Shortage of nurses in various working environments where there are needed is a worldwide economic and health care issue. In foreign countries such as the United States, the Health Resources and Services Administration have reported a critical shortage of nurses which was projected to worsen up to 20% by 2015 and 29% by 2020 (as cited in Andrews & Dziegielewski, 2005). In the local setting, the Philippines annually produce a high number of nursing graduates and licensed nurses throughout the country.
With this, one would assume that Philippine hospitals and health care centers, may they be situated in an urban or rural area, are staffed with ample number of nurses. However, this is not the case. Through the years, a number of health care institutions experience shortage of health care professionals including nurses. When foreign countries have started searching for nurses to work in their health care institutions, the Philippines has responded by producing an increased number of qualified nurses. Over time, the amount of surplus nurses has increased significantly that they cannot find employment in their own country.
There were even cases where in a nurse has to pay to be admitted as a volunteer nurse just so that they would acquire enough experience in their field. Nurses cannot work abroad if they have no or inadequate experience. Working as nurses in foreign countries started as merely just fulfilling the manpower demands of other country. However, this turned into something Filipino nurses dream of. Aside from the advantages of utilize advanced health care technologies, working abroad has become the Filipino nurses’ preferred work since it renders better financial gain and professional enrichment (Reyes-Jackaron, 2011).
Low retention of nurses in various health care facilities contributes to the shortage of staff. Nursing isn’t the only health occupation with reports of shortages. However, among the health professionals, nurses are the primary care givers and supporters of vulnerable patients (Joint Commission on Accreditation of Healthcare Organizations, n. d. ). This shortage or undersupply of nurses in the work environment results to the inability to fulfill the demands for the numerous nursing services. This result may compromise the quality of health care rendered to the patients.
The purpose of this paper is to explore and analyze the different factors which affect nurses’ retention in their workplace in order to come up with strategies that may contribute to the retention of nurses and are applicable in the Philippine setting.
Nurse shortage occurs when there is a lack of nursing graduates that are competent enough to be hired by hospitals. This causes stress to both management and the work force since the ratio of patients to the number of nurses is imbalanced and nurses tend to attend to more patients.
Buerhaus (2009) stated that nursing shortage, especially in the United States, started during the year 1999 and continued to worsen up to 2007 and 2008. There was a decrease in the number of enrollments in nursing school. Although during the year 2007 and 2008, the shortage was slightly compensated by the return to work of experienced nurses. These nurses logged in additional time to offset the decrease in workforce. Wilson (2006) states that there is evidence that may prove that nursing shortage affects not only patient care but also staff morale.
He also states that the negative effect on staff morale may cause a decrease in staff retention or a higher turnover. Edwards (2011) stated that nursing units with a low nurse turnover are likely to have a decrease in number of falls, while a unit with a higher turnover of nurses tend to have an increased number of medication errors. One factor that affects nursing shortage is job retention. Banks and Bailey (2010) state that low pay and poor job satisfaction affect the decision of nurses to change principal jobs.
This results in high turnover of nurses within hospitals and increases the budget that is needed for that certain unit or ward. Edwards (2011) stated that it may take around 1. 2 to 1. 3 times the annual salary of a nurse to replace them. Job retention is commonly associated with job dissatisfaction. According to Aiken (2002), nurse burnout and job satisfaction, as well as intent to stay in the job, are inversely related. The increased burnout of nurses due to multiple factors such as stress, overtime, work environment, and physical state affect their intent to remain employed.
Since there is an increased amount of workload on the current nursing workforce, due to trying to compensate for the shortage of nurses, there is also an increase in the stress levels on these nurses which in turn would decrease job satisfaction. Howard (2010) uses the Neuman Systems Model to further explain this phenomenon. The model states that prevention of primary stress is needed to reduce the occurrence of its effects. There is also supposed to be a “flexible line of defense” that would adjust to the different stressors and help the person adapt to the changes to the workplace and the environment.
The model correlates the high turnover with the burnout felt by the nurse, due to the inability to properly cope with the increase in work demands. This issues need to be quickly addressed to prevent further effects on the healthcare system and the health conditions of the patients present in the hospital. There have been suggestions and researches done to try and find ways or strategies to improve nurse retention and decrease in nurse turnover. Howard (2010) uses the framework of Kanter’s Empowerment Theory, wherein the management would provide nurses with the tools that may empower them in the workplace.
These opportunities to grow and develop would help the nurse adapt to changes more easily since the change is being done by them instead of being forced upon them. They learn to adapt to different changes in the environment. Laschinger (2010) also states that whenever the staff nurses would have more opportunities and control over their decisions, this increases well-being and job satisfaction. Howard also added that the empowering characteristics would have a positive effect on the workplace such as increase of job satisfaction, greater productivity, and promote the retention of the employees.
Kalisch (2010) states that increased levels of teamwork and higher levels of staff adequacy lead to an increase in the job satisfaction of nurses. Improving teamwork of staff nurses present in the ward would have a positive effect both on their job retention and patient care. Howard also specified the need for healthcare environment assessment since most of nurses who are only in their first year of work resign due to workplace factors such as inexperience, tenuous working relationships, and a strong desire for support. These factors may be strengthened and seen by assessing the healthcare environment.
Once assessed, the unit or ward may improve these areas of concern and possibly increase the retention of first year nurses. Proper assessment of the needs of the ward would help in improving its care for both patient and staff. Howard also added that there should be systems framework that would support the retention of nurses in the hospital. It must not be only the hospital that would try to improve nurse retention, it would be multi-disciplinary action that would try and improve the conditions of work for the nurses. It consists of government policies, health care organization policies, assumptions, and quality and safety issues.
