Even with many decades of extensive research, nursing workforce shortages are persistent, widespread, and growing.1,2
While devastating, the COVID-19 revealed the extent and impact of workforce shortages and highlights the urgency of implementing immediate and sustainable solutions.3,4,5 As such, the pandemic might provide the necessary impetus to address these persistent workforce shortages before they worsen.
Drawing on a recently published paper, this article briefly describes the strategies needed to address nursing workforce shortages.6 Based on the existing literature, four core strategies stand out for addressing nursing workforce shortages: enhancing retention, improving recruitment, encouraging return to practice, and drawing on international human resources. No single strategy is likely to be the panacea to solving nursing workforce shortages, however. Addressing these shortages locally, nationally, and globally requires a suite of interconnected policy reforms at all levels enacted both within and beyond nursing.
Enhancing retention
The aim of enhancing the retention of nurses is to address the factors (eg. burnout, lack of sufficient remuneration and recognition, and poor working conditions) that intensify staff turnover and to keep nurses in their jobs and the nursing workforce. Retention strategies must be sensitive to demographic differences (eg. new graduates versus experienced/senior nurses). Examples of specific strategies include; shift/rostering flexibility, fair remuneration, ensuing ability to work to full scope of practice, multidisciplinary/interprofessional teamwork, workplace safety and wellbeing initiatives, appropriate staffing levels and skills mix, enhancing organisational culture.
Improving recruitment
Here, strategies focus on the pipeline of new nurses (eg. students, new graduates, and workers in non-nursing roles who, with further education, might pursue a nursing career). These strategies must be designed with consideration that many of the factors that contribute to poor retention are also likely to result in poor recruitment. This means that strategies for enhancing retention can also be modified to also enable improved recruitment and that without both, neither are likely to work alone. Specific strategies to enhance recruitment include; promoting nursing work as an attractive, rewarding, and respected career path, enabling collaboration between stakeholders (eg. education/training providers, employers, nursing bodies, and unions) around effective transition to practice interventions for current students and new graduates (eg. employment of registered undergraduates), and improving articulation between education/training and job roles.
Encouraging return to practice
Another strategy related to the recruitment of new nurses is encouraging experienced nurses back to clinical practice from retirement, different careers, or from extended leave. Depending on ‘recency of practice’ requirements, nurses may or may not be eligible to move straight back into clinical roles. Return to practice strategies are a comparatively efficient solution that draws on trained, experienced workers. As above, however, without addressing the factors that led to these nurses leaving work originally, this approach is likely to have limited viability. Likewise, strategies to enhance recruitment can similarly be modified to suit experienced nurses re-entering practice. Specific strategies include; accessible, affordable, effective and efficient return to practice policies and processes, facilitating flexible roles and working arrangements.
Drawing on international human resources
This strategy involves recruiting qualified nurses from other countries to plug domestic workforce shortages. Depending on the countries concerned and their policies, international nurses might be eligible to practice in a new country immediately, or be required to undertake further study, supervised practice, or assessment. Drawing on nurses from other countries raises potentially serious ethical and practical issues particularly when this approach simply amplifies workforce shortages and challenges to health and wellbeing in countries with scarce resources. As such, this is likely to be an unfair approach that amplifies global inequity.
As above, many factors relating to recruitment and retention are also important for international nurses. Establishing fair intergovernmental agreements designed to protect the interests and wellbeing of both source and destination countries are also necessary. It is also important that policy enables optimum employment outcomes for domestic graduates as a priority before seeking to employ international nurses. Likewise, where international recruits are employed, policy at all levels must ensure equitability, fairness, and appropriate remuneration and support consistent with the domestic workforce.
Conclusion
Radical, wide-ranging reforms are urgently required from Government and other decision makers to effect widespread and sustainable changes that underpin ensuring a suitably sized, supported, and recognised nursing workforce. A comprehensive combination of strategies and policy reforms are necessary for addressing nursing workforce shortages. As workforce shortages are influenced by broader health sector, political, and social factors, attention must also be directed beyond nursing and healthcare and take into account the varied contextual and historical antecedents of contemporary shortages and other workforce challenges. Issues such as fair pay and retirement income, enterprise bargaining, workplace health and safety laws, effective legislation, university funding, and even childcare support influence how nursing shortages can be lessened.
The pandemic, climate change, war, and political and economic pressures are catastrophic for many, but could provide the motivation to finally take genuine and decisive action to develop and implement radical, multi-pronged, multi-sector reforms to address nursing shortages and working conditions and to help to solve a range of other healthcare system and social challenges.
References
1 Buchan J, Duffield C. & Jordan A. ‘Solving’ nursing shortages: do we need a New Agenda? Journal of Nursing Management. 2015;23(5):543-5. https://doi.org/10.1111/jonm.12315
2 Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z & Januszewicz PA. Nursing shortage – a prospect of global and local policies. International Nursing Review. 2019;66(1): 9-16. https://doi.org/10.1111/inr.12473
3 Adelson P, Fish J, Peters MDJ, Corsini N, Sharplin G, Eckert M. COVID-19 and workforce wellbeing: A survey of the Australian nursing, midwifery, and care worker workforce. A report prepared for the Australian Nursing and Midwifery Federation. Adelaide, SA: University of South Australia, 2021. DOI: https://doi.org/10.25954/6098c87b12e96
4 Lopez V, Anderson J, West S & Cleary M. Does the COVID-19 Pandemic Further Impact Nursing Shortages? Issues in Mental Health Nursing, 2022;43(3): 293-5. https://doi.org/10.1080/01612840.2021.1977875
5 Turale S & Nantsupawat A. 2021. Clinician mental health, nursing shortages and the COVID-19 pandemic: Crises within crises. International Nursing Review. 2021;68(1): 12-4. https://doi.org/10.1111/inr.12674
6 Peters MDJ. Time to solve persistent, pernicious, and widespread nursing workforce shortages. International Nursing Reveview. 2023; [Online First]. https://doi.org/10.1111/inr.12837
Author:
Dr Micah DJ Peters is the Director of the ANMF National Policy Research Unit (Federal Office) and Senior Research Fellow in the Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia
