Nursing Advocacy in the Time of Nursing Shortage
The profession of nursing plays a critical role in achieving the most favorable working conditions for its representatives as well as high-quality care services for patients and the community as a whole. The immense contribution of this profession to the delivery of quality and safe care bases not only on the nature of the nursing work, but also on the fact that it comprises the activities of a major part of the healthcare workforce. However, nursing faces a severe problem that hinders the ability of professionals to perform their tasks effectively; basically, the shortage of the number of nurses due to increased demand for healthcare services is the principal challenge (American Association of Colleges of Nursing [AACN], 2017). According to MacPhee, Dahinten, and Havaei (2017), the acute shortage of these professionals’ number has contributed to the prevalence of job burnout and job dissatisfaction. Thus, the delivery of low-quality and unsafe care has become a norm. Despite the fact that this shortage leads to high rates of patient morbidity and mortality, nurses can use their advocacy role in the struggle for the adoption of effective mitigation strategies.
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Definition of Problem
Nursing shortage entails fewer nurses for sufficing the demand for healthcare services that many patients demonstrate. According to Rahman and Shamsudin (2015), the deficiency of nurses is visible when the nurse-to-patient ratio reaches the level, at which the quality of delivered care faces compromising. In 2014, the United States had experienced a shortage of more than 649,100 nurses for replacement as a result of retirement; besides, the impact of the baby boomers phenomenon and subsequent growth of the general population on the rise of demand for healthcare services has intensified already started shortage of these professionals’ number (American Association of Colleges of Nursing, 2017). The American Nurses Association (2018) states that the factors associated with the increased shortage include fewer clinicians joining the healthcare workforce, fewer nurses preparing to meet different patients’ needs in the dynamic environment, growth of the aging population, and subsequent workforce aging. This problem will continue existing unless one addresses the given causative factors early enough.
It is important to note that nursing shortage usually affects communities, which include both the caregivers and their patients among others. Annually, one documents 98,000 deaths from the medical errors in the United States; these errors relate to enormous deficiency of the number of nurses (Rahman & Shamsudin, 2015). Some of the problems that affect professionals due to the shortage include job dissatisfaction, turnover, and burnout; what is more, high turnover rates intensify the shortage of nurses (Nantsupawat et al., 2017). All these factors contribute to the delivery of poor and unsafe medical care, and in this situation, patients and their communities suffer the most. Nantsupawat et al. (2017) reiterate that nursing shortage not only reduces the quality and safety of care, but also causes an increase in the costs of care and the occurrence of negative patient outcomes. Therefore, the shortage of nurses enhances the care costs as well as morbidity and mortality rates.
Nursing shortage is a historical issue that has persisted for many years. Cox, Willis, and Coustasse (2014) explain that the deficit of nurses has been present since the 1960s. Currently, the demand for registered nurses continue rising; it has grown by 26% – from 2,737,400 to 3,449,300 nurses – from 2010 to 2020. Between 2014 and 2024, the quantity of registered nurses is likely to increase by 439,300 or 16% (AACN, 2017). These figures show how the shortage will make the situation worse since the statistics do not consider an increase in the general population. Many organizations, agencies, and scholars have raised concerns about the presence and nature of this issue. They include the American Association of Colleges of Nursing, the Institute of Medicine, the Bureau of Labor Statistics, and other institutions. This problem became a public agenda as a result of nurses complaining of the shortages, patients receiving low-quality and unsafe care, and healthcare stakeholders trying to identify the issues that one should address for quality improvement of the healthcare system.
There is a need for providing conducive legal and political environment that can enable the creation of policies aimed at increasing the number of nurses. For instance, one cause of the nursing shortage is insufficient staffing that only lobbying of political support and creation of laws and policies, which increase the recruitment of these professionals, can address (Cox et al., 2014). There are no legal policies, which can assist in increasing the number of people enrolled in the nursing programs in the country. For instance, the rate of enrollment in basic programs for registered nurses has been declining for the last five years (American Nurses Association, 2018). In addition, many schools of nursing have been rejecting qualified applicants due to the insufficient training resources (AACN, 2017). All these challenges relate to the lack of legal policies that would increase the allocation of resources to the schools of nursing.
