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Nursing Shortage
Alfa Shrestha
Nursing, Southern New Hampshire University
NUR-300 Scholarly Inquiry
Professor Julie Osmberg
June 12, 2023
Nursing Shortage
Nurses are a critical part of the health care system. Yet the nursing profession continually faces
shortages in all specialties (Brown et al., 2023). Nursing shortages have been present for some time, but
when the COVID pandemic hit this made the previous shortage even more complex (Ross, 2022).
Healthcare organizations in the United States are experiencing a persistent shortage of nurses that has
been projected to increase rapidly throughout the next decade (Brown et al., 2023). This paper will
explore the nursing practice issue of nursing shortage as well as the numerous factors of healthcare that
influence this issue.
Nursing Practice Issue
The nursing shortage is an important and multifaceted challenge in the health systems and has
reached a warning threshold (Shasmi & Peyravi, 2020). Due to the shortages, nurses have not had their
usual periods of recreation leave, have had to work long shifts, and are suffering burnout (Turale &
Meechamnan, 2022). The present shortage of nurses is supported by a decrease in the number of
nurses joining the profession, the presence of severe nursing shortages in various geographical
locations, and a lack of adequately trained nurses to address specific patient requirements in an evolving
healthcare environment (Brown et al., 2023).
Nursing shortage is caused by a variety of factors, including working conditions, increased
number of patients, violence in the healthcare system, retirement of experienced nurses, difficulty
retaining new graduate nurses, lack of seats in nursing programs, and a nursing faculty shortage
(Perkins, 2021). A few consequences of nurse shortage include increased preventable deaths,
readmission rates, hospital-acquired infections, and decreased quality of care (Perkins, 2021).
Rationale
Nurses play a crucial role in healthcare, and the nursing shortage is an issue that needs to be
addressed. The nursing shortage has significantly impacted the healthcare system, and during the
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pandemic, the healthcare industry witnessed the second-highest rate of resignation (Ross, 2022). The
pandemic has caused many negative effects on nurses’ physical, psychological, and social well-being,
and significantly increased their workloads (Turale & Meechamnan, 2022). The stressful nature of the
present work environment amplifies the likelihood of burnout, high turnover rates, and nurses exiting
the profession (Perkins, 2021). This, in turn, perpetuates a harmful cycle of nursing shortage. To suggest
solutions to reduce nursing shortage, the existing research will be fully reviewed, and the various causes
and consequences of nursing shortage shall be analyzed.
Appraisal of Resources
Numerous nursing studies, completed before and during the pandemic, are now focusing on
nursing shortages, nursing retention, and variables influencing nurses' decisions to stay on the job.
However, there is still a lot more research to be done (Turale & Meechamnan, 2022). Nursing is a
respected profession, but it does not diminish the emotional, physical, and mental tiredness that comes
with the job. The following is a brief literature review of two articles that discuss nursing shortage. The
articles were retrieved from the Shapiro Library, using the CINAHL, and OVID databases. The keywords
used for the search were “nursing shortage,” and “consequences of nursing shortage”. Recent data from
within the past five years was used to narrow the search for “nursing shortage,” and “consequences of
nursing shortage” including information and research articles (2019-2023) comprising post-COVID-
related shortage.
Article One
The article “Nursing Shortage: Consequences and Solutions” was published by Perkins. (2021).
The article reviewed the contributing factors, the effect on patients and nurses, and how nurses can
positively impact nursing shortage (Perkins, 2021). The factors that are associated with nursing shortage
are working conditions, patient load, workplace violence, retired seasonal nurses, and lack of seats in
nursing programs (Perkins, 2021). The article suggests ways to reduce nursing shortage, by increasing
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the number of LPNs working in a healthcare organization's staffing levels. Leaders in healthcare
organizations establish and foster a positive and supportive work environment that prioritizes the well-
being of their employees and patients. This involves implementing comprehensive policies and
procedures that consider the needs and interests of all stakeholders within the organization (Perkins,
2021).
Article Two
Turale and Meechamnan (2022) published the article, “Investment in Nursing is Critical for the
Health of the World: We Need 6 Million Additional Nurses.” The article examines the correlation
between the pandemic and nursing burnout, which escalates the likelihood of increased attrition rates
and necessitates investments to support the graduation of a larger cohort of nurses. These measures
aim to establish and maintain an ample number of nursing positions for sustainable healthcare delivery.
