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Shortage in Nursing

1.0 Executive Summary

The report addresses the problem of shortage of nurses in America as the point of view. The historical background of the problem dates back in times of World War II, when the training for nurses was conducted at hospitals. The qualification level at this time was a diploma, and the hospital benefited from the cheap nursing services offered by student nurses. With the introduction of university programs for nurses in early 1970s, the nurses’ shortage escalated only to level at 1980s. Interestingly, study by Elgie in 2007, revealed that America recorded a surplus supply of nurses between early 1900s to early 1990s before the demand overturned the supply. Since this time, there has been increasing nursing shortage statistics, which are projected hit 260000 mark by the year 2025.

The proposed causes of nurses’ shortage in America have increased from those of the early ages to compose more modern causes. Different from the early age’s nurses’ shortage is that the contemporary shortage is caused by demographic changes in the society. The factor of the aging baby boomers is one of the changes that are worsening the shortage due to the increase in healthcare services’ demand. Other factors include aging of the nursing workforce, declining enrolment, availability of optional courses among females and the increasing hospital acuity. Implications of the shortage are far much cutting than just the increased workload in the hospital among nurses. Most of these implications directly reduce the quality of the patient care.  Therefore, solutions must explore to address these issues. This report has given possible solutions including boosting the nursing student enrolment, increasing foreign nurses, promoting nurse educators’ programs, policy support and online training for nurses.  

2.0 Introduction

Nurses are a core input in the healthcare sector. Their contribution into the management of patient continues to be a demanded input for the successful patient recovery. The main role of the nurse is to offer the close link between the client and healthcare teams. They are able to develop the close professional relationship that patient needs. The close association improves the social aspect of the client in the healthcare delivery point enhancing their health recovery rate. Many times, nurses are the people who are close to the patient continuing the monitoring and evaluation consistently and acting and responding accordingly to prevent deviation of the problem to severe cases. Other than medical management, patients need social, physical, emotional, spiritual and psychological therapies that are well offered by nurses due to their extent of bonding with patients. In this manner, nurses are able to unite several arenas of therapeutic science. Moreover, nurses facilitate the smooth flow of patients in the hospital through their management skills, interpersonal skills and ability to triage patients on the basis of conditions and severity.

The care offered by nurses is, therefore, irreplaceable and cannot be supplemented. The link between the nurses and other staffs in the hospital happens to be vital for the smooth running of hospital services. Being close to the patient for the better part of admitted patients in the hospital, they are able to communicate to the different specialists in the healthcare system the best intervention that can help the patient. It is extremely crucial to intervene for patients in cases where patients are not in a position. Advocacy is a role that is well ascribed to nurses. Other than their roles in the hospital setup, nurses play a significant role in the community. There are ample projects that are run by nurses in the society, home-based care, children oriented projects and primary health care services. All these functions depict the eminent role that nurse plays in the healthcare set up. Increase in the shortage of nurses in hospitals will culminate to slowing down hospital activities to a point of sending patients away due to inadequate behavior of the staffs.  

3.0 Define Problem

The healthcare sector remains vital throughout the life of an individual, unlike other sectors that are affected by time as people advance in age. Healthcare needs cannot be postponed, yet can they be suppressed. Therefore, enough staffs to offer the required care must be available in the market to maintain the sector stable (Truth About Nursing. 2007). The problem of nursing shortages can be approached in four directions. First, the world is in the shortage of nurses willing to offer services of nurses in the contemporary healthcare setup. This does not imply that there are no trained nurses. In this approach, the shortage of nurses is as lack of appreciating the role nurses play in the hospital sector. This shortage can also be explained as a way to send a signal to the public dissatisfaction of nurses in the market. This shortage is evidenced by the large number of vacancies announce every day to be filled by nurses, yet go for a long time unfilled.

