Nursing Shortage Issues: Leadership, Standards and Jesuit Values

The Nursing Shortage

 Universally nurses are being asked to do more with less:  Less staff, less resources, and in some cases, less pay.  While on the other hand, nurses are being given more:  more patients, more overtimes, and more paperwork away from their patient care duties.   The purpose of this paper will be to identify how nursing leadership theories, the scope and standard of Nursing practice, and Jesuit values can all help to alleviate this issue of the nursing shortage. 

Issues

 According to the Bureau of Labor Statistics, by the year 2026, the career of registered nursed (RN) is predicated to see a considerable amount of job openings.  More than 438,100 new RN jobs ae estimated to be added by that time.  This is a predicted growth of 15% from 2016 to 2026, which is much faster than for any other occupations (2019).

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As baby boomers age, so does the nursing population.  In 2016 there were approximately one million nurses over the age of 50.  In 10-15 years, these nurses will reach retirement age (Grant’s study as cited in Haddad & Toney-Butler, 2019).  Burnout is another reason for the nursing shortage.  Nursing turnover rates were between 8.8% and 37%, depending on the specialty and location (Haddad & Toney-Butler, 2019). 

 Another large factor is the lack of educators needed to train new nurses.  In a report by the American Colleges of Nursing, in 2016-2017, schools turned away 64,067 qualified nursing applicants due to a shortage of faculty, clinical sites, classroom space, resources, and funding (2019). 

Nursing Theories

 Nursing leaders must take the information they have regarding the various reasons for the

nursing shortage and use a professional theoretical perspective to direct their decisions in order

to change this issue (Arruda, 2005).  

Nursing theory can be defined as “an organized framework of concepts and purposes designed to guide the practice of nursing”.  Nursing theories are developed to explain and describe nursing care, guide nursing practice and provide a foundation for clinical decision making (Petipen, 2016). 

Theory of Human Caring

Nursing is a physically, emotionally, spiritually demanding and stressful job.  Jean Watson’s grand theory of human caring could be utilized to research way to bring about a more nurturing environment for nurses to work in.  Watson’s theory was her attempt to bring meaning and focus to nursing as an emerging discipline and distinct health profession that had its own unique values, knowledge, and practices, and its own ethic and mission to society (Smith & Parker, 2015, p. 322).  The caritas, from the Latin word meaning “to cherish and appreciate, giving special attention to, or loving” were created by Watson as a framework for providing a format and focus for nursing (Smith & Parker, 2015, p. 323).  The ten caritas processes (Watson, 2008) and examples of how they leaders can use them as a guide towards easing the nursing shortage: 

1.   Practice loving kindness toward self and others.  Encourage staff to engage in self-care activities and to practice loving kindness for self and other staff members. 

2.   Instill faith and hope in others.  Incorporate a sense of faith and hope by honoring staff with days off for their religious holidays and celebrations.

3.   Nurture individual beliefs and practices for self and others. Recognize the differences in staff members and promote their potential and their talents.

4.  Promote helping and trusting relationships.  Useeffective communication skills

and be accepting and sensitive to the feelings of the staff. 

5.   Acceptance of positive and negative feelings.  Let the staff voice their feedback, be it positive or negative, without passing judgment on their opinions.

6.   Creative solution-seeking using scientific methods and all ways of knowing. Encourage the staff assist in problem solving when issues arise.

7.   Genuine teaching and learning that supports individual needs.  Support a working environment that offers opportunities for continuing nursing education and create work schedules that accommodate individual as they pursue higher learning.

8.   Creation of a healing environment.  Provide a working environment that is nurturing and supportive of any internal and external pressures that may be affecting the staff.

9.   Provide acts of healing by attending to basic human needs.  Make sure the staff has adequate time for breaks, lunch, and bathroom.

10. Remain open to mystery and the unknowns of existence.   Be open and accepting of the diversity of the staff and their spiritual/religious beliefs.

 Nursing leaders can incorporate the caritas into the daily routine.  Healthy work practices, limiting overtime and on call, and providing healing support with time to rejuvenate, can lead to a more satisfying work environment. 

Theory of Modeling and Role Modeling

 Helen Erickson, Evelyn Tomlin, and Mary Ann Swain developed the grand theory of modeling and role modeling.  Modeling is the process that helps us to understand and see what a person perceives to be important, what caused the problem, and what may help.  Role modeling requires analysis and interpretation and is used to help people grow and find meaning in their

experiences (Smith & Parker, 2015, pp. 186-188). 

