Nursing Shortage, Research Paper Example

Abstract

The nursing shortage in Canada is a serious and challenging problem that continues to impact the quality of patient care in many healthcare organizations. The lack of experienced educators, the cost of education, and the number of graduates completing these programs have led to serious staffing issues and other concerns across nursing units. It is important to identify areas where weaknesses persist in order to increase the number of available nurses throughout Canada. Improving retention rates through positive working conditions will also enable nurses to remain in their positions and to provide high quality of care at all times. Expanded educational opportunities with knowledgeable and experienced faculty will allow larger numbers of nursing students to enter and graduate from these programs, including advanced practice programs. These graduates will then be available to fill open positions and to improve the quality of patient care throughout Canada. These alternatives are essential to the development of new perspectives to fully staff nursing units and to provide patients with the appropriate level of care and attention within the nursing unit.

Nursing Shortage

The shortage of nurses in healthcare organizations throughout Canada is indicative of a much larger problem within the healthcare system. For example, nurse education and training are lacking in some areas as a result of fewer instructors who are available to teach nurses and expand their knowledge of nursing practice objectives. From a nursing leadership perspective, the shortage of qualified and experienced nurses is a critical concern because it interferes with the ability to provide high quality patient care on a consistent basis. It is important to address the primary concerns that are associated with the nursing shortage dilemma in Canada and the possible solutions that are essential to improving these conditions. It is necessary to develop strategies that will promote increased nurse education and training to accommodate the shortage problem in healthcare organizations throughout Canada. This problem is significant because it compromises the quality of care that nurses provide in these organizations and has an impact on the provision of care across many patient populations (Becker et.al, 2010). There are a number of key contributors to this problem, including lack of qualified faculty to educate nursing students, as well as an increased demand for advanced practice nurses with Masters or Doctorate-level education (Canadian Nurses Association, 2010). In this context, it is important to develop strategies that will increase the number of available faculty members to educate nurses and to expand programs that will increase enrollment in advanced nursing education programs. The following discussion will address some of these strategies in greater detail and will emphasize the importance of new perspectives to enhance education and training in order to minimize the current nursing shortage in Canada and its provinces as best as possible. These efforts will demonstrate a commitment to nursing practice objectives that will facilitate higher quality of care and treatment for patients throughout the nation.

Literature Review

Recent statistics demonstrate that entry-to-practice (ETP) programs are popular throughout Canada to obtain education and future RN licensure (Canadian Nurses Association, 2010). Specifically, over 14,000 students entered into these programs in 2008-2009, with a subsequent increase in graduates from these programs (Canadian Nurses Association, 2010). These statistics are relevant because they support the licensure and availability of RNs for available positions throughout Canada; however, there is also an increased demand for continuing education to ensure that the RN knowledge base is maximized (Canadian Nurses Association, 2010). Furthermore, almost 30 percent of ETP schools offer Masters Programs, almost 14 percent provide Doctoral programs, and 25 percent offer Nurse Practitioner programs (Canadian Nurses Association, 2010). This information supports the belief that nurse education and licensure are important in Canada and the availability of licensed graduates is essential to the quality of care that is provided in healthcare organizations (Canadian Nurses Association, 2010).

In Alberta, there are significant issues related to the nursing shortage that include burnout, long hours, and high levels of stress (CBC News, 2013). Many nurses in Alberta face circumstances where they are required to work long hours and then return to work only a few hours later (CBC News, 2013). This is a difficult issue to consider because it has a significant impact on patient care and treatment over time, particularly when the stress of the job is overwhelming (CBC News, 2013). Under these conditions, burnout is likely to be significant and lengthy because nurses are unable to overcome the issues that they face in the workplace setting, many of which are unfair and inequitable (CBC News, 2013).

The nursing shortage in Canada also represents other challenges, including an older workforce and a shift in practice to preventative medicine for an aging population (Becker et.al, 2011). It is widely known that “Dissatisfaction in the workplace due to hours worked and underutilization of knowledge and skills is an important retention and recruitment issue…Allowing knowledgeable and skilled employees to be dissatisfied or underutilized is potentially detrimental to quality patient care and to the nursing profession” (Becker et.al, 2010, p. 47). These concerns are widespread throughout Canada and represent a difficult era in the Canadian nursing workforce, as the economics of healthcare have dictated different policies and other measures to promote cost savings, often at the expense of quality patient care (Becker et.al, 2010). These changes are difficult for many members of the Canadian nursing workforce to accept because they minimize the importance of quality of care and treatment in all healthcare organizations (Becker et.al, 2010). These concerns lead to difficult outcomes in the form of nursing shortages and widespread dissatisfaction that is difficult to overcome and to reverse in many nursing practice environments (Becker et.al, 2010). It is more important than ever to address these concerns in a public forum in order to recognize the severity of these conditions and how they impact patient outcomes over the long term (Becker et.al, 2010).

