PLEASE WRITE THE PAPER BASING IT ON THE ATTACHED AND PREVIOUSLY SUBMITTED PAPER OUTLINE AS WELL AS THE MARKING RUBRIC

This assignment provides the opportunity to critically research a current issue within the nursing profession (ISSUE ALREADY CHOSEN IN THE OUTLINE).

 Choose an issue covered in the course readings that interests and/or directly affects you (ALREADY CHOSEN).

 Utilize two McIntyre & McDonald (2019) Issue Analysis Framework’s as a guideline for the paper (Chapter 1) – Historical Analysis, Ethical and Legal Analysis, Social and Cultural Analysis, Political Analysis, Economic Analysis & Critical Feminist Analysis(TOW FRAMEWORKS ALREADY CHOSEN IN THE OUTLINE)

 Describe the impact (positive or negative) of the issue on yourself, nursing colleagues and the nursing profession.

 Identify and describe potential realistic strategies addressing your chosen issue.

 All papers should be double spaced, with TNR 12” font, one-inch margins and include page numbers.

 Papers must use APA format (6th or 7th ed.).  You may use strategies that help present your analysis, for example charts, diagrams, etc (attach as appendices).

 Length of paper is 10 pages (excluding references and any appendices). Papers beyond the page limit will not be read, and will be penalized.

 Use a minimum of 15 recent (≤ 5 years) peer reviewed research references. Textbook reference is acceptable as additional resource.

 Submit paper to Assignments by the due date/time.

NOTE: Assignments will use Turnitin to check for academic integrity issues.

Note: The marker-grader feedback, comments, or suggestions provided on the paper outline must be reflected in your scholarly paper.

Nursing Shortage in Acute-Care-Settings EssaySample

 What are the contributing factors to the current Nursing Shortage in Acute Care Settings?

Introduction

The nursing workforce is a central component of the healthcare system. Nurses are critical in delivering primary and community care, disease prevention, and health promotion. Nurses provide emergency care and are crucial to achieving universal health coverage. According to the World Health Organization (WHO), over 27 million people comprise the global midwifery and nursing workforce, accounting for 50% of the global health workforce (WHO, 2022). These and many other factors indicate nurses’ importance in the health care system. In Canada, there is projected to be a shortage of about 117,600 nurses by 2030 (Scheffler & Arnold, 2018). In 2020 data produced by the Registered Nurse’ Association of Ontario (RNAO) showed that a third of registered nurses providing direct care to patients are nearing retirement (RNAO, 2021). A 2019 survey conducted by the Canada Federations of Nurses’ Unions (CFNU) showed that 83% of nurses are concerned by the insufficient number of nurses to meet patient needs (CFNU, 2022; Stelnicki et al., 2020).(Nursing Shortage in Acute-Care-Settings EssaySample)

Although most literature relates the current shortage to the pandemic, the nursing shortage predates the pandemic. The pandemic highlighted an existing problem, providing additional pressure, stress, and workload, further exacerbating the situation. When the pandemic hit, most countries, including Canada, were already grappling with an overstretched healthcare system (CFNU, 2022). According to Statistics Canada (2022), at least 32,295 nurse positions, including registered nurses and practice registered nurses, remain vacant and stay open for three months, which further suggests difficulty with the recruiting process, albeit the demand for health services.(Nursing Shortage in Acute-Care-Settings EssaySample)

Before the pandemic, McGillis Hall (2020) alluded that about 60% of nurses stood to quit their jobs by 2021. More than a quarter of this number suggested leaving the nursing profession altogether. Another survey conducted by the RNAO revealed that 4.5% in Ontario were poised to retire during and after the pandemic (RNAO, 2022). The survey further showed that about 13% of nurses aged between 26 and 35 would likely leave the nursing profession after the pandemic. These findings highlight a systemic problem that Canada’s health system faces and will continue to face when solutions based on evidence are not adopted. Although the nurse shortage is evident in all nurse settings, the acute care setting is adversely affected, including critical and emergency care settings. The study aims to determine the contributing factors to the current nursing shortage in an acute care setting in Canada.(Nursing Shortage in Acute-Care-Settings EssaySample)

Research Question

The scholarly paper answers the research question: what are the contributing factors to the current nursing shortage in acute care settings in Canada? The goal of the research question was to help the researcher identify the contributing factors as opined by the acute care nursing population and leadership. The current nurse shortage in the acute care settings in Canada has created substantial difficulties in providing safe and effective healthcare services for patients across the country (CFNU, 2022). The paper identifies the factors contributing to the nurse shortage in acute care and the recommended leadership strategies to overcome the shortage.(Nursing Shortage in Acute-Care-Settings EssaySample)

