Example of literature review on nursing: shortages and interventions

Introduction

Professional setting: Nursing manager
A nurse manager has the responsibility of the clinical and administrative functions of a nursing unit. In my case, I am in charge of the intensive care unit section. There are many challenges that face the sector in specific and the nursing industry in general. The most acute case in this sector is the shortage of nurses.
This paper will provide a literature review on the subject through research by use of peer review journals. It will also use bibliographic databases to prove its facts. The concepts of search include the acute and growing nursing shortage, nursing migration, and international nursing.
Keywords: Nursing; International Nursing; Shortage; Interventions

Importance of the study

This study topic is necessary because there are many factors contribute to why the United States of America faces the problem of nursing shortages. The factors need to be addressed, and before this is done, it is necessary to highlight them systematically. Some of the factors include irreplaceable aging registered nurses, impact of the nursing trainers and curriculum, and the overall negative perception of the nursing field. These are the contributing factors, which do not only affect the nursing profession, but also the patient care. Nurses have a profound duty to provide satisfactory and safe care in the critical setting. The situation presents a puzzling situation regarding how to preserve and minimize turnover for the highly expert registered nurses in the country.

Literature review

The following literature review focuses on the main research question that this paper aims at establishing. The purpose of this research paper is to explicate the meaning of the nursing deficiency in the international nursing set up. Therefore, the main research question of this research study focuses on the increasing reduction in nurses due to various other reasons. Many factors have been put forward in discussing some of the reasons for the increasing reduction in nurses not only within the USA, but also across the global economy. The following review of literatures aims at establishing how every listed reason has significantly contributed to increasing reduction in nurses with USA being the scope or the jurisdiction of study.

Increasing reduction in Nurses across the Globe

Indisputably, nursing shortage is a worldwide catastrophe; hence, this paper considers at research in the field of nursing over the last few years in different countries. Most of the public has had an experience at a hospital, and most of the people were born in hospitals (Feldman, 2003). Most people go to hospitals because they face different life threatening situations that require urgent intervention by healthcare providers. It is devastating that most people think that doctors are the caregivers. However, nurses are the caregivers who walk to patients’ rooms on an hourly basis to check the vitals and assess the patients’ conditions, providing treatment and administration of medicine.
However, nursing shortage has hindered the progressive provision of such services, and many hospitals have fallen under criticism for what many patients term as negligence. They fail to understand that the major cause of the situation is the acute shortage of nurses. Short staffing of nurses in hospitals is the leading cause, but it also has various causes that need to be analyzed in the sections that follow in this paper. Some of the reasons provided include poor, working conditions, unavailability of resources for nursing research and education, the aging labor force, explosive career opportunities in other fields, and the increasing complexity of technology in healthcare. According to Feldman (2003), these are some of the reasons behind understaffing in hospital facilities, and leads to patients complaining of negligence or delayed service provision.
Research has indicated that the shortage of healthcare professionals and nurses is the main obstacle hindering the achievement of the United Nation’s Millennium Development goals, especially goal numbers 4, 5, and 6, which concern health provision and improvement. The reversal of the nursing shortage trend will help in working towards achieving the goals. Nursing dearth and measurement relates to the countries’ resources, staffing levels, and estimations of need for the nursing care services.
Whenever the demand outweighs the supply of the services, then the country has an acute shortage of nurses. This means that quantifying the concept of the nursing shortage is not easy. Other definitions possibly will rely on the impression of the criteria of proficiency capacity, the economic acuity. These facts bring in the fact that determination and definition of nursing deficiency varies from country to country (Sobon-Sensor, 2012). The following section tries to elucidate the causes of the nursing shortages in different countries. The causes seem to conquer in all countries from a general perspective. Specific causes can be found from country profiles.

