Nursing shortage
Encyclopedia
Nursing shortage refers to a situation where the demand for nursing professionals, such as Registered Nurse
s (RN), exceeds the supply, either locally (e.g. within a given health care facility
), nationally or globally. It can be measured, for instance, when the nurse-to-patient
ratio, the nurse-to-population ratio, or the number of job openings
necessitates a higher number of nurses working in health care
than currently available. This situation is observed in developed and developing nations around the world.
Nursing shortage is not necessarily due to a lack of supply of trained nurses in a jurisdiction. In some cases, perceived shortages occur simultaneously with increased admission rates of students into nursing school
s. Potential factors include: lack of adequate staffing ratios in hospital
s and other health care facilities, lack of placement programs for newly trained nurses, and inadequate worker retention incentives.
Globally, the World Health Organization
(WHO) estimates a shortage of almost 4.3 million nurses, physicians and other health human resources
worldwide - reported to be the result of decades of underinvestment in health worker education, training, wages, working environment and management.
. Sociologist Bryan Turner identified nurses’ most important complaints as subordination to the medical profession as well as over regulation, and difficult working conditions. Also, a report from the Commonwealth of Australia identified some of the dissatisfaction as stemming from frequent schedule changes, overloads, shift work, lack of appreciation by superiors and colleagues, as well as lack of childcare
. Inadequate pay was identified as a lesser problem based on the report. Later, a study revealed that the dissatisfaction among nurses focused on conflicting expectations from nurses and managers due to regulation of cost, lack of opportunity to provide comprehensive nursing care, and disillusioned workforce
or “loss of confidence in, and frustration with, the healthcare system.” Limitations to comprehensive care were identified because nurses are overloaded with the number of assigned patients, massive paperwork for billing purposes, and short staffing to cut cost.
In many jurisdictions, administrative/government health policy and practice has changed very little in the last decades, cost-cutting is still the priority, patient loads uncontrolled, and nurses are rarely consulted when recommending changes through health care reform
. The major reason why nurses plan to leave the field, as stated by the First Consulting Group, is because of the working conditions. With the high turnover
rate, the nursing field does not have a chance to build up the already frustrated staff. Aside from the deteriorating working conditions, the real problem is “nursing’s failure to be attractive to the younger generation.” There’s a decline in interest among college students to consider nursing as a probable career
. More than half of currently working nurses “would not recommend nursing to their own children” and a little less than a quarter would advise others to avoid this as a profession altogether.
Australian nursing researchers, John Buchanan and Gillian Considine described hospitals as “being run like a business” with “issues of patient care… of secondary importance.” Emotional support, education, encouragement and counseling are integral to the everyday nursing practice. However, these practices are not easily quantified and considered by managers as unjustified cost for the patients, who are also viewed as consumers
. Therefore, only clinical responsibilities, such as medication
administration, dressing changes, foley catheter
insertions, and anything that involves tangible supplies, are quantified and incorporated into the organizational budget and plan of care for the consumers
.
The nursing shortage also effects the developing countries that supply nurses through recruitment
to work abroad in wealthier countries. For example to accommodate perceived nursing shortage in the United States, American hospital recruit nurses from overseas, especially the Philippines
and Africa
. This in turn can lead to even greater nursing shortage in their home countries. In response to this growing problem, in 2010 the WHO's World Health Assembly
adopted the Global Code of Practice on the International Recruitment of Health Personnel, a policy framework for all countries for the ethical international recruitment of nurses and other health professionals.
. Activists have spread a new term for this: "Brain drain in the south, brain waste in the north." The President of the Philippines Nurse Association, George Codero, was quoted in a New York Times article as saying "The Filipino people will suffer because the U.S. will get all our trained nurses"..
On an individual basis, foreign nurses are subject to exploitation by employers. In 1998 six Americans were charged with falsely obtaining H-1A visas and using them to employ Filipino nurses as nurse aides instead of registered nurses. In another case in 1996 a Catholic archdiocese employed some of these foreign nurses as nurse aides instead of nurses. In 2000, Filipino nurses in Missouri received $2.1 million for failure to receive proper wages that an American in the same position would receive. While these cases were brought to court, many similar situations are left unreported thereby jeopardizing the rights of foreign nurses. Foreign nurses have the tendency to receive less desirable jobs, such as entry-level positions because of their immigrant status and they are excluded from jobs that would lead to facilities, and are often not paid proper salaries.
Some U.S. health care facilities push to “ease restrictions” on the immigration
law to increase the number of recruited foreign nurses. On the other hand, this recruitment
practice is only a temporary solution and does not fully address the nursing shortage as mentioned by American Nursing Association (ANA). Others have taken a stand on ethically recruiting foreign workers. New York University Medical Center was cited in The Search for Nurses Ends in Manila as believing that it is a "poaching exercise" to take nurses from countries in need of their citizens. The former health secretary, Dr. Galvez Tan, in reference to the number of doctors and nurses working for an American green card said, "There has to be give and take, not just take, take, take by the United States."
Saudi Arabia also depends on the international nurse supply with 40 nations represented in its nurse workforce. Netherlands
needed to fill 7,000 nursing positions in the year 2002, England
needed to fill 22,000 positions in the year 2000, and Canada
will need about 10,000 nursing graduates by the year 2011.
Source: Data from the World Health Organization (2006).
In an American Hospital Association
study, the cost to replace one nurse in the U.S. was estimated at around $30,000 - $64,000. This amount is likely related to the cost of recruiting and training nurses into the organization. Hiring foreign nurses is more financially taxing compared to hiring domestic-graduate nurses; however, facilities save money in a long run because foreign nurses have a contractual obligation to complete their term. The JACHO in the United States wrote in a 2002 research report on the shortage in the US that recruiting foreign trained nurses from abroad (not referring to those who reside in the United States already) does not help the global nursing shortage, and, in fact, perpetuates it.
Countries that send their nurses abroad experience a shortage and strain on their own health care system
. In South Africa
, accelerated recruitment
by developed countries such as United States
, United Kingdom
and Australia
has placed more pressure on the health care system due to prevalence of diseases, such as AIDS
, and limited resources. Similar to the U.S., nurses who leave the organization are a financial disadvantage due to the need to fund recruiting and retraining of new nurses into the system. It has been estimated that every nurse that leaves South Africa is an annual loss of $184,000 to the country, related to the financial and economical impact of the nursing shortage.
The following table represents the number of nurses per 100,000-population in Southern African countries.
Retention of nurses by sending (often developing) countries can be addressed by improving working conditions, minimizing wage differentials, and promoting medical tourism. Retention can also be promoted through educational activities to improve job satisfaction. There can be additional unintended impacts of nurses migration abroad. For example, there is growing evidence that physicians in the Philippines
have shifted to the nursing field for better export opportunities. The World Health Organization
(WHO) representative in Manila, believes the government should invest more into its health sector as it is currently only three percent of the Philippines' GDP. Others have suggested programs which require domestic service or employment upon graduation.
