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First published in 2003: Tierney A.J. (2003) What's the scoop on the nursing shortage? Journal of Advanced Nursing 43(4), 325–326

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  2. First published in 2003: Tierney A.J. (2003) What's the scoop on the nursing shortage? Journal of Advanced Nursing 43(4), 325–326
  3. References

To find out, I went surfing. I'm not into surfing (the net, that is) because it just seems to takes up far too much time. Once onto the great World Wide Web, I seem to lose the ability to take myself out, even although all that's required is one click of the mouse. All self-discipline certainly went astray when, the other day, I typed ‘nursing shortage’ into my Google search engine. A couple of hours later, having decided that I'd surfed far enough through a never-ending series of websites, was I any the wiser about the nursing shortage? No, I have to say, not much. The repetitious information and discussion across site after site could be compressed into one short fact file and the solutions being put forward are no more than a well-rehearsed set of the obvious strategies. One web page more or less says it all, or maybe I just liked its enticing headline –‘What's the scoop on the nursing shortage?’ (http://www2.mc.duke.edu/9200bmt/shortage.htm). No ‘scoop’ there either, but at least this web site presented an easy-to-read set of straightforward facts. And, for those who do have time on their hands, Duke's site also has a ‘For Fun’ menu where you will find ‘Things To Do’, ‘Encouraging Words’ and the opportunity to ‘Be An Angel!’…whatever that involves! I resisted and, returning Home with a sigh of relief, I pledged not to go surfing again too soon!

The vast majority of the web pages on nursing shortage come from the USA. Are North American nurses simply more active on the web, or is their nursing shortage markedly worse than anywhere else in the world? In this issue of JAN we publish a paper on ‘The Nursing Shortage in the United States of America’ (Janiszewski Goodin 2003). This paper does not expose anything really new, either in terms of the problem or its possible solutions but, unlike most of the material to be found on the web, this JAN publication is based on an integrative review of the literature and, as such, it provides a useful overview of the USA's nursing shortage.

Quite reasonably, the literature reviewed for that paper comes mainly from North America although several references from JAN are cited. We decided, however, this being an international journal, that some commentaries from other perspectives would help contextualize this US analysis in the bigger picture of the nursing shortage worldwide. Accordingly, Janiszweski Goodin's paper (pp. 335–343) is followed by commentaries (pp. 343–350) from Australia, England and Europe.

Is the nursing shortage any different in these other areas of the world? No, not really. The reasons for the growing shortage of nurses seem to be much the same everywhere. Nursing shortages are not a new phenomenon. There are some factors, however, that make the current shortage much more problematical than in the past. One of these factors is the ‘greying’ of the nursing profession, arguably the key factor in terms of the worrying long-term prospect of nursing shortage. This issue is highlighted in the US paper and in all three of the commentaries that follow. The ageing of the nursing workforce is one factor that has been predictable. It has not been ignored by workforce analysts but the apparent complacency towards the imminent exodus of nurses retiring from the profession really only has been shaken by the escalating difficulties over recruitment and retention.

The short-term problem of attracting adequate numbers of new recruits into the nursing profession, as reflected in declining enrolment into nursing programmes, is an issue highlighted in the US paper and this is one of the key concerns being aired on many of the US websites. Can encouragement be taken from the Australian situation described in Wickett et al.’s commentary where, as a result of aggressive campaigning, there has been a significant upturn in nursing recruitment? In the UK, as we are told in Mullen's commentary, the number of places for preregistration nursing students has been increased markedly in recent years. High drop-out rates, however, continue to present challenges and little is being said about the knock-on effect of increasing student numbers in clinical areas and the university sector. A less-publicised angle on the ageing issue is the fact that the teaching workforce is also ageing rapidly and, indeed, with a mean age already higher than in the nursing service. Is the nurse education sector able to cope with current and future expansion in student numbers, without also undergoing expansion? It is not one of the well-aired issues in the US paper or in the three commentaries.