Nursing Labor Force in USA

Factors that influence the nursing shortage
Alternative Options: The first cause of the problem in the nursing field is the fact that people are finding alternative options to nursing. People who would have gone for nursing are opting for other professions. Opportunities opened up for young women to explore employment in other fields, plus other facts, which add stresses to the nursing profession (Strelioff, 1999). People have begun reconsidering their career choices with better recompense to improve the quality of their lives. As it is currently perceived, many consider that in studying nursing, they will be bound in hospitals and will not have time to supplement their salaries.
According to the American Association of Colleges, the enrolment of nurses dropped by 2. 1% in 2000, but currently the rate of decline in enrolments is more than 10%. The rationale behind it is that nursing student, or those enlisted to join medical schools to study nursing, opt for alternative careers. According to Feldman (2003), nurses especially in the sub-Saharan Africa have opted to work in other regions. The movement however, is not aimed at offering their services to through public facilities, but private facilities, where they can reap benefits of their sweat as far as the nursing career is concerned. According to the teaching curriculum of nursing, the education system of nurses seems to take long as most experts argue. Following this situation, new student opt to enroll in courses, which take short times to allow them join the market of employment. Nursing was initially the favorite professional field for women. In Canada, 2001, it was reported that male nurses were only 5%. Occupations like engineering, medicine law, aviation and architecture were believed to be for men. Currently many females have enrolled in these careers making it difficult for the nursing field to get it sources of recruits. (Cohen & Sherrod, 2003)
Poor working environment within Nursing Profession: The nursing profession is severely, falling short of the desired qualities of life and driving potential nurses to pursue competitive and well-paid careers that people could never achieve in the last three decades. Cohen and Sherrod (2003) add that the corporate field, medicine, and law have provided opportunities for women to pursue careers; hence, putting nursing under scrutiny in terms of its relevance to the quality of service they intend to offer (Feldman, 2003). This trend has led to a severe deficiency of nurses in the field of healthcare, and the trend looks like it is going up at a high rate. With the escalating cost of living, Meadows, (2002) observes that registered nurses in America usually take to the streets every autumn season to demand for salary increments. Through their unions, these nurses were protesting that their working conditions are poor; they work for long hours, there are no tools and resources to execute their roles to patients, some of them complained of harassment from doctors, and risk or fighting from relatives of patients or patients. Keenan and Kennedy (2003) notes that this is a common problem affecting nurses in the whole world.

Influence from other practicing nurses- perception and wrong advice

With the information circulating in the media and from some nurse professionals, new recruits have shunned away from enrolling in nursing schools because of the fear they have regarding the information given. Fox (2009) points out that 17% of nurses in Australia enrolled for other careers even after undertaking a full nursing course as required by their respective nursing councils. The rationale behind this movement is search for good remunerations, and frustrations from the nursing profession among others.

Lack of full support from the government and other stakeholders

Admittedly, the nursing profession usually enjoys limited support from governments and other stakeholders in various economies. Ivanov and Blue (2008) elucidate that some governments, like in Canada have offered a “ plain field” environment of nursing and other professions in terms of scholarships, job recruitments, training and job promotions. Since nursing field seem to be unstable in terms of management and practice, many opt for alternative careers or seeks jobs in the private sector.
Shortage of skilled Nurses: Shortage of skilled nurses is the major cause of problems in the nursing, healthcare provision. Lack of enough knowledge, skills, and information is also reported being a major factor. This is because the field of nursing and health is dynamic and requires timely update of the nursing curriculum (Strelioff, 1999). The practicing nurses lack adequate education to deal with emerging health issues and cases; hence affecting patient care. This creates a dent in the supply-demand curve, where the supply is much less than demand.

