Wednesday, May 29, 2013

Nursing Shortages

Introduction According to Daniels, et al. (2012) there is various challenges which face nursing and health care sector in Canada as with most other countries in the world. One of the major issues is the shortage of nursing staff. In the health care sector, there is no definite way of defining employee shortage. However, an explanation of the concept of shortage of nursing staff gives a clear picture of the issue and what it means to say that there is shortage of nursing staff. Shortage of nursing staff has been defined by Hutchison, et al (2011) as a situation where the demand of nursing staff is more than the supply. Shortage happens when the demand for nurses to fill positions is lower than the supply. For example, there is a rise in demand for nurses in majority of health care facilities in Canada, while the supply is low. Because of this situation, vacancies in the health care sector are left unfilled for a very long time. Nursing shortage can also be understood from the nurse-to-patient ratio, or the nurse-to-population ratio point of view. This is where the number of nurses is less than is needed to provide for the demands of their services. This problem is affecting both the developing and developing nations because of different factors. Shortage of nursing staff requires to be understood in modern nursing as it has substantial implications in the provision of health care. Provision of quality health care in society deeply depends on the ability of nurses to work in a relaxing environment. This is only possible where they are adequate (LaPierre, 2012). Shortage of nursing staff has occurred in the history of health care and the profession. Many health care facilities and hospitals in Canada have been faced with the shortage of registered nurses. The situation particularly affects the field of specialized nurses. It is a kind of shortage which is considered both demand and supply. Different factors have been cited to have contributed to the problem. The factors fall under historical, political social and economic ones. Ageing population is one of the most important factors. Within Canada, it is estimated that half of the nurses will retire within the few years. As nursing staff age, there is retirement, as well as reduction of working hours per day. This leads to the creation of a vacancy, particularly where there are no sufficient younger professionals for replacement. There is also an increase in the demand for health care services with the aging population. The so-called baby-boom generation has augmented and has had a great effect on the health care sector in the country like in other industrialised nations. Borgès Da Silva and Pineault (2012) estimate that the number of people over 65 is expected to augment between 12.5 percent and 20 percent between 2000 and 2050. The demands of this elder population are dissimilar necessitating change in the approach that is taken in health care to meet the needs of this generation. The other problem that has been noted in research is that as older nurses leave the profession by retiring, younger nurses are not coming in at the same rate. In addition, the younger nurses are not ready and capable of catering for the needs of the aging population. This creates a disparity between the people in need of the services and the providers of the services (Hutchison, et al 2011). According to Carlos and Chizuko (2008) research has showed that the nursing school enrolment has not been developing quick enough to provide for the growing demand for nursing staff. Therefore, the other factor which leads to the shortage of nursing staff is insufficiency of fresh nursing graduates. Canada has not been able to attract enough fresh graduates into its health care system. This reveals a decrease in the pipeline of nursing students coming into the profession. This has resulted in the speed at the aging nurses are leaving being more than the speed at which new graduates are being absorbed into the field. The other factor is that new nursing graduates coming to practice face a lot of challenges that force some of them to quit within the initial year of practice. Predominantly due to the workload of the elder nurses, the new nurses are taken into the hospitals and made to work without adequate direct supervision. They are expected to make decisive decisions that affect the lives of the patients so soon in their careers (Schmid et al. 2010). Graduates from medical schools are meant to get between three and seven years during formal residencies. This is how they are trained as they work, but under supervision. Most of the new graduates are lacking this enormous chance to learn and hone their skills. They are taken into the demanding environment without correct supervision and support. This causes some to give up along the way. Studies have revealed that 1 in 5 new graduates starting practice quit within one year of practice. This makes the problem of inadequate fresh graduates entering the field even worse (Borgès Da Silva and Pineault 2012). The always changing health care delivery, reimbursement issues, and management problems have made the environment complicated and stressful making some of the nurses to leave. Nursing has been suggested to be among the most stressing working environment. The shortage has created an even worse situation where the available nurses have