Frameworks

The findings were analyzed based on historical and political contexts outlined by McIntyre & McDonald’s (2019) issue analysis framework. The framework was adopted to provide a broader contextual understanding of the determinants of nurse shortage in the acute care setting. A historical analysis of an issue allows a researcher to review nursing history (McIntyre & McDonald, 2019). As such, a researcher can evaluate a problem based on recorded observations from significant players and obtain historical understanding that is currently overlooked to understand the current issue comprehensively. Contrarily, the political analysis explores the influence and power within the topic of interest (McIntyre & McDonald, 2019). Significantly, political analysis determines the source of knowledge and voice influencing factors associated with an issue of interest. (Nursing Shortage in Acute-Care-Settings EssaySample)

Methodology

A qualitative systematic review method was adopted for this study. Qualitative research design is ideal for evaluating an unfolding context, individual opinions, and experiences relating to a given issue (Hennink et al., 2020). A literature search of three mainstream databases, including the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature On-Line (MEDLINE), was conducted in October 2022. Searches included a combination of terms such as nurse shortage*, nurse retention*, and acute care settings*. These terms were used to help identify research studies that evaluated factors associated with nurse shortage in an acute care setting in Canada. Purposive sampling was used to select only studies about acute care setting populations and leadership. The time frame was restricted to the past decade, considering the dynamic nature of the nursing landscape and the need to identify contemporary issues.(Nursing Shortage in Acute-Care-Settings EssaySample)

The search results were evaluated based on the inclusion and exclusion criteria, which were adopted to ensure the selected research articles were relevant through manual screening of abstracts and titles. For the inclusion criteria, the studies were written in English, and participants had to be registered nurses or leaders working in acute care settings in Canada. The exclusion criteria included studies with respondents who were non-registered nurses and focused on issues other than those related to nurse shortage. Reviews, non-English papers, and dissertations were also excluded. Consequently, the studies were appraised based on the inclusion and exclusion criteria and data thematically extracted for critical analysis.(Nursing Shortage in Acute-Care-Settings EssaySample)

The original literature search identified 8359 articles across the three databases. After duplicates were removed, the title and abstract of 5384 studies were read against the inclusion and exclusion criteria. Fifty-three papers were retrieved from the process and independently assessed by the researcher, excluding additional forty-one studies. The remaining studies were critically appraised using the Critical Appraisal Skills Program (CASP) for qualitative studies, excluding seven studies. CASP tool facilitates a systematic assessment of published papers’ trustworthiness, relevance, and results using various criteria for qualitative and other studies (Nadelson & Nadelson, 2014). The remaining five studies were included in the meta-synthesis using McIntyre & McDonald’s (2019) historical and political issue analysis framework.(Nursing Shortage in Acute-Care-Settings EssaySample)

Findings/Causes of Nurse Shortage

The five selected studies were all from Canada. The findings from the five studies were organized into themes. Twenty factors influencing nurse shortage in acute care settings were identified and synthesized into four categories: individual, positional, organizational, and team. For this study, individual factors were defined as personal issues that depend on nurses’ beliefs, experiences, and personal life. Positional factors were related to nurses’ inherent role in the acute care setting. Organizational factors were defined as those that the organization can influence or change to improve retention and reduce the shortage. Some factors were conceptualized to affect nurse shortage in more than one category, while other factors were defined as unique in their category.(Nursing Shortage in Acute-Care-Settings EssaySample)

Individual Factors

In all the studies, individual factors were fundamental determinants of nurse shortage. Five individual factors were identified across the studies (Hayward et al., 2016; Murphy et al., 2022; Nowrouzi-Kia et al., 2020; Sawatzky & Enns, 2012; Brown et al., 2013). These factors included a dysfunctional working relationship between nurses and physicians and among nurses, job dissatisfaction and job burnout, inflexible interprofessional working relationships, organizational commitment, and feelings of being valued. Hayward et al. (2016) argued that high patient acuity and increased workload associated with acute care settings contribute to job dissatisfaction and high turnover. In the study, Hayward et al. (2016) found that high patient acuity is associated with complex medical needs and health challenges, leading to work pressure in providing care for these patients, and the need for more knowledge results in high turnover. Participants reported feeling overwhelmed, and the consequent stress influenced their decision to leave the profession.(Nursing Shortage in Acute-Care-Settings EssaySample)

