Where Have All the Nurses Gone? Part II

by Kate Rowley, MBA

by Kate Rowley, MBA

The Skills Shortage 

Not only do poor working conditions contribute to the global nursing shortage but the educational and skill level of nurses in many countries is not adequate to address the current medical practices.  There are several approaches to address this skills shortage.


Quality of Nursing Education

The quality of nursing education and training is a problem in developing countries.  Programs are often under-resourced with the limited human capital focused on the wrong activities.  Nursing faculty are frequently an under-valued resource in an under-valued field.  Faculty positions are often part-time and offer low pay and benefits due to the limited budgets of nursing schools.  This results in faculty who are often new graduates who may have graduated top of their class but have limited clinical experience or training in educational techniques.  Their inexperience in the clinical setting leads to reliance on a teaching system of rote memorization and minimal skills training.  This method of teaching and a high teacher to student ratio often results in graduates who are very weak in clinical skills and critical thinking.  These graduates are not properly equipped for the contemporary workplace and this exacerbates the already high attrition rates in a field with limited career growth.  This pattern is repeated throughout the developing world, weakening the base of nurses, and ultimately hurting the nursing profession.

Job Training

On the job training is also inadequate.  This type of education is highly dependent upon the senior nurses; their practices, their knowledge, and their desire to share their education.  When experienced nurses are overworked, their ability to pass on knowledge and the rationale behind practices to new nurses is reduced.  Limited continuing education opportunities also affect the on-going acquisition of knowledge.  If a senior nurse practices outdated methods, they will train a new nurse in these same methods.  In this environment, as experienced nurses retire, their knowledge is not recorded or transferred to the next generation, which weakens the health system and the profession.


Impact on Global Healthcare

Limited numbers of nurses and poorly prepared nurses ultimately impacts the world in ways that are often overlooked.  A shortage of nurses creates systems in which nurses are overworked.  In emerging economies, it is not unheard of for a nurse to work 24 hours a day, 6 days a week, due to the shortage of personnel to fill positions.  This is an unsustainable system and overworked nurses leads to safety concerns.  Research has shown that sleep deprivation has detrimental effects on cognitive and motor abilities [1] [2] [3].  Furthermore, new nurses who are inexperienced are at a greater risk for mistakes.  In a health care system, the outcome is, at best, poor patient care and, at worst, deadly mistakes.


A global nursing shortage also creates imbalances in the access to care [4].  Inadequate staffing levels and undertrained nurses results in physicians being responsible for increasing levels of patient care, thereby, limiting their ability to provide medical care.  In undeveloped and developing nations, nurses are often the only point of access to the health care system.  Due to financial and geographic constraints, nurses act as the primary care givers in the community health systems and as first responders, often substituting for doctors [5].  In nations with nursing shortages, the inability to access care leads to an increase in both acute and chronic diseases and illnesses [6].  This limited access increases the spread of infectious diseases and impacts global public health.


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