Secondly, the shortage of nurses across the globe can be associated with the lack of funds among the hiring institutions where nurse are expected to be absorbed. Similarly, there could be qualified nurses but the institution lacks means to employ them. This is the case, in most of the third world countries and the developing countries. The training institutions produce a lot of nurses, yet the healthcare sector lacks adequate resources to employ and maintain nurses in the field. Among developed countries, this approach is also witnessed in some parts of countries where nurses become the target for balancing the institution economic crisis situation. In cases where an institution cannot cope with the financial projection, people to be laid off are nurses. This causes the shortage of nurse staffs in the institution.  

The third approach is cause by the unclear cut and the distinction between roles of nurses in the hospital sector. In some situations, the care that is offered or directed by nurses has been distrusted by doctors and the patients’ relatives. This leaves the hospital with less need for nurses’ services. The resulting effect is poor nursing care, culminating poor patient care and prognosis. The scientific rationale that is evidenced in the care given by trained nurses lacks in care offered by relatives to patients. Moreover, this reduces their productivity due to overwhelming responsibilities.  This shortage of staffs in the market is common evidence in the developing countries. 

Finally, shortage of nurses can be approached by the direction of competence. Though, there may be a lot of nurses in the field and the market, the quality of knowledge and skills acquired during the training period determines the quality of care that the patient receives.  According to a report drafted by the American Association of Colleges of Nursing in 2007, the outcome of the patient is directly proportional to the level of competency of care givers. This call moves to ensure that nurses advance in education. The training institution should ensure that nurses are well equipped to offer services they are expected to offer. This shortage is mostly evidenced in the developing countries where there is a shortage of resources and financial hardships. Among the developed countries, this shortage is associated with the negative attitude towards nursing roles which may lower the level of patient’s advocacy.

Shortage of nurses is projected to escalate, unless both short and long-term measures are put in place (Truth About Nursing, 2007). For instance, the American population is expected to suffer the worst hit of problems inclined to shortage of nurse. According to the American Association of colleges of Nurses, they recognize the generation of Baby Boomers as a factor that will create instability in the healthcare sector due to upsurge of healthcare need in large scales. According to the United States Registered Nurse Workforce Report Card and Shortage Forecast, January 2012, shortage of nurses is projected to continue to 2030, unless the employment within the healthcare sector is boosted. The current Registered Nurses level of employment in the USA is 50 % of the entire nurse in the country. In a different report prepared by Buerhaus, P. (of Health Affairs), 2010, the shortage of nurses was projected to reach 260 thousands by the year 2025. This was found to be exacerbated by the number of nurses expected to retire during this period.  According to the report by the Nursing Management Aging Workforce Survey, 2006, over half of nurses in the health sector were retired in 2011 to 2020. (Rosseter, 2012)

These are facts that illustrate how the nurse to patient ratio is being compromised, putting the healthcare sector in jeopardy and the prognosis of patients trending towards the negative scale.  The population of nurses is steadily declining as most of the qualified cadres digress into other fields deemed more valuable than nursing. This leaves the stakeholders with questions to address efforts of reversing the trend in the shortage of nurses.

4.0 Literature Review

4.1 Overview

Shortage of nurses has been reported in a number of studies since the era of the Second World War (Truth About Nursing, 2007). The main difference between the previous nursing shortage and the current shortage is the scale and causes. The American government noted the shortage of nurses in 1960s and responded by drafting a program aimed at motivating students to join the nursing profession. The program was incorporated to policies under a heading Title III of Public Health Service Act. During this time, there were few nursing training institutions, and nurses were being trained the clinical setup at diploma levels (smith 2010; p 16). The introduction of diploma courses in hospital sectors was a crucial move to reduce the nurses’ shortage, since the program was cost effective. The students were offered nursing services as they gained knowledge (Buerhaus, 2000). With the system changing to college and university training programs, the shortage of nurses increased  drastically and the cost of running hospitals became a main problem among the administers.  The insurgence of trainees at the universities resulted in the production of more nurses in the market that resulted into the equilibrium of nurse demand and supply in the mid 1980s. According to Elgie (2007), report America recorded a surplus of nurses between 1900 and 1992 (Smith, 2010;  17). Since then, the shortage factor has been of the rise with studies projecting that the problem will persist for a longer duration.

