Analysis of the Problem of Shortage of Nurses in the World - Essay Example

? Running head: Faculty Research Methods Reasons behind Nursing as Career Choice: A Qualitative Study Number: @ 00276631 MSc Advanced Nursing Name of supervisor: Professor Tony long Date of Submission: 14/01/2011 Number of Words: 4695 1. Introduction 1.1 The nature of the problem Nurses play one of the most significant roles in the National Health Service and society as a whole. About 25% of the NHS’ annual budget for employment is normally allotted for nurses who represent 50% of health service workers. Furthermore, over a hundred thousand UK nurses, either qualified or unqualified, are involved in diverse and varied work patterns (Newman, Maylor, and Chansarkar 2002). Unfortunately, a shortage of nurses has been evident in the UK and in other parts of the world, thus increasing efforts for education and training opportunities as a response to this worsening situation (Davey, Murrells and Robinson 2005). Specifically, there are an insufficient number of applicants who have taken up nursing courses and meet the required standards (Kober-Smith and Ferroni 2008). This occurrence has consequently brought about challenges among education providers and has left these institutions with limited options such as recruiting only the most competent candidates or reducing their standards (Buchan 2002). It may also lead to expensive outcomes for such groups with regards to increasing the rate of student failure. There is thus a crucial need for the development of another route with which students can enter nursing as a profession (Kirpal 2004). It is of even greater importance that those student nurses are both successful and satisfied with their career choice. This study aims to identify the ways in which expectations expressed at the point of application relate to the outcomes of the degree programme. 1.2 Significance of the problem Owing to the worldwide shortage of nurses, the need to identify the factors and issues that can influence the choices of individuals to take up nursing careers has become increasingly important. (McPhail 2002) Schools of nursing must recruit and retain qualified applicants in order to confront the current challenge to nursing resources. Perceptions of nursing have been linked to students' decisions to enter nursing programmes as well as to complete them. (Grainger and Bolan 2006) Attracting and retaining health professionals, particularly nurses, has become challenging for many health institutions as people have different motivating factors that drive them to pursue a nursing career. This study may be of great importance to researchers and health professionals alike as it may contribute information about the choice of nursing as a career and the issues that they may possibly encounter. This way, schools and other institutions can align their curriculum, training programmes and opportunities to create positive, accurate expectations among students. At the same time, these bodies of nursing can gain further understanding towards exhibiting a broad, constructive and upbeat environment, providing the needs of nursing employees. As such, there is a better possibility of effectively addressing the shortage of nurses in the UK as well as globally. 1.2 Research questions 1. What expectations and understanding of nursing as a profession and a career are held at the point of application? 2. How do these expectations and understanding relate to the outcome of the degree programme? 2 Literature review 2.1 Search Strategy The following health sciences databases, available online, will be consulted for the purposes of this research: PubMed, the Cumulative Index of Nursing and Health Literature (CINAHL), Medline, and Ovid. Search terms include (but may not be limited to) nursing, students, perceptions, expectations, and programme. Preliminary searches demonstrate a dearth of scholarly literature regarding the perceptions of nursing students on degree programmes success and attrition, further underscoring the need for original research. 2.2 Preliminary review In order to maintain a health care system that is of superior quality, it is essential that a sufficient supply of competent and knowledgeable professional nurses is available. This is attainable, however the high attrition rates in nursing programmes must be addressed. Registered nurses must be retained while recruitment and training of students who desire to pursue a nursing career in the future must effectively be carried out (Cohen, et al 2004). The increasing demand for professional nurses has partly been brought about by the ageing population; an increase in consumer activism; and rapid innovations in medical technology. The fact that there is a worldwide shortage of nurses has driven a number of nations to place their efforts on international recruitment to address this phenomenon and yield short-term outcomes (Brodie, et al 2004). International recruitment is unlikely to prove sustainable as the primary method of addressing this issue. As asserted by Law and Arthur (2003), there is a crucial need to identify and understand the attributes of individuals who desire to pursue a nursing career, especially given the current problems in nursing education and recruitment. Although the recruitment and retention of nurses have become relevant matters in nursing education, such concerns have not been addressed effectively. Previous research on managing nurse careers has suggested a wide range of factors that affect the attraction and retention of nurses within the nursing industry. For instance, the study of Farzadi, Mohammadi, Seyedfatemi, and Taykhah (2007) highlighted the impact of stressors and the necessary coping strategies in order to keep nurses attracted to their profession. Other studies focused on gender issues, academic challenges, and work-life balance concerns in relation to the