Factors Affecting Nurses’ Shortage – Literature Review

The deficiency of nurses has long existed not only in Georgia but also in the world, as indicated by studies conducted in different countries and statistics on the ratio of nurse-patient and doctor-nurse. Of course, the causes and factors vary according to the development of the countries. In some countries, including the United States, the nursing profession is prestigious and in demand, higher nursing education is competitive, mainly the reason for the Nurses shortage is the rapid growth of the country’s population. In a number of countries, as well as in Georgia, the shortage of nurses is due to unpopularity of the Nursing Profession.


Introduction
The shortage of nurses worldwide is recognized by the World Health Organization (WHO) Multidisciplinary Global Advisory Group. The shortage is due to the increased demand for nurses in the health sector, while fewer and fewer people are choosing nursing as a profession. This leads to an increase in the age of working nurses and aging [1][2][3]. The existing shortage applies to both nurses working in practice as well as nursing faculty who teach students. The movement and migration of nurses from developing countries to developed countries often exacerbates the problem within the country and increases the deficit.
Half of the member countries of the World Health Organization (WHO) state that there are 3 nurses and midwives per 1000 population [4,5], while 25% state that less than 1 staff per 1000 total population. There is a shortage of nurses around the world and further complication of the situation is expected in the future unless there is serious, political intervention by states [6].
Medical organizations in the Organization for Economic Cooperation and Development (OECD), including largest countries, such as Canada, Australia, and the United Kingdom, are experiencing instability in the nurses' labour market due to staff shortages and outflows [7][8][9][10]. Lack of nursing is predicted to increase in member countries of the same organization by 2030, 2.5 million.
As mentioned, the lack of nurses affects not only the healthcare sector but also the Nursing education system. Lack of nurses hinders the implementation of nursing education, as there is a shortage of nurse educators [11]. Lack of teachers limits the number of students admitted to nursing programs. According to a 2016-2017 survey by the American Association of Nursing Colleges (AACN), nearly two-thirds of colleges surveyed said they could not meet all the qualified candidates for the nursing program due to a lack of teachers and/or clinical mentors [12,13].
Nursing education in Georgia is provided by 5 higher education institutions, including the University of Georgia and 21 vocational schools. It is a paradox, but given that the tuition fee for the first level of higher nursing education is lower in some higher education institutions of Georgia than in vocational schools, the number of applicants for nursing is higher at the lower level than at the higher education institution. There is no second or third level of higher nursing education (master, doctorate). Tuition fees in higher education institutions range from 1000-3500 GEL, the average annual tuition fee in vocational schools is 2000 GEL.
The nursing profession is one of the professions that are in demand and will be in the future [15][16][17][18]. Therefore, the right approach to the problem and the correct analysis of the research results will strengthen and contribute to the development and popularization of the field, which in itself, will have a positive impact on the development of the profession and the quality of medical services. Among the factors influencing the shortage of nurses in the world, the issue of financial and professional unpopularity has been raised.
A nurse is a healthcare worker who cares for patients and their families, but it is they who suffer from their lack. The fact is that the nursing profession is one of the professions that are in demand and will be in the future. Therefore, the right approach to the problem, which will be scientifically substantiated, will strengthen and contribute to its popularization, which in itself, will have a positive impact on the development of the profession and the quality of medical services.

Research Design
Cross-sectional research.
Expected Outcomes: The reason for the lack of nurses is multifaceted, not a single determining factor, and in many cases, it is common, both locally and globally. It has a complex cause that combines economic and social factors. In Post-Soviet countries (Soviet Union) the nursing profession was considered an ancillary part of the medical profession. There was no level of undergraduate education, only a level of technical education was sufficient, which affect determine the development of nursing as an independent profession. One of the factors of shortage and unpopularity of the nursing profession is the inadequate information of the population, most of them not only do not recognize the nurse as an independent profession but also question the need for higher nursing education.