Nursing shortage Refers to a position Where the demand for nursing professionals , Such As Registered Nurses (RNs) Exceeds the supply-locally (eg, 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, or the number of job openings necessitates a higher number of nurses than currently available. This situation has been observed in developed and developing countries around the world.
Nursing shortage is not necessarily due to a lack of supply of trained nurses. In some cases, perceived shortages occur simultaneously with increased admission 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, and inadequate worker retention incentives. 
Globally, the World Health Organization (WHO) estimates a shortage of almost 4.3 million nurses, physicians and other healthcare resources worldwide. 
Nursing shortage is an issue in many countries. To remedy 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 carryover from the Commonwealth of Australia APPROBATION A Few other matters nurse That led to dissatisfaction:
- Constant schedule changes
- Work overloads due to high number of patients and paperwork
- Shift work
- Lack of appreciation by superiors
- Lack of provided childcare
- Inadequate pay
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. 
In many jurisdictions, administrative / government health policy has changed very little in the last decades. Cost-cutting is the priority, patient loads are uncontrolled, and nurses are rarely consulted when recommending health care reform .  The major reason for the decision to leave the field, as stated by the First Consulting Group, is because of working conditions.  With the high turnover rate, the nursing field does not-have had 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.”  There is a decline in interest among college students to consider nursing as a probable career . More than half of currently working nurses “would not recommend nursing to their own children” and a little less than a quarter would advise others to avoid this altogether profession. 
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, thesis practices are Not Easily quantified and are regarded by managers as unjustified cost for the patient , Who are viewed as Consumers .  Therefore, only clinical responsibilities, such as medication administration, dressing changes, foley catheter insertions, and anything that involves tangible supplies,
The nursing shortage affects the developing countries that supply nurses through recruitment to work abroad in wealthier countries.  For example, to accommodate perceived nursing shortage in the United States, American hospital recruits nurses from overseas, especially the Philippines and Africa . This, in turn, can lead to greater nursing shortages in their home countries. 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 ethical international recruitment of nurses and other health professionals.
Impacts on healthcare
Nursing shortages have been linked to the following effects: 
- Increased nurses’ patient workloads
- Increased risk for error, affecting patient safety
- Increased risk of spreading infection to patients and staff
- Increased risk for occupational injury
- Increase in nursing turnover
- Increase in nurses’ perception of unsafe working conditions, contributing to increased shortage and hindering local or national recruitment efforts
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 US Immigration and Naturalization Service (INS) records that more than 10,000 foreign nurses were given H-1A visas in the same time frame.  The UK 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|
|United States of America||2669603||9.37||2000|
Source: Data from the World Health Organization (2006). In an American Hospital Association study, the cost to replace one nurse in the US Was Estimated at around $ 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, in which the recruiting and training of foreign nationals in the United States, 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 have placed more pressure on the health care system due to prevalence of diseases , such as AIDS , and limited resources.  Similar to the US, 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 economic 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|
|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. [ Citation needed ] Retention can also be promoted through educational activities to improve job satisfaction. There may be more unintended impacts of nurses migration abroad. For example, there is 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 in its health sector as it is 3% of the Philippines’ GDP.
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Foreign nurses that migrate from developing countries to the nursing shortage of developed nations pursue their own economic, career, and lifestyle interests, but there are risks. The media and scholars have been reluctant on the ethical issues concerning the potential exploitation of foreign nurses. ( According to whom? ] On the level of national sovereignty and global equality, there are ethical concerns about the skilled workers and assets. US incentives such as signing bonuses can be seen as promoting brain drain . “Brain drain in the south, brain waste in the north.”  The President of the Philippines Nurse Association, George Codero, was quoted in a New York Times article as saying “The Filipino people will suffer because the US will get all our trained nurses.”  
On an individual basis, foreign nurses are subject to exploitation by employers. In 1998 six Americans were charged with falsely obtaining H-1A visas and using them to employ Filipino nurses as nurse aides instead of registered nurses. [ Citation needed ] In a case in 1996, a Catholic archdiocese employed some of these foreign nurses as nurse aides instead of nurses. In 2000, Filipino nurses in Missouri received $ 2.1 million for failure to receive proper wages that an American in the same position would receive. While these cases have been brought to a close, the Jeopardizing the rights of foreign nurses. Foreign nurses have the tendency to receive less desirable jobs, such as entry-level positions, because of their immigrant status; They are excluded from jobs that would lead to facilities and are often not paid proper salaries. [ Citation needed ]
Some US health care facilities push the “ease restrictions” on the immigration law to increase the number of recruited foreign nurses . On the other hand, this recruitment practice is a temporary solution that does not fully address the nursing shortage as mentioned by American Nursing Association (ANA).  Others have taken a stand on ethically recruiting foreign workers. New York University Medical Center was cited in The Search for Nurses Ends in Manila as believing that it is a “poaching exercise” to take nurses from countries in need of their citizens.  The former health secretary, Dr. Galvez Tan, In the United States of America. ” 
Shortage by country
United States of America…………. The number of nurses in Morocco was 29.025 in 2011, two thirds being registered nurses and one third auxiliary nurses, a ratio of 8 nurses per 10,000 population.  As a result, Morocco has been listed among 57 countries suffering from a glaring shortage of medically trained human resources.
