The coming nursing shortage is a great concern for healthcare. The provision of quality care requires a sufficient labor force of nurses, yet a number of factors of supply and demand are converging in such a way that there is likely to be a shortage. The major reason for this is demographics. There is the perception that many nurses are near retirement age, but not enough new nurses will be available to replace them. Further, a greater proportion of the population is entering their senior years, which predicts a greater need for nursing care. The number of nurses available on a per capita basis will therefore be decreased unless attempts to change the nurse to population ratio are successful.
Demographic factors are the main reason for concern regarding a global shortage of nurses. A recent study which investigated this phenomenon found that the problem was acute in the United States for a variety of reasons, including poor workforce planning and the number of Baby Boomers now reaching an age where one could assume that greater nursing and primary care needs will be required (Cox, Willis & Coustasse, 2014). The researchers also found that the current nursing shortage was an issue of non-replenishment of the existing workforce, which is a problem as the bulk of American nurses approach retirement age (Cox et al., 2014). Issues tied to the non-replenishment factor were turnover and intention to leave, often due to aspects relating to pay, scheduling and job satisfaction (Cox et al., 2014). While this problem has been positioned as one of aging nurses, it would be just as accurate to refer to it as a recruitment and retention issue. There are further compounding issues on both the supply and demand sides.
It is important to realize that the shortage of supply of nurses is a global phenomenon (MacLean, Hassmiller, Shaffer, Rohrbaugh, Collier & Fairman, 2014). Even while developing nations lose their nurses to more lucrative positions in the developed world, there continue to not be enough nurses to meet this need in the developed West (MacLean et al., 2014). It cannot be stressed enough that countries such as the United States, Canada, the United Kingdom and New Zealand currently depend on foreign professionals to meet nurse labor force needs (MacLean et al., 2014). A further factor affecting supply is therefore the rapidly growing economies of the developing world. If more nurses choose to remain in their home countries, the nurse supply shortage in the developed world will increase dramatically. Currently migrant nurses are nearly 12% of the American nursing workforce, over 15% of the British nursing workforce, over 17% in Canada and nearly 25% in Australia (MacLean et al., 2014).
Demand will increase at the cause of the population demographics in the United States which predict increased care needs of the Baby Boomers, however there are also other issues which create an even more dire situation. Another important factor impacting demand has been the increased number of insured persons in the population due to the passage of the Patient Protection and Affordable Care Act (ACA) (Fairman, Rowe, Hassmiller & Shalala, 2011). There is no question that it is important to increase accessibility of primary and preventative care to Americans; however it does result in a sharp increase in demand at the current time as people who previously had no coverage begin to access health services. Another equally positive factor which nonetheless is causing issues with regard to increased demand is the reform of nursing as an industry (Fairman et al., 2011). As nurses advance in their profession and take on specialty roles in informatics, administration and as nurse practitioners the result is fewer traditional nurses. On one hand this restructuring is likely, over the long run, to assist with increasing the efficiency of healthcare as well as a shortage with regard to physicians, however in the short run it does contribute to a nursing shortage.
With the shortage looming, there are various methods that are being used to try to manage the potential problem. These include both increasing the supply of nurses and decreasing the demand for nursing. On the supply side retention and recruitment are seen as critical areas. If nurses are more satisfied in their work, then burnout and other reasons for leaving the profession will be reduced, resulting in a greater ability to meet demand. In other words, pay, scheduling and satisfaction issues of nurses must be resolved if there is to be greater success in maintaining the supply of nurses (Cox et al., 2014). On the demand side, more efficient healthcare is seen as the answer.
Another potential solution requires redesigning the structure of nursing and healthcare. Both supply and demand can be improved through “the effective use of technology, task shifting, interprofessional teams, and more consistent primary care data to build workforce strategies” (MacLean et al., 2014, 443). This refers to organizing the existing workforce more efficiently, and this is a goal which has been incorporated into various programs which derive from the ACA. In the short term, however, it may result in deepening the nursing shortage as nurses retrain for the advanced nursing reform.
The demographic factors affecting the nursing workforce globally predict shortages, and these are complicated by further supply and demand factors. The long term solution is to increase retention and recruitment by ensuring the satisfaction of nurses, and the attractiveness of the profession alongside structural reforms that ensure the healthcare system efficiently uses its labor resources.
