Nursing Shortage in acute care setting Essay Example

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Nursing Shortage in acute care setting



The overall impacts of a projected nursing staff shortage and the growth of hospital care demands of Australians and an increased prevalence of chronic conditions’ in the country portend grave challenges for Australian authorities (El Haddad et al., 2013). According to Twigg et al (2011), nursing staff shortage is a major challenge to the efficient provision of sufficient nurse staffing. In Australia, the number of nursing workforce is becoming slimmer. For instance, in the year 2000 nearly 170000 new nurses were recruited annually, yet by 2020, a decline of up to 12,500 nurses is expected annually, leading to nearly a shortfall of 61,000 nurses. Therefore, while there is a definite growth in demand for nurses, the current supply is weak and merely affords to meet replacement needs (He et al. 2011). Because of the reality of these challenges, the Australian health system is currently going through significant reforms after the Commonwealth Government signed a reform package in August 2011, which set aside AUS$19.8 billion for investment in ‘public healthcare’ settings through to 2020. Set in within the reforms is the appreciation of the importance of the expected nursing staff decline. El Haddad et al. (2013) argue that it is of overriding importance to have sufficient supply of the nursing workforce today and in the future, to attain quality and equitable health outcomes and access to healthcare by consumers. This paper critically explores the causes and impacts of nursing shortage on acute care settings.

Causes of nursing care shortage

In a review by Cowin and Jacobson (2003) on “the nursing shortage as a pathway down the slippery slope,” it is clear that the number of nurses available in the healthcare is critically below the required number. The causal factors for nursing shortages that El Haddad et al (2013) identified include low recruitment and retention levels in the nursing profession. Breier et al (2015) also explained that since the nursing field provides fewer incentives for graduates to join the field, they end up having less recruits.

According to Bragg and Bonner (2014), nursing shortages are stretched across all nursing fields, such as emergency, mental health, general nursing, and intensive care. At the same time, current nursing workforce in Australia is aging with a majority of the nurses expected to retire while one-third of new graduate nurses leaving the workforce within the initial five years of graduation. Indeed, the Health Workforce Australia (HWA) predicted nursing shortage to persist in the country and a projected deficit of up to 24, 767 registered nurses by 2025 for New South Wales (NSW) alone. A number of experienced nurses are also losing their jobs as a result of ‘slash and burn’ health budget cuts currently ongoing in a number of states and territories. Collectively, health budget cuts, retirement, and poor retention exacerbate nursing shortage (Hellerawa & Adambarage 2015).

Impacts nursing care shortage

In my experience as a RN, I have learnt that nursing shortage is a potential cause of poor patient outcomes. This claim is widely supported in literature. Twigg et al (2011) established that interaction and coordination among the nursing staff and physicians reduced patient deaths in acute settings or ICU settings. However, the study had failed to ascertain a causal link between nursing staff shortage and patient’s health outcomes. More so, there has been a larger strand of research that provides evidence showing that RNs provide a continual (24/7) surveillance system to monitor admitted patients. This has facilitated the timely detection and rapid involvement of physicians whenever patients’ conditions deteriorate. It is based on this backdrop that their shortage may have disastrous effects to patient outcomes. Indeed, Twigg et al (2011) explained that efficacy of surveillance provided by nurses is a direct consequence of the number of nurses in existing and on standby to attend to patients on a continually.

The findings by Twigg et al (2011) have significant empirical support. According to the Centre for Disease Control and Prevention (CDC), some 1.7million patients each year develop infections during treatment at the hospitals, while some 98000 of the amount are likely to die from the acquired infection (Cimiotti et al., 2012). A significant body of research has over the years presented evidence linking growth of hospital infections to nursing shortages. For instance, Aiken et al. (2012) highlighted how nursing shortages led to use of invasive clinical practices and invasive devices leading to prevalence of hospital infections. Jarrar et al. (2015) also observed that poor nurse staffing in terms of nurse-patient ratios leading to nurses attending to more ratio or patients is widely blamed for the prevalence of hospital infections.

Nursing shortage, therefore, leads to more hospital infections. As an RN, I have personally observed many incidences where patient report more infections during periods when many we are short of nursing workforce. This claim is supported by empirical evidence. For instance, Twigg et al (2011) found that nursing shortage was a potential cause of patient complications, including urinary tract infections, hospital acquired pneumonia, skin pressure ulcers, upper gastrointestinal bleeding and surgical wound infection. Ultimately, Twigg et al (2011) were concerned that nursing care influenced risk factors. Conversely, greater RN staff ratio, which was measured in terms of RN hours per inpatient-day, was, according to Twigg et al (2011), linked to improved patient outcomes. Additional favourable health outcomes are improved pain management, functional outcomes, as well as improved patient attitude regarding patient care. A study by Henneman et al. (2015) also strongly indicated that decreased RN-to-patient ratios were linked to higher death rate of patients, increased number of days in hospitals also happened when the number of nurses decreased.