According to a study published in the Truth’s Journal (2012), differences between the roles of nurses in the healthcare sector, and the public opinion of nurses’ duties has a main impact on the current nursing shortage. In its report, the International Council of Nurses (2004), quoted that the shortage of nurses is progressing into a healthcare crisis. Qualified nurses are crucial in maintaining the high quality care, which culminates to improved patient care. Shortage of nurses has increased mortality of patients in addition to lowering the productivity of the healthcare system. Some factors reported by researchers to have caused shortages including; poor education strategies, poor working conditions, aging nursing staffs, optional professions, advancement in technology and growing population (in age and numbers).

By the year 2010, nursing profession was the largest healthcare profession in America, covering a total of over 2.7 million (Smith, 2010; p 5). This workforce accounted for the largest population of hospital staffs and is believed to offer the largest portion of primary care services in almost every healthcare institution in the world. According to Nursing (2000) in Indiana, the proportion of nursing students among the health profession in the US was at 52% in the year 2010.

4.2 Changes in the Nursing Profession

4.2.1 Critical Care Nurse

The concept was introduced in the market in 1950’s. The idea behind the introduction of critical care nurse is to ensure that nurses provided an appropriate care that was referred to as “one-on-one care”. To achieve this requirement, nurses needed specialized knowledge and skills. This concept is one of issues that differentiate the current shortage of nurses from the ancient deficit. Critical care has remained to be one of the extremely vital roles of nurses at hospitals. In America, the population of nurses working as critical care nurses was valued at 1/3 of all nurses at hospitals. In March 2004, the Department of Health and Human Services revealed that there were a total of 503,124 nurses (Smith 2010; p 6). Competency of these nurses is quite crucial in maintaining the sound patient care. Most of patients requiring the critical care services have their level of consciousness suppressed, and nurses apply their knowledge, skills and experience to facilitate a decent prognosis of the patient and reassuring relatives and others.

4.2.2 Men in the Nursing Profession

The dominance of females in nursing profession is at risk, owing to the increasing rate of men joining the profession. In 2010, the percentage of men in the nursing profession in USA was 5.8%. The acceptance of males to join the nursing is seen as a main boost in the profession due to their physical strength and ability to withstand strenuous working situations associated with nursing as a profession. This motive will also dilute the stereotype that nursing is a feminine profession.

Other factors that are redefining the profession include changing preferences of employees. Nurses are looking forward into a flexible working schedule that offers them free time other than money motivated careers.  The increasing level of super class employees who are concerned with the quality of care is other than the quantity of patients attended. The current market is also characterized with employees who are loyal to their duties and care less about the employers’ loyalty. This increases the turnover in cases where employer does not encourage the autonomy and democracy in the workplace.  

5.0 Causes of the Problem

5.1 Professional Alternatives

The emergence of more lucrative professions is one of the factors that have increased the shortage of nurses in the healthcare sector. Women, who have been the backbone of the nursing profession, are now opting for pursuing other courses that are more appealing, less strenuous and deemed to promote more the self-image than nursing. The competitiveness of the girl child in the current world has earned women a standing point in many professions. Males, on the other hand, prefer professions that are “manly” rather than involving themselves with the nursing care activities. The increased number of training institutions, such as universities and colleges, offers chances to join other professions, in case one fails to join his dream college. In the past, failure to secure a position in one of the universities to pursue the lucrative professions made many opt for nursing as a career.  This is no longer the case, as competitive areas of learning have been increased. Some professions that have consistently robbed nursing profession applicants include medicine, law, business-related courses and mass communication. The priority to pursue nursing has decline by over 40 percent from 1970s to 2008.