Government policies are laws and acts made by the government to try and support the health care profession, specifically nurses, to try and encourage them to retain their jobs. Health care policies focus on the strategies to try and support the skill development and retaining of nurses. It includes discouragement of policies that promote the early retirement of nurses, and also strengthening the health of nurses as to decrease chances of disability and sicknesses. Assumptions need to be fixed since it is the only way that the state may really focus on the dire need to fix the healthcare system.
The assumptions and misconceptions other people about the true condition of the healthcare system would prevent them from acting and supporting policies that would improve the healthcare system. Lastly, quality and safety issues need to be addressed. Since there is a shortage of nurses, workload increases on the available nurses. This increase in workload and insufficient staffing would lead to burnout, low job satisfaction, and higher rates of work stress which would all have a negative effect on nurse retention and recruitment.
Strategies in improving nurse retention are important since it improves both the health of nurses and patients. Focusing on improving the ratio of nurses to patients and alleviation of workload on nurses would improve their health and mental status. It would also lead to a decrease in the turnover of nurses and improvement of general work condition. Implementation of these strategies may improve job satisfaction, staff competency, and teamwork in the unit. All of which are instrumental in improving nurse retention since they all have positive effects on nurse retention.
Improving nurse retention is the first step to solving the nurse shortage that is currently experienced around the world. It would help in improving the care being provided in the hospital. Lastly, Howard states that nurse retention is an important issue that needs to be quickly addressed to prevent the short term and long term effects of nursing shortage. Allowing the nursing shortage to continue would be detrimental to both the patients and nurses as it would only worsen if not solved.
Nursing shortage is an urgent and present problem in the world today. It is a composite of multiple factors that affect the healthcare team thus, patient outcomes. One of the most evident factors leading to nursing shortage is low levels of nursing retention. Nurse retention signifies the prevention of nurse turnover and keeping nurses employed within the organization (Jones & Gates, 2007 as cited by Howard, 2010). It is also further expanded to keeping nurses within the same profession. In the current global healthcare setting, there is an increased number of nurses seeking other higher-paying jobs. Studies show that there are different causative factors leading to low levels of nurse retention.
These factors include job dissatisfaction, low income, burnout, and even workplace environment. The effects of high nurse turnover are cyclical. The turnover affects the condition of the remaining nurses who would also feel the factors stated above leading them to resign from their current position. Job dissatisfaction occurs due to the three latter factors. Low income, nurse burnout, and unstable workplace environment increase the stress on an individual and would push them to become dissatisfied with the workplace and the work in general.
Low income occurs due to low budget for healthcare in different countries. The income and work ratio would be imbalanced, making the nurse feel that he is doing more work than what he is being paid for. The increased amount of work placed on the nurse would put additional stress on him and prolonging this condition would lead to nurse burnout. Finally, continuous nurse burnout would lead to resignation of these nurses and therefore an influx of new nurses in the unit or area. These novice nurses would lack experience, expertise, and the needed competency for proper care of the patients in the area.
The inexperience of these novice nurses would increase the burden on the experienced nurses, since they would be the ones to guide these new nurses. It would cause additional work and stress on these experienced nurses which could be factors leading to burnout. These factors would increase the chances for nurse resignation. This would cause the instability in the workplace due to the coming and going of staff nurses. Studies suggest that the unstable work environment would have detrimental effects on the nurses and the patients confined in the unit.
Based on a study by Cheryl Howard (2010), the ultimate loser in the resignation of nurses is the patient since it causes increased levels of mortality, rates of infection, falls, medication errors, medical errors, adverse events, and decreased patient satisfaction. In the Philippine setting, there is rampant underemployment of nurses. Underemployment results from three important factors: low wages, lack of job opportunities, and failure of nurses to meet the standard set by different institutions. Due to the longer amounts of time spent on jobs that are not connected to nursing, yet higher-paying.
These nursing graduates would eventually lose motivation to pursue a nursing career in the future. This lack of motivation from numerous nurses, as well as migration of the more experienced nurses, would lead the country to experience a decrease in the level of care provided by the nurses present in the Philippines. The effectiveness of the healthcare system would be diminished due to these factors. Based on the evidences shown above, there would be an increased need to implement nurse retention strategies which is lacking especially in the Philippines.
There are many suggestions that are given in different studies that would possibly improve the motivation of nurses to remain in the nursing field. The suggestion and recommendations emphasized the need to empower the staff, improve the work environment, improve interpersonal relationships within the unit (especially supervisor to subordinate relationship), and enhanced group dynamics within the unit both vertically and horizontally. Empowerment of staff nurses in the unit would improve the self-esteem of the nurse as well as improve their disposition and appreciation for their work since they are performing it individually.
Improvement of work environment would make it easier and remove workplace related stress from adding to the motivation to quit work. Improvement of interpersonal relationships would help in creating bonds and improving cohesion in the workplace which would make work both enjoyable and easy. The light work environment would also create a pleasing and comfortable place to work. Enhancing group dynamics would also affect the decisions of nurses to quit since their attachment to the different members of the unit would make it harder for them to put additional stress by quitting their jobs.
In the Philippine setting, there would be additional recommendation to try and improve nurse retention. Improving the nursing curriculum and education would allow the Filipino nurses to become more competent and suitable for work. It would decrease the motivation for underemployment and settling for easy but high-paying jobs. All in all, evidence suggests that it would be beneficial to improve nurse retention. Advocating these changes both inside the workplace and outside would be essential to improving the healthcare system and patient outcomes. Steps and measures need to be taken to ensure the improvement in the global healthcare society.