Nursing shortages also cause job-related burnout among nurses. From personal experience, I tend to go through extreme burnouts when we are short of labour, as am forced to work unusually long shifts. This, in my view, has been a potential cause of job stress and medical errors. In many cases when stressed, I have found myself reluctantly attending to patients or developing memory slips leading to risks of giving wrong medication. In such occasions, I often feel less satisfied with my work. In a study by Cimiotti et al (2012), the researchers implicated nursing shortages for the prevalence of job-related burnouts among nurses. Cimiotti et al (2012) further linked job-related burnouts to suboptimal medical care and poor patient satisfaction. According to Maslach’s theory, a basic element of burnout among the nursing staff is emotional exhaustion, which comes about from “cognitive and emotional detachment from” work as a means to coping with work demands. In the study, Cimiotti et al (2012) examined the impacts of nursing staff decline and burnout on hospital infections like urinary tract infections. Their findings confirmed a link between nurse shortage and infection rates. Indeed, there were smaller numbers of infections observed in hospitals with adequate nurses and fewer patients. For these reasons, the high prevalence of hospital infections where nurses has to attend to more patients appeared to be linked partially to high nurse burnout, which was linked to heftier patient caseloads. Cimiotti et al (2012) also established when the workload of any single nurses was increased by 1 percent; the patients attended to would be associated with increased surgical site and urinary tract infections.

There is also plenty of empirical evidence showing that nursing shortage also leads to poor patient and nursing satisfaction. In a study by Everhart et al. (2013), it was found that inadequate nurse staffing contributes to poor patient satisfaction, which in turn adversely affects the hospitals financial performance. Interestingly, Everhart et al. (2013) also found that inadequate nurse staffing also had significant nurse outcomes, as it lower nurses’ satisfaction and increases their turnover rates. These findings are consistent with that of Farquharson et al. (2013).


RNs provide a continual surveillance for hospitalised patients, which facilitate timely detection of complications and rapid nurse intervention whenever patients’ conditions deteriorate. The efficacy of the surveillance activities provided by the nurses is a direct consequence of the number nurses who can accessibly attend to patients on a continually. However, surveillance demands adequate nurse staffing to ensure favourable patient outcomes. Nursing shortage is a potential cause of patient complications, including urinary tract infections, hospital acquired pneumonia, skin pressure ulcers, upper gastrointestinal bleeding and surgical wound infection. Nursing shortage also leads to use of invasive clinical practices and invasive devices leading to prevalence of hospital infections. It also causes job-related burnout among nurses, which are connected to unsatisfactory medical care and poor satisfaction of patients. Nursing shortage also leads to poor patient and nursing satisfaction. Overall, scholarly evidence has indicated that nurses are likely to experience job-related burnouts because of overwork, which in turn may affect clinical outcomes. Therefore, curbing nursing shortages can save lives. When nurses have to work in situations where there is low nurse-to-patient ratio, the patients are likely to acquire hospital infections, get injuries, die, or be discharged without sufficient education on how to attend to their illnesses.

Reference List

Aiken, L, Sermeus, W, Heede, K, Sloane, D et al. 2012, «Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States,» BMJ, 344

Breier, M, Wildschut, A & Mgqolozana, T 2015, ‘Nursing in a new era’.

Cimiotti, J, Aiken, L, Sloane, D & Wu, E 2012, «Nurse staffing, burnout, and health careeassociated infection,» American Journal of Infection Control, vol 40, pp.486-90

Cowin, L & Jacobsson, D 2003, ‘The nursing shortage: part way down the slippery slope’, Collegian, vol. 10, no.3, pp.31-35.

El Haddad, M, Moxham, L & Broadbent, M 2013, “Graduate registered nurse practice readiness in the Australian context: an issue worthy of discussion,” Collegian, vol 20 no 4, pp.233-238.

Everhart, D, Neff, D, Al-Amin, M, Nogle, J & Robert, W 2013, «The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets,» Health Care Manage Rev, vol 38 no 2, pp.146–155.

Farquharson, B, Bell, C, Johnstone, D et al. 2013, «Nursing stress and patient care: real-time investigation of the effect of nursing tasks and demands on psychological stress, physiological stress, and job performance: study protocol,» Journal of Advanced Nursing, vol 1 no 1, pp.1-9

He, J, Hou, X, Toloo, S, Patrick, J & Gerald, G 2011, «Demand for hospital emergency departments: a conceptual understanding,» World Journal of Emergency Medicine, vol 2 no 4, pp253–261.

Hellerawa, K & Adambarage, A 2015, «The Nursing Shortage Impact on Job Outcome (The Case in Sri Lanka),» Journal of Competitiveness, vol 7, iss 3, pp.75-94

Henneman, P, Yeob, S & Brun, Y 2015, «Using Computer Simulation to Study Nurse-to-Patient Ratios in an Emergency Department,» JONA, vol 45 no. 11, pp.551-556

Jarrar, M, Rahman, H & Shamsudin, A 2015, «The Impact of Patient to Nurse Ratio on Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study,» Asian Social Science, vol. 11, no. 9, pp.316-322

Twigg, D, Duffield, C, Thompson, P, & Rapley, P 2011, “The impact of nurses on patient morbidity and mortality — the need for a policy change in response to the nursing shortage,” Australian Health Review, vol 34 no 3, pp.312 -316