5.2 Low Enrolment Levels in Training School

According to the American Association of colleges of nursing report on the enrolment levels of nurses in America, 75,587 nurses’ applicants were turned away in 2011 even after being qualified for the training. The main reasons hinted to be causes of decreasing low enrolment in the nursing schools were understaffing and insufficiency of resources. This illustrates how bad the nursing faculties are managed, owing to the fact that other faculties compared during this report had less number of applicants being shunned away. This report was more or less concordant to figures reported by Health Resources and Services Administration back in 2006, which showed that nursing training institutions turned down 32,617 qualified applicants in 2005, while those turned away in 2007-2008 academic year were 41,348 students. The percentage of students admitted in the academic year 2007-2008 was 42.3 % of all the successful applicants (Smith, 2010; p. 8). The admission board proposed an addition of nurses being admitted in training institutions to be increased by over 87 percent.

In addition to the decline in a number of students entering the nursing schools, a growing concern in the field of nursing education is the shortage of nursing educators. According to AACN statistics, the average age of a professor in nursing 52 years old. This is comparatively higher than in other professions where the average age in medicine was 48 years, in law, business field and communication field were 45 years. The report traced the shortage of trainers’ beck in the year 1995 when enrollments in doctoral nursing programs recorded a main decline. Since then, there have been minimal increases in the number being recruited in the program. Factors contribute to the shortage of nurses by reducing the rate of producing qualified nurses in to the market.

5.3 Age Factor

According to 2008 national sample survey of registered nurses in the USA, conducted by Federal Division of Nursing, the average age of registered nurses in the market has raised concerns during the past 15 years. To illustrate this fact, the report compared the average age of registered nurses in 2000 which was 45 years, while in 2008, the age had increased to 46 years. The statistics from AACN shows that currently, the average age of a registered nurse in the healthcare sector is 44.5 years. Furthermore, the statistics shows that the average age of graduate registered nurse is 31 years. These figures infer the risk the nursing profession is facing. With older working forces in the market and very few young generations, the profession in future may be highly affected. Most of these nurses are in the wake of retiring, which will further exacerbate the mayhem. Another reason creating the shortage in the profession is the minimal number of years that graduates’ nurses are in the field. Graduating at thirty one years old and retiring between 55 to 60 years, with low enrolment levels, balance between recruits and retirees is completely offset. This contributes severely to the shortage of nurses in the market.

5.4 Changing Demographic Factors in the Population

The generation of baby boomers is on the verge of health needs due to the age advancement. The sudden increase in the demand for healthcare services strains available resources in the healthcare sector. Therefore, increase in the workload demands recruitment of new nurses to maintain the ration of nurse patient ratio. The projection from the Federal Affairs office illustrates that the population of individuals aged over 65 year is expected to double in between 2010 and 2025 (Haller, 2011). These projections are enhanced by the increase in age among the baby boomers’ generation.

5.5 Hospital Acuity

Advancements in technology, infrastructure and increase in population have resulted in acuity in hospitals. Most healthcare institutions have adopted the fast and efficient technology in the market to offer healthcare services. The need to employ specialist nurses to offer the critical care has been on the verge of concern. With less nurses going for further nursing education, specialized and skilled nurses to fill these positions have fallen onto a hard ground (Nursing RN BSN.gather.com, 2008).

5.6 Nurses’ Digression

A common trend observed not only in America but in other countries is the issue of nurses shifting from their profession to other arenas once they are qualified. Many people who are qualified from the nursing profession have digressed to areas such as public and community health sectors, escalating the demand for nurses at hospitals. According to an article Nurses for a Better Tomorrow Association (2012) poor working conditions. poor salaries, tuff policies, increasing workload, poor motivation, minimal chances to advance in education and tarnished nursing image have prompted nurses to digress from the nursing profession.  The increasing non-governmental agencies recruiting nurses have been one of the fields that are robbing the profession its’ qualified personnel. In addition, the current evidenced extensions in care delivery setting, which have included home-based care and community-based health care strategies, offer optional areas of recruitment among nurses.