Barriers to the resolution of nursing research

Research highlights training deficiencies in institutions. Continuously declining rates of enrolment of student trainees and educators has proved fatal for the health sector. Over the recent years, admissions into the nursing colleges have declined.
The US Congress (2001) reported that nursing schools and colleges have declined to admit qualified applicants on the basis that they do not have enough nursing trainers. To be exact, nursing colleges and universities declined to admit 32, 617 qualified students because of the shortage of trainers. Reports have concluded that there is the need for the United States to graduate more than 90 percent of the nurses getting into the nursing training.
Another point accrues from the issue of aging nurses. Youths have lost interest in the nursing profession due to its challenges and better benefits in other fields. This has led to a sharp rise in the average age of registered nurses, which is between 46 and 56 in United States of America (Buerhaus, Staiger & Auerbach, 2004). This means that half of the registered nurses will likely reach their retirement age and create a surge in the profession.
Poor funding prioritization has also been reported to be a leading cause of the woes in the profession. Insufficiency of funds has hindered staffing of hospitals and other healthcare facilities (Ivanov, L. L., & Blue, C. L. (2008). It has also led to low salaries for the registered nurses, lack of work privileges and incentives as in other professions, which affects their living standards. This leads to professionals reviewing their choice of careers.
Poor working conditions in the field have also played a massive role in creating the surge in the field. Some nurses describe the conditions as horrible (US Congress, 2001). The amount of work is a lot leading to exaggerated patient to nurse ratios. Increasing health challenges have led to increase in the nursing workload due to nurses running away from the field (Aiken, et. al, 2002). The fact that there is no guarantee of compensation for the extra work makes the profession more demoralizing (Sobon-Sensor, 2012). Most nurses have even uttered that they do not see themselves in the field of nursing for long; they would rather seek options in other professions. They assert that the working conditions do not allow them to put in extra efforts, and this makes the field less favorite.
In summary, the pertinent causes of the nursing dearth include methodologies that the trainers use in training, a review of the relevance and scope of the nursing training curriculum, staffing models that hospitals and employment authority’s use, retention efforts for the registered nurses (Cohen & Sherrod, 2003), and increasing the revenue that governments allocate to the relevant ministries in healthcare.

Best practices related to nursing shortage

Lintern (2012) reports that the major causes of nursing shortages accrue from human prioritization errors. The decisions that authorities make in the field of nursing lead to deficits of various. Here are some of the recommendations and alternatives that will help in dealing with the situation at hand.
It is also necessary to improve efforts of recruiting nurses. This will lower the high ratio of the patient to nurse. This will also work to improve the shortage levels. It is imperative to work on retention, which is an aspect that needs serious consideration (Strelioff, 1999). Strategies should be put, in place, to ensure that registered nurses do not leave the profession for other professional fields. Various strategies can help in achieving this point, like recompense, and reviewing the healthcare, working conditions, among others.
Additionally, Strelioff (1999) writes that there are fundamental reforms for evaluation within a short span in order to improve the inadequacy in the nursing profession. The restructuring involves intervention in the existing policies governing healthcare provision. Some of the reforms include economic policies and healthcare financing, positive practice environment, and employment and retention of nurses and healthcare providers.
Feldman (2003) indicates that all countries should strive to attain independence in terms of the healthcare personnel without creating surges in other countries. For instance, over the past few years, Philippine nurses have been migrating to the United States of America due to their overproduction and their increasing demand in America (Olson, 2001). Independence regards to the ability of a state, to supply the number of required nursing care providers at a given time, and the ability to sustain and retain them appropriately. Many countries have failed to retain such a status, and have ended up on either side of importing or exporting nurses.
It is imperative for nursing and healthcare administrators, in conjunction with policy makers to devise ways of balancing between the supply and demand of the nursing labor force (Ivanov & Blue, 2008). The field of health is dynamic with different health complications emanating every day. The sad thing is that most nurses in the field are undereducated to meet the growing and changing demands. Enhancement of the nursing education opportunities for the present and future will reduce most of the factors leading to the problem. This will increase the supply of nurses to allow for the provision of better, permanent, and safe care for patients, and a permanent stay in the profession because it will lead to improved working conditions.

Conclusion

Nursing shortages vary depending on each country’s needs and preferences in the field. Nevertheless, the deficiency is ultimately worldwide and same in all nations. This is so because from the above discussions, the bases and possible mediations are indistinguishable. There is the need for incentives in the field in order to entice the young generations to get into the field. This will ensure the security of the work force in the future of the nursing field. It is conceivable that the United Nations can intervene and pass proficient strategies that will influence the profession; hence introduce changes that will resuscitate the nursing profession.
There is the need to explore issues like the historical perspectives of the nursing deficiency, review of policies regarding nursing and healthcare. The merits and demerits of the policies should be evaluated time after time and intervention of support solutions for future prediction of trends in the nursing field. The significant question that needs an immediate answer is what will be the recommendations that healthcare administrators and policy implementers have in order to inculcate a balance between demand and supply of nurses in the profession. This paper has provided adequate measures that will help to provide alternative ways of dealing with the situation, which seems to worsen daily.