The complexity associated with high-acuity patients increases the workload since some patients require simultaneous care, leading to conflicting administrative and patient demands (Hayward et al., 2016). Increased patient demands are associated with operational failures in acute care settings, including persistent short staffing, high nurse-patient ratios, and overpopulated care units. Murphy et al. (2022) argued that the aging population, changing demographics, and patient acuity contribute to the rising demands on nursing services and the consequent nurse shortage. Nowrouzi-Kia et al. (2020), Sawatzky & Enns (2012), and Brown et al. (2013) related high job dissatisfaction with higher intent to leave the profession among nurses and low retention of nurses. Moreover, Brown et al. (2013) posited that feeling valued by the organization, staff, and fellow nurses is associated with high work performance, emotional commitment to the organization, and consequent nurse retention.(Nursing Shortage in Acute-Care-Settings EssaySample)

Team Factors

Two studies identified team factors associated with nurse shortage in acute care settings. Two factors were identified across the two studies (Hayward et al., 2016; Nowrouzi-Kia et al., 2020). One of the two factors is the dysfunctional working relationships between nurses and physicians and among nurses. The other factor is the inflexible interpersonal relationships in clinical settings. Hayward et al. (2016) argued that working relationship is a persistent challenge for nurses and is attributed to adverse mental and physical health outcomes.(Nursing Shortage in Acute-Care-Settings EssaySample)

Consequently, disrespectful and hostile professional working nurse-nurse or nurse-physician relationship directly impacts turnover intention. Equally, negative nurse-physician relationships can lead to a toxic work environment, incivility, job dissatisfaction, low level of organizational commitment, stress, burnout, and high turnover intentions. On the other hand, Nowrouzi-Kia et al. (2020) described the flexibility of nurses’ relationships in terms of autonomous practice and collaborative working relationships. The two aspects were identified as significant determinants of nurse retention and the consequent shortage of nurses in acute care hospitals.(Nursing Shortage in Acute-Care-Settings EssaySample)

Positional Factors 

Four studies identified positional factors as crucial determinants of nurse shortage in acute care settings. Four factors were identified across four studies (Hayward et al., 2016; Murphy et al., 2022; Sawatzky & Enns, 2012; Brown et al., 2013). These factors included high patient acuity, demand for services/increased workload, professional quality of life, and inadequate time to complete tasks. Sawatzky & Enns (2012) posited that the professional quality of life factors are defined by compassion satisfaction, compassion fatigue, and burnout. The factors related to professional quality are intertwined with individual nurses’ factors, including beliefs, experiences, and values. Moreover, Brown et al. (2013) observed that the lack of time associated with acute care settings often leads to the inability to complete tasks and consequently subverts work-life balance.(Nursing Shortage in Acute-Care-Settings EssaySample)

Institutional Factors

All selected studies identified organizational factors as significant determinants of nursing retention and shortage in acute care settings. Nine factors were identified across the fur studies contributing to retention and shortage (Hayward et al., 2016; Murphy et al., 2022; Nowrouzi-Kia et al., 2020; Sawatzky & Enns, 2012; Brown et al., 2013). These factors included inefficient leadership support, inadequate recruitment/supply of new nurses, retention/turnover, insufficient/lack of funding, resource availability, engagement, organizational commitment, and organizational cultures and values. In this study by Hayward et al. (2016), participants describe leadership gaps, notably absent nurse managers and failure to incorporate nurses’ views or acknowledge nurses’ contributions to unit functioning and patient care. Hayward et al. (2016) emphasized that leadership gaps negatively impact nurses’ mental health and well-being.(Nursing Shortage in Acute-Care-Settings EssaySample)

Murphy et al. (2022) identified significant issues associated with inadequate resources, an unsupportive work environment, turnover, retention, and insufficient funding. Underfunding and underinvestment in nursing units, inadequate clinical, faculty, and classroom space, low enrollment in nursing programs, shrinking application numbers, and poor nursing image collectively contributes to the nursing shortage in nurse settings in Canada and beyond (Murphy et al., 2022). Furthermore, Murphy et al. (2022) highlighted poor nurse-patient ratios, unsupportive leadership, lack of autonomy, lack of recognition, poor teamwork, inconsistent organizational culture, and feelings of being deprioritized as significant factors that characterized unsupportive work environment and contributors to the nursing shortage.(Nursing Shortage in Acute-Care-Settings EssaySample)