While the number of U.S. trained licensed nurses has increased each year, the projected nursing demand growth rate from 2008–2018, as reported by the U.S. Bureau of Labor Statistics is anticipated to be a 22%, or 2.12% annually. Therefore, the 9.8% annual growth of new R.N.'s exceeds the current new position growth rate by a net of 7.7% per year with the assumption of consistent growth figures over the next decade.
The US population is projected to grow at least 18% over two decades in the 21st century, while the population
of those 65 and older is expected to increase three times that rate. The current shortfall of nurses is projected at over 1 million by the year 2020.
Professional and related occupations are expected to rapidly increase between years 2000–2012. The demand for healthcare practitioners and technical occupations will continue to increase. It is projected that there will be 1.7 million job openings between 2000 and 2012. The demand for registered nurses is even higher. Registered nurses are predicted to have a total of 1,101,000 openings due to growth during this 10 year period. In a 2001 American Hospital Association survey, 715 hospitals reported that 126,000 nursing positions were unfilled.
However, other research findings report a projection of opposite trend. Although the demand for nurses continues to increase, the rate of employment has slowed down since 1994 because hospitals were incorporating more less-skilled nursing personnel to substitute for nurses. With the decrease in employment, the earnings for nurses also decreased. Wage
among nurses leveled off in correlation with inflation between 1990 and 1994. The recent economic crisis of 2009 has further decreased the demand for RN's.
Comparing the data released by the Bureau of Health Professions, the projections of shortage within two years have increased.
US: Supply versus Demand Projections for FTE Registered Nurses
Source: Data from the Bureau of Health Professions (2002)
However, emergency and acute care nurses are still in great demand, and this temporary reduction of the shortage is not expected to last as the economy improves. In 2009, it was reported that in places like Des Moines, Iowa
that newly graduated nurses are having more difficulty finding jobs and older nurses are delaying retirement due to economic conditions. This hiring situation was mostly found in hospitals; whereas nursing homes continued to hire and recruit nurses in strong numbers.
Some states are have a surplus of nurses while other states face a shortage. This is due to factors such as the number of new graduates and the total demand for nurses in each area. Some states face a severe shortage (such as the Northwestern states, as well as Texas and OK), while other states actually have a surplus of registered nurses.
US: Supply versus Demand Projections for FTE Registered Nurses
Source: Data from the Bureau of Health Professions. (2004).
are important methods to achieve a long-term solution to the nursing shortage. Recruitment is promoted through ways of making nursing attractive as a profession, especially to younger workers to counteract the high average age of RNs and therefore future waves of retirement. Additionally, financial opportunities such as signing bonuses can attract more nurses.
To assist the health sector, Congress approved the Nurse Reinvestment Act passed in 2002 to provide funding to advance nursing education, scholarships, grants, diversity programs
, loan repayment programs, nursing faculty programs, and comprehensive geriatric education. Currently, mandatory overtime for nurses is prohibited in nine states, hospital accountability to implement valid staffing plans in seven states, and only one state implement the minimum staffing ratio.
In order to respond to fluctuating needs in the short term, health care industries have utilized float pool nurses and agency nurses. Float pool nurses are nursing staffs employed by the hospital
to work in any unit within the organization. Agency nurses are employed by an independent staffing organization and have the opportunity to work in any hospitals on a daily, weekly or contractual basis. Similar to other professionals, both types of nurses can only work within their licensed scope of practice
, training, and certification.
Float pool nurses and agency nurses, as mentioned by First Consulting group, are currently used in response to the current shortage. Use of the said services increases the cost of healthcare, decreases specialty, and decreases the interest in long-term solutions to the shortage.
International recruitment
is often used to fill the nursing gap but gives rise to concern of late now that the U.S. Homeland Security has stopped the issuance of the H-1C visa, which was deemed specifically for Nurses. "Obama Health Care Reform", which will result in every American being insured, it is estimated that there will be an even greater need for Nurses. U.S. trained nurses are concerned, however, that this recruitment initiative impedes on their ability to obtain positions in the field after completing their training. A nursing shortage does not translate to new nursing jobs. Any increase in demand will likely increase the nurse patient ratio and risk patient safety. It is predicted by the National Healthcare Organization, that the entire U.S. Healthcare system will come crumbling down because nurses are the core foundation of all healthcare. The issue is not in the supply of nurses, but the number of positions available in U.S. hospitals to cover the high nurse to patient ratios. Recruitment focus should geared toward under-served areas.
A growing response to the nursing shortage is the advent of travel nursing
a specialized sub-set of the staffing agency industry that has evolved to serve the needs of hospitals affected by the increasing nursing shortage. According to the Professional Association of Nurse Travelers
, there are an estimated 25,500 Registered Nurse Travelers working in the U.S. The number of LVN/LPN Nurse Travelers is not known.
There is a nursing recruitment initiative and nursing workforce development program for residents of the United States originally from foreign countries, who were professional nurses in their countries but are no longer in that profession in the United States. This initiative helps these nurses get back into the nursing profession, especially getting through credentialing and the nursing board exams. The original model was developed in 2001 at San Francisco State University in cooperation with City College of San Francisco
("The San Francisco Welcome Back Center") and there are centers in many cities, such as Los Angeles, San Diego, and Boston, Massachusetts, where it is called a "Boston Welcome Back Center for Internationally Educated Nurses". It is a program meant for residents of the United States only, not others who are overseas wishing to practice in the United States. The Boston Welcome Back Center was opened in October 2005 with a $50,000 seed grant from the Board of Higher Education’s Nursing Initiative.
In April 2008, in the 110th Congress, H.R. 5924: Emergency Nursing Supply Relief Act was introduced as a bill to the House of Representatives by Robert Wexler
of Florida. If it had passed, it would have amended the American Competitiveness in the Twenty-first Century Act of 2000 and would have given up to 20,000 visas per year to nurses and physical therapists until September 2011. Immediate family members of visa beneficiaries would not be counted against the 20,000 yearly cap. The bill was referred to committees for study in Congress but was never reported on by the committees.
On February 11, 2009, legislation was introduced by Representatives John Shadegg
(R-AZ), Jeff Flake
(R-AZ), and Ed Pastor
(D-AZ) in the 111th Congress to the House of Representatives, HR 1001 ("The Nursing Relief Act of 2009" : To create a new non-immigrant visa category for registered nurses, and for other purposes) making a new non-immigrant "W" visa category for nurses to be able to work in the United States. This was to relieve the nursing shortage still considered to be a crisis despite the economic problems in the country. The proposed bill was referred to the Committee on the Judiciary but was never reported on by Committee.
