Literature review of staff shortage in healthcare


This paper is areview of literature on the shortage of staff in healthcare and thestrategies for addressing it.

Literature review

The US populationis aging and therefore, the healthcare demand is increasing at anunprecedented rate. Juraschek et al. (2011) carried aninvestigation with the objective of determining the workforce scorecard and shortage of registered nurses (RNs). In the study,population projections were made. The investigators employed theconcept of demand and supply to project the RN job shortage in everystate in the US. Juraschek et al. (2011) projected that by2030 US will have a total national deficit of between 725619 and1112112 registered nurses jobs. From the research results, there willbe largest shortage ratio of 389 RN jobs per 100000 in the westernstates of US. The study concluded that initiatives directed towardsunderstanding the dynamics of the RN shortage can enable theformulation of appropriate interventions.

Staiger, Auerbah&amp Buerhaus (2012) conducted a study to determine the relationshipbetween economic recession and shortage of nurses. When there is aneconomic downturn, health professionals especially registered nurseare likely to occupy job vacancies in healthcare industry to meettheir needs. Furthermore, there are reduced alternative employmentopportunities during this period. The research employed a workforcemodel which showed that RN employment is influenced by cohorteffects, change in population size and age effects. The investigatorscompared the annual unemployment rate with the difference between theactual nursing staff and predicted workforce based the cohort,population and age effects. When there is high unemployment rate,registered nurse workforce increases. In the last 40 years, thesupply of nurses grew more than expected when unemployment raterises. Juraschek et al. (2011) projected that by 2015 118000full-time registered nurses will leave their job for otheropportunities. Since the US economy is expected to increase in thefuture, the shortage of nurse workforce is likely to rise. The studyrecommended that healthcare employers and workforce policy makersshould develop counter-measures for post-recession shortages andensure effective and efficient utilization of the existing nurses.

In a study,Sargen, Hooker &amp Cooper (2011) evaluated the capabilities ofphysicians to meet future clinical service demands. The investigatorsdeveloped projections of supply of physicians and correlated with theprojects of their demand for advanced clinical services. Whentraining activities for the clinicians increase without the expansionof physician residency programs, the supply of the clinicians willhave significant changes. Increasing the number of entry-levelresidents by at least 500 every year can help in reducing clinicianshortage. The investigators recommended increasing the output ofclinicians, strengthening clinical practice infrastructure anddelegating duties to a broadened spectrum of caregivers.

Staff shortage inhealthcare is experienced in various countries around the world.Bruckner et al. (2011) aimed at estimating the inadequacy ofhealth staff in low and middle-income countries (LMICs). Theyobtained country-specific data on 8 priority problems associated withmental healthcare service delivery package from 58 LMICs. Depression,schizophrenia, psychoses, suicide, epilepsy, dementia, drug-relateddisorders, and pediatric mental disorders are the priority problems.The study found out that all low-income countries and more than halfof middle-income nations have small number of health professionalsneeded to address their health demands. The 58 LMICs need at least239000 full-time equivalent health specialists to solve the shortage.Bruckner et al. (2011) recommended development ofcountry-specific policies to address the staffing shortage in mentalhealthcare. This research provides important information fordesigning and implementing strategies to counter the shortage.

The researchconducted by Duffield et al. (2011) assessed the impact ofnursing leadership on staff satisfaction and retention. According tothe investigation, good workplace environment increases the level ofjob satisfaction and retaining workers. Leaders have theresponsibility of creating favorable working conditions. Secondaryanalysis was performed on the data from 94 wards in 21 publichospitals. The study found that nursing managers are perceived bynurses to be good leaders and are responsible for adopting policiesthat promote staff retention. The investigation is relevant in thiscase since it provide information on the factors that may make nursesquit their jobs and how managers can are responsible for addressingsuch issues.

Through a studyon nurse shortage, Chan et al. (2013) focused on nurses’ desire toleave their jobs. They based their investigation on electronicdatabases for identifying reasons that may make nurses to quit theirprofession. From the research results, the intention to leave isinfluenced by organizational and individual factor. Chan et al.(2013) recommended further studies to investigate how externalfactors such as employment rate influence nurses’ intention toleave. This is important in nursing management since it providesuseful information in formulating and implementation ofproblem-specific strategies reducing the inadequacy.

Inadequateinformation on human resources for health (HRH) is a major setback indeveloping policies and plan to address staffing shortages and meetthe dynamic demands of a population. Ahmed et al. (2011) conducted aninvestigation aimed at filling the HRH knowledge gap in Bangladesh.The research employed a survey to collect data from a sample for alltypes of active healthcare providers. A simple free listing wasconducted to develop an inventory of the healthcare providers in thesampling areas. From the study results, the ratio of healthcareproviders to population was 1:10000. There were five physicians andtwo nurses per 10000 populations. The shortage of healthcareprofessionals was more in the rural areas of Bangladesh. Theinvestigation also found that in every 10000 people there wereapproximately 12 unskilled community doctors and 11 drug retailers.The non-governmental sector was responsible for most of the communityhealth workers. Ahmed et al. (2011) concluded their study that therewas a severe shortage of health workers. This research providesinsights on the stakeholders in healthcare sector and how they helpin reducing HRH crisis.

