Research Article Creative Commons, CC-BY
Impact of The Nurses Education and Shortage on The Patients Care Outcomes-Literature Review
*Corresponding author: Manana Machitidze, School of Health Sciences, University of Georgia, Georgia.
Received: January 23, 2022; Published: February 25, 2022
Aim/Objective: The reasons for the shortage of nurses and the factors affecting it varies according to the development of the countries. However, the Covid-19 pandemic has exacerbated the problem globally. The aim of this article is to analyze the problem and its triggers, as well as the consequences.
Background: Qualified nurses are needed to ensure proper care for patients and the general population. Therefore, the lack of well-trained and educated nurses is a rather big problem, especially if the deficit is widespread. The shortage of nurses has reached a critical level for healthcare services, both locally and globally. The global shortage of nurses has been further exacerbated by the impact of the Covid-19 pandemic. Lack of human resources and professional nurses affects patient care outcomes. With sufficient human resources, qualified nurses are needed. The quality of patient care can only be ameliorated if there is sufficient nursing staff in the hospital. Lack of nurses hinders the implementation of nursing education, as there is a shortage in this area. Shortage of teachers limits the number of students admitted to nursing programs.
Design and Methods: The article is based on secondary research and limited to descriptive analysis. The article is based on the analysis of publications and analysis of international organizations (WHO, the International Council of Nurses (ICN)), as well as a review on the shortage of nurses and COVID -19 pandemic impact on Nurses shortage (SCOPUS, PubMed).
Results and Conclusions: Nursing shortages are worrisome, because effects the safety of both-the nurse and the patient. Nurses are busier, more stressed, and less focused on the details during working. The result of this is less communication to patients/ colleagues, making mistakes during working, which increases risks for errors and unsafety during patient care, treatment, and recovery processes. The global shortage of nurses has been further exacerbated by the impact of the Covid-19 pandemic.
Keywords: Nurse, Education, Nursing Shortage, Triggers; Well-Trained; Human Resources; Ameliorated; Communication; Stressed; International Organizations
The nursing shortage is a critical issue not only in Georgia but in different parts of the world. For instance, in the United States, the shortage of nurses in the hospitals happens to cause serious problems since it affects the overall quality of patient care . What’s more, as early research demonstrates, the lack of nursing staff is directly linked to patient complications and even death . Several organizations in the United States, including the IOM, AHRQ and CMS focus on improving the standards and safety of patient care on a national scale. These organizations understand that to reach this goal, they need to first work on increasing the quantity of highly qualified nursing workforce in the hospitals . In other words, the quality of patient care can only be ameliorated if there is sufficient nursing staff in the hospital (ibid).
Moreover, Hassmiller and Cozine  explore different ways to address the nurse shortage. By taking the Robert Wood Johnson Foundation’s (RWJF’s) example of supporting nurses, the authors outline how crucial it is to invest in the nursing programs, including leadership and mentoring programs for nurses. It is equally important to change the working processes for nurses-instead of spending more time on administrative tasks, the nurses should focus on the patient and improve care in their units. Furthermore, Hassmiller and Cozine emphasize the role of investing in research. In the case of RWJF, the foundation supported new studies at New York University and the University of Buffalo by tracking the career paths of newly graduated nurses over four years and identifying the factors impacting their work decisions. It is important to note that the problem with the nursing shortage should be addressed by bothprivate and public organizations and invest in the qualified nursing workforce at local and national levels (ibid). Correspondingly, Hahn and Truman’s  study describes the importance of public health interventions through educational programs and policies.
While it is important to look at the implications of the shortage of highly qualified nursing staff, it is equally crucial to examine the reasons behind this problem. The nursing shortage is both-a local and a global multifaceted problem. Based on the World Health Organization (WHO) report, 7.2 million healthcare workers are in shortage regarding the existing health needs. This problem, which is becoming more and more serious in Europe, Asia, and North America, might regulate the future world health policy . It’s important to note that population aging and changes in global demographics become one of the factors standing behind the global undersupply of nursing staff. According to the UN, there will be a double quantity of people aged 60 and over, increasing up to 2.1 billion seniors by 2050 . Aside from the demographic reasons, there is also a strong factor of migration involved in the processes. For instance, as Poland became part of the EU, highly qualified nurses started to move to different countries to ameliorate their living conditions. Economic migration of qualified nurses is not only the source of undersupplied nursing staff in Poland but in various countries . It is evident, that to avoid further shortage of the nursing staff in the future, the healthcare system needs to develop better employment conditions for nurses, implement programs oriented on their professional growth and regulate their salary system (ibid). As there is increasing number of nurses leaving their profession  it is crucial to urgently address the problem through governmental and non-governmental interventions.