Foreign nurses compete amongst themselves, with professionals, and other skilled workers for 140,000 employment-based viases (EB) every year. The Filipino nurses are only allocated 2,800 visas per year, thereby creating a backlog among applicants. For example, in September 2009, 56,896 Filipinos were waiting for EB-3 visa numbers. This number contrasts with the 95,000 nurses licensed in 2009, many of whom want to migrate to the U.S. Once a nurse obtains a visa number and is approved for a visa and authorized to work in the U.S., they must pass the National Council Licensure Examination to qualify for U.S. nursing standards.
Scholars point out that the use of foreign nurses prolongs the underlying issues of the nursing shortage. As a result, many of the problems with the U.S. health system will continue until addressed by a more long-term solution. For example, the unemployment rate in the Philippines was 7.5% in 2009 according to the CIA World Factbook; it was 10.6% in the US as of February 2009 according to the U.S. Bureau of Labor Statistics. Thousands of U.S. licensed newly trained nurses remain unemployed and are forced to leave the profession while thousands of seasoned nurses return to the profession to help their families make ends meet.
study reported that one of every six foreign-born nurses in the OECD countries is from the Philippines. Of all employed Filipino RNs, roughly 85% are working overseas. This is partially in response to the inability of Filipino nurses to enter their domestic workforce due to a lack of jobs and instead become heavily dependent upon international job markets for nurses. The United States has an especially prominent representation of Filipino nurses. Of the 100,000 foreign nurses working in the U.S. as of 2000, 32.6% were from the Philippines.
of Filipino nurses takes place in response to "push and pull" factors. The push factors are rooted in the economic conditions in the Philippines in which there is an overabundance of RNs and a lack of open employment positions. The unemployment rate in the Philippines currently exceeds 10 percent. Additionally, health care budgets set up Filipino nurses for low wages and poor benefit packages for employees. There are also fewer jobs available thereby increasing the workload and pressure on RNs. Filipinos often find it in their interest to pursue international employment to avoid the economic instability and poor labor conditions in their native country. The government also highly encourages the exportation of RNs internationally. Filipino nurses are pulled to work abroad for the economic benefits of international positions. While a nurse in the Philippines will earn between $180 and $200 U.S. dollars per per month, a nurse in the U.S. receives a salary of $4000 per year. Nurses abroad are greatly respected in the Philippines as they are able to support an entire family back at home through the sending of remittances. In 1993, Filipinos abroad sent $800 million to their families in the Philippines thereby supporting the Filipino economy. Additionally, remittances from Filipinos made up 5.2% of the Filipino GDP (gross national product) between 1990 and 2000. Further pull factors stem from the additional economic benefits of signing bonuses in the U.S. In order to attract more foreign nurses, U.S. hospitals increased signing bonuses from $1,000 to $7,000. Positions abroad in the health sector are also enticing for their immigration benefits for individuals and families. Throughout the past 50 years of nurse migration, the U.S. has made efforts to ease the visa application process to further encourage international nurses to fulfill the nursing shortage. Scholars also note that the better living and working conditions, higher income, and opportunities for career advancement draw nurses from the Philippines to work in the U.S.
As the relation between the U.S. and the Philippines stretches back 50 years, Filipino nursing institutions often reflect the same educational standards and methods as the U.S. curriculum. Furthermore, a knowledge of English in the Philippines makes it easier for Filipino nurses rather than nurses from other developing nations to work in the U.S.
Since 1916, 2,000 nurses have arrived each year in the U.S. In 1999, the U.S. approved 50,000 migrant visas for these nurses. Today, on average, there are about 30,000 Filipino nurses traveling to the U.S. each year to escape the push factors of their homeland and enjoy the benefits of the pulls of their new home.
Unfortunately, according to many Filipinos working in hospitals, the most educated and skilled nurses are always the first to go abroad. There is disagreement among scholars on the extent to which the Filipino health sector is burdened by its own nursing shortage. While the numerical data are inconsistent about whether the nurse supply is in excess or a shortage, it is clear that there is a short supply of the most skilled nurses who choose to go abroad. As a result, operating rooms are often staffed by novice nurses and nurses with more experience work extremely long hours at one time As skilled nurses decline in the urban areas, nurses from rural areas migrate to hospitals in the cities for better pay. As a result, rural communities experience their own drain of health resources. Stories and studies alike demonstrate that a treatable emergency in the provinces may be fatal because there are no medical professionals to help treat them outside of the cities. In fact "the number of Filipinos dying without medical attention has been steadily increasing for the last decade." The lack of attention from medical professionals has increased over time despite advances in technology and medicine and the increasing number of trained nurses in the Philippines.
Not only have nurses departed their positions in rural communities, but so too have doctors changed professions and joined the international mobility trend. Filipino doctors have begun leaving their professions to train as nurses under the title MD-RN with the hope of immigrating to the U.S. or other developed nations more easily. Since 2000, 3,500 Filipino doctors have migrated abroad as nurses. The U.S. incentives for nurse migration encourage doctors to train as nurses in the hopes of increasing their economic prospects. As a result, the Philippines have a lower average of doctors and nurses with .58 and 1.69 respectively for a population of 1,000. The average statistics globally in contrast are 1.23 and 2.56. Between 2002 and 2007, 1,000 Filipino hospitals closed due to a shortage of health workers. A study conducted by the former Philippine Secretary of Health, Jaime Galvez-Tan, concluded that close to 80 percent of all government doctors have become nurses or are studying nursing. Of the 9,000 doctors-turned-nurses, otherwise known as MD-RNs, 5,000 are currently working overseas. The extraordinary influence of this international migration has had devastating effects on the health of Filipinos. The number of deaths that were not prevented with medical attention have only increased over time as hospitals are shut down and rural areas are deprived of any medical treatment.
Due to the high interest in international mobility, there is little permanency in the nursing positions in the Philippines. Most RNs choose to sign short term contracts that will allow for more flexibility to work overseas. The Filipino nurses also feel less committed to the hospitals as they are only temporary staff members. This lack of attachment and minimal responsibility only worsens the health of Filipino patients.
In addition to the negative effects of RN emigration on the health sector, the educational system has also been hurt by the outrageous increase of nurses in the Philippines. As Filipinos are attracted to the opportunities that come from working as a nurse, the number of nursing students has steadily increased. As a result, the number of nursing programs has grown incredibly quickly in a commercialized manner. In the 1970s, there were only 40 nursing schools in the Philippines but by 2005 the number had grown to 441 nursing colleges. While the educational opportunities for nursing students has grown tremendously, the quality of education has declined. This can be seen by the low rate (50%) of students who pass the nursing exam since the 1990s. Furthermore, the Technical Committee on Nursing Education of the Commission on Higher Education (CHED), determined that 23 percent of the Filipino nursing schools failed to meet the requirements set by the government.