All these factors have jointly contributed to the shortage of nurses that is evidenced in the US and many other countries in the world. However, these factors have a different magnitude of effect depending on nation of institution locality. 

6.0 Implications to Nurses’ Shortages

6.1 Lowering the Quality of Care

With the reduction of population of nurses in the field, the quality of care is projected to the reduction with over 60 % by the year 2020. This is ironical since the public expect that the profession should take the advantage of technological advancement and improve the quality healthcare delivery system. The increase in age among the workforce hints a slower service delivery as young energetic people are able to tolerate the heat and pressures in hospital and having no place in the hospital. Moreover, the population of baby boomers, as hinted before, is expected to add the already overwhelming workload among nurses. This will definitely reduce the expected quality care at hospitals. In a study conducted by Blegen, M (et al, 2011), which was published by Medical Care, researchers found that higher adequate nursing staffs resulted into reduction in the number of deaths reported in the healthcare institutions. The problem of understaffing was also identified to mortality by 6%. This was documented in New England Journal of Medicine, 2011.

Another factor which is expected to contribute to poor quality services decrease in the number of nursing educators in training schools. The decline in the number of nurses advancing their nursing qualification reduces availability of nurses to train more nurses and, therefore, quality of education will reduce impacting negatively to quality of healthcare services.

6.2 Increase in Number of Unattended Patients

Insufficient number of staffs to attend patients will project the problem of turning patients away from hospitals. Many patients will go unattended, since the staff shortage cannot cope with patients’ demands. This, on the other hand, will increase the mortality and morbidity in the society, as affecting the quality of health is affecting the nation at large. The increased workload will also lead to a less productivity of the available nurses at the hospital. Many patients will tend to opt for finishing the counter medication, even without prescription by doctors or healthcare professionals. This has been noted to cause adverse effects from cure, due to inadequate information among the patient of contraindication, adverse effects and drug interactions. Effects of over the counter medical exacerbated by patients’ being turn away from hospitals will add to poor productivity of the nation at large.  

6.3 Conflict at Hospitals

Work overload has been quoted as a crucial cause of conflicts among the institutions (Smith, 2010). Staff tends to project their anger, feelings of underachievement and issues of exhaustion to fellow colleagues or even patients. This, in turn, affects the productivity of the institutional large.  Internal institutional wrangles increase pressure among nurses. Patients identify these quarrels and associate such institutions with unsatisfactory health services.

6.4 Increased Turnover of Nurses

The worse repercussion that shortage of nurses will cause is the increase in the rate of nurses’ turnover from healthcare institutions. Less staff means increased workload among available nurses, poor working conditions, less leisure time for nurses and increase in conflicts in institutions. This will culminate to stress built up among nurses; thus, increase the rate of employees’ turnover. The problem will be in that instead of solving the problem, consequences’ shortage multiplies the main problem. In a study conducted by Dr. Linda in 2002, nurses expressed dissatisfaction and emotional exhaustion as the number of patients under their care increases. Retention of nurse as being a factor that is proposed to ameliorate the shortage of nurses will, therefore, be off balanced in this cases affecting the care level.

These consequences of nurses’ shortage will culminate severely, affecting the patient who is the prime factor in the healthcare delivery. Therefore, there is a need to address causes to maintain the nation’s health.

7.0 Possible Solutions and their Implementation Justification

7.1 Online Nursing Education

Nursing education is composed of two sets of parallel programs (Nursing RN BSN.gather.com, 2008). Competent  nurses  have to be well-equipped with knowledge regarding patients’ management, ethics of the profession, theories of nursing, research methodologies in nursing and other necessary information required to dispense their duties, both in clinical and community levels. The other portion that constitutes a competent nurse is the clinical exposure, practices and experience. The latter is well-gained in the clinical set up under the facilitation from clinical instructors and one-on-one exposure to clients. Two programs have to complement each other to ensure that there is a close and sound link between the theory and actual practices in patient management.