pursuance of a nursing career and development (Ogu 2008). A significant body of research related to attrition in nursing programmes has been completed. The economic growth in the UK has resulted in considerable labour shortages as well as fierce competition for a skilled and knowledgeable workforce. This has resulted in young individuals being less interested in pursuing nursing as a career choice (Wells and McElwee 2000). One of the outcomes of an adequate number of nurses in the workforce are better health care outcomes and care quality. This trend from 10 years ago seems to persist until the present. In fact, the Bureau of Labor Statistics in the United States (BLS) in 2009 anticipates that close to 600,000 nurse positions will need to be filled by 2018, increasing the nurse workforce by 22%. Demand for nurses is expected to exceed the demand of all other jobs (BLS 2009). Moreover, it is also more likely to improve the level of satisfaction among nurses. According to Burns and Grove (2005), nursing shortages at present and in the future may be brought about by demographic, economic, and sociological factors such as a smaller number of individuals entering into the nursing workforce; greater professional opportunities outside the nursing career; negative beliefs and observations about work patterns and conditions among nurses, along with rising number of aging nurses who shall soon have to retire. Additionally, Muldoon and Reilly (2003) assert that the challenges in recruiting and retaining nurses may be associated with the difference between the professional status of nurses and doctors. Furthermore, nursing has been considered by many as a gendered career. According to the Royal College of Nursing (2005), the United Kingdom has failed to invest in nursing education. Nonetheless, the number of new professional nurses has increased, which can be linked to the increase in government funds and resources for advertising, recruiting, and training (Dunnion, Dunnion, and McBride 2010). Such stakeholders must hold a clear and comprehensive vision that can bring about long-term outcomes for nursing education and the nurse workforce in the UK. It is also suggested that nurse managers should be capable of enhancing the nursing image and seeking ways by which young individuals can be motivated in pursuing a nursing career. In research commissioned by the English National Board for Nursing, Lask, Smith, and Masterson (1994) have affirmed the need to create new educational curricula that shall more effectually integrate the health philosophy. Despite the significance of nurse education, the RCN (2005) has pointed out the lack of detail in the number of students who have engaged in nursing education and the number of nursing students who graduate every year. This calls for further research on the perceptions of students with regards to a nursing career, and this makes it more worthwhile to pursue this through research given the dire global shortage in nurse practitioners pointed out in the preceding sections. This may enable institutions to create appropriate campaigns that will motivate young students who are choosing careers to consider nursing as a viable career option (Dunnion et al 2010). 2.2 Issues in Pursuing a Nursing Career 2.2.1 Barriers to Recruitment Several barriers may pose considerable impact on nursing recruitment. Low levels of competency and inaccurate knowledge on nursing among students serve as one of the largest challenges among nursing institutions (Pawson and Boaz 2003). Furthermore, young students can have an unclear notion on the level of qualifications necessary for them to become professional nurses as they are likely to either undervalue or overestimate entry requirements to the nursing workforce (Daly, Johal, and Swindlehurst 2003). Although the skilful and valuable role of nurses has been continuously acknowledged, the negative characteristics of nursing may prevail over the advantages of going into the nursing profession. Normally, nursing is considered to be a stressful and demanding job as it requires individuals to spend long hours, away from family and friends, to carry out tedious duties that generally involve their patients. These implicit notions were brought about by the inadequate opportunities that are provided to students to obtain insight about nursing while still in school (Klem and Notter 2001). Other studies suggested that poor career-related advice can be a possible restriction in pursuing nursing careers (Goldacre, Davidson, and Lambert 2004). Appropriate advice on careers are sometimes denied to nursing students as an outcome of career staff having inadequate knowledge about the educational and career ambitions of students. According to Darr (2001), although ample information is given to students who are interested in taking up nursing, students who remain uncertain about their careers are not provided with the opportunities to discuss nursing as a career prospect. Moreover, it was also found out that career advisors tend seldom to recommend nursing as a career to students owing to its perceived work patterns and demands, and stringent professional standards (Daly et al 2003). Meanwhile, parents who had been interviewed regarding career advice reported the crucial need to provide clear information among educational institutions about nursing training requirements, opportunities for employment, and career structure (Klem and Notter 2001). Additionally, religious issues have become a barrier to the pursuance of nursing careers (Brookes and Haselgrove 2002) along with racist behaviours (Mackay and Elliott 2002). Finally, family members can either motivate or discourage young individuals in pursuing a nursing career. While some nurses would suggest nursing as a career option to students regardless of their unfavourable experiences, others would also discourage young individuals to follow them into the nursing workforce (Harrison 2004). 