This theory uses five goals:  build trust, promote positive orientation, promote control, promote strengths, and set health-directed mutual goals (Smith & Parker, 2015, p. 187).  The modeling and role modeling theory uses instincts and drives which are necessary for humans to travel through life.  These instincts and drives closely follow Maslow’s hierarchy of needs pyramid (Arruda, 2005).

This theory can be utilized to alleviate the nursing shortage by first meeting the basic needs of nurses (physiological).  Consider the wages and benefits packages offered to the staff.  Make sure they have kept up with the cost of living and are adequate for survival.  Second is safety.  Nurse-to-patient ratios must be at a satisfactory level so that safety is not an issue for staff or patient.  Third is love and belonging.  Pleasant relationships with co-workers and mutual decision making can lead to nurses that feel respected and a part of the team.  Self Esteem is the fourth step.  Providing positive feedback to staff and meaningful communication gives staff recognition for their hard work.  Self-actualization occurs when nurses find gratification and recognize the potential they have.  Assisting staff with professional development is a step toward helping them prepare for advanced opportunities. There is a sixth level that is sometimes seen in Maslow’s pyramid and that is transcendence. When the nursing staff has reached a level of self-actualization, they should be encouraged to help others also achieve that level (Arruda, 2005). 

Leadership Attributes Needed for Implementing Change

Nursing leaders need skills and attributes to achieve change to the current nursing

shortage crisis.  They need to be respectful, be honest, establish trust, be accessible, and be confident.  The leader needs to have excellent communication skills.  They need to ask for feedback and listen to what is being said (Carlson, 2015).

 The leader needs to be fair.  Not all decisions made will seem fair to everyone. Decisions need to be thoroughly thought out and explanations given as to how the leader arrived at that decision (Carlson, 2015).

 Leaders need to have self-knowledge.  They need to critically look at their leadership style and admit to any shortcomings or errors in judgement.  They need to continue to learn and grow from their reflections of their way of leading (Carlson, 2015).

 They need to be flexible.  Not all things must be “carved in stone”.  Leaders need to evaluate situations in an objective manner and determine what is working and what is not.  They need to listen to suggestions from the staff and determine if the suggestions are reasonable and would work in their environment (Carlson, 2015).

 Leaders need to discipline without shame.  Staff members may commit errors, but a leader should never be condescending.  Errors should never be discussed in the presence of others (Carlson, 2015). 

 Nurse Leaders need excellent interpersonal skills.  This will enable them to work with a variety of different personalities.  Nurses are unique individuals and leaders need to take this into consideration when having interactions. 

 Leaders have to take into account staffing and make it a priority.  The ratio of nurses to patients must be safe and acceptable.  Quality patient care, patient satisfaction, and health related

outcomes decrease when nurses have too many patients to care for. 

 A great leader would have exceptional team building skills.  Leaders and staff need to

have a shared vision and purpose for their work area.  Weekly staff meetings and daily huddles can help keep this vison and purpose in focus.  This vison and purpose should be revisited on a regular basis to decide if it is still relevant or if any changes need to be made. 

 Problem solving skills is another attribute needed to be an effective leader.  The nurse leader needs to be able to quickly think and access a situation when it occurs.  Critical thinking and brainstorming with others to come to a solution is crucial.

 Healthcare settings are becoming more technology directed.  As with all nursing staff, leaders need to be able to cope with these changes.  As these changes increase, it is becoming critical for nurse leaders to have in-depth knowledge regarding the newest technology and innovative procedures happening in healthcare. 

 Great leaders respect people.  They value and treat others equally.  Those of different race, religion, ethnicity, gender, sexual orientation, age, socioeconomic status, or political differences need to be treated with the same regard.  This also applies to the workplace as nursing units are often made up of many diverse individuals.  Diversity should be acknowledged and valued in the workplace.  All employees are unique and their values and life experiences are varied.  They may therefore have different ways of looking at the big picture.  Leaders and other staff members must respect these viewpoints and see if there are ways that these views can bring about creative change. 

