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The Cause and Effect of the Growing Nursing Shortage
School of Business, Liberty University
BUSI 511: Healthcare Administration
Jane Satterfield, RN BSN
Respectfully Submitted to Dr Lynn Brown-Bulloch on 8/9/2023
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ABSTRACT
The purpose of this research paper is to discover some of the major causes of the growing global
nursing shortage. Once these causes are acknowledged and addressed, we can look at proposed
and implemented solutions that could be potential repairs to our healthcare system ailments.
While these solutions may not always be a total fix, they can aid in the burden of nursing
shortages or bring to light better solutions that could be a complete solution for this issue. The
researcher challenges healthcare system administrators and leaders to value and encourage their
remaining staff and to provide a positive environment that proves their value and does not place
a band-aid on this apparent problem. The researcher used the Jerry Fallwell Library to discover
many peer-reviewed articles that both supported and disproved the thesis statement, in order to
provide an unbiased platform that presents realistic problems and solutions. The researcher was
able to find many causes of the growing nursing shortage. The researcher presented several
solutions to this problem, regardless of the length of terms of solution it could provide.
Keywords: nursing, nursing shortage, leadership, administration, research, solutions
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The Cause and Effect of the Current Nursing Shortage
When considering the current nursing shortage, which is not only affecting the United States, but
also the entire world, we must look at some causes and if solutions can be implemented. We
know there is a growing issue, but how is it being addressed and are the proposed solutions
effective? Why are nurses leaving their professions in droves? While there may be many answers
to this question, the problem is growing and there does not seem to be a universal solution to this
global issue. But, before we can pose solutions, we must discover the causes. While COVID-19
pandemic affected every aspect of our world as we know it, we also recognize that it greatly
impacted our healthcare system and our healthcare providers, including nurses. The pressure and
weight it placed on our front-line nurses and healthcare workers was great, and the entire world
has had a hard time recovering from it. The growing nursing shortage also greatly impacts the
care our patients and consumers receive at all ends of the healthcare spectrum, from inpatient
care to primary care to outpatient/ambulatory care. We often focus on the nursing shortage within
our inpatient hospital system, but other areas have greatly been impacted as well. This leads to
patient demise, medication errors, improper or ineffective patient education, and higher
readmission rates. Many people acknowledge the nursing shortage is a growing problem, but we
must also evaluate the effectiveness of the proposed solution. While there are many short-term
fixes that have been presented and implemented, we need to evaluate if they are sustainable long
term. In this paper, we will address some of the causes of the current nursing shortage, view how
COVID-19 pandemic influenced the nursing shortage concerns, see how the growing nursing
shortage is affecting patients and their care, and investigate the solutions proposed to cure this
growing disease and if they are actual solutions to the problem.
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Some Causes of the Current Nursing Shortage
First, we can address and discuss the causes of this growing global problem. Burnout has
been a side effect of exhaustion or overuse of a person or their abilities within their job needs.
“Moral distress or burnout can occur when nurses experience powerlessness, low levels of
control, inadequate support or resources, increased job stress, and high job demands,”
(Guttormson, J., Calkins, K., McAndrew, K., Fitzgerald, J., Losurdo, H., Loonsfoot, D., 2022, p.
128). While burnout can be used as a flippant term or an excuse for nurses to leave the
profession, it has been seen as a clinically diagnosed syndrome. This article reviews the
theoretical and practical understanding of burnout. “This review focuses on burnout, an
occupational phenomenon that results from chronic stress in the workplace. After analyzing how
burnout occurs and its different dimensions, the following aspects are discussed: (1) Description
of the factors that can trigger burnout and the individual factors that have been proposed to
modulate it, (2) identification of the effects that burnout generates at both individual and
organizational levels, (3) presentation of the main actions that can be used to prevent and/or
reduce burnout, and (4) recapitulation of the main tools that have been developed so far to
measure burnout, both from a generic perspective or applied to specific occupations,” (Edú-
Valsania S, Laguía A, Moriano JA. 2022, p.1). Burnout has also been included in the World
Health Organization’s ICD-11, making a globally recognized diagnosis. This information helps
support the fact that exhaustion and mental fatigue within the healthcare system can lead to a
mental health diagnosis, limiting one’s ability to attend work and complete required tasks. It
makes burnout much more than an excuse for one to leave their career. This is important as it
shows a cause and effect. If nursing struggles are not acknowledged, then burnout can be
experienced. Burnout seems to be a common side effect seen in all areas of nursing, but
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especially within the hospital walls, including intensive care units. The critically ill patients, long
work hours, high stress shifts, little support from management all play a role in the phenomenon
of burnout. This phenomenon is not being experienced only in the United States, but globally.
