Buchan J. & Aiken L. (2008). Solving nursing shortages: A common priority. Journal of
Clinical Nursing, 17(24), 3262–3268. doi:10.1111/j.1365-2702.2008.02636.x
The article aimed at highlighting the challenge of nursing shortage and the implications of policy decision making in dealing with the challenge. The researchers found out that, population ratios of nurses differ in different regions and countries but very low in Africa and South East Asia regions. However, the shortage is not only defined by relatively few individuals with nursing credentials but also qualified nurses unwilling to work in the current conditions with great impacts on healthcare delivery and outcomes. Resource constrained undersupply of new staff, ineffective use of available nursing resources through inappropriate skill mix and utilization, poor and inadequate career support and incentive structures, poor recruitment, retention and ‘return’ policies, and inadequate workforce planning and allocation mechanisms are some of the factors causing nurse shortage. The authors concluded that policy makers in developed countries like Japan have to address supply as well as demand-side challenges related to nursing shortage and that a coordinated package of policies that will provide a sustainable, long term solution is the only hope.
Primarily, the reasoning process that the researchers used to formulate their conclusions involved a systematic process involving documentary analysis of previous articles dealing with shortages in healthcare human resources with an emphasis on nurses. The authors utilized information about estimates involving the nursing workforce from the World Health Organization (WHO) in quantifying results about the nursing shortage. The information estimated that the shortage was proportional to a global deficit of 2.4 million nurses, doctors and midwives with serious shortages in sub-Saharan Africa and south East Asia (WHO, 2006). Through deductive analysis, the researchers highlighted that unemployment and economic dynamics in poor countries and high care demand for aging populations in developed countries will lead to nursing shortages in both regions. To support their conclusions, they deduced that factors like imperfect private labor markets, political interference, poverty and lack of public funds in poor countries will create nursing shortages, not through lack of personnel but through lack of employment.
With regards to rich countries, growing populations of the elderly who are prone to ailments, families reduced capacity and willingness to provide care to their elderly and a shift by students from nursing education will reduce nurse supply in these countries. However, nurse supply will increase from poor countries that are struggling to maintain the few healthcare workers they have, thus leading to a further decrease in nurses. With such a complex mix of factors involved in the nursing shortages and which must be addressed, the authors appropriately deduced that a coordinated package of policies that will provide a sustainable long term solution that will help in dealing with the shortage. The weaknesses in their analysis are tied to the study’s limitations which include the definition of ‘nurse’ as different regions have different definitions and therefore different numbers of ‘nurses’. The data from WHO also involves main regions where the author acknowledges that the maximum and minimum ratios produced may be representative of one or two outlier countries, hence skewing the results and that looking at one type of staff may produce misleading ratios (Buchan & Aiken, 2008). However, the researchers carefully factored in all the variables to come up with conclusions that provided a general and appropriate picture on nursing shortages.
Drawing from the data used in coming up with the study’s conclusions, other possible alternate conclusions that the researchers could have drawn include higher nursing shortages in Latin America considering that the region has almost three times more physicians than there are nurses. Moreover, the nursing shortage in developing countries could have been lessened if the number of unemployed nurses in rural areas were considered especially when studies reveal that many countries are unable to recruit and retain nurses in rural and remote areas (Hossain & Begum, 1998). The study found out that the nursing shortage was not necessarily a shortage of individuals with nursing qualifications, but a shortage of nurses willing to work as nurses in the present conditions. Furthermore, the shortage is also tied to individual and collective decision making and choice (Buchan, 2006). This is highlighted by how nurses may choose not to pursue a career in nursing but other more lucrative and prestigious professions, hence reducing the availability of nurses in the nursing profession. This enabled the researchers in addressing their research question in assessing the scale of nursing shortage and by extension, enabled them to come up with appropriate conclusions.
Moreover, the authors also found out that the shortage was also linked to other variables such as geographical distribution both in developing and developed nations due to nurse migration to urban centers. This finding conclusively aided in identifying why a shortage of nurses involved the number of nurses available in some areas considering that the data used targeted major regions. In a bid to build on the study‘s findings and at the same time gain a fuller understanding of the nursing shortage problem, additional and more specific research on numbers and specific factors contributing to nurse shortage can be done. Kane et al. (2007) and Aiken et al. (2002a) identified a link between nursing shortage and negative health outcomes including increased mortality rates and adverse events after surgery which were compounded by high levels of job burnout in the nursing workforce. Other studies identified increased incidence of violence against healthcare personnel, patient injuries and accident rates as well as increased cross infection rates (Stanton, 2004). Summarily, this shows why a coordinated package of policies that will provide a sustainable long term solution is of utmost importance.