2.2.2 Nursing Image For effective recruitment of new nurses, campaigns for an image makeover for the nursing profession have been suggested (Newman et al 2002). Current perceptions of the nurse workforce and its demoralising experience include receiving low salaries in exchange for demanding tasks, and working in poor quality conditions with long social hours. Campaigns that restate nursing values such as compassion and dedication may be sending the wrong message. The nursing profession at present may require to highlight its professional standards, job variety and challenges, autonomy at work, as well as great opportunities for career development and higher salaries with additional bonuses of employment security and benefits (Donner and Wheeler 2001). Some nursing students at present are not required to pay tuition fees, receiving free university education for three years. Newly qualified nurses get paid during holidays, receive large amounts of sickness benefits, and can be employed in any place and at any time that they desire at least in the United States (International Council of Nurses 2001); however, this may not necessarily be true in the UK. These facts, however, are insufficient in increasing the number of nurse applications as a response to nurse shortages and the rising number of locations which are in need of nursing care. To address this concern, selection and recruitment of possible candidates may involve psychometric tests or self-assessment questionnaires before being enrolled for them to understand and be exposed to the realities of having a nursing career (Hall 2008). Training opportunities should also be capable of preparing the overall aspects of the nurses for their duties. In a study of the perceptions of nursing students, Sand-Jecklin & Shaffer examined the ways in which students' perceptions of nursing as a profession changed after their initial experiences in the classroom as well as clinical settings. (Sand-Jecklin & Shaffer, 2006) To understand and accept the factors which contribute to the negative image of nursing and discourage young individuals to become nurses is a crucial step in developing effective human resource policies (McGillis Hall, Waddell, Donner, and Wheeler 2004). Financial reward has become the focus of the nurses’ complaints over the years (De Gieter, Cooman, Pepermans, Caers, Du Bois, and Jegers 2006; Jolner and Hafer 1983). Through an increase in pay levels, working conditions for nurses may see an increase in staff members. Flexibility in working hours, employment security, enhancement of facilities and an increased effectiveness of management are some of the other means for attracting nurse applicants. 2.2.3 Policies for Nursing Government efforts for improving the working conditions of nurses have been placed on various measures that were developed such as those for the enhancement of work-life balance issues (Hancock 2001). For example, in the UK, the Human Resources Performance Framework set targets for addressing human resource objectives for the NHS, such as enhancing working lives; making sure that the NHS provides an environment where members are motivated to work together and deliver quality health services; securing a reliable and competent workforce by facilitating clinical governance, workplace equality, and sickness absences; and building up the workforce through an increase in training and education opportunities, investments for leadership development, and establishment of clear career directions (Department of Health 2000). Equality frameworks were also established to promote equal opportunities, decrease the rate of work harassment, and improve policies for the zero tolerance for physical attacks on staff members (HSC 2000). These schemes represent a systematic approach towards human resource management within the NHS as it exhibits an understanding of the need to enhance HR systems within the public sector alongside improvements in the private sector’s HR practices. It is commendable to develop such plans and effectively conduct these strategies to meet the targets for additional nurses and address shortages in the process (Newman et al 2002). 2.2.4 Career Commitment and Job Performance The career commitment of nurses can be defined in various ways, most often characterized by the intent of nurses to pursue their nursing career for a long time. Psychologists such as Cohen (2003) have examined commitment in the workplace, particularly the ways with which it can be developed and measured, and how the concept may be related to job performance and professional and personal satisfaction. Career commitment of nurses include their dedication towards the nursing profession, particularly their desire to act in accordance with values of nursing; to work for the betterment of nursing; and to continue carrying out their duties for nursing (Fort and Voltero 2004). It plays a crucial role in driving employees to develop the necessary technical and soft skills to maintain a gainful nursing career. The relationship which exists between commitment and work performance has been examined by several researchers such as Wright and Bonett (2002). The latter indicated that career commitment can influence job performance and turnover among nurses who are newly employed. A drop in career commitment during their first year of work is likely the reason for a higher rate of turnover among these registered nurses. A number of factors can affect career commitment such as the increasing nursing shortage worldwide, educational and organisational culture, gender, and clinical settings. The study of Ingersoll, Olsan, Drew-Gates, De Vinney, and Davies (2002) pointed out that the nurses who worked in psychiatric and medical-surgical areas along with those in the intensive care units showed the lowest levels of career commitment. As commitment to