Improving Nursing Shortfalls in the American Healthcare Industry

Nurses are imperative in the delivery of healthcare because of their proximity to sufferers compared to other healthcare providers. Their shortages can confer momentary and long-term impacts, or permanent compromise of healthcare quality and safety. The shortages are multifaceted, though they can be potentiated by human resource, systemic and structural challenges in the demand/supply aspects of healthcare. The shortfalls have bad impacts including unfavourable medical events, and increased morbidity and mortality. However, enchancment initiatives minimize the impacts of the shortfalls, lowering potential compromises to the care delivery. Therefore, it is recommended that the American Nurse Association adopts a combine of human resource, advocacy and structural strategies in dealing with the current and future nurse shortages to facilitate improvements in the nursing shortfalls.

Table of Contents




Nursing shortages4

Impacts of Nursing Shortages5

Improving Nursing Shortfalls5




Improving Nursing Shortfalls in the American Healthcare Industry: A Recommendation Report


Nurses spend considerable time with patients compared to other healthcare providers. This aspect makes them the cornerstone of healthcare provision and delivery in hospitals, and other care agencies. Their proximity to patients has made them highly invaluable in the delivery of safe and quality healthcare. However, the healthcare industry is experiencing nursing shortfalls, which are projected into the future. Discrepancies in nursing personnel are multifaceted, and emanate from different factors. Research has shown that nursing shortages are caused by demographic changes (Buchan & Aiken, 2008), ageing baby boomers (Buchan & Aiken, 2008; Hassmiller & Cozine, 2006), inadequate recruitment and retention strategies (Beecroft, Dorey, & Wenten, 2008), educational challenges and legislative barriers (Buchan & Aiken, 2008; Hassmiller & Cozine, 2006), among others. Healthcare safety and quality is tied to nurse personnel number and the circumstances surrounding their working conditions. The nursing environment is associated with incidences of work overload, job satisfaction, and nurse burnout, if there are inadequate nursing employees per shift (Cox, Willis & Coustasse, 2014). Because of the connection between nursing shortages and poor quality and unsafe health, there is need to improve on the personnel shortfalls to prevent the long-term and permanent persistence of the problem. For that matter, the American Nurse Association (ANA) should consider legislative actions, structural and systemic strategies, as well as adequate human resource initiatives to minimize the nursing shortfalls. This report proposes tactics for solving nursing shortages in the healthcare industry.


This report is a literature survey and review of the existing data on possible ways of improving nursing shortfalls in the healthcare industry. A literature search on the problem was conducted in PubMed and Google Scholar as the primary databases, and the relevant healthcare websites, as well as hospital reports on how various healthcare organizations dealt with nursing shortages. The search process utilized the following phrases: “nursing shortages,” “nursing shortfalls,” “improving nursing shortages,” or “improving nursing shortfalls.” The search was intended to find articles that focused on either nursing shortages and/or improving nursing shortages. The relevant themes from the articles were identified and highlighted, and useful information extracted and written down appropriately. The extracted data was reviewed and then used to isolate the strategies that could help improve nursing shortfalls in the healthcare industry.


Nursing shortages

On nursing shortages, the data shows that insufficient numbers of nursing personnel alone was not linked to the discrepancies. However, it was found that nurse turnover was the biggest impediment to nurse retention. The turnover was a conglomerate of individual characteristics, the working environment, and organizational factors (Beecroft et al., 2008). On individual factors, the nurse demographic elements, coupled with competencies and coping strategies were related with nurse turnover. On working environment, the data has revealed the mediating effect of the magnet hospital environment, shift duration, workload per shift, and perceived nurse burnout in the exacerbation of nurse turnover (Cox et al., 2014; Dawson et al., 2014). The organizational factors on their part included nurse empowerment, job autonomy and perceptions of organizational belonging, and manager-subordinate relationships, as well as employee compensation (American Association of College of Nursing AACN, 2014; Beecroft et al., 2008). Besides, the capacities of the training institutions, and the willingness to become a nurse among the general populations (Hassmiller & Cozine, 2006) also contribute to the shortages.

Impacts of Nursing Shortages

Literature shows that nursing shortage has varied effects on the health quality and safety. Research indicates that nursing shortages cause higher readmission rates among hospitalized patients (AACN, 2014), which emanate from nurse burnout and the increased error-making probabilities. Although nurse turnover potentiates nurse shortages, it is also a product of nurse shortages because of its subsequent elevation of nurse workload, burnout, and a reduction in morale and job satisfaction (Beecroft et al., 2008). Besides, the shortfalls increase medical and associated healthcare errors, which potentiate higher healthcare costs, increased incidences of disease exacerbations and death rates, and other adverse events (AACN, 2014). The shortages can also externalizing behavior among patients and their families, including violence against providers, leading to both patient and provider injuries.

Improving Nursing Shortfalls

On improving nursing shortages, the studies suggest a mix of various strategies, which cut through the health demand and supply factors. The initiatives can be grouped into human resource initiatives, structural and systemic strategies. Human resource strategies target the expansion of nurse recruitment and retention beyond college or high school life. Overseas recruitment and below high school educational levels, are some of the expansions that the findings reveal (Navidjon & Erickson, 2001). The current and future globalization and international migrations allow the cross-border exchange of skills to bolster the existing supply in the US (Allutis, Bishaw, & Frank, 2014). Adequate workforce planning and allocation strategies, as well as management support and adequate manager-subordinate collaboration are some of the ways of improving shortages (Buchan & Aiken, 2008). Data also reveals the expansion of training institutions to increase the numeracy of nurses (AACN, 2014; Buchan & Aiken, 2008; Hassmiller & Cozine, 2006), partnership with public and private partners (AACN, 2014; Hassmiller & Cozine, 2006), and legislative support (Buchan & Aiken, 2008). Apart from these initiatives, literature reveals that nursing image also modulates the recruitment and retention of nurses (Navidjon & Erickson, 2001). Additionally, the findings demonstrate that these strategies have both direct and indirect impacts on nurse shortfalls, leading to their improvement.