One of the more unique strategies that have emerged in recent years is to obtain nursing degrees in conjunction with other types of degrees in order to reduce the nursing shortage (Hickey et.al, 2011). Due to difficult challenges associated with economic supply and demand, there have been critical losses of funding for many educational programs, increased and often unaffordable tuition rates, and a lack of focus in recruiting qualified candidates for faculty positions (Hickey et.al, 2011). Since there are insufficient numbers of nurses obtaining Doctoral degrees, it becomes very difficult to secure educators for positions in nursing education programs, thereby creating a shortfall of teachers and subsequently capping student enrollment in some schools (Hickey et.al, 2011). These concerns are particularly relevant because they limit progress and halt education for many students who are qualified to pursue nursing degrees (Hickey et.al, 2011). When the number of nursing educators is limited, it becomes increasingly difficult to admit students to nursing education programs, thereby contributing to a shortfall in available graduates in the future (Hickey et.al, 2011). From this perspective, it is more important than ever to address these challenges by expanding Doctoral programs to recruit educators to teach future nurses in a variety of degree-granting programs (Hickey et.al, 2011). These efforts will also support the continued growth and development of nurse education programs in order to increase the nursing graduate pool, subsequent licensure, and recruitment for available positions (Hickey et.al, 2011).

From an advanced practice perspective, nursing education is critical to the expansion of advanced practice nurse availability throughout Canada (Dicenso and Bryant-Lukosius, 2010). In a general context, “The role of APNs in global and Canadian healthcare systems has never been stronger. As clinical experts, leaders, and change agents, there is high worldwide demand for APN roles as a strategy for developing sustainable models of healthcare. The development of provincial legislation across the country to support autonomous practice, increasing numbers of graduates and deployment of new positions across acute, ambulatory, community, long-term care and public health sectors are just a few indications of the progress that has been made to integrate the NP role in the Canadian healthcare system” (Dicenso and Bryant-Lukosius, 2010, p. 18). Under these circumstances, it is necessary to address the primary issues that are associated with advanced practice nursing as a primary benefit to patients in healthcare organizations throughout Canada (Dicenso and Bryant-Lukosius, 2010). However, this role continues to be explored in depth as an opportunity to expand quality of care and the level of skill that is offered to patients during consultations, direct care, and treatment (Dicenso and Bryant-Lukosius, 2010).These findings are relevant because advanced practice nurses have become increasingly important to the success of nursing practice strategies in order to maximize quality of care and minimize the consequences of nursing shortages and other deficiencies (Dicenso and Bryant-Lukosius, 2010). Advanced practice nursing has emerged as one of the most critical areas of growth within nursing practice; therefore, it must continue to be expanded in Canada in order to improve quality and the delivery of care and treatment to a large yet diverse patient population in Canada (Dicenso and Bryant-Lukosius, 2010).

The nursing shortage in Canada involves a difficult set of circumstances and requires a greater understanding of the need for advanced practice nurses in a variety of settings (Dicenso et.al, 2010). The efforts that are made to admit students into advanced practice nursing programs will lead to significant benefits for healthcare organizations when knowledgeable and experienced advanced practice nurses are available to fill open positions (Dicenso et.al, 2010). From this perspective, it may be argued that advanced practice nurses serve a critical purpose in providing different types of knowledge, care and treatment to patients that is greater in scope than baccalaureate nurses (Dicenso et.al, 2010). This group of nurses has become increasingly important to the healthcare system in Canada as a means of expanding practice and preventative medicine objectives in an effort to reduce cost and promote efficiency across organizations (Dicenso et.al, 2010).

As mentioned previously in the discussion, there is a significant need for continuing education in nursing practice to promote greater knowledge and skill development for nurses (Lalonde et.al, 2013). Therefore, these efforts must be effective in supporting the ongoing demands of nursing practice through the development of continuing education models to ensure that nurses remain interested in the field and do not experience burnout (Lalonde et.al, 2013). This is an important contribution to nursing practice objectives in Canada to increase nurse retention and to minimize the nursing shortage (Lalonde et.al, 2013). It is important to identify how continuing education might play a role in enabling nurses to explore new directions within their careers in order to reduce dissatisfaction and without compromising their current roles (Lalonde et.al, 2013). These issues are critical to the success of nurses throughout Canada in response to the nursing shortage and its impact on patient care in a variety of settings (Lalonde et.al, 2013).