one’s career has been linked to job performance, it is necessary that the commitment of young students and new nurses is kept at a satisfactory level (Cooper-Hakim and Viswesvaran 2005). Moreover, other factors should be present such as interpersonal support from peers and supervisors, reliable and consistent management, communication, recognition, as well as training and education (Meretoja and Leino-Kilpi 2001; Tzeng 2004). On the other hand, job stress, excessive workload, difficulties in leadership, inadequate job-related skills, as well as old age, did not have a positive influence on the job performance of nurses (Reid and Dawson 2001; McConnell 2003). These suggest how career commitment and job performance can be influenced by each other; therefore, in order to attract and retain members of the nurse workforce, it is necessary that all possible factors which contribute to commitment and performance be reinforced. As a corollary, others that may have an adverse impact on the behaviours and actions of nurses must be reduced. 3 Methodology 3.1 Research Philosophy Two main research philosophies, positivism and interpretivism, refer to paradigms upon which the quantitative and qualitative methods are rooted (Lin 1998). Positivism, which is generally associated with quantitative research, upholds the scientific method with which physical and human events that happen are observed in a systematic manner and captured through numerical representations. The ideal research methodology epitomising positivism is the experiment, which is marked by stringent control of variables. Such approaches espouse methodical means of measuring and analysing data (Matveev 2009), and the use of survey methodology is subsumed under these approaches. Because it intends to predict the causes and effects of phenomena as in the case of experiments, these relationships between the variables of interest are systematically uncovered. Researchers often find it simpler to conduct quantitative research methods, which are equated with positivism, compared to qualitative ones. Quantitative methods enable conclusions from empirical means and break constructs into explicit, measurable variables, thereby having more control over the process (Creswell 2003). Statistics, empirical observations, and other consistent means of measurement also guide researchers in the analysis of such variables. The concept of empiricism puts forth reasonable and valid conclusions from scientific methods that lend themselves readily to replication (Balnaves and Caputi 2001). Generally, positivism proves to be of use particularly when the researcher aims to collect a significant amount of data without having to utilize considerable time and resources. When additional data are necessary for further explanations, the use of follow-up interviews or focus group discussions may be employed. On the other hand, the philosophy of interpretivism highlights the in-depth and comprehensive way of gathering data, mainly by individual interpretations of occurrences and experiences and deriving conclusions from these (Denzin and Lincoln 2003). One of the most common criticisms towards this approach is that, although qualitative data may pay more attention to detail, the interpretation of these primarily relies on the opinions and judgement of the researcher, hence, the greater possibility for bias. Because the researcher’s views form the main foundation for interpreting all gathered data, the researcher must exercise prudence to prevent subjectivity in interpretation (Denzin and Lincoln 2003). Moreover, the participants in qualitative research are sometimes asked to provide a detailed and in-depth account of their experiences as they narrate these to the researcher. The recall of such experiences also helps them to further understand what they have undergone in the past, and be able to articulate these to the investigator. The study proposed here is qualitative in nature and fits within an interpretive approach. 3.2 Research design The research design plays a crucial role as it becomes the foundation for the ways with which data will be collected, measured and analysed. The current study will take on a qualitative, descriptive research design that will allow the researcher to observe and describe the phenomenon at hand without influencing it in any manner. Descriptive research thus obtains an overall outlook of the subject without introducing any intervention or modifying the context in which the behaviour or phenomenon occurs (Burns and Grove 2005). It takes place in an unchanged natural environment and guides the researcher into testing the variables that are worth investigating. Although the results from a qualitative descriptive research design may not be used as a final answer or a means of refuting the hypotheses, these may be used as a springboard for future research. This study will use a mixed research approach to ascertain whether the personal statement matches with the outcomes that students actually achieve within their nursing degree.. Upon collection of data from personal statements, these shall be analysed according to the method of qualitative content analysis proposed by Elo and Kyngas (2008): 1) whether there is a match between their personal statement and the actual outcomes upon degree completion; and 2) the main reasons for selecting nursing as a career choice. These will be translated into simple descriptive statistics, specifically frequency and percentage breakdowns, to provide an extensive overview of the results as well as qualitative commentary on links and explanations. The main research strategy that shall be employed is documentary analysis. The main sources of primary data in documentary analyses are primary documents, which in the case of the present research are in the form of personal statements of nursing students. In simple terms, thematic analysis requires the identification of distinct themes that arise on a specific question or category, and qualitatively determining how preponderant these themes are from the interviewees’ responses. 