Annotated Bibliography

Cohen, Shelley, and Dennis, Sherrod. (2003). ” Creating a Work Environment That Fosters
Retention.” Surviving the nursing shortage: strategies for recruitment and retention.
Marblehead, MA: Opus Communications, . 15-40. Print.
Relevance: This article looks at the working conditions in the nursing profession. It elucidates on the plight of nurses, and why they shift to other professions due to the non-conducive working environment.
Strelioff, S. J. (1999, January 14). Good Nursing, Good Health: An Investment for the 21st

Century – Ministry Reports – Publications – Public Information – MOHLTC. Ministry of

Health and Long-Term Care / Ministère de la Santé et des Soins de longue durée.

Retrieved December 21, 2012, from

http://www. health. gov. on. ca/en/common/ministry/publications/reports/nurserep99/nurse_
rep. aspx
Relevance: This site provides the hardships that the trainers go through while in the practice. It elucidates on the reasons as to why the nursing and health trainers opt for other professions at the expense of nursing.
Feldman, Harriet R. (2003). ” Major Reports on the Nursing Shortage.” The nursing shortage:
strategies for recruitment and retention in clinical practice and education. New York:
Springer Pub.,. 175. Print.
Relevance: This book gives specific cases that elaborate on the seriousness of the shortages in the nursing profession. It is relevant as it gives possible remedies for the situation and areas which need to be addressed.
Krasner, Melvin I.. (1989); ” shortage of nurses.” The nursing shortage: new approaches to an
an old problem. New York, N. Y.: The Fund,. 1938. Print.
Relevance: This book explores the problem of nursing shortages as an ancient problem and explores possible avenues to approach the problem. It provides tactics that can be explored to reach the solutions to the problem.

US, Congress. (June 14, 2001); Looming nursing shortage: impact on the Department of

Veterans Affairs : hearing before the Committee on Veterans’ Affairs, United States
Senate, One Hundred Seventh Congress, first session, . Washington: U. S. G. P. O. :, 2002.

Print.

Relevance: This is a report by the United States Congress addressing the dire need for retention of nurses in order to eradicate the looming problem of the nursing shortage in the country. The report also elucidates on the causes of the situation and provides possible solutions to the problem.
Daniels, R. (2004). Nursing fundamentals: caring & clinical decision-making. Australia: Delmar Learning.
Relevance: The report covers the nursing expectations that hold them responsible for the decisions they make. The caring responsibility in the recent nursing experience is surrounded by litigation issues, which deter nurse development.
Feldman, H. R. (2003). The nursing shortage strategies for recruitment and retention in clinical practice and education. New York: Springer Pub.
Relevance: The book expounds on the relevant strategies that must feature in a successful recruitment process. These strategies have the impact on nurse retention and other clinical officers. In relation to this work, the book provides avenues to improve nurse retention through effective recruitment procedures.
Finkler, S. A., Kovner, C. T., & Jones, C. B. (2007). Financial management for nurse managers and executives (3rd ed.). Philadelphia, Pa.: Saunders Elsevier.
Relevance: This book provides possible reasons that make finances a risky subject in discussions, which compels majority of registered nurses to quit, in turn elevating the shortage further. The text also highlights how management of personal finances among the nurses professional is also possible to trigger the shortage.
Meadows, G. (2002). Nursing Shortages: Can Technological Information Help? Nursing Economics, 20(1), 46-48.
Relevance: this journal relates the nursing shortage to complexity and sensitivity in the nursing profession. The current technological advancement in all spheres of life compels nurses to update their competence or remain redundant in the field, a reason according to this article justifying the upward trend.