Murphy et al. (2022) further identified the aging workforce, stressful work environment, poor nurse transition, inadequate resources for nurse training, scarce advancement opportunities, mental health issues, burnout, and chronic anxiety as factors associated with low retention and high turnover among nurses. Lastly, Murphy et al. (2022) identified resource constraints, economic recessions/downturns, declining investments in nursing, consistent underinvestment in nursing, funding cuts, and limited planning policies for the nursing workforce as crucial factors contributing to the inadequate funding of nursing activities and consequent nurse shortage. The lack of resources and poor engagement of nurses are equally highlighted by Nowrouzi-Kia et al. (2020) and Sawatzky & Enns (2012) as contributing factors to nurse shortage in an acute care setting.(Nursing Shortage in Acute-Care-Settings EssaySample)

Unique Factors

The unique factor identified in this study is the Covid-19 pandemic. Murphy et al. (2022) emphasized the impact of the Covid-19 pandemic on the current nurse shortage in Canada. However, Murphy et al. (2022) and other studies acknowledge that the nurse shortage in Canada was evident before the pandemic and that the pandemic only amplified and exacerbated the situation. Murphy et al. (2022) argued that although the pandemic is a contributing factor to the nurse shortage, it amplified the demand for nurses in acute care settings and increased the number of hours that nurses have to work and adapt to the changing guidelines, leading to poor mental and physical health outcomes and intent to leave the profession altogether. Although the impact of the pandemic on nursing demand and guidelines have died down and services normalized, nurses who worked under the Covid-19 conditions felt a loss of teamwork, and some have consequently left the profession. The pandemic also contributed to increased staffing conditions, inspiring high turnover and high financial pressure on hospitals to recruit and retain staff. (Nursing Shortage in Acute-Care-Settings EssaySample)

Discussion

The high number of literature retrieved and the small number of literature selected for the analysis demonstrates that little research has focused on the opinions of nurses and leaders on nurse shortage in an acute care setting in the last decade. Nurse shortage is determined by a complex interaction of several individual, team, and organizational factors. Nurse shortage in the acute care setting is further determined by positional factors, i.e., the characteristics of nurse roles in the acute care settings. These findings are significant in advancing knowledge of possible interventions to minimize nurse shortages in acute care settings.(Nursing Shortage in Acute-Care-Settings EssaySample)

The studies analyzed offered explanations of the impact of nurse shortage on clinical settings, and these impacts have been validated in correlational studies. Hayward et al. (2016) asserted that the consequent nurse shortage is the primary determinant of poor quality of care. Poor quality of care results from factors such as the inability to complete tasks, exhaustion, burnout, frustrations, and poor mental and physical well-being. These findings corroborate those of Gosselin et al. (2016) that there is a significant association between psychological distress, job strain, psychological well-being, and intention to quit among ICU nurses. Hayward et al. (2016) further argue that strained professional relationships, as associated with negative attitudes and behaviors and impaired collaboration and cohesion among nurses, resulting in failure to answer patients’ calls and harassment, which are related to poor healthcare delivery and adverse patient health outcomes. Similar conceptions are shared in other studies and primarily conceived as poor care quality, unsafe patient care, and impaired quality improvement (Murphy et al., 2022; Nowrouzi-Kia et al., 2020; Sawatzky & Enns, 2012; Brown et al., 2013).

These findings are coherent with the most recent health survey among nurses conducted by the Registered Nurses Association of Ontario (RNAO). The survey revealed that the pandemic exacerbated an already dire situation affecting Ontario’s health system (RNAO, 2021). Moreover, the nurse shortage in Ontario is at risk post the pandemic, and the magnitude of potential departures associated with changes in career paths and retirement is a significant concern worth immediate response from healthcare providers and the government. According to Statistics Canada, nurses are most likely to leave their profession or change jobs in three years (Statistics Canada, 2022). The survey by Statistics Canada also highlights the role of job stress and burnout, as highlighted in the review, as the significant contributing factors to high intentions to leave the nursing profession.(Nursing Shortage in Acute-Care-Settings EssaySample)

These findings highlight the chronic nature of the nurse shortage affecting the Canadian health system. Dyer (2020) identified at least 14 hospitals operating without critical services in August 2022. These facilities are exhausting and depleting their nursing staff and are struggling to cope with the rising cases of Covid-19 patients and patients presenting other conditions requiring acute care. Dyer (2020) points to the closure of intensive and emergency care units in prominent hospitals, including Wingham, Peth, Clinton, Brampton, Alexandria, Bowmanville, and Listowel. The current trends point to the persistent inability of political leaders to provide sustainable ways of curbing the nurse shortage. The lack of appropriate recruitment, remuneration, and work environment policies demands explicit consideration of historical factors and appropriate political intervention.(Nursing Shortage in Acute-Care-Settings EssaySample)