In summary, the emigration of Filipino nurses has encouraged doctors to switch to nursing, created a shortage of skilled specialized and experienced nurses, affected the educational system, and distorted health care
delivery and attention to medical issues in rural areas. While remittances, return migration, and the transfer of knowledge support the Philippines they fail to fully compensate the loss of health workers, which disrupts the Filipino health and educational sector.
Dr. Jaime-Galvez Tan, the former Philippine Secretary of Health, warns that if the U.S. passes legislation allowing for freer immigration of nurses the health service of the Philippines could bleed to death and collapse.
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
s (RN), exceeds the supply, either locally (e.g. within a given health care facility
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
), nationally or globally. It can be measured, for instance, when the nurse-to-patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
ratio, the nurse-to-population ratio, or the number of job openings
Job (role)
A job is a regular activity performed in exchange for payment. A person usually begins a job by becoming an employee, volunteering, or starting a business. The duration of a job may range from an hour to a lifetime . If a person is trained for a certain type of job, they may have a profession...
necessitates a higher number of nurses working in health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
than currently available. This situation is observed in developed and developing nations around the world.
Nursing shortage is not necessarily due to a lack of supply of trained nurses in a jurisdiction. In some cases, perceived shortages occur simultaneously with increased admission rates of students into nursing school
Nursing school
A nursing school is a type of educational institution, or part thereof, providing education and training to become a fully qualified nurse. The nature of nursing education and nursing qualifications varies considerably across the world.-United Kingdom:...
s. Potential factors include: lack of adequate staffing ratios in hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s and other health care facilities, lack of placement programs for newly trained nurses, and inadequate worker retention incentives.
Globally, the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) estimates a shortage of almost 4.3 million nurses, physicians and other health human resources
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
worldwide - reported to be the result of decades of underinvestment in health worker education, training, wages, working environment and management.
Market philosophy
Studies have shown that nursing shortage is a serious issue in the United States and many other countries around the world. Several studies have been done to understand how nurses feel about their careerCareer
Career is defined by the Oxford English Dictionary as a person's "course or progress through life ". It is usually considered to pertain to remunerative work ....
. Sociologist Bryan Turner identified nurses’ most important complaints as subordination to the medical profession as well as over regulation, and difficult working conditions. Also, a report from the Commonwealth of Australia identified some of the dissatisfaction as stemming from frequent schedule changes, overloads, shift work, lack of appreciation by superiors and colleagues, as well as lack of childcare
Childcare
Child care means caring for and supervising child/children usually from 0–13 years of age. In the United States child care is increasingly referred to as early childhood education due to the understanding of the impact of early experiences of the developing child...
. Inadequate pay was identified as a lesser problem based on the report. Later, a study revealed that the dissatisfaction among nurses focused on conflicting expectations from nurses and managers due to regulation of cost, lack of opportunity to provide comprehensive nursing care, and disillusioned workforce
Workforce
The workforce is the labour pool in employment. It is generally used to describe those working for a single company or industry, but can also apply to a geographic region like a city, country, state, etc. The term generally excludes the employers or management, and implies those involved in...
or “loss of confidence in, and frustration with, the healthcare system.” Limitations to comprehensive care were identified because nurses are overloaded with the number of assigned patients, massive paperwork for billing purposes, and short staffing to cut cost.
In many jurisdictions, administrative/government health policy and practice has changed very little in the last decades, cost-cutting is still the priority, patient loads uncontrolled, and nurses are rarely consulted when recommending changes through health care reform
Health care reform
Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place...
. The major reason why nurses plan to leave the field, as stated by the First Consulting Group, is because of the working conditions. With the high turnover
Turnover (employment)
In a human resources context, turnover or staff turnover or labour turnover is the rate at which an employer gains and loses employees. Simple ways to describe it are "how long employees tend to stay" or "the rate of traffic through the revolving door." Turnover is measured for individual companies...
rate, the nursing field does not have a chance to build up the already frustrated staff. Aside from the deteriorating working conditions, the real problem is “nursing’s failure to be attractive to the younger generation.” There’s a decline in interest among college students to consider nursing as a probable career
Career
Career is defined by the Oxford English Dictionary as a person's "course or progress through life ". It is usually considered to pertain to remunerative work ....
. More than half of currently working nurses “would not recommend nursing to their own children” and a little less than a quarter would advise others to avoid this as a profession altogether.
Australian nursing researchers, John Buchanan and Gillian Considine described hospitals as “being run like a business” with “issues of patient care… of secondary importance.” Emotional support, education, encouragement and counseling are integral to the everyday nursing practice. However, these practices are not easily quantified and considered by managers as unjustified cost for the patients, who are also viewed as consumers
Consumer
Consumer is a broad label for any individuals or households that use goods generated within the economy. The concept of a consumer occurs in different contexts, so that the usage and significance of the term may vary.-Economics and marketing:...
. Therefore, only clinical responsibilities, such as medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
administration, dressing changes, foley catheter
Foley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
insertions, and anything that involves tangible supplies, are quantified and incorporated into the organizational budget and plan of care for the consumers
Consumer
Consumer is a broad label for any individuals or households that use goods generated within the economy. The concept of a consumer occurs in different contexts, so that the usage and significance of the term may vary.-Economics and marketing:...
.
The nursing shortage also effects the developing countries that supply nurses through recruitment
Recruitment
Recruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
to work abroad in wealthier countries. For example to accommodate perceived nursing shortage in the United States, American hospital recruit nurses from overseas, especially the Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
and Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
. This in turn can lead to even greater nursing shortage in their home countries. In response to this growing problem, in 2010 the WHO's World Health Assembly
World Health Assembly
The World Health Assembly is the forum through which the World Health Organization is governed by its 194 member states. It is the world's highest health policy setting body and is composed of health ministers from member states....
adopted the Global Code of Practice on the International Recruitment of Health Personnel, a policy framework for all countries for the ethical international recruitment of nurses and other health professionals.
Ethical concerns
Foreign nurses that migrate from developing countries to fill the nursing shortage of developed nations pursue their own economic, career, and lifestyle interests but there are risks for immigrant nurses. Unfortunately the media and scholars alike have remained relatively silent on the ethical concerns involving the potential exploitation of foreign nurses. On the level of national sovereignty and global equality, there are ethical concerns about the pull of developed nations on developing countries' skilled workers and assets. U.S. incentives such as signing bonuses can be seen as promoting a brain drainBrain drain
Human capital flight, more commonly referred to as "brain drain", is the large-scale emigration of a large group of individuals with technical skills or knowledge. The reasons usually include two aspects which respectively come from countries and individuals...
