Introduction
The health care system remains a fundamental component in national development. An effective health care system enables a country to attain high economic development by providing quality medical services to the people. The system ensures that members of the public access reliable, affordable, and quality medical services. This move creates a healthy and working nation because people can engage in social economic activities and contributes, in national development. The system also creates a conducive environment to nurture talents, innovativeness, creativity, and invention, thus attracting local and foreign investors. Most developed states have invested in health care through hiring qualified and competent nurses, establishing medical training institutions, equipping and integrating technology in hospital management. This move enables citizens from developed nations increase their productivity and improve their living standards. Consequently, developing nations have not reformed their health care system because they lack finance and human resource; an idea that lowers productivity, innovativeness and creativity.
Although developed nations have a better health care system than developing states, shortage of nurses coupled with nurse turnover remains a major challenge experienced by both systems. For many years, shortage of nurses coupled with nurse turn-over remains an underpinning challenge facing medical sector (Cadiz, 2010). Countries across the globe experience shortage of nurses and high rate of nurse turnover annually, thus raising a concern from the public and other stakeholders. Governments have addressed this issue by formulating and enacting policies focused on reforming the education curriculum, expanding medical training institutions, and offering lucrative wages to nurses, but in vain. Nurse-patient ratio remains high because patients’ number exceeds the number of registered nurses in health care facilities.
The paper compares and contrasts views of nurse leaders and managers on the issue of nurse shortage and nurse turn-over and provides a theoretical rationale in the argument.
The role of nurses in the medical industry cannot be underestimated because they work collaboratively with physicians. Doctors and other medical practitioners cannot work effectively without the support of nurses. This affirms that nurses hold a central position in the medical industry and their contribution remains paramount. Nursing shortage occurs when the demand of registered and qualified nurses exceeds supply regionally and globally. Existence of the nursing shortage does not imply that there are no qualified nurses in the labour market, but other factors may influence the shortage. Lack of incentive programs, performance appraisal, ineffectiveness of a replacement program and under staffing are some of the contributing factors. In order to establish the prevalence of the nursing shortage, researchers use nurse-patient ratios, population-nurse ratio and overload of work as measuring parameters.
A report released by World Health Organization (2010) acknowledged that the nursing shortage and nurse-turn-over is a serious problem. The report affirms that more than 4.2 million nurses, doctors, and other medical practitioners are needed. Although demand of nurse remains high, several factors such as poor, working conditions, low wage, inadequate training institutions, and poor management system have contributed in nursing shortage for the last few decades.
Nurse turn-over is another aspect that influence nursing shortage. It occurs when a nurse decides to quit employment through termination, resignation, and transfer. One may quit employment either voluntarily or involuntarily thus creating nurse shortage. Factors that influence nurse turn-over are similar to those influencing nursing shortage. However, the latter factors include; lack of retention programs, unfavorable working environment, low wages and salaries and work overload, to name but a few. In his study focusing on motivation and performance in the nursing profession Swansburg (2009 ) established that poor communication, low motivation, harsh working conditions, lack of moral and material support from managers and lack of autonomy contribute to high nurse turn-over.
High nurse turn-over has negative impacts on the organization and service delivery. Hiring and recruiting new nurses is an expensive exercise because it entails advertising, venting the applicants, and training them. This increases operation cost and lowers organization profits. Consequently, it affects the quality of service rendered to patients; an idea that may affect their health. A study done by American Hospital Association (2007) indicated that the US government spent $40,000-$50,000 on training and hiring a new nurse (Swansburg, 2009). However, the amount varies with nurse’s qualification, experience, and area of specialty.
Nursing shortage and nurse turn-over is a global challenge, but nurse leaders and managers have the obligation of resolving this problem amicably and professionally. The leaders need to develop an effective framework that will enhance efficiency and utilize available human resource towards service delivery. Nursing shortage coupled with nurse turn-over is a leadership and management challenge emanating from the government and internal environment with the organizations. Nurse leaders and managers have diverged view on this matter as illustrated in the following analysis.
