The issue of high nurse-patient rations will continue to affect the delivery of healthcare services across the U.S (Institute of Medicine, 2004). Additionally, the nursing shortage in the USA is expected to grow to 260,000 registered nursing staff by the year 2025. A shortage of this degree will be double that experienced in the past, in the US since the 1960s. Relating the case of nurse shortage in the U.S, one of the developed nations of the world, the case has not been any different for less developed nations like Taiwan. In Taiwan, a high number of hospitals are facing the problem of low nurse-staffing. The case has been very acute in recent years, leading to the closure of a number of wards at given hospitals, according to the statistics drawn from a study by the National union of Nurses’ association (Central News Agency, 2011).
Research studies on hospitals and healthcare centers show that institutions with inadequate nursing personnel show poorer patient outcomes, which compromises the care administered to patients. Decreased nurse staffing was linked to patient safety concerns and the increased incidence of adverse situations like the development of pneumonia, pressure ulcers, urinary tract infections (UTIs) (Lichtig, Knauf & Milholland, 1999), patient mortality (Aiken et al., 2002), medication errors (McGills-Hall, Doran & Pink, 2004), unplanned extubation cases (Marcin et al., 2005) and longer length of stay on average (Pronovost et al., 1999). Blegen and Vaughn (1998) discussed that, with a higher proportion of the service hours offered by registered nurses (RNs), there was a resultant decrease in the average length of stay (ALOS), cases of upper gastrointestinal bleeding, UTIs, medication errors and patient complaints, pressure ulcers, and pneumonia and cardiac arrests or shock with failure to rescue. Towards addressing the nurse shortage, the government has adopted a potential payment model to address the increasing medical expenditures. This has been affected through the imposition of measures like, the restructure of the operations of the hospitals facing financial pressure. This encompasses the adoption of strategies like the hiring of unlicensed assistant nurses or casual nurses, who are paid lower amounts as compared to the RNs, and can fill the service gaps (Sun et al., 2005). Nevertheless, it is challenging to improve nursing staff levels, even after the replacement of registered nurses with the less costly personnel. The factors leading to the unsolvable nature of the situation include the gap between the numbers of available vacancies and the number of qualified registered nurses, willing to fill these vacancies, the working conditions, the nurse burnout resulting from the shortage and low job satisfaction levels (Yin & Yang, 2002). Another issue heightening the nursing shortage is the abandonment of the nursing profession due to increased involvement in extra-patient care services like nursing informatics and utilization management. This is evident from a recent study, which showed an average vacancy level of 28% in Taiwan (Sun et al., 2005). In Taiwan, there is also legislation requiring a minimum nurse-to-patient ratio of 1:8 at hospitals. However, this minimum ratio was