. Activists have spread a new term for this: "Brain drain in the south, brain waste in the north." The President of the Philippines Nurse Association, George Codero, was quoted in a New York Times article as saying "The Filipino people will suffer because the U.S. will get all our trained nurses"..
On an individual basis, foreign nurses are subject to exploitation by employers. In 1998 six Americans were charged with falsely obtaining H-1A visas and using them to employ Filipino nurses as nurse aides instead of registered nurses. In another case in 1996 a Catholic archdiocese employed some of these foreign nurses as nurse aides instead of nurses. In 2000, Filipino nurses in Missouri received $2.1 million for failure to receive proper wages that an American in the same position would receive. While these cases were brought to court, many similar situations are left unreported thereby jeopardizing the rights of foreign nurses. Foreign nurses have the tendency to receive less desirable jobs, such as entry-level positions because of their immigrant status and they are excluded from jobs that would lead to facilities, and are often not paid proper salaries.
Some U.S. health care facilities push to “ease restrictions” on the immigration
Immigration
Immigration is the act of foreigners passing or coming into a country for the purpose of permanent residence...
law to increase the number of recruited foreign nurses. On the other hand, this recruitment
Recruitment
Recruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
practice is only a temporary solution and does not fully address the nursing shortage as mentioned by American Nursing Association (ANA). Others have taken a stand on ethically recruiting foreign workers. New York University Medical Center was cited in The Search for Nurses Ends in Manila as believing that it is a "poaching exercise" to take nurses from countries in need of their citizens. The former health secretary, Dr. Galvez Tan, in reference to the number of doctors and nurses working for an American green card said, "There has to be give and take, not just take, take, take by the United States."
Impacts on healthcare
Nursing shortages have been linked to the following effects:- Increased nurses’ patient workloads
- Increased risk for error, thereby compromising patient safetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
- Increased risk of spreading infectionInfectionAn infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
to patients and staffs - Increased risk for occupational injuryInjury-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
- Increase in nursing turnover, thereby leading to greater costs for the employer and the health care system
- Increase in nurses' perception of unsafe working conditions, contributing to increased shortage and hindering local or national recruitmentRecruitmentRecruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
efforts
Global shortage and international recruitment
The nursing shortage takes place on a global scale. Australia, the UK, and the US receive the largest number of migrant nurses to fill the employment gap in the health sector. Australia received 11,757 nurses from other countries between 1995 and 2000. The U.S. Immigration and Naturalization Service (INS) records show that more than 10,000 foreign nurses were given H-1A visas to enter the United States within the same time frame In only four years, the U.K. admitted 26,286 foreign nurses from 1998 to 2002.Saudi Arabia also depends on the international nurse supply with 40 nations represented in its nurse workforce. Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
needed to fill 7,000 nursing positions in the year 2002, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
needed to fill 22,000 positions in the year 2000, and Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
will need about 10,000 nursing graduates by the year 2011.
| Country | Number of Nurses | Density per 1000 population | Year |
|---|---|---|---|
| Canada Canada Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean... |
309576 | 9.95 | 2003 |
| China China Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture... |
1358000 | 1.05 | 2001 |
| India India India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world... |
865135 | 0.80 | 2004 |
| Japan Japan Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south... |
993628 | 7.79 | 2002 |
| New Zealand New Zealand New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga... |
31128 | 8.16 | 2001 |
| Nigeria Nigeria Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in... |
210306 | 0.28 | 2003 |
| Philippines Philippines The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam... |
127595 | 1.69 | 2000 |
| United Kingdom United Kingdom The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages... |
704332 | 12.12 | 1997 |
| United States of America | 2669603 | 9.37 | 2000 |
| Zimbabwe Zimbabwe Zimbabwe is a landlocked country located in the southern part of the African continent, between the Zambezi and Limpopo rivers. It is bordered by South Africa to the south, Botswana to the southwest, Zambia and a tip of Namibia to the northwest and Mozambique to the east. Zimbabwe has three... |
9357 | 0.72 | 2004 |
In an American Hospital Association
American Hospital Association
The American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
study, the cost to replace one nurse in the U.S. was estimated at around $30,000 - $64,000. This amount is likely related to the cost of recruiting and training nurses into the organization. Hiring foreign nurses is more financially taxing compared to hiring domestic-graduate nurses; however, facilities save money in a long run because foreign nurses have a contractual obligation to complete their term. The JACHO in the United States wrote in a 2002 research report on the shortage in the US that recruiting foreign trained nurses from abroad (not referring to those who reside in the United States already) does not help the global nursing shortage, and, in fact, perpetuates it.
Countries that send their nurses abroad experience a shortage and strain on their own health care system
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
. In South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
, accelerated recruitment
Recruitment
Recruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
by developed countries such as United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
and Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
has placed more pressure on the health care system due to prevalence of diseases, such as AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, and limited resources. Similar to the U.S., nurses who leave the organization are a financial disadvantage due to the need to fund recruiting and retraining of new nurses into the system. It has been estimated that every nurse that leaves South Africa is an annual loss of $184,000 to the country, related to the financial and economical impact of the nursing shortage.
The following table represents the number of nurses per 100,000-population in Southern African countries.
| Number of Southern African countries | Number of nurses per 100,000 population |
|---|---|
| 16 | 100 |
| 10 | 50 |
| 9 | 20 |
| 3 | Less than 10 |
Retention of nurses by sending (often developing) countries can be addressed by improving working conditions, minimizing wage differentials, and promoting medical tourism. Retention can also be promoted through educational activities to improve job satisfaction. There can be additional unintended impacts of nurses migration abroad. For example, there is growing evidence that physicians in the Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
have shifted to the nursing field for better export opportunities. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) representative in Manila, believes the government should invest more into its health sector as it is currently only three percent of the Philippines' GDP. Others have suggested programs which require domestic service or employment upon graduation.
United States
According to the American National Council of State Boards of Nursing, the number of U.S. trained nurses has been increasing over the past decade: In 2000, 71,475 U.S. trained nurses became newly licensed. In 2005, 99,187 U.S. trained nurses became newly licensed. In 2009, 134,708 U.S. trained nurses became newly licensed. Therefore, a 9.8% annual increase of newly licensed U.S. nurses has been observed each year over the past 9 years. It is clear that, nursing enrollment in the U.S. has significantly increased over the past decade relative to the 1.19% annual U.S. population growth.While the number of U.S. trained licensed nurses has increased each year, the projected nursing demand growth rate from 2008–2018, as reported by the U.S. Bureau of Labor Statistics is anticipated to be a 22%, or 2.12% annually. Therefore, the 9.8% annual growth of new R.N.'s exceeds the current new position growth rate by a net of 7.7% per year with the assumption of consistent growth figures over the next decade.