Nurses play significant roles compared to other healthcare providers because of their proximity to patients in the care continuum. Nurse shortages are prevalent in the American healthcare industry. It is not uncommon to find inadequate staff in the hospitals and other care centers. These shortages span into the future, and if unaddressed, they can cause long-term or permanent shortfalls in nursing care. The shortfalls cut through the recruitment and retention strategies to include educational and politico-legal barriers. They have various impacts on healthcare such as increased hospital readmission rates, medication and healthcare errors, morbidity and mortality, which compromise the safety and quality of care. However, the development of strategies that improve nursing shortfalls minimize the impacts and mediate healthcare improvements. The initiatives range from workforce planning and allocation patterns based on appropriate skills mix, collaborative management support, expanding nursing faculties, and broadening recruitment strategies to overseas nurses and lower educational levels. These initiatives minimize the effects of nurse shortages and facilitate the provision of safe and quality care.


Expanding the nurse recruitment spectrum to include overseas nurses and junior high school students. Exiting research has shown that the American nurse faculties are inadequate to meet the demand for nurses in the US. AACN (2014) reports that nursing schools turned away about 79,659 qualified applicants in the year 2012-2013 due to limited faculties, clinical sites, classroom space, and clinical preceptors, among others. As a result, the American Nurse Association should liaise with the department of immigration and the US foreign affairs ministry to solicit for qualified and highly trained nurses from overseas to fill the skills gaps. Besides, it is common knowledge that children in fifth grade can identify and associate with particular careers (Nevidjon & Erickson, 2001); hence, the need for ANA to expand recruitment drives to these children to model them for future nursing roles.

Broadening partnerships with public, non-profit, and private organizations for financial resources. ANA needs close ties with different organizations to facilitate their acquisition of financial resources that will enable them to reduce some of the impediments towards expanded nursing services. They can utilize the cash to lobby for additional clinical sites, clinical preceptors, or setting up nursing schools to increase enrolment to the profession. The Robert Wood Johnson Foundation has been instrumental in the improvement of nursing care, and if ANA can partner with many similar organizations, the nursing profession will meet minimal enrolment and nurse shortages.

Engaging the nursing staff and the public on the roles and scope of nursing care. Nevdjon and Erickson (2001) highlight that despite the nurses’ contribution to healthcare and subsequent trust gained from the public regarding the importance of the profession, the public image of nursing is still unattractive and less lucrative vis-à-vis the doctors’ or pharmacists images. ANA, in conjunction with hospitals and other care facilities should embark on a publicity campaign to popularize and reinforce the nursing image. This can be achieved through television commercials, motion pictures and music videos, among other promotional strategies. Similarly, ANA needs to get the nursing staff views regarding their recommendation of the profession to their children and significant others. By surveying their views anonymously, ANA should develop an action plan for turning the negativities into empowerment.

Redesigning patient care delivery to support an older workforce. The ageing baby boomers contribute to the nursing shortfalls. However, despite their old age, these nurses still have their competencies and experiences intact, apart from the fact that they may be a little tired. While awaiting enrolment increments among nursing schools, these professionals can perform their duties for shorter shift durations and flexible timelines, while being given considerable sabbaticals and time offs.

Organizational cultural shifts. The management should consider collaborative management and participative decision-making to empower and motivate the nurses towards work commitment. Besides, workforce planning and job allocation should consider employee skills mixes that adequately match with their training. This way, the nurses will have greater autonomy and the freedom to do their jobs with minimal supervision, consequently reducing nurse turnovers.


Allutis, C., Bishaw, T., & Frank, M.W. (2014). The workforce for health in a globalized context- global shortages and international migration. Global Health Action, 7. DOI: 10.3402/gha.v7.23611

American Association of Colleges of Nurses (AACN). (2014). Nursing shortages. Accessed on April 7, 2017, from

Beecroft, P.C., Dorey, F., & Wenten, M. (2008). Turnover intention in new graduate nurses: A multivariate analysis. Journal of Advanced Nursing, 62(1), 41-52.

Buchan, J., & Aiken, L. (2008). Solving nursing shortages: A common priority. Journal of Clinical Nursing, 17(24), 3262-3268.

Cox, P., Willis, K., & Coustasse, A. (2014). The American epidemic: The US nursing shortage and turnover problem. Paper presented at BHAA 2014, Chicago, IL.

Dawson, A.J., Stasa, H., Roche, M.A., Homer, C.S.E., & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies. BMC Nursing, 13:11. DOI: 10.1186/1472-6955-13-11

Hassmiller, S.B., & Cozine, M. (2006). Addressing the nurse shortage to improve the quality of patient care. Health Affairs, 25(1), 268-274.

Nevidjon, B., & Erickson, J. (2001). The nursing shortage: solutions for the short-term and long-term. The Online Journal of Issues in Nursing, 6(1), 1-11.

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