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Nursing staff shortages continue to challenge healthcare delivery to an ever-increasing global population(WHO, 2018). The shortage of nurses had led to a decrease in the quality of service and care to patients. Nurses are the backbone of healthcare service delivery. They play a fundamental role in patient care, comfort, and recovery (Potter, 2020).A shortage of nursing staff is caused by a lack of trained nurses and a lack of knowledge and practice experience. The lack of experience in practice reduces the efficiency and job satisfaction of available nurses that further complicates the service delivery (Duffin, 2015). Shortages in nursing staff are at the core of patient care and should be considered an imminent crisis that requires immediate attention.

Nursing staff shortages are prevalent in the United States and Africa, Asia, and South America. Africa has a nurse to patient ratio that ranges from 80 nurses to 10000 patients (WHO, 2018). Midwives are also considered part of this statistic, and the number of skilled nurses in Africa is way less than the projected statistic. In some countries like India, the physician to patient ratio is higher than the nurse to patient ratio(Potter, 2020). The shortage of nurses has been a recurring problem since allocation mechanisms for nursing education and training became a low priority for hospitals worldwide. Most nurses do not have incentives that support their training. Once on the workforce, the focus becomes performance evaluations and patient outcomes instead of improving nursing care quality.

Causes of Nursing Staff Shortages

The fundamental cause of shortages in the staff is the high turnover number of nursing staff. Such a high turnover is multifaceted in underlying causes, ranging from depression, burnout, low work-life balance, and low job satisfaction. Nurses work for an average of 5.6 years, which is only 16.8% of their nursing practice(Anne,  2017). Nurses are two times more likely to attempt suicide than people in other professions. Nurses spend a significant amount of time at work and are at the frontline in managing patient recovery(Potter, 2020). Scheduled nurses’ duties are done by administrative and red tape influence that does not take into account nurses’ occupational health. Consequently, nurses end up frustrated at work and resort to home-based care and other specialized practices that do not include ward runs.

The faculty staff for nursing is also experiencing significant shortages. Compensation for faculty staff is almost seventy-five percent less than the nurses perusing specialized practice. The number of nurses turned away by the nursing schools due to lack of clinical sites and reduced faculty staff contributes to a low number of nurse recruits(Friberg et al., 2019). On the other hand, about eight percent of faculty positions remain unfilled. The crisis extends to the hospitals where about half the nursing staff is nearing retirement. In 2018, about 40% of the nurses were due to retirement in less than ten years. About 55% of experienced nurses are over fifty years, and due for retirement in the United States of America (Nantsupawat et al., 2016). Consequently, the nurses retire with the knowledge and skill required to enhance nursing practice and further complicate the service delivery.

Nurses have reported that they are not well represented in administration, and the bureaucracies do not address matters related to nurses adequately. For instance, the upsurge in violence against female nurses has reduced nurses’ job satisfaction. There has been an 11% increase in violence since 2005, and by 2018, the numbers have soared. Nurses feel unsafe in their workplaces (WHO, 2018). The administration also fails to provide useful platforms for career goals and development. Nurses have fewer growth opportunities and once they qualify, leave the practice as soon as they can. Increased life expectancy means that nurse hours for patients are longer than they did a decade ago.

Impacts of Reduced Nurse to Patient Ratio

Reduced patient to nurse ratio affects patient outcomes and service delivery. Training expenses amount to about $85000 annually due to the high turnover of nursing staff in the United States (Friberg et al., 2019). The costs are even higher in Europe and Sweden. Shortages also result in inadequate quality training for nurses, which translates to more extended recovery periods for patients and, in some extreme cases, patient death. Reduced work-life balance due to the high turnover means that nurses are burnt out seventy percent of their time,and this increases the chances for medical error(Duffin, 2015). Low work satisfaction reduces the 5acuity of patient safety and care. Patient care is directly associated with hospital expenses to the staff and management. For instance, unattended pressure ulcers lead to an increased hospital stay and can result in a bad reputation for the hospital.