Gaps in Literature

One less known yet critical factor in the Canadian nursing shortage is the migration effort that some nurses have made to move to the United States to gain employment in a different type of system with typically higher pay (McGillis et.al, 2009). This approach has become increasingly common because it conveys the lack of acceptance of the Canadian healthcare system as a positive work environment for many nurses, who would rather gain employment elsewhere (McGillis et.al, 2009). In this context, it is more important than ever to address the concerns that many Canadian healthcare organizations must consider when their employees leave their respective institutions and move to the United States for employment (McGillis et.al, 2009). It is necessary to address this problem in greater detail in future studies because it represents a continuous challenge for Canadian healthcare organizations and places a strain on these economies in different ways (McGillis et.al, 2009). The strain of these circumstances is not well known; however, they must be considered in order to increase retention rates and prevent organizations from losing quality employees to their national neighbors due to greater salaries and benefits (McGillis et.al 2009). When Canadian healthcare organizations begin to recognize the serious nature of this problem, they might consider other alternatives in order to prevent nurses from leaving Canada altogether (McGillis et.al, 2009).

Many organizations play the blame game and attribute this problem to economic conditions, many of which reduce the potential for employees to offer full-time positions with higher salaries and benefits (Murphy et.al 2012). Under these conditions, there is a significant need to address why healthcare organizations believe that it is more cost effective to hire two part-time nurses than to employ one full-time nurse (Murphy et.al, 2012). In essence, this solution does not appear to solve the problem because human capital is required to provide training to two part-time nurses at a larger level than a single full-time nurse (Murphy et.al, 2012). Therefore, this issue must be addressed further because it limits retention rates in some organizations when employees are dissatisfied with part-time employment (Murphy et.al, 2012). The issues surrounding this problem are largely economic in nature, but while attempting to save money by recruiting two part-time nurses, an organization may compromise the quality of its care in the process (Murphy et.al, 2012).

The nursing shortage in Canada also represents an opportunity to explore the different dimensions of leadership, including where weaknesses are evident (Regan et.al, 2009). These perspectives are important because they convey the issues that are common within nursing practice organizations that may lead to employee dissatisfaction and subsequent nurse shortages (Regan et.al, 2009). When these circumstances occur, leadership qualities and performance must be examined more closely in order to determine if additional concerns are evident and are contributing to the problems throughout the nursing workforce (Regan et.al, 2009). Nurse leaders must demonstrate an example to their fellow employees, but when their actions do not exhibit leadership in the expected manner, problems may arise that are largely challenging because they may impact the availability of nurses, particularly when they become dissatisfied with their work environments and leave their organizations or the field altogether (Regan et.al, 2009).

Finally, the standards of nursing education are of critical importance because they contribute to some of the issues that may lead to nursing shortages in Canada, such as limited enrollment in educational programs and excessive enrollment requirements for advanced practice programs (Morin, 2011). These circumstances are important because they provide a greater sense of where the country is headed with respect to nursing education and how these conditions might be limiting for many students seeking a major in this field (Morin, 2011). It is important to identify areas where educational standards might be modified and even aligned with those of other countries, so that nurses will gain international knowledge and an understanding of how nurses throughout the world practice and provide patient care (Morin, 2011).

Responsive Action

From a leadership perspective, the nursing shortage in Canada is a critical issue because it conveys the importance of offering high quality education for nursing students to enable them to graduate, gain licensure, and obtain employment in healthcare organizations throughout Canada. In the immediate future, it is necessary to identify problems within a given organization that have contributed to the nursing shortage, including budgetary constraints, turnover rates, fewer qualified employees, etc. Each of these factors is relevant and may be addressed through the development of an action plan as soon as possible to begin to address the shortage in an effective manner.

The nursing shortage is a widespread problem and is more severe in some locations than others; however, this problem expands beyond Canada’s borders and is a serious concern throughout the world. As a result, it is important to utilize leadership skills and experience in order to address the primary issues that impact the nursing shortage, particularly in Canada. For instance, economic conditions are challenging, as money is tight and many organizations are working with small budgets in order to treat their patients. Over time, this will compromise quality of care and may even contribute to more serious consequences. A lack of focus regarding the important issues at hand has been a significant problem; therefore, immediate discussion regarding these challenges across disciplines must convey the urgency of this issue and invoke passion regarding the problem. When passionate people are involved, it is likely that the results will be effective and appropriate for the problem and in halting the expansion of the nursing shortage.