Scholarly journals in the references

Buerhaus, P. I., Staiger, D. O., & Auerbach, D. I. (2004, June 14). JAMA Network | JAMA: The
Relevance: This journal explores the field of nursing professional aging population and its impacts to the field. It looks at the challenges in the field due to the aging population without its replacement.
Sobon-Sensor, Connie. (13 May 2012) ” Nursing Shortage.” STTI Home Page. Version 12. The
Honor Society of Nursing,. Web. 19 Dec. 2012.
.
Relevance: This website provides information on the shortage of nurses and the hostage situation that accrues from it. The Honor Society of Nursing gives the reasons for the situation and provides possible solutions to the problem.
Olson, Karen. (17 May 2001) ” Nursing Shortages: A Growing Concern.” Almanac of Policy
Issues. Version 11. Almanac of Policy Issues,. Web. 19 Dec. 2012.
.
Relevance: This article looks into the issue of nursing shortage, and provides insight into the reasons for the situation. It gives the possible avenues that can be explored to reach the solutions to the problem.
Lintern, Shaun . (22 Oct. 2012); ” NHS faces a nursing shortage, review for RCN warns | News |
Nursing Times.” Nursing practice and peer-reviewed clinical research for all nurses.
Version 11. Nursing Times,. Web. 19 Dec. 2012..
Relevance: This source is credible and looks at reasons why there are shortages of nurses. It bases on research by the NHS and reviews by RCN. It also gives the possible remedies to the situation, which seems to be on the rise.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002, October 23).

JAMA Network | JAMA: The Journal of the American Medical Association | Hospital

Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA
Network | JAMA: The Journal of the American Medical Association | Home. Retrieved
December 21, 2012, from http://jama. jamanetwork. com/article. aspx? articleid= 195438
Relevance: This article explores the available options that authorities can look into in the effort to resolve the situation of understaffing in the sector. It provides
alternatives to the nursing shortage and explains the reasons as to why it should be
the top priority.
Berlin, L., & Sechrist,, K. (2002). The Shortage of Doctorally Prepared Nursing Faculty: A Dire Situation. Nursing Outlook, 50(2), 50-57.
Relevance: the article reflects on the circumstances, which compels registered nurses to quit their professional. Measures to salvage the rising shortages of nurses proposed entails; recruiting internally and promotion of existing nurses for motivation and retention purposes. Consequently, increased enrollment as proposed could salvage the situation.
Fox, R. (2009). A Critical Examination of the U. S. Nursing Shortage: Contributing Factors, Public Policy Implications. Journal Compilation, 44(4), 235-247.
Relevance: the journal expounds on the impact the nursing policies have on the professionalism of the nurses. It entails policies on posting and promotions of nurses, stipulating their terms of work and litigation issues in case a malpractice occurs in the course of work.
Ivanov, L. L., & Blue, C. L. (2008). Public health nursing: leadership, policy, & practice. Australia: Delmar Cengage.
Relevance: the book highlights on the hierarchy of nursing structure and the influence it has on performance of nurses. The leadership organization policies as highlighted plays a crucial role in encouraging career development among practicing nurses.
Janiszewski, H. (2003). The nursing shortage in the United States of America: an integrative review of the literature. Journal of Advanced Nursing, 43(4), 335-350.
Relevance: the article elucidates on the probable causes on the upward trend in nurse shortage. Consequently, the journal provides the possible avenues for managing the shortage. The shortage relates to poor policy formulation and implementation, therefore, solutions to these problems must address the structural inefficiency of nursing professionalism.
Keenan, P., & Kennedy, J. (2003). The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions. Issue Brief, 16(18), 1-7.
Relevance: this article correlates the current trends in nursing globally. The practical causes and consequences of nurse shortages in the text is in line with the projected economic situation in the global context. The solutions to these problems as highlighted propose restructuring of the policies governing the nursing profession.
Kirby, S. (2009). Recruitment, retention and representation of nurses: a historical perspective. Journal of Clinical Nursing, 1(18), 2725-2731.
Relevance: this journal provides an in-depth analysis on the procedures and process of nurse recruitment. The methods applicable in nurse retention, though theoretical, have the necessary implication to bring the looming crisis of nursing shortage. The historical context on the genesis of the shortage is of significant in formulating solutions.
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