While it is easy to focus on the United States, we cannot overlook that this is a growing concern.
“An overview of the problem indicates ineffective planning and use of available nursing
resources, poor recruitment or an undersupply of a new staff, and global demographic
conditions,” (Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z. & Januszewicz, P. 2019,
p.9).
While some changes have and should be made, the process is slow and should not be
viewed as a quick fix. Many other countries across Europe are implementing policies and
protocols to aid in the same issues they are seeing. Poland has “started improving working
conditions, preparing and implementing the employment target rate of nurses for every 1000
inhabitants, preparing an employment policy and career promotion programme, providing the
possibility of lifelong learning, determining the number of specialists in particular areas of
nursing for every district (province), regulation of minimum employment standards as well as an
information campaign about the measures taken by the government to tackle nursing shortages
and ensure healthcare services,” (Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z. &
Januszewicz, P. 2019, p.14). But again, they are seeing the slow burn of progress, while the
nursing shortage continues to grow.
The growing shortage seems to be a supply demand problem. Supply-side includes the
retirement and aging out of our baby boomer professionals. The demand-side includes the system
being overwhelmed by the COVID-19 pandemic. “On the supply side, many baby boom (BB)
RNs (about 1.2 million or roughly one-third of the total RN workforce) began retiring in 2010.
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Initially about 60,000 BB RNs retired each year. By the end of the decade, it was estimated this
number would increase to approximately 70,000 per. The annual exit of RNs resulted in a
striking loss of clinical and organizational experience, judgment, leadership, mentorship,
relationships with physicians and administrators, and nurses who knew how to overcome barriers
to get things done for patients. The nursing workforce will lose more than 2 million years of
nursing experience each year between 2020-2030 as the remaining estimated 640,000 BB RNs
retire,” (Buerhaus, P., 2017, p. 248). The major demand-side factor would be that of the COVID-
19 pandemic, where the healthcare systems were suddenly overrun with patients, without enough
staff and nurses to care for them.
When considering nursing shortages, often primary care can be overlooked. The focus
seems to remain on the shortages within the hospitals, so it is important to identify that nursing
covers many other institutions outside of the hospitals. “In the United States, three overarching
issues affect the primary care workforce supply: (a) lack of a sustainable health care workforce
caused by decades of poor workforce planning; (b) poorly constructed payment incentives (many
health promotion, disease prevention, and patient education services are not reimbursable),
which drive potential physician and nursing candidates away from primary care; and (c)
geographic maldistribution exacerbating shortages in rural and disadvantaged urban areas,”
(MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., Fairman, J., 2014, p.448).
This is important as it gives some causes to the nursing shortage seen with primary health care,
which can allow the solvers of this problem to find a solution.
The Effect of COVID-19 Pandemic on the Nursing Shortage
The COVID-19 Pandemic affected all aspects of the world as we know it. But how did it impact
the status of our healthcare system? It definitely did not increase the number of nurses our
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education system developed. It did not encourage young students to pursue a nursing career. And
it most definitely did not provide a positive and uplifting environment for existing nurses.
COVID-19 and the conditions nurses worked in during that time will leave a negative mark on
those who were on the frontlines. “There is no doubt that nursing in the time of COVID‐19 is
having a profound effect on the mental health of nurses, especially clinicians on the front lines of
the pandemic, and governments need to be seriously concerned with investing in nursing.”