Nurses require representation in administration so that their bedside challenges are adequately addressed(Smith et al., 2012). Besides, nurses require a care plan that manages their stress levels and adequately ensures that they have the right certification and licenses. A nurse experiencing health challenges such as being overweight and depression requires a particular care procedure that maintains a healthy balance between their lives and work. Nurses’ opportunities for growth, careerdevelopment, and a scheme toenhance their skills and weaknesses are mitigated(Scott, 2014). It is a fundamental right for nurses to have policies that describe and sustain their well-being. Nurses do not need constant pressure to perform in a world already in shortage.

Initiatives for nursing aides and other subordinate training make it easier for the nurses to handle only the core needs. In contrast, other needs can be handled by assistants. Such measures reduce the pressure on the nurses while increasing efficiency (Rimmer, 2020). Faculty staffs also require a review of their compensation because as long as an opportunity to earn more arises, nurses will opt out of teaching. Reduced clinical sites for training should also be addressed in policy such that the training is elevated to levels that increase patient outcomes.Accordingto Duffin (2015), allowing nurses from other countries can provide additional support to the staff in practice.

Lastly, the ineffective use of available nursing resources should be avoided at all costs. Nursing practice requires initiatives that support nursing practice at all levels of development and learning(Duffin, 2015). Most facilities are allocated to physicians and rarely integrate the nursing practice. There are red tape policies that undermine nurses’ contribution to the overall healthcare and put physicians at an advantage,yet their duties are complementary(Scott, 2014).Nurses require as much support in training, skill set development, growth, and capacity building as physicians. It is unfair to allocate funds to facilitate physicians’ specialized training but limit nurses’ similar exposure.


Nurses are the backbone of patient care and play a vital role in delivering a healthcare facility’s quality of service. A shortage in the number of nurses is multifaceted in the causes. The causes range from nurses’ high turnover to a systemic gap in the administration of policies that protect nurses’ welfare. Growth opportunities are still in their infancy as nurses continuously deal with a low work-life balance and burnout. The needs for proper representation of nursing issues in the health care facilities go a long way in ensuring that their grievances are addressed. Ensuring that nurses are well trained is an issue of resource allocation and affects teamwork and overall nursing practice satisfaction. The undersupply of nursing staff is a matter of national security and should be addressed globally because the effects transcend a single country.


Anne. (2017). Keep blowing the whistle on staff shortages. Nursing Standard, 32(7), 30. https://doi.org/10.7748/ns.32.7.30.s31

Duffin, C. (2015). Rejected immigration requests causing ‘desperate’ staff shortages.Nursing Standard, 30(5), 10.https://doi.org/10.7748/ns.30.5.10.s9

Friberg, Elizabeth E., and Joan L. Creasia. 2019. Conceptual foundations: the bridge to professional nursing practice. http://www.vlebooks.com/vleweb/product/openreader?id=none&isbn=978032359460

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O.-A., Thienthong, H., &Poghosyan, L. (2016). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98. https://doi.org/10.1111/inr.12342

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2020).Fundamentals of Nursing.

Rimmer, A. (2020). NHS England workforce plan fails to tackle staff shortages, say health leaders. BMJ, m3057.https://doi.org/10.1136/bmj.m3057

Scott, G. (2014). ‘Don’t blame nurses for poor patient satisfaction, blame staff shortages.’ Nursing Standard, 29(6), 10.https://doi.org/10.7748/ns.29.6.10.s4

Smith, Thomas, Capitulo, Kathleena S. K., Quinn Griffin, Mary  T., & Fitzpatrick, Joyce  J. (2012). Structural empowerment and anticipated turnover among behavioural health nurses. Journal of Nursing Management, 20(5), 679–684. https://doi.org/10.1111/j.1365-2834.2012.01384.x

World Health Organization. (2018, July 23). WHO | The Global Nursing Shortage: Priority Areas for Intervention. WHO.https://www.who.int/workforcealliance/knowledge/resources/icn_nursesretention/en/

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