to work for longer hours to cater for the increasing demand. This makes those getting better opportunities to quit and the ones who are considering joining might shy away and look for another career path (LaPierre, 2012). Nurses have reported greater exhaustion and job displeasure when they are responsible for a higher number of patients than they can contentedly cater for. Results from research in different nations have revealed that stress and dissatisfaction that are related to the workplace problems is a major issue in recruitment and retention of nurses. The complicatedness of the fast paced, specialized technology-based patient care units and the often understaffed environment has created an environment that is different from what nurses consider an appropriate one (Daniels, et al. 2012). There is a steep increase in population that tips the nurse-to-patience ratio off the balance. Different provinces and territories in the country have reported a considerable increase in population. This means an increase in the people in need for the services from nurses. This coupled with the fact that there is a decrease in the number of students in the nursing colleges makes the shortage worse. This is because it makes the demand higher while the supply is low. With an increase in the general as well as the aging population, the demand for services is increasing (Carlos and Chizuko, 2008). According to Borgès Da Silva and Pineault (2012) given the fact that nursing is one of the most complex and stressing profession, there must be policies in the health care system as well as the government (federal, provincial and territorial) to protect the health and well-being of the nurses. The government and policy makers in the health care sector have the duty of developing policies and coming up with legislations, but there should be adequacy of staff to ensure that they are implemented. Although little research is available on international recruitment, recruitment of health care professionals from the developing countries has become as one of the major responses to the problem of shortage. Nurses from the developing nations are being recruited by hospitals in the countries such as Australia in permanent and temporary basis. This could be a great help for the health care sector in Canada. Globalization of the labour market for healthcare professionals has opened up this opportunity for a solution in the middle of this crisis. Though the movement of labour from the developing nations to the developed nations has some unique implications, most of them are on the positive as far as addressing this problem is concerned (Drury, Francis and Chambers, 2009). Loss of older experienced nurses is one of the major issues in the shortage. Some countries like Belgium have come up with a program that has instituted shorter working days in a week for older nurses. Canada could consider this and developing other incentives to retain older workers. Buffer benefits shorter work days, job sharing, and intergenerational day-care for those older nurses taking care of aged parents are some of the incentives that should be considered in retaining older nurses for a longer time. Refresher courses, especially for the nurses who left the field, maybe to care for their children or parents and want to come back, should be developed. Elimination of one-size-fits-all means of hiring is another move towards solving the problem (Schmid et al. 2010). In summary, other measures to increase supply of nurses include improved technologies to automate some of the services offered by the hospitals, restricting compulsory overtime so that the professionals can work comfortably, enacting laws to protect nurses from employers, requiring establishment of acuity systems, creating a suitable working environment (ensuring adequate supply of resources, implementation of standards, and opportunities for training and development, and involvement of nurses in decision making). Generally the government and other stakeholders in the health care system must be ready to invest in addressing the problem (Drury, Francis and Chambers, 2009). References Borgès Da Silva, R., & Pineault, R. (2012). Impact of physician distribution policies on primary care practices in rural Quebec. Canadian Journal Of Rural Medicine, 17(3), 92-98. Carlos, M. R., & Chizuko, S. (2008). Sending Society's Responses to International Migration of Nurses and Its Policy Implications: The Case of the Philippines. Ritsumeikan International Affairs 6, 27-51. Daniels, F., Laporte, A., Lemieux-Charles, L., Baumann, A., Onate, K., & Deber, R. (2012). The Importance of Employment Status in Determining Exit Rates From Nursing. Nursing Economic$, 30(4), 201-206. Drury, V., Francis, K., & Chambers, Y. (2009). Where have all the young ones gone: implications for the nursing workforce, Online Journal of Issues in Nursing, v.14, n.1 Hutchison, B., Levesque, J., Strumpf, E., & Coyle, N. (2011). Primary Health Care in Canada: Systems in Motion. Milbank Quarterly, 89(2), 256-288 LaPierre, T. A. (2012). Comparing the Canadian and US Systems of Health Care in an Era of Health Care Reform. Journal Of Health Care Finance, 38(4), 1-18. Schmid, A., Cacace, M., Götze, R., & Rothgang, H. (2010). Explaining Health Care System Change: Problem Pressure and the Emergence of "Hybrid" Health Care Systems. Journal Of Health Politics, Policy & Law, 35(4), 455-486