Online training will majorly be involved in teaching nurses the theory part, while the clinical exposure is organized locally where students will be placed in hospitals and other institutions where practical experiences will be gained. Online program is evidenced at schools, such as Indiana State and Jacksonville universities, which have been accredited by both the National League of Nurses and Commission on Collegiate Nurses Education. Embracing this form of training will ensure that more nurses are released into the field with the required competency. Moreover, nurses can also use this program to advance in specialized areas, according to market requirements. This program will not only boost the number of nurses in the field, but offer convenient benefits such as; cost-effective education, conducive for nurses’ educators and offer student nurses opportunity to develop the student centered learning, sharpening their research skills.

7.2 Improving Nursing Image

The role of nurses should be discussed with the public, especially students at schools. According to Nursing RN, BSN.com, (2008), many students have a negative attitude to nursing as a profession and associated roles that nurses have in the hospital. The public also has negative stereotype of nurse duties that contribute negatively to the effect of student’s joining the nursing profession. The government and nursing organizations should embark on campaign to foster a decent nursing relation with the community. One of the steps that can help motivate students to join the nursing profession is a clear distinction of duties of nurses depending on their qualification. This will encourage the advancement in the nursing profession, thus, availing a decent number of nurses’ specialist needed. In addition, there should be a clear delineation of duties of nurses’ aid and professional nurses. The professional nurses should be more involved in duties that level with their education, knowledge and skills.  

Complains, raised by the working nurse about the shortage of nurses and the overwhelming work at hospitals that the nurses claim to do, contribute negative to motivating students to join the profession. Complains of incompetence evidenced within the profession have been another case of tarnished nursing image in the society.  For instance, in 2000, Chicago Tribune reported a series of stories displaying nurses strikes, stories of layoffs in the nursing profession and nurses’ errors result are examples of poor image of nurses in the public level.  

7.3 Training more Nurse Educators

Increasing the number of nurse educators will promote the establishment of new nursing schools, reduce the shortage of staffs in the existing nursing training schools and increase the competition of advancing the nursing programs. In 2007, Tennessee State moved to lift nursing educators in the state and the nation, at large. Then, the governor Philip Bredesen promoted and initiated a program that aimed at promoting registered nurses to advance their degree levels. The program was granted $1.4 million as the initial funding kit (Rosseter, 2012). Increasing nurses at the BSN levels would ensure that they are well-equipped with knowledge that is necessary to train more nurses.  This move of sponsoring more degree nurses were motivated by the fact that the effort to expand the number of nurses in the market was restrained by ability of nurses’ educators. Implementing this program in other states or even at the national level will defiantly help reduce shortages of nurses.

7.4 Restructuring the Training Strategies

Not only is nursing shortage felt at the basic levels, but also at the specialist cadres. The education strategies were identified by Health Affairs in 2008 as a core promoter of the shortage of nurses. The report lamented that lack of opportunities among employed nurses to advance to higher levels in the profession has limited the ability of America to produce enough nurse specialists (Rosseter, 2012). Other strategies that could be restructures or revisited include the flexing of the education scheme to allow employed nurses to attend the class, deemed to improve their education levels. Moreover, the government should step in to subsidize nurse educators’ salaries in order to promote the interest among the qualified personnel to engage in education. The training schools should engage in partnership programs with governmental and other nongovernmental organizations to foster scholarships in the nursing profession. 

7.5 Improving the Profession

For a long time, nursing as a profession has been dominated by females, with a handful of males. This limits the possible catchment for recruits to be deployed in the field. The male population in the profession diverts to other field after passing the basic level of training. This leads to a profession where almost 80% are females. Therefore, the profession has to be improved to ensure that the stereotype on “nursing is a female thing” should be revoked by encouraging more males to join the profession. Parents should also be advised not to discourage kids with dreams of becoming nurses. This has been reported as a factor that hinders the growth of the profession to higher levels (Nevidjon & Erickson, 2011). Therefore, improving the profession culture from local levels would encourage more nurses to join the profession. Children should be approached in their earlier ages’ image of nursing profession promoted so as to enforce the desire of being a nurse. It should be noted that nursing is beyond the “handmaiden” of doctors, as believed by many laymen.