The US population is projected to grow at least 18% over two decades in the 21st century, while the population
Population
A population is all the organisms that both belong to the same group or species and live in the same geographical area. The area that is used to define a sexual population is such that inter-breeding is possible between any pair within the area and more probable than cross-breeding with individuals...
of those 65 and older is expected to increase three times that rate. The current shortfall of nurses is projected at over 1 million by the year 2020.
Professional and related occupations are expected to rapidly increase between years 2000–2012. The demand for healthcare practitioners and technical occupations will continue to increase. It is projected that there will be 1.7 million job openings between 2000 and 2012. The demand for registered nurses is even higher. Registered nurses are predicted to have a total of 1,101,000 openings due to growth during this 10 year period. In a 2001 American Hospital Association survey, 715 hospitals reported that 126,000 nursing positions were unfilled.
However, other research findings report a projection of opposite trend. Although the demand for nurses continues to increase, the rate of employment has slowed down since 1994 because hospitals were incorporating more less-skilled nursing personnel to substitute for nurses. With the decrease in employment, the earnings for nurses also decreased. Wage
Wage
A wage is a compensation, usually financial, received by workers in exchange for their labor.Compensation in terms of wages is given to workers and compensation in terms of salary is given to employees...
among nurses leveled off in correlation with inflation between 1990 and 1994. The recent economic crisis of 2009 has further decreased the demand for RN's.
Comparing the data released by the Bureau of Health Professions, the projections of shortage within two years have increased.
| Year | Supply | Demand | Shortage | Percent |
|---|---|---|---|---|
| 2000 | 1,889,243 | 1,999,950 | -110,707 | -6% |
| 2005 | 2,012,444 | 2,161,831 | -149,387 | -7% |
| 2010 | 2,069,369 | 2,344,584 | -275,215 | -12% |
| 2015 | 2,055,491 | 2,562,554 | -507,063 | -20% |
| 2020 | 2,001,998 | 2,810,414 | -808,416 | -28.8% |
Source: Data from the Bureau of Health Professions (2002)
However, emergency and acute care nurses are still in great demand, and this temporary reduction of the shortage is not expected to last as the economy improves. In 2009, it was reported that in places like Des Moines, Iowa
Des Moines, Iowa
Des Moines is the capital and the most populous city in the US state of Iowa. It is also the county seat of Polk County. A small portion of the city extends into Warren County. It was incorporated on September 22, 1851, as Fort Des Moines which was shortened to "Des Moines" in 1857...
that newly graduated nurses are having more difficulty finding jobs and older nurses are delaying retirement due to economic conditions. This hiring situation was mostly found in hospitals; whereas nursing homes continued to hire and recruit nurses in strong numbers.
Some states are have a surplus of nurses while other states face a shortage. This is due to factors such as the number of new graduates and the total demand for nurses in each area. Some states face a severe shortage (such as the Northwestern states, as well as Texas and OK), while other states actually have a surplus of registered nurses.
| Year | Supply | Demand | Shortage | Percent |
|---|---|---|---|---|
| 2000 | 1,890,700 | 2,001,500 | -110,800 | -6% |
| 2005 | 1,942,500 | 2,161,300 | -218,800 | -10% |
| 2010 | 1,941,200 | 2,347,000 | -405,800 | -17% |
| 2015 | 1,886,100 | 2,569,800 | -683,700 | -27% |
| 2020 | 1,808,000 | 2,824,900 | -1,016,900 | -36% |
Source: Data from the Bureau of Health Professions. (2004).
Patching up the shortage
Nursing shortages can be consistent or intermittent depending on the current number of patients needing medical attention. Retention and recruitmentRecruitment
Recruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
are important methods to achieve a long-term solution to the nursing shortage. Recruitment is promoted through ways of making nursing attractive as a profession, especially to younger workers to counteract the high average age of RNs and therefore future waves of retirement. Additionally, financial opportunities such as signing bonuses can attract more nurses.
To assist the health sector, Congress approved the Nurse Reinvestment Act passed in 2002 to provide funding to advance nursing education, scholarships, grants, diversity programs
Diversity (business)
The "business case for diversity" stems from the progression of the models of diversity within the workplace since the 1960's. The original model for diversity was situated around affirmative action drawing strength from the law and a need to comply with equal employment opportunity objectives...
, loan repayment programs, nursing faculty programs, and comprehensive geriatric education. Currently, mandatory overtime for nurses is prohibited in nine states, hospital accountability to implement valid staffing plans in seven states, and only one state implement the minimum staffing ratio.
In order to respond to fluctuating needs in the short term, health care industries have utilized float pool nurses and agency nurses. Float pool nurses are nursing staffs employed by the hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
to work in any unit within the organization. Agency nurses are employed by an independent staffing organization and have the opportunity to work in any hospitals on a daily, weekly or contractual basis. Similar to other professionals, both types of nurses can only work within their licensed scope of practice
Scope of Practice
Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. The scope of practice is limited to that which the law allows for specific education...
, training, and certification.
Float pool nurses and agency nurses, as mentioned by First Consulting group, are currently used in response to the current shortage. Use of the said services increases the cost of healthcare, decreases specialty, and decreases the interest in long-term solutions to the shortage.
International recruitment
Recruitment
Recruitment refers to the process of attracting, screening, and selecting qualified people for a job. For some components of the recruitment process, mid- and large-size organizations often retain professional recruiters or outsource some of the process to recruitment agencies.The recruitment...
is often used to fill the nursing gap but gives rise to concern of late now that the U.S. Homeland Security has stopped the issuance of the H-1C visa, which was deemed specifically for Nurses. "Obama Health Care Reform", which will result in every American being insured, it is estimated that there will be an even greater need for Nurses. U.S. trained nurses are concerned, however, that this recruitment initiative impedes on their ability to obtain positions in the field after completing their training. A nursing shortage does not translate to new nursing jobs. Any increase in demand will likely increase the nurse patient ratio and risk patient safety. It is predicted by the National Healthcare Organization, that the entire U.S. Healthcare system will come crumbling down because nurses are the core foundation of all healthcare. The issue is not in the supply of nurses, but the number of positions available in U.S. hospitals to cover the high nurse to patient ratios. Recruitment focus should geared toward under-served areas.
A growing response to the nursing shortage is the advent of travel nursing
Travel nursing
Travel nursing and the Travel Nursing Industry developed in response to the nursing shortage in which nurses travel to work temporary short-term nursing positions. The current severe shortage of nurses in the United States has increased the need for this type of position...
a specialized sub-set of the staffing agency industry that has evolved to serve the needs of hospitals affected by the increasing nursing shortage. According to the Professional Association of Nurse Travelers
Professional Association of Nurse Travelers
The Professional Association of Nurse Travelers , a non-profit association, is a professional organization to advance and protect the nursing profession specialty of travel nursing. It was conceived by an alliance of healthcare travelers in July 2005 and incorporated in January 2006...