Similarities
Both nurse leaders and managers should approach the issue of nurse shortage and nurse turnover from a broader perspective. The leaders need to appreciate the fact this is a serious challenge facing the medical industry and affecting nursing profession. This problem has existed in the medical profession for many years, but there is the need to mobilize resources and work towards resolving this matter exhaustively. Government and other stakeholders have strived to address the issue, but they are overwhelmed by the situation. However, the question that needs to be addressed is how nurse leaders and the manager can help in resolving this matter. Under nursing ethics and codes of conduct, the managers have defined roles, duties, and responsibility in an organization. They are vote heads of health care facilities because they make the final decision on matters of management. They make organizational policies that provide a framework of operation. However, within their line of duty, managers should incorporate programs that motivate nurses to work, enhance performance, and remain in the nursing profession. This move will reduce nursing shortage and nurse turn-over and enhance efficiency. In a similar vein, nurse leaders have the obligation of supporting the management and presenting needs of nurses to the management. Teamwork should be emphasized between the two parties.
Although the issue of the nursing shortage and nurse turn-over is a multifaceted aspect, both leaders should focus on disintegrating it into smaller units so that to resolve the matter exhaustively. Nurse Managers have approached this issue from the external perspective; an idea that has hampered efforts exerted towards resolving the matter. Internal factors within an organization contribute in nursing shortage, but they can be addressed through internal analysis. Most nurses complain of poor working conditions, poor communication protocol, ineffective management system, and lack on incentives in health care facilities. Managers should tackle this matter from within by providing conducive working environment and formulating policies aimed at restoring dignity of nurses. Managers in private hospitals should help nurses advance their careers by offering them lucrative salaries. This will reduce brain drain and prevent nurses from moving to other countries in search of green pastures.
Differences
Nurse leaders and managers differ on management and exercise of the power. A nurse leader has an informal power that is derived from within. The leader mediates between co-workers and management by presenting the needs of nurse, their grievances, suggestion, and complaints. The leader affirms that this challenge can be resolved effectively when both parties work collaboratively. Nurse leaders argue that managers have failed to use their powers effectively and in return oppress nurses. The law has accorded managers powers to formulate and reform existing labor laws. However, managers have failed to carry their obligation thus leading to this problem. On the other hand, nurse leaders have played their role, but they are denied the power to exercise their leadership skills. Managers intimidate, oppress, and infringe rights their rights thus contributing to the problem.
Nurse leaders and managers agree that this challenge can be resolved, but they have diverged view on, which approach is suitable. Nurse leaders advocate for the use of internal diagnostic approach while managers advocate for external diagnostic model. Nurse leaders believe that government plays a key role in this matter, but managers should create a conducive working environment for nurses. Consequently, managers’ state that the matter should be addressed from higher levels of government before proceeding to lower levels. Managers attribute discordant in the policies fuels nursing shortage and nurse turn-over issue.
Incorporation of transformational learning theory in the analysis
Transformational learning theory provides nurse leaders and managers with the most appropriate approach to address this challenge. Transformational theory articulates that leaders and followers should motivate, encourage, and support each other until they achieve a common goal (Taylor, & Cranton, 2012). Transformational leadership has impacts on the leader and followers thus promoting performance. Nurses raise their grievances to the management, but they lack transformational leaders who can help them resolve their problems amicably. This theory offers managers and nurse leaders a chance to evaluate factors that lead to nurse shortage and nurse turn over internally. Transformational leaders relate well with employees, leads by example and resolve conflicts thus enhancing performance. Therefore, transformational leadership is suitable because it promotes inclusiveness during the decision-making process.
I believe that transformational leadership theory is appropriate because it guides nurse leaders and managers to evaluate the association between nursing shortage and nurse turn-over.
Conclusion
Health care system promotes economic development national, regional, and worldwide. Developed nations have effective health care systems, which offer reliable, affordable, and accessible medical care services. Nursing shortage and nurse turn is a challenge experienced both in developed and developing nations. Nursing shortage occurs when demand of nurse exceeds the supply in labour market. Nurse turn over occurs when nurse quit employment through termination, resignation and transfer. Both nurse leaders and managers should use a broader approach in addressing the issue. Both leader exercise power differently. Transformational theory is the most suitable approach as it encourages inclusiveness, increase performance and adhere to nursing ethics and code of conduct.
References
Cadiz, D. M. (2010). The effects of ageism climates and core self-evaluations on nurses' turnover intentions, organizational commitment, and work engagement. Portland, Or.: Portland State University.
Swansburg, R. (2009). Management and Leadership for Nurse Managers. NewYork: Jones & Bartlett Learning.
Taylor, E. W., & Cranton, P. (2012). The Handbook of Transformative Learning Theory, Research, and Practice.. Hoboken: John Wiley & Sons.
World Health Organization. (2010, January 5). The World Health Report 2010 - working together for health. World Health Organization. Retrieved March 15, 2013, from www.who.int/whr/2006/en/