A delicate balance must be achieved that will allow healthcare organizations to recruit nurses in order to meet national standards of care, thereby reducing the risk of burnout for employed nurses. This problem is common and serious because it may lead nurses to make mistakes or errors that could compromise the lives of their patients under some conditions. A nurse leader must recognize the potential of current staff members through brief evaluations in order to provide them with opportunities for growth, and challenge the status quo by utilizing knowledge, expertise, and smart budgeting to accommodate new nurses. At the same time, in areas where there are low numbers of nursing graduates, educational programs must be prepared to accommodate new students by aggressively recruiting high quality candidates for available faculty positions. Nursing faculty must be able to utilize their knowledge and experience in a favorable manner in order to educate students and provide them with skill development and training to meet the needs of the nursing profession as a whole. These opportunities will convey the importance of nursing education, graduation, licensure, and recruitment as several pieces of a much larger puzzle that will minimize the nursing shortage as best as possible.

Conclusion

The nursing shortage in Canada is a complex problem that encompasses many areas, including education and employment. Low numbers of available experienced faculty contributes to the issue of limited educational and admission opportunities for many students who aspire to become nurses. Furthermore, these concerns represent a challenge to the nursing field because when there are fewer students, there are fewer graduates and fewer licensed nurses who are available to fill open positions in healthcare organizations throughout Canada. This problem is cyclical in nature and requires additional insight into the complex issues that contribute to the shortage to begin with. Under these conditions, Canadian nurse leaders must utilize their core strengths in order to increase nurse satisfaction rates and minimize turnover so that nurses are available to fill open positions in a timely and efficient manner throughout the nation and its provinces.

References

Becker, S., McCutcheon, H., and Hegney, D. (2011). Causalisation in the nursing workforce – the need to make it work. Australian Journal of Advanced Nursing, 28(1), 45-51.

Canadian Nurses Association (2010). Nursing education in Canada statistics, 2008-2009. Retrieved from http://206.191.8.149/~/media/cna/page%20content/pdf%20en/2013/07/26/11/08/education_statistics_report_2008_2009_e.pdf

CBC News (2013). Alberta nurses overworked and burnt out, finds CBC survey. Retrieved from http://www.cbc.ca/news/canada/calgary/alberta-nurses-overworked-and-burnt-out-finds-cbc-survey-1.1359370

Dicenso, A., and Bryant-Lukosius, D. (2010). Clinical nurse specialists and nurse practitioners in Canada. Canadian Health Services Research Foundation, retrieved from http://www.cfhi-fcass.ca/migrated/pdf/10-CHSRF-0362_Dicenso_EN_Final.pdf

DiCenso, A., Bryant-Lukosius, D., Martin-Misener, R., Donald, F., Abelson, J., Bourgeault, I., Kilpatrick, K., Carter, N., Kaasalainen, S., and Harbman, P. (2010). Factors enabling advanced practice nursing role integration in Canada. Nursing Leadership, 23, 211-238.

Hickey, N., Sumsion, J., and Harrison, L. (2011). Nursing double degrees: a higher education initiative in times of nursing shortages. Australian Journal of Advanced Nursing, 28(1), 52-59.

Lalonde, M., McGillis Hall, L., Price, S., Andrews, G., Harris, A., and MacDonald-Rencz, S. (2013). Support and access for nursing continuing education in Canadian work environments. Nursing Leadership, 26, 51-60.

McGillis Hall, L., Pink, G.H., Jones, C.B., Leatt, P., Gates, M., and Peterson, J. (2009). Is the grass any greener? Canada to United States of America nurse migration. International Nursing Review, 56(2), 198-205.

Morin, K.H. (2011). Worldwide standards for nursing education: one answer to a critical need. Journal of Nursing Education, 50(7), 363-364.

Murphy, G.T., Birch, S., MacKenzie, A., Alder, R., Lethbridge, L., and Little, L. (2012). Eliminating the shortage of registered nurses in Canada: an exercise in applied needs-based planning. Health Policy, 105(2), 192-202.

Regan, S., Thorne, S., and Mildon, B. (2009). Uncovering blind spots in education and practice leadership: towards a collaborative response to the nurse shortage. Nursing Leadership (Toronto Ontario), 22(2), 30-40.