(Turale & Meechamnan, 2022). The article collected data from World Health Organization (WHO). The
lack of sufficient investment in nursing and nursing education, coupled with years of funding reductions
in the healthcare sector, is completely unacceptable (Turale & Meechamnan, 2022). A major investment
is needed in nursing education to facilitate the graduation of a greater number of nurses under
improved working conditions and fair compensation. Furthermore, improving tactics for increasing
retention rates and ensuring nurses remain in the workforce is critical, necessitating a more planned
approach (Turale & Meechamnan, 2022).
Scope and Standards
The standard of care for the profession of nursing can be found in the Nursing Scope and
Standards of Practice (4th Ed.) (American Nurses Association [ANA], 2021). It is important to understand
that standards of nursing practice are affected by nursing practice issues.
There are two standards that are affected by the nursing shortage. Standard 15 and Standard 18
are not effectively completed when discussing the nursing shortage. Standard 15 is Quality of Practice,
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the registered nurse contributes to high-quality nursing practice (ANA, 2021). There are problems in
meeting patients’ needs if the nurses are dissatisfied with their job or the way they are treated (Shamsi,
& Peyravi, 2020). Standard 18 is an environmental health, which states the registered nurse practices in
a manner that advances environmental safety and health (ANA, 2021). The present work conditions
pose multiple difficulties, such as an increasing need for services, inadequate support structures,
restricted independence, strained interpersonal dynamics among coworkers, and concerns regarding
fairness, incivility, and the absence of respect (Perkins, 2021).
Legal Implications
Nurses are the first line of patient care and should be responsible to prevent practice errors,
faulty diagnoses, wrong medicines, and other related caring issues (Tajabidi et al., 2020). The shortage
of nurses contributes to an increased workload, leading nurses to potentially resort to shortcuts that
compromise safety to overcome obstacles and complete tasks more efficiently (Andel et al., 2022). This
creates medication errors due to the high workload and inadequate time for proper documentation.
Ideally, electronic documentation can reduce drug mistakes, support decision-making, and increase
patient participation in the process of care (Tajabidi et al., 2020).
Errors resulting in negative outcomes for patients are reported to state agencies and are
investigated depending on the severity of the event according to the Massachusetts Board of Nursing
(2023). Every state's Board of Nursing has established specific regulations and expectations that all
nurses are required to adhere to. In Massachusetts, nurses engage in behavior that is likely to harm the
health, safety, or welfare of the public. The Board of Nursing has the right to suspend or revoke a
nurse’s license for errors made that put the patient in harm’s way (MBON, 2023).
Ethical Implications
Nurses are ethically obliged to prioritize their well-being and safety to guarantee the delivery of
safe patient care (Hossain & Clatty, 2021). This includes displaying a sense of duty to self, as defined in
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the Code of Ethics for Nurses With Interpretive Statements “The nurse owes the same duties to self as to
others, including the responsibility to promote health and safety, preserve wholeness of character and
integrity” (American Nurses Association [ANA], 2021, p. 37). Nurses are faced with moral distress and
ethical dilemmas while providing care for their patients and dealing with staffing shortages. Increase
workload has consequences for healthcare workers’ mental and physical health, and precipitates
burnout and job turnover (Härkänen et al., 2021; Kelly, Runge, & Spencer, 2015.) Managers should strive
to achieve a balance between understaffing and overstaffing, despite constantly changing patient
numbers, to assure high satisfaction of nursing staff (Saaiman et al., 2021).
Finance
Nursing shortages can lead to available nurses working overtime and overflowing job duties
which can be attributed to high RN turnover (Gelina, 2022). The growing shortage of nurses and
turnover in nursing is expensive to organizations. It is estimated that nurses leaving a typical hospital
cost between $3.6 million and $6.5 million annually and that for every percent a hospital organization
improves retention, it may decrease annual turnover costs by $270 800 (Thompson et al., 2022). A
hospital with a high turnover rate can easily find itself with a financial burden of several million
dollars a year (Hopkins, 2022).
Quality Patient Care
According to Winter et al. (2020), research has shown that hospital staff shortages measured by
self-reports, vacancies, and turnover relate significantly to patient dissatisfaction with nursing care.
Patients are significantly less satisfied with their care when staffing ratios are low. The researchers
utilized the Weisse Liste database, which comprises aggregated results from a patient satisfaction survey
conducted through a questionnaire focused on the patients' experiences and an empirical model which
provides a subjective questionnaire to hospitals (Winter et al., 2020).
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Empirical studies have shown that inadequate nurse staffing is linked to a higher occurrence of
missed care. This, in turn, has been associated with lower reported quality of nursing care and patient
safety, increased rates of adverse events and mortality, as well as reduced levels of patient satisfaction.