(Turale, S., & Nantsupawat, A., 2021, p. 14). Nurses and other healthcare professionals were
among some of the only professions that did not stop or shelter in place when the pandemic hit
the United States. Regardless of PPE shortages and the overwhelming number of patients
flocking to the emergency departments, nurses were still required to show up and care for
patients, regardless of exposure risks or sickness themselves. The effect that the pandemic had on
the mental health of nurses can be seen as a direct correlation to nurses leaving the field in
droves. COVID-19 also had a major impact on our nursing education and student nurses were
taught and trained. “Although nursing faculty across the country have done an astonishing job in
providing continuity in their students’ educational programs that were, like almost everything
else in the country, brought to a halt by COVID-19, it is still unclear what portion of the
prelicensure nursing student population graduated on time,” (Spurlock, D. 2020, p. 303). This is
important as one solution that will be mentioned is that the new graduate students will help
cushion the nurses retiring or leaving the profession. While this may appear as a solution, we
must remember that these new graduate nurses are not an equal replacement for more seasoned
and experienced nurses.
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How is the Nursing Shortage Impacting Patients?
In the concern and debate about nursing shortages, there have been research studies to discover
what is causing nursing shortages, and how the skill levels are working nursing is affecting the
safety of care as well as patient outcomes. “Key intervening variables of nursing care that have
shown to affect patient outcomes are the application of nurse intuition, operation of clinical
judgement, and missed nursing care/tasks left undone,” (Subirana, M., Long, A., Greenhalgh, J.,
Firth, J., 2014, p. 8). This quote comes from an article that studies how the drive to hire new
graduate nurses is not a solution to this problem. New graduate nurses do not have the intuition,
knowledge, or experience to be an equal replacement for the nurses leaving healthcare. Another
factor we should address is the financial investment that a nurse is for their healthcare system
and entity. The extensive training is costly. The time, effort, and money it takes to fully train a
nurse is extensive. This is required as you must have competent nurses to take care of human
lives, administer medications, monitor vital signs, aid in challenging procedures, etc. “The total
cost of turnover, which includes pre- and post-hire expenses, is between $7.875 million and
$8.449 million in the United States. To break this number down, organizations spend
approximately $300,000 annually for every 1% increase in nursing turnover,” (Gellasch, P.,
2015, p. 64). These numbers also heavily impact the financial burden of health care on our
consumers and patients. And then we must mention the poor patient outcomes that can result
from nursing shortages. When a unit or floor is short staffed, the nurses that are caring for the
patients are stretched thin and cannot provide the best quality care for their patients. “Perhaps the
most noteworthy consequence is that nursing shortages directly contribute to increased health
care costs (Roberts, n.d.). One study reported hospitals with inadequate staffing are positively
correlated with higher readmission rates (McHugh, Berez, & Small, 2013); unnecessary hospital
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re-admission costs the Center for Medicare & Medicaid Services approximately $26 billion
annually (Lavizzo-Mourey, 2013). High patient-to-nurse ratios are also associated with increased
urinary tract and surgical site infections (Cimiotti, Aiken, Sloan, & Wu, 2012). Adjusting for
inflation using the Consumer Price Index-Urban (CPI-U) with a base year of 2005, surgical site
infections cost an organization between $10,443 to $25,546 per infection and $589 to $758 per
catheter-associated urinary tract infection (Scott, 2009). In addition, inadequate staffing ratios
contribute to ventilator-associated pneumonia, central line-associated bloodstream infection, and
Clostridium difficile infection; these five nosocomial infections directly cost the U.S. health care
system (adjusted for CPI-U) between $28.4 and $33.8 billion annually (Scott, 2009). Certainly,
low staffing levels are not solely responsible for hospital-acquired infections and their
subsequent costs; however, they are a major contributor,” (Snavely, T. M., 2016, p. 99-100).
While this quote is long, and involves many different numbers and statistics, it highlights more
costly effects of nursing shortages. Patients are discharged before they are clinically ready, just to
lessen the load for the nurses that are working the floors and units, which leads to improper
education before discharge, other health factors that were ignored to prevent longer
hospitalizations, and tests and procedures that were not performed due to lack of staff.