The shortage of nurses became particularly acute at the onset of the Covid-19 pandemic. The current situation has exacerbated the problem. The statistics are disturbing. According to the State of the World’s Nursing (SOWN) report, there was a global deficit of almost 6 million nurses before the pandemic, with the majority (89%) concentrated in low-and low-middle-income countries. Added to this is the fact that for the next 10 years, one in six nurses in the world is expected to retire. This means that 4.7 million new nurses will have to replace them; The migration of nurses puts at risk some country’s health requirements. By the same report, every eighth nurse is in migration. . Countries should seriously consider maintaining nursing attractiveness as a profession. It is important for them to be provided with pay and working conditions, career prospects, continuing postgraduate education. Which will help ensure that the periodic and long-term supply of new nurses will not be delayed.
According to the American Nurses Association (ANA), by 2022 there will be available more registered nurses working than in other professions. According to an article in the Nursing Times, based on a study by the U.S. Bureau of Labor Statistics, 11 million additional nurses are needed to prevent deficits in the future. It is also expected that from 2016 to 2026, the employment of nurses will grow at a faster rate (15%) than in other professions. (NCBI, 2020).
The global shortage of nurses has been further exacerbated by the impact of the Covid-19 pandemic. It is likely that in countries where the impact of different waves of pandemics was significant and severe, it also affected nursing staff. Because nurses ‘’burned out’’, infected, and ‘’post-COVID’’ disability helped to isolate them from work for a short or long period of time. 90% of NNAs report inadequate busy work schedules and a lack of human resources due to pandemics. Low pay, fatigue, stress, and busy work schedules are the major determinants that make nurses think to leave working during pandemics. ICN member NNAs 20% indicates that in 2020 the number of nurses who left the job increased. 70% of associations says their countries are ready to increase the number of nursing students, but still be an interval of few years before new graduate nurses are ready to enter the workforce. It is unfortunate that due to the lack of nurses, the aging of staff, and pandemic result, the ICN estimates that up to 13 million nurses will be needed to fill the global shortage of nurses in the future. (International Council of Nurses, 2021). The data is really alarming.
Addressing the problem of lack of nurses is important for improving the treatment outcomes of patients. Much research is still needed to explore, analyze, and better determine the relationship between nursing care and patient outcomes. When talking about the shortage of nurses, it is interesting to have a consistent analysis of where the shortage of nurses begins. Where is the shortage of nurses coming from-lack of nursing students or graduates? While there is a shortage of nurses in the country, how easy is it for a graduate to get a job? Why do nurses leave their jobs? Is the nursing faculty ready to accept students and ensure a quality teaching process? What is the distribution of this deficit in the different specializations of nursing, can we equate the shortage/deficit with the number of primary care workers and the number of nurses in the clinical sector? Consequently, the factors that contribute to the shortage of nurses are different, not only globally, but also nationwide, and therefore, effective strategies to eliminate the shortage must be different. Unfortunately, due to the lack of nursing staff for a variety of reasons, the nursing profession continues to be in short supply. This is due to the lack of potential nursing educators/mentors, unequal distribution of labor, and migration. Nursing shortages are worrisome because effects the safety of both-the nurse and the patient. Nurses are busier, more stressed, and less focused on the details during working. The result of this is less communication to patients/colleagues, making mistakes during working, which increases risks for errors and unsafety during patient care, treatment, and recovery processes.
I thank the International organizations and the authors for their work whose research findings were used in the article.
Conflict of Interest
- Peter I Buerhaus, Karen Donelan, Beth T Ulrich, Linda Norman, Mamie Williams, et al. (2005) Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care. Nurs Econ 23(5): 214-221.
- Jack Needleman, Peter Buerhaus (2003) Nurse staffing and patient safety: Current knowledge and implications for action. Int J Qual Health Care 15(4): 275-277.
- Susan B Hassmiller, Maureen Cozine (2006) Addressing the nurse shortage to improve the quality of patient care. Health Affairs 25(1): 268-274.
- Anita Atwal, Kay Caldwell (2006) Nurses' perceptions of multidisciplinary team work in acute health-care. Int J Nurs Pract 12(6): 359-365.
- Lisa M Haddad, Pavan Annamaraju, Tammy J Toney-Butler (2020) Nursing Shortage. Stat Pearls [Internet].
- Robert A Hahn, Benedict I Truman, (2015) Education improves public health and promotes health equity. Int J Health Serv 45(4): 657-678.
- International Council of Nurses (2020) COVID-19 and The International Supply of Nurses. Report For The International Council of Nurses.
- Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P (2018) A nursing shortage - a prospect of global and local policies. Int Nurs Rev 66(1): 9-16.
- United Nations (2015) World Population Prospects: The 2015 Revision.
- World Health Organization (2013) A Universal Truth: No Health Without a Workforce.