The significant impact on patient care and satisfaction is evident through these adverse patient
outcomes (Cho et al., 2019; Ball et al., 2017).
Nursing Safety Challenges
Nurses are required to work overtime due to a shortage of nursing staff or to provide
appropriate nursing services to meet the daily variations in the patient census (Bae et al., 2022).
Working for long periods without sufficient rest can have a detrimental impact on nurses (Bae et al.,
2022; Min et al., 2019). It is estimated 45% of Registered Nurses (RNs) in the United States worked more
than 39 hours per week, and 19.3% of nurses worked 48 or more hours per week (Bae et al., 2022) The
consequences of working long hours are emotional exhaustion, depersonalization, physical injuries,
impaired sleep, and cognitive dysfunction (Bae et al., 2022). Heightened stress levels lead to decreased
job satisfaction, contributing to burnout and an increased turnover rate. The burden on the remaining
staff increases and the cycle continues, with many posts left unfilled (Härkänen et al., 2019). According
to Skillman & Tom (2022), healthcare organizations should establish a work environment that fosters job
satisfaction and promotes a sense of safety for nurses to deliver care effectively. This can be achieved by
implementing realistic patient-to-staff ratios and workloads that allow for optimal patient and self-care
(Skillman & Tom, 2022). Additionally, creating a supportive atmosphere where nurses feel backed by
their leaders is crucial (Skillman & Tom, 2022).
Interprofessional Collaboration
Interprofessional collaboration (IPC) is a huge component to overall healthcare and patient.
outcomes
Interprofessional collaboration (IPC) is a huge component to overall healthcare and patient
outcomes
Interprofessional collaboration (IPC) is a huge component to overall healthcare and patient
outcomes
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Interprofessional collaboration (IPC) is a huge component to overall healthcare and patient
outcomes
Interprofessional collaboration (IPC) is an essential element of healthcare that ensures the
delivery of safe and effective patient care (Pantha et al., 2020). Interprofessional teamwork is an
important aspect of nurses’ work environment, and the Institute of Medicine has emphasized the
importance of interprofessional teamwork in delivering safe, quality care in several of its reports (Kang
et al., 2020). The involvement of nurses in collaboration is critical for patient advocacy and safe, high-
quality care (Kearney-Nunnery, 2020). The shortage of nurses affected all aspects of patient care and
collaborative practice (Sabone, 2020). Nurse staffing levels that affect nurses–physicians’ teamwork is
associated with poor patient outcomes (Kang et al., 2020). According to Kang (2020), the importance of
nurse-physician collaboration demonstrates an association between better teamwork and improved
patient outcomes.
Concept Outside of Nursing
There are various forms of grand theories that can be applied in nursing. In terms of the nursing
shortage, Maslow’s theory is applicable. Maslow’s Theory views the complexity of human behavior,
especially concerning the motivation of behavior. Maslow’s theory recognizes that basic needs must be
addressed before an individual can ascend the levels to eventual self-realization. It does not address
specific nursing concerns except as they are related to human behavior with environmental influences
(Kearney-Nunnery, 2020). This theory considers and acknowledges the variations and unique
characteristics of individuals which put them at different levels (Kearney-Nunnery, 2020).
The nursing shortage has created an external stressor on the nurses that hinders them from
reaching their full potential (Hasanov et al., 2020). Self actualization is an individual's need to develop ‐
potential; it is learning and growing in the work environment, feeling of being professionally competent,
experiencing professional self esteem, striving for professional growth and personal development, and ‐
experiencing work satisfaction (Hasanov et al., 2020).
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Nursing Concept
Orem’s Self-Care Theory centers on the ability of individuals to meet their own and dependent
on others’ therapeutic self-care demands (Kearney-Nunnery, 2022). The theory possesses information
required to improve interprofessional collaboration centered on self-care activities. (Hartweg & Metcalf,
2021). According to Orem, “the practice of activities that individuals initiate and perform on their behalf
in maintaining life, health, and well-being” (Hartweg & Metcalf, 2021). This theory provides a framework
for nursing's disciplinary identity within a complicated healthcare system, particularly within the larger
science of self-care which enabled nurses to have their disciplinary perspective and voice while
practicing self-care (Hartweg & Metcalf, 2021).