, there are an estimated 25,500 Registered Nurse Travelers working in the U.S. The number of LVN/LPN Nurse Travelers is not known.
There is a nursing recruitment initiative and nursing workforce development program for residents of the United States originally from foreign countries, who were professional nurses in their countries but are no longer in that profession in the United States. This initiative helps these nurses get back into the nursing profession, especially getting through credentialing and the nursing board exams. The original model was developed in 2001 at San Francisco State University in cooperation with City College of San Francisco
City College of San Francisco
City College of San Francisco, or CCSF, is a two-year community college in San Francisco, California. The Ocean Avenue campus, in the Ingleside neighborhood, is the college's primary location...
("The San Francisco Welcome Back Center") and there are centers in many cities, such as Los Angeles, San Diego, and Boston, Massachusetts, where it is called a "Boston Welcome Back Center for Internationally Educated Nurses". It is a program meant for residents of the United States only, not others who are overseas wishing to practice in the United States. The Boston Welcome Back Center was opened in October 2005 with a $50,000 seed grant from the Board of Higher Education’s Nursing Initiative.
Legislation
In September 2007, in the 110th Congress, Senator Richard Durbin of Illinois introduced S.2064: Nurse Training and Retention Act of 2007 on the floor of the Senate. It was a bill to fund comprehensive programs to ensure an adequate supply of nurses. It was referred to committee for study but was never reported on by the committee.In April 2008, in the 110th Congress, H.R. 5924: Emergency Nursing Supply Relief Act was introduced as a bill to the House of Representatives by Robert Wexler
Robert Wexler
Robert Wexler is the president of the Washington-based S. Daniel Abraham Center for Middle East Peace.Wexler was a Democratic member of the U.S. House of Representatives, representing , from 1997 until his resignation on January 3, 2010.-Early life:Wexler was born in Queens, New York to Sonny and...
of Florida. If it had passed, it would have amended the American Competitiveness in the Twenty-first Century Act of 2000 and would have given up to 20,000 visas per year to nurses and physical therapists until September 2011. Immediate family members of visa beneficiaries would not be counted against the 20,000 yearly cap. The bill was referred to committees for study in Congress but was never reported on by the committees.
On February 11, 2009, legislation was introduced by Representatives John Shadegg
John Shadegg
John Barden Shadegg is the former U.S. Representative for , serving from 1995 until 2011. He is a member of the Republican Party.The district, numbered as the 4th District before the 2000 Census, includes much of northern Phoenix....
(R-AZ), Jeff Flake
Jeff Flake
Jeffrey Lane "Jeff" Flake is the U.S. Representative for , serving since 2001. He is a member of the Republican Party. He was featured in the documentary series How Democracy Works Now: Twelve Stories....
(R-AZ), and Ed Pastor
Ed Pastor
Edward Lopez "Ed" Pastor is the U.S. Representative for , serving since 1991. He is a member of the Democratic Party.The district includes most of southern, western, and downtown Phoenix, along with a portion of Glendale....
(D-AZ) in the 111th Congress to the House of Representatives, HR 1001 ("The Nursing Relief Act of 2009" : To create a new non-immigrant visa category for registered nurses, and for other purposes) making a new non-immigrant "W" visa category for nurses to be able to work in the United States. This was to relieve the nursing shortage still considered to be a crisis despite the economic problems in the country. The proposed bill was referred to the Committee on the Judiciary but was never reported on by Committee.
Immigration Process to U.S.
Nurses seeking to immigrate to the U.S. can either apply as direct hires or through a recruitment agency. For entry to the U.S. a foreign nurse must pass a Visa Screen which includes three parts of the process. First they must pass a creditable review, followed by a test of nursing knowledge called the Commission on Graduates of Foreign Nursing Schools examination (CGFNS), and finally a test of English-language proficiency.Foreign nurses compete amongst themselves, with professionals, and other skilled workers for 140,000 employment-based viases (EB) every year. The Filipino nurses are only allocated 2,800 visas per year, thereby creating a backlog among applicants. For example, in September 2009, 56,896 Filipinos were waiting for EB-3 visa numbers. This number contrasts with the 95,000 nurses licensed in 2009, many of whom want to migrate to the U.S. Once a nurse obtains a visa number and is approved for a visa and authorized to work in the U.S., they must pass the National Council Licensure Examination to qualify for U.S. nursing standards.
Scholars point out that the use of foreign nurses prolongs the underlying issues of the nursing shortage. As a result, many of the problems with the U.S. health system will continue until addressed by a more long-term solution. For example, the unemployment rate in the Philippines was 7.5% in 2009 according to the CIA World Factbook; it was 10.6% in the US as of February 2009 according to the U.S. Bureau of Labor Statistics. Thousands of U.S. licensed newly trained nurses remain unemployed and are forced to leave the profession while thousands of seasoned nurses return to the profession to help their families make ends meet.
The Philippines
The Philippines is the largest exporter of nurses in the world supplying 25% of all overseas nurses. An Organisation for Economic Co-operation and DevelopmentOrganisation for Economic Co-operation and Development
The Organisation for Economic Co-operation and Development is an international economic organisation of 34 countries founded in 1961 to stimulate economic progress and world trade...
study reported that one of every six foreign-born nurses in the OECD countries is from the Philippines. Of all employed Filipino RNs, roughly 85% are working overseas. This is partially in response to the inability of Filipino nurses to enter their domestic workforce due to a lack of jobs and instead become heavily dependent upon international job markets for nurses. The United States has an especially prominent representation of Filipino nurses. Of the 100,000 foreign nurses working in the U.S. as of 2000, 32.6% were from the Philippines.
Reasons for international migration
The international migrationHuman migration
Human migration is physical movement by humans from one area to another, sometimes over long distances or in large groups. Historically this movement was nomadic, often causing significant conflict with the indigenous population and their displacement or cultural assimilation. Only a few nomadic...
of Filipino nurses takes place in response to "push and pull" factors. The push factors are rooted in the economic conditions in the Philippines in which there is an overabundance of RNs and a lack of open employment positions. The unemployment rate in the Philippines currently exceeds 10 percent. Additionally, health care budgets set up Filipino nurses for low wages and poor benefit packages for employees. There are also fewer jobs available thereby increasing the workload and pressure on RNs. Filipinos often find it in their interest to pursue international employment to avoid the economic instability and poor labor conditions in their native country. The government also highly encourages the exportation of RNs internationally. Filipino nurses are pulled to work abroad for the economic benefits of international positions. While a nurse in the Philippines will earn between $180 and $200 U.S. dollars per per month, a nurse in the U.S. receives a salary of $4000 per year. Nurses abroad are greatly respected in the Philippines as they are able to support an entire family back at home through the sending of remittances. In 1993, Filipinos abroad sent $800 million to their families in the Philippines thereby supporting the Filipino economy. Additionally, remittances from Filipinos made up 5.2% of the Filipino GDP (gross national product) between 1990 and 2000. Further pull factors stem from the additional economic benefits of signing bonuses in the U.S. In order to attract more foreign nurses, U.S. hospitals increased signing bonuses from $1,000 to $7,000. Positions abroad in the health sector are also enticing for their immigration benefits for individuals and families. Throughout the past 50 years of nurse migration, the U.S. has made efforts to ease the visa application process to further encourage international nurses to fulfill the nursing shortage. Scholars also note that the better living and working conditions, higher income, and opportunities for career advancement draw nurses from the Philippines to work in the U.S.