A recent study by the European Institute of Health Sciences (European Institute of Health Sciences) in Casablanca person based on scientific modeling of future needs  indicates que la condition will worsen and That to bridge the gap nursing, Morocco needs to Produce entre 40,000 and 80,000 new nurse graduates until the year 2025.
The Philippines is the largest exporter of nurses in the world supplying 25% of all overseas nurses.  An Organization for Economic Co-operation and Development in the OECD Countries of the Philippines.  Of all employed Filipino RNs, roughly 85% are working overseas.  This is a partial response to the inability of Filipino nurses to enter their domestic workforce due to a lack of jobs and instead become heavily dependent on international job markets for nurses. The United States has a particularly prominent representation of Filipino nurses. Of the 100,000 foreign nurses working in the US as of 2000, 32.6% were from the Philippines. 
Reasons for international migration
The international migration of Filipino nurses takes place in response to “push and pull” factors. This article is based on an analysis of the role of the labor market in the Philippines. The unemployment rate in the Philippines exceeds 10%.  Additionally, health care budgets set up Filipino nurses for low wages and benefit packages. There are fewer jobs available, and increasing the workload and pressure on RNs. Filipinos often pursue international employment to avoid the economic instability and poor labor conditions in their native country. The government also encourages the export of RNs internationally. Filipino nurses are internationally recognized. While a nurse in the Philippines will earn between $ 180 and $ 200 US per month, a nurse in the US receives a salary of $ 4,000 per month.  Nurses abroad are greatly respected in the Philippines as they are able to support an entire family at home through remittances. In 1993, Filipinos abroad sent $ 800 million to their families in the Philippines to support the economy.  Additionally, remittances from Filipinos made up 5.2% of the Filipino GDP (gross national product) between 1990 and 2000.  Further pull factors stem from the additional economic benefits of signing bonuses in the US To attract more foreign nurses, US Hospitals increased signing bonuses from $ 1,000 to $ 7,000.  Positions abroad in the health sector are also enticing for their immigration benefits. Throughout the past 50 years of nurse migration, the US has made efforts to ease the visa application process to further international nurses to relieve the nursing shortage. Scholars note that the best living and working conditions, higher income, and opportunities for career advancement draw nurses from the Philippines to work in the US
As the relationship between the US and the Philippines stretches back 50 years, Filipino nursing institutions often reflect the same education and methods as the US curriculum. Filipino nurses (work in the Philippines) to work in the US
Since 1916, 2,000 nurses have arrived each year in the US  In 1999, the US approved 50,000 migrant visas for these nurses.  Today, on average, there are about 30,000 Filipino nurses traveling to the US each year.
Effects of migration
The transnational migration of Filipino RNs has profound effects on the economy and workforce dynamics in both sending and receiving nations. The departure of nurses from the domestic workforce represents a loss of skilled personnel and the economic investment in education. In addition, the “scarce and relatively expensive-to-train resources” invested are lost when a worker chooses to work abroad.  When RNs migrate internationally, the country they emigrated from loses a valuable resource and any financial or educational support that was invested in the individual.
According to many Filipinos working in hospitals, the most educated and skilled nurses are the first to go abroad. There is disagreement among the scholars on the extent to which the Filipino health sector is burdened by its nursing shortage. While the numerical data are inconsistent about whether the nurse supply is in excess or a shortage, it is clear that there is a short supply of the most skilled nurses who go abroad. As a result, the staff is very helpful and very helpful. As skilled nurses decline in the urban areas, nurses from rural areas migrate to hospitals in the cities for better pay. As a result, rural communities experience a drain of health resources. Stories and studies alike demonstrate that a treatable emergency in the provinces may be fatal because there are no medical professionals to help treat them. In fact, “the number of Filipinos dying without medical attention has been steadily increasing for the last decade.”  The lack of attention from medical professionals has increased in advances in technology and medicine and the growing number of trained nurses in the Philippines.