LMICs suffer fromextreme shortages and inequitable distribution of healthprofessionals. In their study, Lehmann, Dieleman &amp Martineau(2011) identified the causes of the shortages to be associated withtraining, recruiting and retention strategies in the healthcaresector. Their study aimed at exploring the link between attractionand retention factors and strategies based on the organizationaldiversity and decision-making process. They used secondary data onfrom publications. They found out that the shortage of health staffand the retention strategies are influenced by the complexinteraction of environmental factors. This review is essential indecision-making process and developing appropriate interventions tocounter the issue of staffing shortage.

Toh, Ang &ampDevi(2012) carried out a research aimed at establishing the evidence ofthe linkage between health staff inadequacy and job satisfaction andstress. Electronic databases were used to collect data using athree-step search strategy. There was positive bicorrelation betweenstaff shortage and RN’s job dissatisfaction, stress and burnout.Nurses with substandard working environment often express jobdissatisfaction, stress and burnout. Such working conditions may pushthem to seek better employment opportunities and thus, resultingstaff shortage. Toh, Ang &ampDevi (2012) recommended customizationof strategies for recruiting and retaining health professionals. Theinsights from the investigation are useful in developing strategiesfor increasing job satisfaction and reducing stress in workplaces

Hoyler et al.(2014) carried out a systematic search and review of literature aboutthe supply certain health professionals in LMICs. They identified sixcountries with comprehensive data. The ratio of surgeons was0.13-1.57 per 100,000 people, obstetrician ratio was 0.042-12.5 per100,000 and 0-4.9 per 100,000 for anesthesiologists. Theinvestigation recommended the collection information on the causes ofthe shortages. A global health workforce database can be useful tohealth agencies and health professionals in developingcounter-measures.

The study carriedout by Macfarlane et al. (2011) sought to explore human resourceissues in healthcare. Their research employed management theories anda multi-level model for diversification of innovation. A realistapproach was used to data collected from interviews, ethnographicobservation and documentary analysis. Five strategies were identifiedto be employed to address the issue of staff shortage in healthcare:recruit staff for skill transformation redesigning responsibilitiesembracing workforce planning development planning based on servicedemands and utilizing opportunities for sharing and exchange ofknowledge. These strategies can be incorporated in a comprehensivestrategy that to ensures long lasting solution.

Chiang Y. &ampChang Y. (2012) compared the levels of stress, depression, and desireto leave among clinical nurses to their demographic characteristics.Cross-sectional spearman’s correlation, one-way ANOVA andregression analysis were used in the study. 314 individuals wereenrolled in the survey. Marital status and working tenure wereimportant indicators of stress, depression, and desire to leave.Nurses in the internal medical wards were more likely to havedepression than emergency room nurses and professional nursingpractitioners. The conditions in various medical units influence thelevels of stress, depression and intention to leave. Increased levelsof these factors are associated with shortage of staff.Identification of the factors and ways of addressing them isimportant in analysis of factors associated with shortage of staff.

There existrelationships between work environments and retention of nurses.Ritter D. (2011) carried out a research to investigate the influenceof favorable work environment on retaining nurses. The study mainlyrelied on secondary data from electronic databases. Healthy workenvironment enhance the ability of employers to retain their staff.Managers play an essential role in creating and maintaining aconducive environment of the healthcare staff.

There are several forecasts of shortages of primary care providersdue to the Affordable Care Act that is likely to increase healthcaredemands. Auerbach et al. (2013) analyzed the impacts ofnurse-manage health centers and patient-centered medical home. Thestudy found out that the projected shortages were likely to reduce inplausible cases without increasing the supply of physicians due tothe application of new service deliver models. From this research itis evident healthcare centers can utilize existing staff efficientlyand effectively as a way of addressing shortages.

The population ofmental health nurses is aging. Therefore, many of them will retire inthe next few years. Browne et al.’s study (2013) suggested theemployment of nursing student as assistants in mental healthcarecenters as a strategy for reducing shortage. This strategy alsoencourages them to major in mental health specialty. Nursingassistants can be effectively utilized in increasing workforce. Theapproach also addresses future supply of mental health nurses.