As the relation between the U.S. and the Philippines stretches back 50 years, Filipino nursing institutions often reflect the same educational standards and methods as the U.S. curriculum. Furthermore, a knowledge of English in the Philippines makes it easier for Filipino nurses rather than nurses from other developing nations to work in the U.S.
Since 1916, 2,000 nurses have arrived each year in the U.S. In 1999, the U.S. approved 50,000 migrant visas for these nurses. Today, on average, there are about 30,000 Filipino nurses traveling to the U.S. each year to escape the push factors of their homeland and enjoy the benefits of the pulls of their new home.
Effects of migration
The transnational migration of Filipino RNs has profound effects on the economy and workforce dynamics in both sending and receiving nations. The departure of nurses from the domestic workforce represents a loss of skilled personnel and the economic investment in education. In addition, the "scarce and relatively expensive-to-train resources" invested are lost when a worker chooses to work abroad. When RNs migrate internationally, the country from which they emigrate loses a valuable resource and any financial or educational support that was invested in the individual that travels overseas.Unfortunately, according to many Filipinos working in hospitals, the most educated and skilled nurses are always the first to go abroad. There is disagreement among scholars on the extent to which the Filipino health sector is burdened by its own nursing shortage. While the numerical data are inconsistent about whether the nurse supply is in excess or a shortage, it is clear that there is a short supply of the most skilled nurses who choose to go abroad. As a result, operating rooms are often staffed by novice nurses and nurses with more experience work extremely long hours at one time As skilled nurses decline in the urban areas, nurses from rural areas migrate to hospitals in the cities for better pay. As a result, rural communities experience their own drain of health resources. Stories and studies alike demonstrate that a treatable emergency in the provinces may be fatal because there are no medical professionals to help treat them outside of the cities. In fact "the number of Filipinos dying without medical attention has been steadily increasing for the last decade." The lack of attention from medical professionals has increased over time despite advances in technology and medicine and the increasing number of trained nurses in the Philippines.
Not only have nurses departed their positions in rural communities, but so too have doctors changed professions and joined the international mobility trend. Filipino doctors have begun leaving their professions to train as nurses under the title MD-RN with the hope of immigrating to the U.S. or other developed nations more easily. Since 2000, 3,500 Filipino doctors have migrated abroad as nurses. The U.S. incentives for nurse migration encourage doctors to train as nurses in the hopes of increasing their economic prospects. As a result, the Philippines have a lower average of doctors and nurses with .58 and 1.69 respectively for a population of 1,000. The average statistics globally in contrast are 1.23 and 2.56. Between 2002 and 2007, 1,000 Filipino hospitals closed due to a shortage of health workers. A study conducted by the former Philippine Secretary of Health, Jaime Galvez-Tan, concluded that close to 80 percent of all government doctors have become nurses or are studying nursing. Of the 9,000 doctors-turned-nurses, otherwise known as MD-RNs, 5,000 are currently working overseas. The extraordinary influence of this international migration has had devastating effects on the health of Filipinos. The number of deaths that were not prevented with medical attention have only increased over time as hospitals are shut down and rural areas are deprived of any medical treatment.
Due to the high interest in international mobility, there is little permanency in the nursing positions in the Philippines. Most RNs choose to sign short term contracts that will allow for more flexibility to work overseas. The Filipino nurses also feel less committed to the hospitals as they are only temporary staff members. This lack of attachment and minimal responsibility only worsens the health of Filipino patients.
In addition to the negative effects of RN emigration on the health sector, the educational system has also been hurt by the outrageous increase of nurses in the Philippines. As Filipinos are attracted to the opportunities that come from working as a nurse, the number of nursing students has steadily increased. As a result, the number of nursing programs has grown incredibly quickly in a commercialized manner. In the 1970s, there were only 40 nursing schools in the Philippines but by 2005 the number had grown to 441 nursing colleges. While the educational opportunities for nursing students has grown tremendously, the quality of education has declined. This can be seen by the low rate (50%) of students who pass the nursing exam since the 1990s. Furthermore, the Technical Committee on Nursing Education of the Commission on Higher Education (CHED), determined that 23 percent of the Filipino nursing schools failed to meet the requirements set by the government.
In summary, the emigration of Filipino nurses has encouraged doctors to switch to nursing, created a shortage of skilled specialized and experienced nurses, affected the educational system, and distorted health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
delivery and attention to medical issues in rural areas. While remittances, return migration, and the transfer of knowledge support the Philippines they fail to fully compensate the loss of health workers, which disrupts the Filipino health and educational sector.
Dr. Jaime-Galvez Tan, the former Philippine Secretary of Health, warns that if the U.S. passes legislation allowing for freer immigration of nurses the health service of the Philippines could bleed to death and collapse.
See also
- Health Human ResourcesHealth Human ResourcesHealth human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
- Health care providerHealth care providerA health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
s - Physician supply
- Brain drainBrain drainHuman capital flight, more commonly referred to as "brain drain", is the large-scale emigration of a large group of individuals with technical skills or knowledge. The reasons usually include two aspects which respectively come from countries and individuals...
Further reading
- Adeniran, Rita K., et al., "Transitioning Internationally Educated Nurses for Success: A Model Program", OJIN: The Online Journal of Issues in Nursing, American Nurses AssociationAmerican Nurses AssociationThe American Nurses Association is a professional organization to advance and protect the profession of nursing. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911...
, May 31, 2008 - Drury, V., Francis, K., & Chambers, Y. (2009). "Where have all the young ones gone: implications for the nursing workforce", Online Journal of Issues in Nursing, v.14, n.1
External links
- California Nurses Association
- American Nurses Association (ANA): Nursing Shortage & Staffing
- American Nurses Association, U.S. Government Affairs
- First Consulting Group
- U.S. Census Bureau
- U.S. Department of Health and Human Services: Health Resources and Services Administration (HRSA)
- World Health Organization (WHO)
- Nursing Associations - Listing of nursing associations
- Australian Occupational English Test
- American Association of Foreign Educated Nurses