Doctors, too, have changed professions and joined the international mobility trend. Filipino doctors have begun leaving their professions to train as nurses under the title MD-RN with the hope of immigrating to the US or other developed nations more easily. Since 2000, 3,500 Filipino doctors have migrated abroad as nurses.  The US incentives for nurse migration encourage doctors to train as nurses in the hopes of increasing their economic prospects. As a result, the Philippines has a lower average of doctors and nurses with 0.58 and 1.69 respectively for a population of 1,000. The average statistics globally in contrast are 1.23 and 2.56. Between 2002 and 2007, 1,000 Filipino hospitals closed due to a shortage of health workers. A study conducted by the Philippine Secretary of Health, Jaime Galvez-Tan, concluded that 80% of government doctors have become nurses or are studying nursing.  Of the 9,000 doctors-turned-nurses, 5,000 are working overseas.  The extraordinary influence of this international migration has had devastating effects on the health of Filipinos. The number of deaths which were not prevented with medical attention have increased as well as the medical treatment.  The extraordinary influence of this international migration has had devastating effects on the health of Filipinos. The number of deaths which were not prevented with medical attention have increased as well as the medical treatment.  The extraordinary influence of this international migration has had devastating effects on the health of Filipinos. The number of deaths which were not prevented with medical attention have increased as well as the medical treatment.
Due to the high interest in international mobility, there is little permanence in the nursing positions in the Philippines. Most RNs choose to sign short-term contracts that will allow for more flexibility to work overseas. Filipino nurses are committed to the hospitals as they are temporary staff members. This lack of attachment and minimal responsibility worsens the health of Filipino patients.
The education system has also been hurt by the increase of nurses in the Philippines. As Filipinos are attracted to working as nurses, the number of nursing students has steadily increased. As a result, the number of nursing programs has grown rapidly in a commercialized manner. In the 1970s, there were only 40 nursing schools in the Philippines; By 2005 the number had grown to 441 nursing colleges.  While the education opportunities for nursing students have grown tremendously, the quality of education has declined. This can be seen by the low rate (50%) of students who pass the nursing exam since the 1990s. In addition, the National Committee on Higher Education (CHED) determined that 23% of Filipino nursing schools failed to meet the requirements set by the government.
In summary, the emigration of Filipino nurses HAS Encouraged doctors to switch to nursing, created a shortage of skilled Specialized and Experienced nurses, affected the education system, and distorted health caredelivery and care to medical issues in rural areas. While remittances, return migration, and the transfer of knowledge support the Philippines, they fail to fully compensate for the loss of health workers , which disrupts the Filipino health and education sectors.
Dr. Jaime-Galvez Tan, the former Philippine Secretary of Health, warns that if the US passes legislation permits the immigration of the health service of the Philippines could collapse. 
In October 2015 The Government of the United States of America. 
In December 2015 207 out of 232 English hospitals (90%) reported nursing shortages. 
In January 2016, the RCN stated that more than 10,000 nursing posts would go unfilled in 2015.  This item will have a 3% increase in 2011 and 14% in 2014 and 17% in 2015 of all London nursing positions 10% as an average nationwide.  According to a BBC article the Department of Health said it did not recognize the figures. 
According to the American National Council of State Boards of Nursing ,  the number of US trained nurses has been increasing over the past decade: In 2000, 71,475 US-trained nurses became newly licensed. In 2005, 99,187 US-trained nurses became newly licensed. In 2009, 134,708 US-trained nurses became newly licensed. Therefore, a 9.8% annual increase of newly licensed US nurses has been observed each year over nine years. It is clear that, nursing enrollment in the United States has increased 1.19% annual US population growth.
While the number of US licensed nurses trained HAS Increased Each year, the nursing projected demand growth rate from 2008 to 2018, as Reported by the US Bureau of Labor Statistics,  is Anticipated to be 22%, or 2.12% Annually. Therefore, the 9.8% annual growth of new RN’s 7.7% per year with the assumption of consistent growth figures over the next decade.
The United States population is projected to grow at least 18% over two decades in the 21st century, while the population of those 65 and older is expected to increase three times that rate.  The increase in the number of elderly is projected to lead to an increase in demand for nurses in the care of the nurses as they reach the retirement age. Projections suggest that by 2020 to 2025 one third of the current RN and LPN workforce will be eligible to retire.  The current shortfall of nurses is projected at 800,000 by the year 2020. 