3.3 Sampling Method A non-probability sampling method will be used in this whole population sample of applicants to a nursing programme in order to reduce problems of selection bias. Ideally several cohorts will be surveyed, allowing for control of various demographic factors relating to success and attrition in nursing programmes. This will enable a clearer delineation of the effects which attitudes have on student success across all demographics, so the results will be representative of the entire cohort and of potentially greater value than more limited studies. A more representative population will have the drawback of creating more variables which must be considered in the final synthesis. 3.4 Data collection A data collection instrument will be designed to facilitate this study. It will take the form of a questionnaire to be utilised in conjuncion with primary documents. The questionnaire will survey demographics and personality traits as well as reasons for applying to the programme and expectations of both the programme and professional nursing. (See Appendix ) Information collected will be stored in a database to facilitate easier sorting according to various criteria. The sorting process will focus on the primary factors for attrition and allow for the exclusion from the final data set of students who, for reasons unrelated to their attitudes about nursing, would have been unlikely to achieve successful completion of the programme for which they applied. Archived application files will be viewed, in particular personal statements, and will be labelled with student numbers to facilitate correlation between attitudes and final outcomes. 3.5 Ethical Considerations Say that you will adopt a risk-benefit approach according to Long and Johnson (2007) –this is in the reading list. There is the possibility of breach of confidentiality, but several steps will be taken to minimize the risk. No documents will be removed from school premises, and all data collection will occur in a secure room allocated by the school. Records will be identified exclusively by student number and, as they are recorded, will be assigned a unique project number in order to ensure student anonymity. Data will be stored either on a password-protected computer with access restricted to the researcher or stored in a locked filing cabinet, as appropriate. All reported results will be based on anonymous pooled data; It will not be possible to identify information pertaining to any individual student. Consent: Although individuals will not be involved in this study, their records will be the main source of data. All students give consent to the data held by the school being used to improve the programme and the student experience, so consent has already been secured as long as you remain within the agreed remit of the study. 3.6 Resources Required Access to student applications, as well as the opportunity to spend several hours with those records will be required. Depending on the number of students in the cohort studied, time requirements may vary considerably. A laptop computer will facilitate rapid transfer of information from primary sources to the proposed database, as well as replacement of student numbers with randomly assigned, unique project numbers. All notes related to the research will be stored on the computer in a single and secure folder. Printing the final report will necessitate paper and ink, though the exact quantity of either cannot be accurately determined in advance of the preliminary research (e.g. the number of students in the cohort, pages of final report). 3.7 Proposed Method of Analysis The qualitative data that will be collected through the personal statements will be subjected to inductive content analysis as detailed by Elo and Kyngas (2008). "The aim [of qualitative analysis] is to attain a condensed and broad description of the phenomenon, and the outcome of the analysis is concepts or categories describing the phenomenon." (Elo & Kyngas, 2008) Analysis includes three phases: Preparation, organising, and reporting. Preparation will include the formal literature review, final decisions regarding the the use of words, phrases, or sentences in the inductive analysis process, actual collection of data and subsequent data review. Organisation will include the entry of collected data into a secure database as well as sorting of data according to various factors associated with attrition and choosing which data will be included in the study, with clear explanations of any data excluded. Following organisation and categorisation of data, results will be reported. This report will include any charts or tables created during the organisational phase. 3.8 Limitations This study will be limited by researcher bias, as some subjective interpretation of primary documents may be required as there are no systematic rules for the qualitative analysis of data. (Elo & Kyngas, 2008) It may also be limited by a lack of information regarding the causes of individual student attrition; This will depend on what information was collected by the school at the time of attrition. By developing an appropriate instrument, applying content analysis techniques outlined by Elo and Kyngas (2008), and sorting data according to demographic variables, these issues will hopefully be minimised if not mitigated. 4. Conclusion 4.1 Summary The dearth of literature regarding the effect of applicant attitudes toward nursing on successful completion of a nursing degree programme compels us to further research. Many factors are known to contribute to attrition, but this particular relationship has not been recently studied in any great detail. 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