nursing shortage nursing shortage a nursing shortage occurs when the demand for nursing professionals, such as registered nurses (rns), exceeds the supply locally—within a health care facility—nationally or globally. it can be measured, for instance, when the nurse-to-patient ratio, the nurse-to-population ratio, the number of job openings necessitates a higher number of nurses than currently available, or the current number of nurses is above a certain age where retirement becomes an option and plays a factor in staffing making the work force in a higher need of nurses. the nursing shortage is global according to 2022 world health organization fact sheet. nursing shortage is a problem in several districts of norway. this nurse is employed at a nursing home. a nursing shortage is not necessarily due to a lack of trained nurses. in some cases, perceived shortages occur simultaneously with increased admission rates of students into nursing schools. potential factors include lack of adequate staffing ratios in hospitals and other health care facilities, lack of placement programs for newly trained nurses, inability for students to complete schooling in general or with the appropriate grade and inadequate worker retention incentives. the reduced number of nurses today does play a role in shortages across the world, though. as of 2006, the who estimated a global shortage of almost 4.3 million nurses, physicians and other health human resources worldwide—reported to be the result of decades of underinvestment in health worker education, training, wages, working environment and management. these will continue to be reoccurring issues if not disentangled now. a study in 2009 by the emergency nurse has predicted that there will be a shortage of 260,000 registered nurses by the year 2025. a 2020 world health organization report urged governments and all relevant stakeholders to create at least 6 million new nursing jobs by 2030, primarily in low- and middle income countries, to off set the projected shortages and redress the inequitable distribution of nurses across the world. while the nursing shortage is most acute in countries in south east asia and africa, it is global, according to 2022 world health organization fact sheet. the shortage extends to the global health workforce in general, which represents an estimated 27 million people. nurses and midwives represent about 50% of the health workforce globally. current overview a march 2022 who fact sheet reported that about 50% of the global health workforce was experiencing a global shortage. of the 27 million people who make up that workforce, approximately 50% are nurses and midwives. this is most acute in countries in south east asia and africa. causes nursing shortage is an issue in many countries. to interpret the problem, psychological studies have been completed to ascertain how nurses feel about their career in the hope that they can determine what is preventing some nurses from keeping the profession as a long-term career. in a study completed by sociologist bryan turner, the study found that the most common nursing complaints were: subordination to the medical profession on all matters, even over standardized regulations difficult working conditions a report from the commonwealth of australia identified a few other matters that led to nurse dissatisfaction: constant schedule changes work overloads due to high number of patients and paperwork, according to a 2002 journal article; shift work lack of appreciation by superiors lack of provided childcare inadequate pay lack of interest to join the field in countries with inadequate pay, according to a 2020 "systematic review and meta-analysis"; another study found that nurse dissatisfaction stemmed from: conflicting expectations from nurses and managers due to regulation of cost inability to provide comprehensive nursing care due to work loss of confidence in the health care system, based on a 2014 russian non-academic paper. another study reported in a 2020 british journal of nursing article, conducted by peate and colleague, found that the inability to provide effect and efficient care to patents caused nurses to question their job abilities and fear that their job was at stake. in many jurisdictions in the united states, by 2003, administrative/government health policy and practice had changed very little for decades. a 2003 nursing science quarterly article said that one of the priorities at that time was cost-cutting and that patient loads were uncontrolled, and nurses were rarely consulted when recommending health care reform. as of 2004, the major reason for nurses planning to leave the field, according to a 2004 emerging infectious diseases journal article, was because of working conditions. with the high turnover rate, the nursing field does not have a chance to build up the already frustrated staff. aside from the deteriorating working conditions, the real problem is "nursing's failure to be attractive to the younger generation." a 2004 journal of nursing education article said that there was a decline in interest among college students to consider nursing as a probable career. at that time, more than half of working nurses said they "would not recommend nursing to their own children" and a little less than a quarter would advise others to avoid this as a profession altogether. in a 2006 journal of advanced nursing article, australian nursing researchers john buchanan and gillian considine described hospitals as "being run like a business" with "issues of patient care… of secondary importance." emotional support, education, encouragement and counseling are integral to the everyday nursing practice. however, these practices are not easily quantified and are considered by managers as unjustified cost for the patients, who are viewed as consumers. therefore, only clinical responsibilities, such as medication administration, dressing changes, foley catheter insertions, and anything that involves tangible supplies, are quantified and incorporated into the organization budget and plan of care for the consumers. by 2004, the undersupply of nurses in health care facilities in the united states was predicted to become even more critical over the following twenty years. along with more aggressive "efforts to attract and retain nurses" in the united states, many institutions increasingly recruited foreign nurses. while this created a domestic and international lucrative business opportunity, a 2004 health affairs journal article raised ethical concerns in terms of how nursing shortages affected african countries and the