Applying Leadership Theory to the Resolution

 Transformational theory transforms and changes people and it is concerned with emotions, values, ethics, standards, and long-term goals (Northouse, 2016, p. 161).  The goal here is to resolve the nursing shortage issue.  Transformational leadership influences followers to accomplish more than what is normally expected of them.  These leaders are often self-confident, have strong moral values, are competent, have high expectations, and are excellent role models (Northouse, 2016, pp. 161, 165). 

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 In order to help alleviate the nursing shortage, transformational nurse leaders will need to have a plan of action and present it to the staff.  The leader may want to consider bringing the nursing team in at the beginning to get suggestions for the plan.  The plan would include how to make the new nurse on the unit feel welcome and a part of the team.  It should cover the best way to transition new nurses to the unit.  The leader needs to question the staff to find out ways that they would want to be rewarded for taking on an extra shift when the unit is short.   The leader should encourage learning.  Sending staff to conferences and classes that are relevant to their field should be incorporated into the plan.  The leader should look into taking on nursing students who are finishing their education as a way of enticing them to apply once they have passed their board exams.  Self-scheduling is a great incentive to retain nurses.  Many nurses leave as they cannot return to school or fit their nursing schedules around their family needs.  By putting this option into the plan, the nurse leader retains her staff and the nurse is able to have less stress and worry in her life. 

Scope and Standards of Nursing Practice and the Nursing Shortage

 A register nurse and advanced practice nurse are required to follow the Scope of Nursing Practice as mandated by each state. The Scope of Nursing Practice is the range of tasks, positions, and obligations which licensed registered and advanced practice nurses are authorized to perform.  The Standards of Nursing Practice are duties that all registered and advanced practice nurses are expected to be able to perform with competence (American Nurses Association, 2015, p. 51).  Several standards of nursing practice could address the nursing

shortage, but the focus will be on Standard of Practice 4, planning and Standard of Practice 5, implementation. 

Standard of Practice 4: Planning

 In this standard of practice 4-planning, the “registered nurse develops a plan that prescribes strategies to attain expected, measurable outcomes” (American Nurses Association, 2015, p. 59).  Nursing leaders should develop a plan as to how best use the ten caritas from Jean Watson’s theory of human caring on a daily basis in their work environment.  The plan should be developed utilizing the suggestions of the staff, it should make the staff a priority, it should promote a positive working environment, be supportive, and be diverse to meet the needs of the all the staff (American Nurses Association, 2015, pp. 59-60).

 Using Erikson’s, Tomlin’s, and Swain’s theory of modeling and role modeling this planning standard could be designed to align with the instincts and drives that are vital for nurses.  Nursing leaders should create a plan that advocates for staffing salaries and benefits that are sufficient for maintaining a living.  Their plan should include evidence based data on what safe nursing-patient ratios are on their type of unit.  The leaders need to have supportive care as part of the plan to improve self-esteem and they need to implement steps to assist staff with professional education advancements Using Erikson’s, Tomlin’s, and Swain’s theory of modeling and role modeling this planning standard could be designed to align with the instincts and drives that are vital for nurses.  Nursing leaders should create a plan that advocates for staffing salaries and benefits that are sufficient for maintaining a living.  Their plan should include evidence based data on what safe nursing-patient ratios are on their type of unit.  The leaders need to have supportive care as part of the plan to improve self-esteem and they need to

implement steps to assist staff with professional education advancements (American Nurses

Association, 2015, p. 59). 

Standard of Practice 5: Implementation

 This is the implementation of the plan that the nurse leader has formulated.  The leader will incorporate Watson’s ten caritas into the daily routine of the unit.  They will provide a culturally congruent holistic environment by recognizing the diversity of the staff and being sensitive to their differences.  They will demonstrate caring behaviors to develop a relationship with the staff (American Nurses Association, 2015, p. 61).   The leaders will communicate, collaborate, and consult effectively with their staff (American Nurses Association, 2015, p. 62).      

 Implementing the modeling and role modeling theory the nurse leader will meet the needs of the nursing staff.  The leader needs to use evidence based information to ascertain that the staff makes an adequate wage and has necessary benefits (American Nurses Association, 2015, p. 61).  Their plan should include evidence based data on what safe nursing-patient ratios are on their type of unit and translate this evidence into practice to provide safety for the patients and nursing staff (American Nurses Association, 2015, pp. 61-62).   Leaders will implement an effective working relationship with the staff in order to promote self-esteem American Nurses Association, 2015, p. 62). 