The Middle-Range Theory of Taking Care of Oneself in High-Risk Environment was developed
from Orem’s Self-Care Theory. The theory suggests that Self-care is a relational aspect of healthcare
practice, Self-compassion is a positive emotion that supports effective self-care practice in healthcare
professionals, and The relationship between self-compassion and compassion for others varies
according to individual compassion literacy (Mills, 2021). This theory states that practicing self-
compassion is linked to enhanced ability for self-care and heightened levels of mindfulness, and
professional quality of life, while also reducing the perception of burnout and secondary traumatic
stress (Mills, 2021). Healthcare professionals can engage in holistic self-care by cultivating self-
awareness, which encompasses caring for all aspects of their well-being. Additionally, incorporating self-
compassion into their self-care practices can lead to more genuine and impactful outcomes (Mills,
2021).
Nursing Metaparadigm Concepts
A metaparadigm offers a framework that preserves the fundamental concepts of a particular
field of study. Jacqueline Fawcett has fostered the nursing metaparadigm that compromises four key
concepts: human beings, health, nursing, and environment (Kearney-Nunnery, 2020). Fawcett also
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identified three specific relationships among the domains: person-health, person-health-environment,
and person-health-nursing (Subratra & Phuphaibul, 2019). A person will interact with their environment
and nursing theory enables nurses to comprehend patients’ behavior in normal and critical situations.
The correlation between nursing and health emphasizes that nursing interventions can change a
patient’s health status which allows nurses to see the patient holistically (Subratra & Phuphaibul, 2019).
The shortage of nurses has an impact on the delivery of crucial nursing interventions that are necessary
for achieving favorable patient outcomes (Peate, 2020). As a result, it becomes difficult to properly
preserve the metaparadigm within nursing practice.
Evidence-Based Recommended Solutions
Nursing shortage has been widespread and persistent, it is remarkable that many of the well-
known factors behind nursing shortages appear to not have been addressed (Peters, 2023). Nurses
understand insufficient staffing puts them at risk for fatigue, missed care, and moral distress. At the
same time, the ongoing pressure on healthcare organizations to reduce costs while providing high-
quality care puts a target on labor, and nurses make up most of the workforce. To combat nursing
shortage evidence-based nurse staffing approaches that consider a variety of factors, including patient
acuity, patient turnover, nurses' skills and experience, and other team members' support (Cipriano &
Nelson, 2021). A few of the tactics and recommendations are addressed here.
One strategy to decrease the nursing shortage is to ensure that nurses can work shifts aligned to
their individual preferences and lifestyles would be a reasonable and practical approach in areas where
policies currently limit staff rostering in ways that do not support flexibility (Peters, 2023).
Another strategy is encouraging experienced nurses back to clinical practice from retirement,
different careers, or from extended leave to care for children or loved ones (Peters, 2023). During the
pandemic, numerous governments implemented emergency measures to expedite the inclusion of
previously registered healthcare professionals, including nurses, in temporary registers. This initiative
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aimed to provide support to overwhelmed healthcare teams facing significant caseloads and staff
shortages (Peters, 2023). In addition, strategies for improving retention and recruitment of new nurses
would likely have additional impacts on helping to make nursing work attractive to already qualified
nurses, as these would improve staffing levels and skills mix and ideally reduce workloads on other staff
(Peters, 2023). It is vital to implement policy reforms from employers and governments to guarantee
equitable compensation, workplace safety, adequate staffing levels, and a well-balanced mix of skills
(Peters, 2023).
Comprehensive Review
As discussed above, the nursing shortage is not a recent problem, and failure to implement
measures addressing the factors leading to nurse turnover will exacerbate the situation even more.
According to Andel et al. (2022), the exacerbation of staffing problems occurs in a population that is
already plagued by chronic understaffing. Hospital administrators need to recognize that the absence of
nurses to provide patient care would render the hospital unable to function effectively. Buchan (2019)
highlights that when a nurse resigns, it can result in significant financial costs for the hospital, equivalent
to several months' worth of salary. When workplace-related problems contribute to nurses leaving their
positions, it is noted that these costs can be avoided if these issues are effectively addressed (Andel et
al, 2022). Hospitals can prevent nurse resignations and promote retention by developing and
implementing retention strategies. Gaffney (2022) presents innovative retention strategies that focus on
flexible staffing, new organizational policies, and innovative care models. The COVID-19 pandemic has
intensified the demand for additional hospital beds due to the rising number of patients in need of
hospitalization. This has placed an overwhelming strain on the healthcare system and its workforce.
(Lopez et al., 2022). The pandemic has further highlighted the strain on the healthcare system,
emphasizing the importance of supporting nurses in the workplace.
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