philippines, for example, as american recruiters risked diminishing their own domestic supply of trained nurses. in response, in 2010 the who's world health assembly adopted the global code of practice on the international recruitment of health personnel, a policy framework for all countries for the ethical international recruitment of nurses and other health professionals. impacts of nursing shortage nursing shortages (including low hospital-level nurse-to-patient ratios) have been linked to the following effects: increased nurses' patient workloads increased risk for error, thereby compromising patient safety increased risk of spreading infection to patients and staff increased risk of adverse outcomes such as falls, pneumonia, shock, cardiac arrest, and urinary tract infections increased risk for occupational injury increase in nursing turnover, thereby leading to greater costs for the employer and the health care system increase in nurses' perception of unsafe working conditions, contributing to increased shortage and hindering local or national recruitment efforts there is an increase in the number of nurses suffering from nurse burnout due to an extreme increase in stress. extensive amounts of stress on the human body lead to psychological, mental and, physical health effects such as headaches, body aches, sleep disruption, chronic fatigue which in the long run can lead to anxiety, depression, somatic symptoms. nursing shortages have an impact on the healthcare environment in all aspects of nursing, but it does impact other nurses directly causing the nursing community to face issues of burnout. burnout is a feeling that nurses experience when an overwhelming amount of workload is placed on a nurse. usually this causes nurses to experience exhaustion in many different aspects, a sense of not feeling like themselves, and a sense of not feeling accomplished enough. sometimes, burnout can interfere with good professional behavior and play a factor in the quality of care nurses give their patients. the feeling of burnout tends to contribute to feelings of stress as well. in relation to burnout, nurses are known to experience sleep disturbance which consist of trouble falling asleep as well as experiencing poor quality sleep. sleep disturbance correlates directly with stress and burnout presenting that nurses with a higher level of sleep disturbance have lower levels of stress management. the issue of burnout tends to be a common factor that many nurses face due to the stress from an overwhelming workload, which can make it hard for some nurses to fall in love with their career field. poor working conditions can place nurses at a higher risk for being a victim of workplace violence, such as not taking the proper vacation time, causing increased patient exposure as well as stress and exhaustion. this can have a negative affect on patient care as some nurses may resort to bringing self defense weapons to work to protect themselves. global shortage and international recruitment the nursing shortage takes place on a global scale. australia, the uk, and the us receive the largest number of migrant nurses. australia received 11,757 nurses from other countries between 1995 and 2000. the u.s. immigration and naturalization service (ins) records show that more than 10,000 foreign nurses were given h-1a visas in the same time frame. the u.k. admitted 26,286 foreign nurses from 1998 to 2002. saudi arabia also depends on the international nurse supply with 40 nations represented in its nurse workforce. netherlands needed to fill 7,000 nursing positions in 2002, england needed to fill 22,000 positions in 2000, and canada would need about 10,000 nursing graduates by 2011. country number of nurses density per 1,000 population year canada 309,576 9.95 2003 china 1,358,000 1.05 2001 india 865,135 0.80 2004 japan 993,628 7.79 2002 new zealand 31,128 8.16 2001 nigeria 210,306 0.28 2003 philippines 127,595 1.69 2000 united kingdom 704,332 12.12 1997 united states of america 2,669,603 9.37 2000 zimbabwe 9,357 0.72 2004 source: data from the world health organization (2006). in an american hospital association study, the cost to replace one nurse in the u.s. was estimated at $30,000–$64,000. this amount is likely related to the cost of recruiting and training nurses into the organization. hiring foreign nurses is more financially taxing compared to hiring domestic-graduate nurses; however, facilities save money in the long run because foreign nurses have a contractual obligation to complete their term. the jacho in the united states wrote in a 2002 research report on the shortage in the us that recruiting foreign trained nurses from abroad (not referring to those who reside in the united states already) does not help the global nursing shortage and, in fact, perpetuates it. countries that send their nurses abroad experience a shortage and strain on their health care systems. in south africa, accelerated recruitment by developed countries such as united states, united kingdom and australia has placed more pressure on the health care system due to prevalence of diseases, such as aids, and limited resources. similar to the u.s., nurses who leave the organization are a financial disadvantage due to the need to fund recruiting and retraining of new nurses into the system. it has been estimated that every nurse who leaves south africa is an annual loss of $184,000 to the country, related to the financial and economical impact of the nursing shortage. the following table represents the number of nurses per 100,000-population in southern african countries. number of southern african countries number of nurses per 100,000 population 16 100 10 50 9 20 3 less than 10 in india international migration has been considered as one of the reasons behind shortages of nursing workforce. social, economic and professional reasons have been cited behind this shortfall. retention of nurses by sending (often developing) countries can be addressed by improving working conditions, minimizing wage differentials, and promoting medical tourism. retention can also be promoted through educational activities to improve job satisfaction. there can be additional unintended impacts of nurses migration abroad. for example, there is growing evidence that physicians in the philippines have shifted to the nursing field for better export opportunities. the world health organization (who) representative in manila believes the government should invest more into its health sector as it is 3% of the philippines' gdp. others have suggested programs which require domestic service or employment