Jesuit Values and the Nursing Shortage

 There are six key values that the Jesuits emphasize.  These values are Cura Personalis, Magis, Men and Women for and with Others, Unity of Mind and Heart, Contemplatives in

Action, and Finding God in all Things (Regis University, 2019).  The resolution to the nursing shortage can be reflected in these Jesuit values. 

 Cura Personalis is Latin and means caring for the whole person (Regis University, 2019). Nursing leaders need to be open and accepting of all the differences in their staff.  They need to demonstrate to the nursing staff that they are valued.  Leaders need to practice self-care for themselves and encourage their staff to do the same.  This includes caring for the whole self-body, mind and spirit.   Leaders: give attention to the person standing in front of you.   Nursing staff: give attention to the reflection you see in the mirror.  

Magis is Latin for more (Regis Univsersity, 2019).  Leaders should be available to give support to the staff when it is needed.  They need to be approachable and be readily accessible to the staff.

Men and Women for and with Others-This Jesuit value represents a spirit of giving (Regis University, 2019).  The nurse leaders should be competent, committed, and compassionate toward their staff and their diverse needs.

Unity of Mind and Heart– Leaders should develop the professional skills of their staff.  By encouraging a learning environment the nursing staff will be able to feel a stronger sense of accomplishment in their career. 

Contemplatives in Action-Occasionally nursing leaders need to stop and reflect on what they have been implementing and whether it is still an effective plan for the staff.  

Finding God in All Things-This phrase sums up Ignatian Spirituality (Regis University, 2019).  Nursing leaders need to be aware of all their actions and the effects they have.  They need to encourage their staff to express their feelings and concerns and really listen without trying to formulate in their head how they should respond. 

Summary and Conclusion

The healthcare industry needs to find creative ways to retain the current nursing staff and recruit new staff.  Applying the theory of human caring and the theory of modeling and role

modeling, to tackle the nursing shortage presents the opportunity to make long lasting changes.  Transformational leadership theory can enable an valuable nurse leader to transform their staff and influence the staff to accomplish more than what is expected of them.  Nursing leaders need to design a plan and then implement those plans using evidence based data to ensure an effective action plan to resolve the nursing shortage.   Reflecting on the six Jesuit values can also lead to a resolution of the nursing shortage.     

References

• American Association of Colleges of Nursing. (2019). Nursing Shortages Fact Sheet.  Retrieved from:  https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
• American Nurses Association. (2015).  Standards of Practice. In Nursing: Scope and standards of practice (3^rd e). (pp. 51, 59-62).  Silver Spring, MD:  Nursesbooks.org
• Arruda, E. (2005).  Better retention through nursing theory. Nursing Management, 36(4). 16-18.  Retrieved from:  http://web.b.ebscohost.com.dml.regis.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=a08f967e-899f-4ba4-ab7d-f0447f67903b%40pdc-v-sessmgr05
• Bureau of Labor Statistics. (2019). United States Department of Labor. Occupational Outlook Handbook.  Retrieved from:  https://www.bls.gov/ooh/healthcare/registered-nurses.htm
• Carlson, K. (2015). 5 positive traits of a high-caliber nurse leader.  Nurse.com. Retrieved from:  https://www.nurse.com/blog/2015/10/18/5-positive-traits-of-a-high-caliber-nurse-leader/
• Haddad, L. M. & Toney-Butler, T. J. (2019).  Nursing shortage.  Treasure Island, FL: StatPearls Publishing.  Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK493175/
• Petipen, A. (2016).  Nursing theory definition.  Retrieved from:  http://www.nursing-theory.org/articles/nursing-theory-definition.php
• Regis University. (2019). Key Jesuit values.  Retrieved from: https://www.regis.edu/About-Regis-University/JesuitEducated/Key-Jesuit-Values.aspx
• Smith, M. C. & Parker, M. E. (2015).  Helen Erickson, Evelyn Tomlin, and Mary Ann Swain’s  theory of modeling and role modeling. In Nursing theories and nursing practice (4^th ed.), (pp. 187-189). Philadelphia, PA: F. A. Davis Company
• Smith, M. C. & Parker, M. E. (2015). Jean Watson’s theory of human caring.  In Nursing theories and nursing practice (4^th ed.) (pp. 322-323). Philadelphia, PA: F. A. Davis Company
• Watson, J. (2008). Nursing: The philosophy and science of caring. (Rev. ed.). Boulder, CO: University Press of Colorado