There is, however, clear agreement across all four contributions that solving the nursing shortage, and preventing its return, is wholly dependent on a simple, two-sided equation: namely, adequate recruitment and effective retention. No scoop there! But, in reality, that simple equation is what it all boils down to in the end.

The complexities lie in how these dual objectives can be achieved and maintained. In this respect, I found the commentaries on the US paper do provide some food for new thought. De Raeve's commentary focuses attention on a simple but essential question: namely, how many nurses do we need? We talk of ‘nursing shortage’, but the focus invariably is on the shortage (or, more accurately, the shortfall) of nurses. Shortage of nurses and shortage of nursing are not one and the same. De Raeve presses the need for better information about workforce numbers and for workforce planning to be more strongly based on an estimation of a population's need for nursing. Of course, it is not just a matter of numbers, but a question of how those numbers are most effectively deployed. A Canadian health policy analyst (Lewis 2002) who had followed the debate last year in the BMJ about the nursing shortage (Finlayson et al. 2002) wrote to suggest that the ‘extent of the nursing shortage will be known only when nurses spend all their time nursing’. There may be a shortage of nursing, he argued, but not necessarily a shortage of nurses. ‘Nurses spend much of their time doing things that should be delegated to others’, he wrote, ‘and not enough of their time doing what they are educated to do’.

Only one of our commentators really latches onto this theme, and Mullen does not do it meekly. She describes the radical and all-encompassing approach to longer-term re-engineering of the NHS workforce as a whole that is being tried out in her area. Delegation of ‘patient- focused’ care to ‘assistant practitioners’ will free up the time of registered nurses – and other professional members of the healthcare team – thus allowing registered staff to concentrate on the role for which, through their education, they are specially equipped to play. Unlike De Raeve, who expresses resistance, Mullen appears content with the prospect of a continuing downward trend in the proportion of the nursing workforce that is made up of registered nurses. I confess to feeling ambivalent about this but, head over heart, I have believed for some time now that it is unrealistic that ever-improving levels of pay and education can be afforded for an ever-larger, all-registered nursing profession. It is the realism that is driving Mullen's approach that appeals to me greatly. Health services are changing. Nurses now are a part of a multidisciplinary healthcare team. There is no place for the status quo. Realism has to prevail. Where is the supply to meet the staffing demands in the health service? In Mullen's area at least, it would appear that many of the people who do want to work in the health service are people who need to be brought in on the ‘skills escalator’ that Mullen describes. Whatever we think of this notion, Mullen's arguments are rooted in an important reality: namely, that local recruitment is the only real and really long-term solution to the current crisis of the nursing shortage.

‘Think globally, act locally’– it's one of my favourite maxims, and you have heard it before, but it is a very apt slogan for thinking sensibly about the nursing shortage. It is a global problem, but its solutions can only be local. Nursing services, most still requiring round-the-clock cover, only can be staffed by people who live locally. Indeed, the local allegiance that nurses once had to ‘their’ hospital, where first they trained and then they worked, may be one of the old-fashioned things that actually worked. Local recruitment to nursing is how the shortage will be solved, and then kept at bay, and not by the global recruitment that is growing more frenzied by the day. International movement of nurses is nothing other than a good thing, and it will continue to go on, but aggressive recruitment by any one country of another country's nurses is something else altogether, and it achieves nothing by way of resolving the global nursing shortage as a whole. Only one of the contributors – De Raeve – homes in on this issue and he presents a compelling argument, on ethical grounds, that the ‘poaching’ of nurses by one country from another needs to be brought swiftly to a halt.

I hope that the collected contributions about the nursing shortage in this issue of JAN will stimulate further thinking and debate about what is arguably the most pressing and potentially serious crisis for the profession worldwide. No, we have not come up with any ‘scoop’ but, hopefully, some thought-provoking ideas. Further contributions on the topic would be welcome, especially from a wider range of countries around the world, and a JAN Forum will follow if readers respond.

References

  1. Top of page
  2. First published in 2003: Tierney A.J. (2003) What's the scoop on the nursing shortage? Journal of Advanced Nursing 43(4), 325–326
  3. References