Impact on Population
Nursing shortage impacts patients, their communities, and nurses themselves. According to Mtega, Kibona, Dhamani, and Petrucka (2017), patients who receive care in facilities with an acute shortage of nurse practitioners experience adverse incidents, which emanate from medical errors and affect their satisfaction with care level. In addition, nursing shortage increases the rates of morbidity and mortality in the hospitals. Because of the nursing shortage, such patient outcomes as re-hospitalization cases and increased time of hospital stay result in the growth of care costs, emotional and psychological traumas of patients’ relatives, and subsequent economic downfall, which negatively affects communities. In addition, nurses experience heavy workloads, which lead to high rates of job burnout and dissatisfaction and the delivery of low-quality care (MacPhee, Dahinten, & Havaei, 2017). Eventually, turnover rates increase, and it make the problem more serious as well.
After synthesizing the literature, it becomes evident that the menace of the nursing shortage is a real issue, which requires immediate intervention. The latter will help to enhance the quality of delivered care. This menace results in fewer nurses handling wider variety of tasks than they can. They suffer from fatigue and job burnout due to role overload. According to Nantsupawat et al. (2017), role overload that emanates from the acute shortage of nursing professionals increases the frequency of occurrence of unfavorable human resource factors, for example, job dissatisfaction, turnover, and burnout. All these factors substantially reduce the quality and safety of care and often lead to medical errors. Eventually, patients receive low-quality care associated with high morbidity and mortality rates. Besides, the community and the entire country waste huge amounts of money on correcting medical errors and the associated complications. Therefore, nursing shortage requires from nurses actively execute their advocacy role to uphold the welfare of their profession as well as protect the rights of patients who must receive quality care to fight the diseases.
Application to Nursing Advocacy
Nursing advocacy during the period of shortage should aim to companioning for the improvement of the quality of care and reduction of clinical workload through influencing the policies and decisions in the healthcare system. Since they are a part of the leaders’ team, they can influence policies through effective communication, political knowledge, and collaboration with other team members (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2014). In nursing, advocacy entails representing the patients and caregivers, defending their rights, and protecting their interests through contributions to the process of making decisions that affect the delivery of healthcare services (Davoodvand, Abbaszadeh, & Ahmadi, 2016). Therefore, as the members of the healthcare teams, nurses should notice the changes that signal a clinical problem due to the compromised quality safety of care before expressing opinions and initiating a process that can mitigate the challenges (Shannon, 2016). In this case, nurses should not only raise the issue of shortage, but also form a part of the team that formulates and implements strategies aimed at preventing its occurrence.
Strategy of Addressing Nursing Shortage
The most essential strategy of stopping the nursing shortage is the achievement of an increase in the training capacities of schools of nursing as well as the improvement of working conditions for reducing high turnover rates. For instance, schools of nursing should increase their enrollment capacities to accommodate all qualified applicants rather than refuse some of them due to the lack of resources and other factors (AACN, 2017). In this case, nurses should demand increased funding of educational activities from both the government and private sectors to get more resources and the capacity to educate the workforce (American Nurses Association, 2018). Similarly, these professionals should advocate appropriate remuneration and improved working conditions for reducing high turnover rate and increasing retention level.
Nursing shortage diminishes care quality and safety. It results in preventable adverse patient outcomes as well as high morbidity and mortality rates. This shortage has remained a significant problem of the healthcare system for many years. Evidence suggests worsening statistics in future decades. Nursing advocacy becomes a fundamental responsibility of the professionals of this field who want to improve the working conditions and the quality of delivered care through addressing the shortage. Since one of the primary roles of nurses is advocating enhancement of quality and safety of care, they have the responsibility of curbing nursing shortage through taking active part in initiating effective mitigation strategies and creation of specific policies. Nurses should struggle for increased training of new nurses and improved working conditions, which would help to raise clinician retention rates.