Leaders in the profession should embark on repositioning the profession as a valuable career with different lines of specialization, including the advancement in technology, customer services, leadership and research fields. On top of these areas, the nursing as a profession can enhance individuals to maximize their critical thinking skills (Rosseter, 2012). This will improve the profession and awaken desires of young people to pursue it, while those employed will engage themselves in advancing their qualification. There have been many complains among patients and clients on the issue of paper work. The documentation process, though an essential part of the career, should not be a drawback in polishing the image of the profession. Institutions should adopt a highly convenient and efficient mode of documentation to reduce the unnecessary workload among nurses.  

7.6 Reducing Turnover

Just like other professions, the nursing profession is faced by the increased rate of employees’ turnover. However, there are differences in the employees’ turnover in other professions, those in the nursing targets other areas besides working as nurses. Schools may be producing a decent figure of nurses into the market every year, yet the number nurses in the nursing profession continues to be low. This has been attributed to the job satisfaction and benefits that employees gain while in the profession, as compared to other professions or areas of revenue generation. The nation and other governing bodies in the profession should institute measures that will prevent or reduce the nurses’ turnover.

Possible measures that need to be addressed in this category include changing institutional culture to enforce a strong administrative support. In this manner, nurses will be maintained in institutions, such hospitals, since the administration is ready to liaise with them in a manner that will improve their welfare and job characteristics.  Measures to retain nurses instead of replacing them with young forces will encourage nurses to remain in the profession where there are few cases of layoffs. Moreover, hospitals and the nursing training institution should facilitate the development of nurses’ autonomy in the practice areas, as well as enforcing a strong communication scheme in the field. These measures will ensure that the profession attracts more nurses and, hence, combat the migration to other profession. One of the programs targeting that has really made tremendous steps in enhancing nurses’ retention is the American Nurses Association Magnetic hospital program (Policyalmanac.org. 2011) (Truth About Nursing. 2007).

7.7 Revisiting Policies and Regulation in the Profession

Policies on accrediting nurses training institutions have to be revisited to ensure that more training institutions are not restricted over minor requirements that can be attained as the school establishes with time.  Other than the issue of accreditation, policies dealing with licensure and practices ethics need to be revisited to ensure that the do not act as obstacles in releasing nurses into the market.   

7.8 Foreign of Nurses

The government needs to loosen policies restricting the flow of nurses into the nation. To reduce problems associated with the shortage of nurses due to a low production of nurses in the country, foreign professionals should be allowed to fill in the gaps identified (Rosseter, 2012). Other countries such, as the developing countries and the third world countries are characterized with an increased number of professionals without jobs. America can capitalize of this opportunity and offer nurses from such countries an employment to cover the shortage.

8.0 Conclusion

Exploring the current shortage of nurses is imperative to understand causes, so that adequate steps could be instituted to reverse the trend. The importance of nurses has been identified as a core input in healthcare management arenas, and their roles cannot be overlooked or ignored. The researcher identified a number of causes which include the following; professional options among females, who happened to be the large component of nursing profession, there is a decreased enrolment of people in colleges willing to join the profession, hospital acuity which has increased the need for specialized nurses and changing demographic factors in the society. In addition to these factors, the healthcare sector has been faced by the problem of aging workforce. The researcher identified possible solution that can be implemented to ensure that the problem of nurses’ shortage is addressed in an amicable manner. Recommendations offered included; Foreign of nurses, Revisiting policies and Regulation in the profession, Reducing turnover, Improving the profession, Restructuring the training strategies, Training more nurse educators, Improving nursing image and Online nursing education. These solutions are focused on causes of the shortage of nurses and instituting them will address the core causes of the problem.

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