Theoretical framework

The shortage ofhealth professionals and the strategies for mitigating it are basedon job satisfaction, recruitment, work environment and externalfactors (Spurgeon, Burke &amp Cooper, 2012). Job satisfaction isachieved when the needs of health professionals are met by theiremployers. Any individual loves working in a place where they feeltheir concerns are considered during planning and implementation ofvarious projects. The health professionals who quit their specialtyfor other opportunities are driven by the pursuit for meeting theirneeds. The staff morale improves with their job satisfaction. Theshortage and morale of the staff is also influenced by their workenvironments (Weiss &amp Tappen, 2015). A healthy work environmentreduces factors such as stress, dissatisfaction and depression thatare associated with the intention to leave. A comprehensive strategyfor reducing staffing inadequacies in healthcare should focus onaddressing the social, economic, psychological and physical needs ofthe health professionals.


Ahmed, S. M., Hossain, M. A., RajaChowdhury, A. M., &amp Bhuiya, A.U. (2011). The health workforce crisis in Bangladesh: shortage,inappropriate skill-mix and inequitable distribution.&nbspHumanResources for Health,&nbsp9(1), 1.

Auerbach, D. I., Chen, P. G., Friedberg, M. W., Reid, R., Lau, C.,Buerhaus, P. I., &amp Mehrotra, A. (2013). Nurse-managed healthcenters and patient-centered medical homes could mitigate expectedprimary care physician shortage.&nbspHealth Affairs,&nbsp32(11),1933-1941.

Browne, G., Cashin, A., Graham, I., &amp Shaw, W. (2013). Addressingthe mental health nurse shortage: Undergraduate nursing studentsworking as assistants in nursing in inpatient mental healthsettings.&nbspInternational journal of nursing practice,&nbsp19(5),539-545.

Bruckner, T. A., Scheffler, R. M., Shen, G., Yoon, J., Chisholm, D.,Morris, J., … &amp Saxena, S. (2011). The mental health workforcegap in low-and middle-income countries: a needs-basedapproach.&nbspBulletin of the World Health Organization,&nbsp89(3),184-194.

Chan, Z. C., Tam, W. S., Lung, M. K., Wong, W. Y., &amp Chau, C. W.(2013). A systematic literature review of nurse shortage and theintention to leave.Journal of Nursing Management,&nbsp21(4),605-613.

Chiang, Y. M., &amp Chang, Y. (2012). Stress, depression, andintention to leave among nurses in different medical units:Implications for healthcare management/nursing practice.&nbspHealthPolicy,&nbsp108(2), 149-157.

Duffield, C. M., Roche, M. A., Blay, N., &amp Stasa, H. (2011).Nursing unit managers, staff retention and the workenvironment.&nbspJournal of clinical nursing,&nbsp20(1‐2),23-33.

Hoyler, M., Finlayson, S. R., McClain, C. D., Meara, J. G., &ampHagander, L. (2014). Shortage of doctors, shortage of data: a reviewof the global surgery, obstetrics, and anesthesia workforceliterature.&nbspWorld journal of surgery,38(2),269-280.

Juraschek, S. P., Zhang, X., Ranganathan, V., &amp Lin, V. W.(2012). United States registered nurse workforce report card andshortage forecast.American Journal of Medical Quality,&nbsp27(3),241-249.

Lehmann, U., Dieleman, M., &amp Martineau, T. (2011). Staffingremote rural areas in middle-and low-income countries: a literaturereview of attraction and retention.&nbspBMC health servicesresearch,&nbsp8(1), 1.

Macfarlane, F., Greenhalgh, T., Humphrey, C., Hughes, J., Butler, C.,&amp Pawson, R. (2011). A new workforce in the making? A case studyof strategic human resource management in a whole-system changeeffort in healthcare.&nbspJournal of health organization andmanagement,&nbsp25(1), 55-72.

Ritter, D. (2011). The relationship between healthy work environmentsand retention of nurses in a hospital setting.&nbspJournal ofnursing management,19(1), 27-32.

Sargen, M., Hooker, R. S., &amp Cooper, R. A. (2011). Gaps in thesupply of physicians, advance practice nurses, and physicianassistants.&nbspJournal of the American College ofSurgeons,&nbsp212(6), 991-999.

Spurgeon, P., Burke, R. J., &amp Cooper, C. L. (2012).&nbspTheinnovation imperative in health care organisations: Critical role ofhuman resource management in the cost, quality, and productivityequation. Cheltenham, UK: Edward Elgar.

Staiger, D. O., Auerbach, D. I., &amp Buerhaus, P. I. (2012).Registered nurse labor supply and the recession—are we in abubble?.&nbspNew England Journal of Medicine,&nbsp366(16),1463-1465.

Toh, S. G., Ang, E., &amp Devi, M. K. (2012). Systematic review onthe relationship between the nursing shortage and job satisfaction,stress and burnout levels among nurses in oncology/haematologysettings.&nbspInternational Journal of EvidencebasedHealthcare,&nbsp10(2), 126-141.

Weiss, S. A., &amp Tappen, R. M. (2015).&nbspEssentials ofnursing leadership and management.Philadelphia : F.A. Davis