Occupational health and related occupations are expected to increase rapidly between 2000 and 2012. The demand for health care practitioners and technical occupations will continue to increase. It is projected that there will be 1.7 million job openings between 2000 and 2012. The demand for registered nurses is even higher. Registered nurses are predicted to have 1,101,000 openings due to growth during this 10-year period.  In a 2001 American Hospital Association survey, 715 hospitals reported that 126,000 nursing positions were unfilled. 
Other research findings report a projection of opposite trend. Although the demand for nurses continued to increase, the rate of employment has slowed down since 1994 because hospitals were incorporating more less-skilled nursing staff to substitute for nurses .  With the decrease in employment, the earnings for nurses decreased. Wage among nurses leveled off in correlation with inflation between 1990 and 1994.  The recent economic crisis of 2009 has further decreased the demand for RNs.
Comparing the data released by the Bureau of Health Professions, the projections of shortage within two years have increased.
US: Supply versus Demand Projections for FTE Registered Nurses
Source: Data from the Bureau of Health Professions (2002) 
However, this is not the case for the economy.   In 2009, Des Moines, Iowa, the newly graduated nurses were having difficulty finding jobs. This hiring situation was mostly found in hospitals; Nursing homes in. 
Some states have a surplus of nurses while other states face a shortage. This is due to factors such as the number of graduates and the total demand for nurses in each area. Some states face a severe shortage, while other states have a surplus of registered nurses.
US: Supply versus Demand Projections for FTE Registered Nurses
Source: Data from the Bureau of Health Professions. (2004). 
Patching up the shortage
Nursing Shortages Can Be consist intermittent gold DEPENDING on the number of patients Needing medical attention.
Retention and recruitment are important methods to achieve a long-term solution to the nursing shortage. Recruitment is promoted through making nursing as a profession, especially to younger workers, to counteract the high average age of RNs and future waves of retirement. Refining the work environment can improve the overall perception of nursing as an occupation. This can be achieved by matching satisfaction. Writers Lori Candela, Antonio Gutierrez, and Sarah Keating in the newspaper, Nurse Education Today , how the academic nursing administrators can make a change. “Individual support to expect workshops or conferences, participation in on-campus teaching / learning faculty sessions,
To assist the health sector, the Nurse Reinvestment Act (2002) provides funding for nursing education, scholarships , grants, diversity programs , loan repayment programs, nursing faculty programs, and comprehensive geriatric education.  Currently, mandatory overtime for nurses is prohibited in nine states, hospital accountability to implement valid staffing plans in seven states, and only one state implements the minimum staffing ratio. 
Other ways of assisting to fill the shortage in the United States would include their own overtime and schedules. Also, it would be a great incentive to be able to entertain the guests. 
To respond to fluctuating needs in the short term, nurses and nurses. Float pool nurses are staffed by the hospital to work in any unit. Agency nurses are employed by an independent staffing organization and have the opportunity to work in any hospitals on a daily, weekly or contractual basis. Similar to other professionals , both types of nurses can only work within the scope of practice , training, and certification.
Float pool nurses and agency nurses, as mentioned by First Consulting group, are used in response to the current shortage. [ Citation needed ] Use of the said services to increase the cost of health care, decreases specialty, and decreases the interest in long-term solutions to the shortage . [ Citation needed ]
International recruitment is often used to fill the nursing gap with the US Homeland Security has stopped the issuance of the H-1C visa, which was deemed specifically for nurses. Because of the Affordable Care Act, which will result in an increased number of insured Americans, it is estimated that there will be an even greater need for nurses in the near future.  US trained nurses are concerned, however, that this recruitment initiative impedes their ability to obtain positions in the field after completing their training. [ Citation needed ] A nursing shortage does not translate to new nursing jobs.
In response to the growing nursing shortage is the advent of travel nursing has Specialized sub-set of the staffing agency industry Evolved That HAS to serve the needs of hospitals affected. According to the Professional Association of Nurse Travelers , there are an estimated 25,500  working in the US The number of LVN / LPN nurse travelers is not known.
There is a nursing recruitment initiative and nursing workforce development program for residents of the United States originally from foreign countries, who were professional nurses in their countries. This initiative helps them get back into the nursing profession, especially getting through credentialing and nursing board exams.  The original model was developed in 2001 at San Francisco State University in cooperation with City of San Francisco (“The San Francisco Welcome Back Center”). There are a lot of places to visit in Los Angeles, San Diego and Boston.  It is a program for residents of the United States only.  The Boston Welcome Back Center was opened in October 2005 with a $ 50,000 seed grant from the Board of Higher Education’s Nursing Initiative. 
