affordable in the US. The ACA is disbursing funding to the health care system in the US, including learning institutions. Advanced education programs for nursing for APNs, nurse-midwife programs, and NPs are funded to address the nursing shortage in the US.
Health Disparities Demonstrated in Nursing Shortage
Nursing shortage continues to be a significant problem even in advanced countries such as the US, which demonstrates health disparities for communities. Nurses work in health administration, environmental health, laboratory and education, and research. Nursing shortage presents health threats to individual families and communities. In the case of communities, nursing shortage impacts IPC practices such as immunization, home care, and herd protocols. The outcomes are usually the prevalence of infections and diseases such as asthma, pneumonia, HIV/AIDS, and dementia. These health disparities are further stirred by low-quality nursing care and reduced patient safety, which lead to increased mortality rates. Nursing shortage incapacitates the health care systems in the provision of preventative and curative health care.
Improvement of nursing shortage
The WHO has been instrumental in the improvement of nursing shortage in global markets such as the UK. The major focus in improving the issues has been the policies of employment and retention. The main argument in the change of focus to policymaking is that most countries make health care policies based on the linearity of nursing. The policies tend to oversimplify the reality of nursing supply and demand. Most countries have in the past focused on increasing the numbers of individuals entering nursing education, and they have failed in increasing the numbers of already trained RNs entering the labor market (Drennan & Ross 2019). The policies applied in this perspective are not favorable for filling the gaps in priority nursing areas with a history of human capital shortage, such as community health. The futile health care policies are coupled with insufficient healthcare-related infrastructure for nursing education, clinical practice, and weak nursing training regulation.
Health care policy reforms in countries such as the UK entail attending to supply and demand to increase nursing productivity. Utilizing the full extent of nursing care license is encouraged coupled with nursing shifts to reduce burnout and use technology to attend community health care. The policy also focuses on the supply of more nurses into the labor market through increased nursing education enrolments, efficient recruitment, and retention. The WHO has a global health care strategy of addressing nursing shortage similar to the one in the UK, where rural and remote areas prioritize nursing supply improvements. Rural populations are susceptible to health disparities such as healthcare-related infections and diseases, communicable diseases such as pneumonia, and nutrition needs. Therefore, ensuring a sufficient supply of nurses to these areas is significant in tackling the nursing shortage globally.
Recommendation
The nursing shortage is an issue whose application draws from economic principles of demand and supply. It is nearly impossible to bring demand and supply t equilibrium because there are factors that constantly influence the two market forces. However, the supply of nurses can be improved.
Allocating resources to all areas of the health care system can boost the nursing supply. For instance, in the US, the ACA started funding all nursing-related departments of the health care system, such as nursing education. Promoting the education and training of more professional nurses by resource allocation can stabilize the supply of nurses against the growing demand.
Creating policies that make it easy for fresh graduates to secure nursing jobs is essential to fill the gap left by retiring nurses. Graduates struggle to find nursing jobs when they are not well guided. There is a need to transition from college to labor efficient and effective to improve the nursing shortage.
Utilizing the resources available is an economic principle that needs to be fully undertaken to make nursing care efficient. It may take time to fill the existing gap caused by the nursing shortage. However, if each available nurse is trained on the efficient utilization of resources, the quality of health care and safety can improve. The demands of health care can be met at a reasonable level. Nurses can provide less costly and quality health care coupled with optimized patient safety, such as monitoring for patient falls more quickly than physicians and doctors.
Conclusion
Due to the nursing shortage, the nursing field has been clouded with low-quality care and reduced patient safety, which leads to a negative patient and organizational outcomes. Nurses contribute significantly in the health care sector, considering they are supplementary and complementary to physicians and doctors. Nurses make it easy for patients to access health care, even for the aged at home. The major market forces that influence nursing shortage are supply and demand, which are affected by changing economic trends such as a recession. The economic downturn is a double-edged sword in that it can lead to an increase or decrease in the supply of nurses. During a recession, nurses working part-time jobs and those not working may seek employment for financial security. After the economic recession, they may get back to their regular working schedules. Also, during a recession, health institutions may not retain their nurses, which may lead to a shortage. There is a need for health care policies to focus on increasing nursing supply to the labor market rather than maintaining the traditional perspective of training more nurses.
Reference
Drennan, V. M., & Ross, F. (2019). Global nurse shortages: The facts, the impact, and action for change. British Medical Bulletin, 130(1), 25-37.
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls [Internet].
Mehdaova, E. A. (2017). Strategies to overcome the nursing shortage.
Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economics, 34(2), 98-101.
Thompson, M. (2017). How the ACA Affects Nurses. Retrieved 10 May 2021, from https://nhcps.com/aca-affects-nurses/
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