Abstract
Nursing shortage is an important issue given its impact on the ability of the U.S. healthcare system to meet current and future demand. A good understanding of the issue is vital to taking the right actions in order to alleviate the shortage. The purpose of this paper is to explore current statistics on the nursing shortage, the demographics of the nursing workforce, and strategies in enhancing the recruitment and retention of nurses. Statistics show 1.13 million vacancies in nursing by 2022 and a shortage of nurses until 2030 (AACN, 2014; American Nurses Association, 2014). The demographics show a disparity in the number and education of urban and rural nurses and a largely aging nursing workforce (American Nurses Association, 2014). Strategies to enhance recruitment and retention should aim to create a supportive work environment (Hart & Warren, 2015) through mentorship or preceptorship (Cottingham et al., 2011), addressing lateral violence (Ceravolo et al., 2012), and creating structures and processes for shared governance (Barden et al., 2011). To increase recruitment, it is necessary to partner with local nursing programs in the training of student nurses which gives the latter the opportunity to get to know the organization (Beal, 2012).
A shortage of nurses negatively impacts the ability of the U.S. health care system to provide adequate care in the face of current health reforms, an aging population, and the epidemic levels of non-communicable conditions such as diabetes. Nursing shortage began to be felt beginning in 2009 and is forecasted to continue until 2030 (AACN, 2014). It is estimated that the nursing labor force will grow to 3.24 million in 2022, up from 2.71 million in 2012 (AACN, 2014). However, it is estimated that by 2022 there will be 1.13 million job openings in the nursing workforce arising from replacements and growth in the demand for health care (American Nurses Association, 2014). The western and southern parts of the country are expected to be the worst hit by the shortage.
In terms of demographics, 15.7% of nurses work in rural areas which imply that the overwhelming majority are in urban areas (American Nurses Association, 2014). In terms of education, 46.6% of RNs in urban settings have a BSN compared to 33.9% of rural RNs (American Nurses Association, 2014). Overall, only 55% have a BSN as of 2014. While 11.4% of urban RNs have post-graduate degrees, only 6.8% of urban RNs do (American Nurses Association, 2014). In terms of age, estimates show that in 2013, more than half or 53% of nurses were older than 50 years (American Nurses Association, 2014). In terms of gender, 89% of the nursing workforce is female.
The work environment remains the biggest factor affecting the recruitment and retention of nurses. Issues such as the high nurse-patient ratios, high levels of stress, and the inability to maintain a favorable work-life balance have been raised by nurses and often regarded as equally important as salary increases (Hart & Warren, 2015). As such, fostering a positive working environment is paramount. One strategy is the mentoring or preceptorship of newly graduated nurses or nurses new to a practice setting (Cottingham et al., 2011). New nurses need guidance and support as they learn the ropes of the clinical role and integrate into the organization’s culture. In contrast, leaving them to either sink or swim often leads to turnover after only one year (Cottingham et al., 2011). In addition, it is paramount to address lateral violence which is a source of stress and burnout among nurses (Ceravolo et al., 2012). Promoting and modeling respect for peers in both communication and social interactions help foster a positive work environment.
Another strategy is empowering nurses to have control over their work. Through shared governance, nurses are able to address practice and work environment issues in order to promote safe and quality patient care and the health and wellbeing of the staff (Barden et al., 2011). Shared governance requires structures and processes such as governance councils and collaboration among nurses. Recruitment can also be improved by partnering with nursing programs in terms of clinical placement (Beal, 2012) and offering preceptorship following graduation and licensure. Being visible to future nurses and allowing them to experience what it is like to work in the organization can influence them to seek future employment there.
In summary, the nursing shortage is a reality that must be proactively addressed. Organizations should make projections of their nursing workforce to determine labor needs and employ effective strategies to recruit and retain nurses. Besides salary, a major driver of turnover is the work environment. As such, nurse managers should advocate for and ensure a supportive, respectful, and cohesive workplace through strategies such as mentoring and shared governance. Partnering with nursing programs and preceptorship programs can enhance recruitment.
References
American Association of Colleges in Nursing (AACN) (2014). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
American Nurses Association (2014). Fast facts – The nursing workforce 2014: Growth, salaries, education, demographics and trends. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursin g/workforce/Fast-Facts-2014-Nursing-Workforce.pdf
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Beal, J.A. (2012). Academic-service partnerships in nursing: An integrative review. Nursing Research and Practice, 2012(501564), 1-9. doi: http://dx.doi.org/10.1155/2012/501564
Ceravolo, D.J., Schwartz, D.G., Foltz-Ramos, K.M., & Castner, J. (2012). Strengthening communication to overcome lateral violence. Journal of Nursing Management, 20, 599-606. doi: 10.1111/j.1365-2834.2012.01402.x
Cottingham, S., DiBartolo, M.C., Battistoni, S., & Brown, T. (2011). Partners in nursing: A mentoring initiative to enhance nurse retention. Nurse Education Perspectives, 32(4), 250-255. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21923006
Hart, S.M., & Warren, A.M. (2015). Understanding nurses’ work: Exploring the links between changing work, labour relations, workload, stress, retention and recruitment. Economic and Industrial Democracy, 36(2), 305-329. doi: 10.1177/0143831X13505119