In September 2007, in the 110th Congress, Senator Richard Durbin of Illinois introduced S.2064: Nurse Training and Retention Act of 2007 on the floor of the Senate. It was a comprehensive program to ensure an adequate supply of nurses. It was referred to committee for study but was never reported by the committee. 
In April 2008, in the 110th Congress, HR 5924: Emergency Nursing Supply Relief Act was introduced to the House of Representatives by Robert Wexler of Florida. If it had passed, it would have amended the American Competitiveness in the Twenty-first Century Act of 2000 and would have given up to 20,000 visas per year to nurses and physical therapists until September 2011. Immediate family members of visa beneficiaries would not be counted Against the 20,000 yearly cap. The bill was referred to committees for study in Congress but was never reported by the committees.   
On February 11, 2009, John Shadegg (R-AZ), Jeff Flake (R-AZ), and Ed Pastor (D-AZ) in the 111th Congress to the House of Representatives, HR 1001 Nursing Relief Act of 2009 “: to create a new non-immigrant visa category for registered nurses, and for other purposes) making a new non-immigrant” W “visa category for nurses to be able to work in the United States. This was the first time in the history of the nursing shortage. The proposed bill was referred to the Committee on the Judiciary.   
The 2010 Patient Protection and Affordable Care Act includes more strategies for funding and retention. The Nursing Workforce is a nursing, nursing, and nursing education program. The program is designed to provide a high level of education and training to the students. 
The Nurse Reinvestment Act of 2002 had many strategies. This article is available in English, French, German, Spanish, Italian, Portuguese and Spanish. Creating options for the people who already have a degree but would like to go into nursing. 
Immigration process to US
Nurses seeking to immigrate to the US. For entry to the US a foreign nurse must pass a visa screen which includes three parts of the process. They must first pass a creditable review, Followed by a test of nursing knowledge called Expired the Commission on Graduates of Foreign Nursing Schools examination (CGFNS), and finally a test of English-language proficiency.
Foreign nurses compete amongst themselves, with professionals, and other skilled workers for 140,000 employment-based (EB) visas every year.  Filipino nurses are only allocated 2,800 visas per year, creating a backlog among applicants. For example, in September 2009, 56,896 Filipinos were waiting for EB-3 visa numbers.  This number contrasts with the 95,000 nurses licensed in 2009, many of whom want to migrate to the US Licensure Examination to qualify for US nursing standards. (See also Nursing visa retrogression in US .)
- Nursing portal
- Brain drain
- Health care providers
- Health Human Resources
- Physician supply
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- Jump up^ Boston Welcome Back Center for Internationally Educated Nurses “
- Jump up^ Fifield, Mary L., “World-Class Care: Boston Welcome Back Center Puts Internationally Educated Nurses Back to Work”(PDF) . New England Journal of Higher Education . 22 n4: 17-18 Winter 2008.
- Jump up^ Mendelsohn, Janet (June 2006). “Welcome Back Program Addresses Critical Nursing Shortage – Bunker Hill Community College magazine” (PDF) . Janetmendelsohn.com .
- Jump up^ “HR2064” . GovTrack .
- Jump up^ “HR 5924” . Govtrack.us .
- Jump up^ “HR5924 Emergency Nursing Supply Relief Act (Introduced in House)” . THOMAS Library of Congress .
- Jump up^ “HR5924: Emergency Nursing Supply Relief Act – US Congress – OpenCongress” . OpenCongress .
- Jump up^ The Nursing Relief Act of 2009 (HR1001) tracked in the Congress
- Jump up^ “Proposed Nonimmigrant Visa Category for Professional Nurses Would Help Fix the Shortage of Qualified Nurses” . globalimmigrationcounsel.com. March 5, 2009.
- Jump up^ “Nursing Relief Act of 2009 (Introduced in House) HR 1001 IH”. Library of Congress THOMAS (contains the full proposed bill).
- Jump up^ “College Nursing Scholarships & Grants for Nursing” . College Nursing Scholarships & Grants . Retrieved 28 March 2013 .
- Jump up^ “The Nurse Reinvestment” . The Nurse Reinvestment Act . Retrieved 28 March 2013 .
- ^ Jump up to:a b Pastor, Cristina DC. “Once a Hospital Mainstay, Filipino Immigrant Nurses Face Dwindling Job Opportunities.” Feet in 2 Worlds. Center of New York City, 14 Apr. 2010. Web. 05 May 2010.