The increase in nursing shortage is a global issue. The rate of turnover and migration through health care system professionals is highly increasing which cause shortage in some countries or hospitals. This shortage is considered vital as it affects patients’ health status and quality of delivered care. In order to achieve health care effectiveness, health care systems have to overcome the shortage of qualified health personnel. Hiring graduated nurses and retaining employed staff nurses is very essential. The aim of this paper is to discuss generally the global nursing shortage and particularly the nursing shortage in UAE.
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Nurses play an important role in health care systems as they are considered the front line of any health care system. The crisis of nursing shortage is highly increasing worldwide. Buchan & Aiken, (2008) defined nursing shortage as the unwilling to work in specific conditions rather than the shortage of people having nursing qualifications. Health care systems face difficulties in recruiting & retaining nurses due to two reasons; nursing shortage and staff turnover. For example, the turnover rate in USA in year 2000 was between 10%- 30%, while in UK it was between 15%- 20% (Zurn et al. 2005). Turnover can be either voluntary like looking for a better income or better working conditions, and less work stress and overload, or involuntary like dismissal or medical disability. However, nursing shortage is considered a problem due to aging population, population growth and higher patient expectations (Simoen et al. 2005). In USA, the ratio of nurse: patient is 10:1000, while in Asia and Africa it is 0.5:1000 which is huge shortage (Buchan & Aiken, 2008).
The impact of nursing shortage
Nursing shortage has a depressing impact on health care systems. The inability to overcome this shortage will affect the improvement of health care systems. Nursing shortage can be noted when there is an imbalance between nursing skills and the actual number of nurses (Buchan & Aiken, 2008). On the other hand, not all available nurses are willing to work in their field due to payment and benefits issues which make them to choose non-nursing employment or no employment. Moreover, the shortage is widely noted in nurses who have specialty in some areas like critical care or emergency (Kingma, 2007).
Causes of nursing shortage
There are plenty of factors which lead to nursing shortage like decrease number of new recruited staff, inappropriate use of nursing skills, inadequate career support, gender-based discrimination in some cultures, and poor recruitment policies (National Center for Health Workforce Analysis, 2007; Buchan, 2006). Nurses keep searching for better opportunities to improve their skills, knowledge, and economic level. Therefore, nurses migrate from one country to the other.
Barriers to nursing migration
When nurses take the decision to migrate they keep in consideration some obstacles that they might face. One important issue to think about is certificate accreditation and requalification process. Other issues include the cost of living, the need to learn new language, and adapting a new clinical environment (Chandra and Willis, 2005; Kingma, 2006). Socially, there are some other barriers to migration; leaving families to stabilize person’s condition, facing new culture and environment, and racism which may lead to discrimination (Chandra and Willis, 2005).
Ways to decrease turnover rate
In order to overcome turnover problem, health care systems have to change their style of management. One way is by involving staff in decision making which make staff responsible. Promotions are also considered another way of decreasing turnover rate as staff will remain in hospitals to achieve and reach better positions. Moreover, staff self-scheduling is a good way of decreasing turnover rate as some staff don’t like to work weekends, nights, or overtime (Stordeur & Hoore, 2006).
Nursing shortage in UAE
Nowadays Emirati women have the right to join different educational and working fields. They are supported by low and government to improve their selves. However, Emirati women are not very involved in all fields like nursing. The dependency on expatriate nurses in UAE is very considerable as the percentage of Emirati national nurses is only 3% (FDON 2003). In 1960s, expatriate nurses started to turn up in UAE, while there were basic healthcare services in some areas like Dubai and Ras Al Khaima (al Rifai et al, 1996). As stated by Al Rifai & Van Der Merwe (2002), the MOH is the largest health care source and it has more than 17000 employees, 10000 from different countries and backgrounds. Around 6000 work in MOH and the rest are divided in the privet sector (Al-Rifai & van der Merwe2002).
Disadvantages of hiring expatriate nurses
Delivering the appropriate nursing care with respect to cultural and back ground differences is threatened by hiring expatiate nurses who are sometimes not fully aware of the surrounding culture. This issue may develop a conflict between nurses and patients, and increase the gap between them. However, this conflict may affect the quality of nursing care as nurses may try to enforce their own believes and values on patients. On the other hand, patients might be affected by not continuing treatment or following the treatment regimen properly because of stress, cultural conflict and ethical issues (El-Haddad, 2006).
Factors that lead to nursing shortage in UAE
There are some factors that lead to low percentage of national nurses in UAE. An important factor is gender-bias; the general idea in the country is that women have to take care and nurse their own families and that nurses are the handmaids for doctors. Another factor is the difference in nursing programs with the lack of updated educational resources. One more, is the low English level of students with the lack of Arabic educational resources (El-Haddad, 2006).
Establishing Federal Department of Nursing & Emirates Nursing Association
Federal Department of Nursing was established in 1992 by MOH. A team of professional nurses and administrative staff were specially made to evaluate the nursing profession (Al-Rifai & van der Merwe2002). On the other hand, the establishment of Emirates Nursing Association started much earlier; in 1970s. To start with the process of establishing an association there should be 50 national nurses according to UAE low. The effort remained over 30 years until finally in 2001 national nurses were able to start the Emirates Nursing Association which was considered an important event in the history of UAE. Since that time nationals started to join nursing field and be effective members within the health care system (El-Haddad, 2006).
WHO recommendations to improve nursing programs
According to (WHO, EMRO, 1998) recommendation in 1995, nursing programs have to be standardized within 15 years. The program would be designed as a four years university program with a certificate of bachelor of nursing science. On the other hand, nurses who have diploma degree will have the chance of continuing their education by joining bridging programs, which is encouraged and supported by the government until all nurses within the 15 years period time will have the BSN degree. This program will improve the nursing education and will improve the quality of care in the health care system. Nurses will be more updated and will have a solid base to build on their skills and experience, and will be able to work according to high level of standards. With regards to patients, patient will have better outcomes as they will be receiving a high quality of care. On the other hand, the number of practical nurses who depend on skills only will decrease by time (WHO, EMRO, 1998).
To conclude, there is a global nursing shortage worldwide. Population growth, searching for a better income and being involved in a better working environment are causing nurses to migrate from one country to the other; causing an increase demand of recruiting and retaining nurses. In UAE, nursing profession started to improve and develop recently. The need for a high number of national nurses made the government to encourage students by giving them a high standard level of education, higher income, and improving staff by giving them the chance of continuing education. The mission of government by this development is to prove the effective role of national nurses, overcome nursing shortage in UAE, and to improve the quality of care being delivered to patient as their expectations and level of knowledge are increasing. In my opinion, nurses are the forefront in the health care system and the better the level of nurses the system has, the better outcomes achieved.
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