Proposed Solutions to the Current Nursing Shortage
Now that we have discussed the problem, we can now evaluate some proposed solutions and
their efficacy. One way the United States has tried to combat the growing nursing shortage, is to
import foreign nurses, give an abbreviated training, education, and orientation to our healthcare
system, and then disperse them into systems that are experiencing shortages. While this may
seem like a positive and helpful strategy, statistics have shown that the long-term effects of these
foreign-based nurses could be consequential with displacement and ultimately returning home of
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these nurses. “Taken together, our findings suggest that while importing foreign nurses might be
an effective strategy to address nursing shortages in the short run, it might have the unintended
consequence of significantly reducing the long-run supply of native nurses,” (Cortes, P., Pan, J.,
2014, p. 179). While this can be a short-term solution to the problem, we need to ensure a long-
term solution or complete fix of this problem. The current nursing shortage has impacted our
healthcare and hospital systems, but it has also affected the nurses employed to educate the new
professionals entering the work force, plaguing our nursing schools and the formal education
they can offer. “By designing new education models that fit global healthcare needs and pooling
teaching resources, designing and using the same databases across organizations to track and
project faculty needs, and collaborating between schools and businesses to create mutually
beneficial agreements for services, nursing faculty capacity can be enhanced, and nursing’s
capacity to meet global healthcare needs can be expanded,” (Nardi, D., Gyurko, C., 2013, p.
317). This is a strategy proposed to streamline nursing education and allow for a weaving effect
of training and education. To truly evaluate the effective solutions implemented by the successful
systems, we must look at the programs that have been successful. In speaking of the United
States, we can zoom into the results at the state level. “As early as 2002, the South Dakota
legislature passed 3 critical bills: one bill funded a permanent nursing workforce center to study
the state dynamics of the nursing workforce, the second bill expanded enrollment in state
universities and colleges, and the third bill was designed to provide funds to reward nurses who
practiced in South Dakota facilities for 2 years following graduation. The results of these efforts
have been most gratifying. The RN supply increased from 13,803 in 2005 to 21,650 in 2016, a
57% increase,” (Zhang, X., Tai, D., Pforsich, H., Lin, V.W., 2018, p. 334). These results are proof
that advocation and validation for the nursing field, with support from your state and federal
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lawmakers, is shown to aid in the growing nursing shortage. This can also be seen when
administrators and managers are challenged to take ownership of their staff, which has been
shown to be effective in working through nursing shortages. “Nurse leaders could promote
organizational programs such as higher staffing levels and a higher quality of care to aid in the
retention of experienced nurses in healthcare settings.” (Lartey, S., Cummings, G., Profetto-
McGrath, J., 2014, p. 1038). The strategies used in this study involved practice models,
teamwork, leadership on both the organizational and individual levels. The last proposed solution
is the use of technology. “The use of technology enables health care managers to address
challenges associated with workforce shortages in inpatient settings such as in the emergency
department and ICU and home-based care. However, the managers need to adopt effective ways
of addressing the challenges such as financing, and other legal challenges, to facilitate effective
adoption of technologies,” (Oakpala, P., 2022, p. 265). This includes the current push for
telehealth. Telehealth was a major positive that grew during and after the COVID-19 pandemic.
Allowing patients to be assessed, diagnosed, and treated within their homes is a positive solution
to the growing nursing shortage, it takes some of the burden of primary care offices, urgent cares,
and emergency departments that are being used to treat minor illnesses and injuries.
Conclusion
In conclusion, to find solutions to a growing problem, we must first recognize the
problem and then find the causes of that problem. Through this paper, we have discovered that
the main causes of the growing nursing shortage that is affecting the entire world, are burnout,
and imbalanced supply and demand for nurses, and all of the aspects of healthcare being
affected, including primary care. Next, we need to acknowledge how the COVID-19 pandemic
has been a driving force for nurses leaving their profession. After both topics are acknowledged
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and defined, we can then propose and implement some solutions to aid the growing problem.
While these solutions are not quick, easy, or forever fixes, they can help us get to a place where
the problem is more manageable for long-term solutions to be discovered and completed. The
researcher would encourage our health care administrators and leaders to provide nurses with a
supportive and valuing environment, where they can learn and grow to provide the consumers
and patients with the best quality care.
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