Clinical Implications

The studies analyzed have recommended various strategies to address the nurse shortage. These strategies are multi-pronged and poised to provide an effective solution to nursing shortage compared to independent policies and single interventions. Hayward et al. (2016) recommend sharing responsibilities among nurses at the point of care and autonomous practices(Nursing Shortage in Acute-Care-Settings EssaySample). The recommendation validates Sherman & Pross’ (2010) argument that strong working relationships can be promoted through open communication and support for one another. In this case, nurse managers must provide immediate attention to issues faced by nurses and offer coaching opportunities to nurses on how to handle challenging situations. Providing mentorship in collaborative practice and creating a shared organizational style would enhance accountability and responsibility among nurses and influence positive organizational culture.(Nursing Shortage in Acute-Care-Settings EssaySample)

Murphy et al. (2022) recommend supportive leadership, effective organizational communication, team cohesion, positive organizational culture and support, job security, and nurse engagement. Ideally, interventions for nurse retention in acute care settings should be underscored by evidence. Moreover, healthcare providers and relevant decision-makers, including the government through political leadership, should be at the forefront, lifting the responsibility of supporting nurses concerning the persistent barriers to the recruitment of local and foreign nurses, advocating for nursing concerns and well-being through investment and establishment of opportunities for career growth and advancement.(Nursing Shortage in Acute-Care-Settings EssaySample)

Conclusion

It is suitable for healthcare providers and relevant authorities to seek ways to minimize nurse shortages. The measures should aim at attaining high retention, minimizing turnover, and recruiting qualified nurses on a rolling basis. However, the evidence from the reviewed articles highlights long-standing issues in the Canadian healthcare system that contribute to the nurse shortage. These factors are related to individual nurses, organizations, acute care roles, and team dynamics. These factors are intertwined, and no one-size-fit intervention that con completely solved. Therefore, multidisciplinary action is necessary to mitigate the nurse shortage. Specifically, appropriate organizational culture, nursing investments, recruitment and retention policies, improvement opportunities, collaborative nursing practice, and leadership support are crucial in mitigating nurse shortage.(Nursing Shortage in Acute-Care-Settings EssaySample)

References

Brown, P., Fraser, K., Wong, C. A., Muise, M., & Cummings, G. (2013). Factors influencing intentions to stay and retention of nurse managers: a systematic review. Journal of Nursing Management, 21(3), 459-472. https://doi.org/10.1111/j.1365-2834.2012.01352.x

Canada Federations of Nurses’ Unions (CFNU). (2022, January). Canada’s nursing shortage at a glance: A media reference guide. Available at: https://nursesunions.ca/wp-content/uploads/2022/07/nurses_shortage_media_ref_guide_comp.pdf  (Accessed 17 October 2022)(Nursing Shortage in Acute-Care-Settings EssaySample)

Dyer, O. (2022, 01 August). Covid-19: Ontario hospitals close wards as nursing shortage bites. https://doi.org/10.1136/bmj.o1917

Gosselin, E., Bourgault, P., & Lavoie, S. (2016). Association between job strain, mental health, and empathy among intensive care nurses. Nursing in Critical Care, 21(3), 137-145. https://doi.org/10.1111/nicc.12064

Hayward, D., Bungay, V., Wolff, A. C., & MacDonald, V. (2016). A qualitative study of experienced nurses’ voluntary turnover: learning from their perspectives. Journal of Clinical Nursing, 25(9-10), 1336-1345. https://doi.org/10.1111/jocn.13210

McGillis Hall, L. (2020). Outlook on Nursing: A snapshot from Canadian nurses on work environments pre-COVID-19. Canadian Federation of Nurses Unions. Available at:  https://nursesunions.ca/research/outlook-on-nursing/ (Accessed 17 October 2022)

Murphy, G. T., Sampalli, T., Bearskin, L. B., Cashen, N., Cummings, G., Rose, A. E., … & Villeneuve, M. (2022). Investing in Canada’s nursing workforce post-pandemic: A call to action. Facets. https://doi.org/10.1139/facets-2022-0002

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Nowrouzi-Kia, B., & Fox, M. T. (2020). Factors associated with intent to leave in registered nurses working in acute care hospitals: a cross-sectional study in Ontario, Canada. Workplace Health & Safety, 68(3), 121-128.(Nursing Shortage in Acute-Care-Settings EssaySample) http://dx.doi.org/10.1177/2165079919884956

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