A narrative review on the effect of economic downturns on the nursing labour market: implications for policy and planning (original) (raw)
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Labor Market Trends Among Registered Nurses: 2008-2011
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The impact of the Retirement of Baby Boomer Nurses on the Healthcare System', 2024
Healthcare System is becoming the backbone of « Prosperity and Sustained Existence of Any Given Country » because it helps prevent diseases while in the same time improving the quality of life, productivity, profitability and competitiveness. Unfortunately, several challenges are now preventing the Healthcare System from bearing all the fruits expected. For example, despite the current acceleration of the Care-centric Economy Era, many countries are facing Healthcare crisis mainly driven by the ‘ Nursing Shortage ’. Since then, it becomes relevant to understand the driving factors of this shortage in the U.S. and Worldwide. Accordingly, the current ‘ Demographic Revolution ’ mainly driven by the growing importance of ‘Aging Population’ ( James Michael WALKER, 2024) has started to be considered as one of the key driving factor of the current ' Nursing Shortage' because the growing importance of the Baby boomers and their retirement is negatively impacting the Healthcare System. In fact, Buerhaus, Peter I. et al. (2017) found that compassionate, career-minded, predominantly female baby boomers embraced the nursing profession in the early 1970s following the introduction of Medicare and Medicaid programs. As a result, in 1990, there were 1 million baby boomer registered nurses (RNs), making up about two-thirds of the RN workforce. Furthermore, Montana State University (2015) found that in 2015, almost 40 % of RNs were boomers over 50. Moreover, according to Bradley University (2021), in 2021, nursing workforce (approximately 4 million as of 2021) was made up of four generations : Twenty-two percent of registered nurses (RN) were baby boomers born between 1946 and 1964 (ages 57 to 75 in 2021). Thirty-seven percent were Gen Xers born 1965 to 1980 (ages 41 to 56 in 2021). Thirty-nine percent are millennials born 1981 to 1996 (ages 25 to 40 in 2021). Only 1 % are Gen Zers born 1997 to 2012 (ages 9 to 24 in 2021). Since then, the massive retirement of the aging nurses has started to dramatically reduce the ' U.S. Healhcare Labor Force '. Accordingly and at the global level, International Council of Nurses (ICN) (2021) found that with the ageing of the nursing workforce, 17 % of nurses globally are expected to retire within the next ten years, and 4.7 million additional nurses will need to be educated and employed just to maintain current workforce numbers, let alone address the shortages. In the U.S., Qualtrics (2024) finds that the average age of practicing nurse is 50 years old and it’s estimated that nearly one-third of the workforce will reach retirement age in the next 10-15 years. Furthermore, Buerhaus, Peter I. et al. (2017) predicted that the number of baby boomer RNs would reach 660, 000 in 2020, about half their 2008 peak. Moreover, Yun et al. (2010) found that in the United States of America (USA) , there is an extreme shortage of nurses as it will need approximately 3 million nurses to fulfil its nursing gap, a demand that cannot be easily achieved . In addition, Adams et al. (2021) and Yahyaei et al. (2022) found that the U.S. will experience an estimate of 12.9 million deficit of skilled nurses and midwives by 2035. Since then, Qualtrics (2024) finds that without a steady pipeline of new registered nurses to fill this gap, the industry expects to see a massive lack of nurses by 2030. Unfortunately, doing could put the U.S. at a greater risk of Healthcare Crisis. Unfortunately, the 2020 COVID-19 Pandemic with its associated Great Resignation has already shown to us what this Healthcare crisis associated with the nursing shortage will look like. In fact according to Morris, Gayle (2023), the COVID-19 has highlighted the gaps in healthcare and created an increasing demand for bedside nurses. For example, due to existing nursing shortages, the aging of the nursing workforce and the COVID-19 effect, ICN estimates up to 13 million of nurses will be needed to fill the global nurse shortage gap in the future. Furthermore, International Center on Nurse Migration (2020) found that in total, 10.6 million additional nurses will be needed by 2030. In the United States, it's projected that 1.1 million nurses are needed to replace retiring nurses by 2022. Since then, and in aggregate terms, Buerhaus, Peter I. et al. (2017) found that four challenges face the nursing workforce today and tomorrow : the aging of the baby boom generation, the shortage and uneven distribution of physicians, the accelerating rate of registered nurse retirements, and the uncertainty of health care reform. Beside the COVID-19 pandemic, some other Systemic Risks such as the 2007-2009 Financial Crisis have also put the U.S. at a greater risk of ' Nursing Shortage'. In fact, Buerhaus, Peter I. et al. (2017) explained that major events like the Great Recession have led to baby boomer RNs retiring in large numbers, with roughly 60, 000 boomer RNs departing the workforce annually since 2012. Since then, it's becoming relevant to note that massive retirement of the ' Baby Boomer Registered Nurses (RNs)' and Systemic Risks such as the 2007-2009 Financial Crisis and the 2020 COVID-19 Pandemic are and will becoming one of the key driving factors of Nursing Shortage in the U.S. However, some specific ' Endogeneous Factors' are also playing a role into the current Nursing Shortage. Accordingly, Qualtrics (2024) finds that : - Schools are citing a lack of qualified nurse faculty and budget constraints as primary reasons for turning away aspiring nurses. Accordingly for example, in 2019, U.S. nursing schools turned away over 80,000 qualified applicants due to nurse faculty shortages and insufficient resources. - Schools don’t seem to be preparing nurses properly for entry into the workforce, with some estimates reporting that between 30-57 % of nurses quit their job within their first two years of employment. New nurses often cite workload, scheduling and lack of resources to meet their patients’ needs as reasons for leaving. Therefore, Kovner, C. (2022) has said that : « Therefore are concerns that the future balance between the supply and demand for nurses will result in major nursing shortages around the world ». As a result, both ' Endogenous and Exogenous Driving Factors ' of the Nursing Shortage' could prevent the Care-centric Economy Era from bearing all the fruits in the U.S. and Worldwide. Key Words : Healthcare System ; Nursing Shortage ; Demographic Revolution; Aging Population; Baby boomers; Registered Nurses (RNs); Nursing Gaps: Skilled Nurses ; Healthcare Crisis; Great Resignation; COVID-19 Pandemic; COVID-19 effect; Endogenous and Exogenous Driving Factors; Lack of Nursing Education Resources; Burnout and Stress Related to the Pandemic; Care-centric Economy Era.
Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993-2004)
Journal of Advanced Nursing, 2009
Title. Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993Canada ( -2004. Aim. This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals. Background. Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/ community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector. Method. Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status. Findings. For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1AE3 and four nurses, respectively, dropped out of Ontario's labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63AE3% (1994-95) to 38AE6% (2001-02). The proportion dropping out of Ontario's market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses' jobs. Conclusion. Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses.
Registered Nurses: The Curious Case of a Persistent Shortage
Journal of Nursing Scholarship, 2016
Purpose: To better understand the apparent persistent shortage of registered nurses (RNs), including both aggregate trends and cyclical responses. Design: We examine the employment of RNs over variations in economic activity, employing national aggregate and unique micro-population data on nurses in Arizona. Methods: These data, including our unique, ongoing survey of nurses in Arizona, enable a systematic examination of the cyclical demand for hospital care and institutional responses to that demand in the nursing market by employing multivariate regressions. Findings: Demand for hospital nursing care increases rapidly during the early years of recessions, moderating as the economy improves. Hospitals initially employ more temporary nurses, then reduce temporary hires by shifting employed RNs from part time to full time while also adding RNs not previously employed in hospitals. The substitution of regularly employed RNs for temporary nurses reflects the need to reduce staffing costs to offset increases in uncompensated care. Conclusions: The increased supply of nurses came from delayed retirements, higher relative hospital wages (inducing nurses in other sectors to return to hospitals), and added-worker effects. Additional nursing hours were drawn from a pool of RNs who were not employed in health care. Clinical Relevance: These results strongly suggest that correctly aligned incentives could reduce RN shortages without waiting for another recession. Shortages of registered nurses (RNs) in the hospital industry persist in good times and disappear during reces
Nursing Workforce Policy and the Economic Crisis: A Global Overview
Purpose: To assess the impact of the global financial crisis on the nursing workforce and identify appropriate policy responses. Organizing Construct and Methods: This article draws from international data sources (Organisation for Economic Cooperation and Development [OECD] and World Health Organization), from national data sources (nursing regulatory authorities), and the literature to provide a context in which to examine trends in labor market and health spending indicators, nurse employment, and nurse migration patterns. Findings: A variable impact of the crisis at the country level was shown by different changes in unemployment rates and funding of the health sector. Some evidence was obtained of reductions in nurse staffing in a small number of countries. A significant and variable change in the patterns of nurse migration also was observed. Conclusions: The crisis has had a variable impact; nursing shortages are likely to reappear in some OECD countries. Policy responses will have to take account of the changed economic reality in many countries. Clinical Relevance: This article highlights key trends and issues for the global nursing workforce; it then identifies policy interventions appropriate to the new economic realities in many OECD countries. This article examines recent trends and dynamics in the nursing workforce in a world deeply affected by economic change and financial recession. Demographically driven change in healthcare systems and policy responses are now compounded by an economic and financial crisis and its aftermath. Our objectives are to present an overview of the current global profile and dynamics of nursing in this changing situation; to provide country examples of the impact of the economic crisis on nursing mobility; and to discuss critical nursing workforce challenges and related policy responses. Databases of the Organisation for Economic Cooperation and Development (OECD) and of the World Health Organization (WHO) are the main sources; selected country level data and information were also analyzed.
Policies to sustain the nursing workforce: an international perspective
International nursing review, 2015
Examine metrics and policies regarding nurse workforce across four countries. International comparisons informs health policy makers. Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US ...
The International Journal of Human Resource Management, 2014
The healthcare system underwent considerable restructuring and downsizing in the early to mid-1990s in several countries as governments cut costs to reduce their budget deficits. Studies of the effects of these efforts on nursing staff and hospital functioning in various countries generally reported negative impacts. Healthcare restructuring and hospital downsizing is again being implemented in North America in 2009/2010 as governments struggle to reduce their deficits at a time of worldwide economic recession. The present study examines the relationship of hospital restructuring initiatives in and their link with increased threats to job security with a variety of individual and hospital outcomes in a sample of nursing staff working in hospitals undergoing significant restructuring and downsizing. Data were collected from 289 nursing staff working in California hospitals. Nurses reported a relatively large number of restructuring and downsizing initiatives. Restructuring initiatives and threats to job security accounted for a greater increment in explained variance on every outcome measure than did personal demographic factors and work situation characteristics. Threats to job security were generally associated with negative work attitudes and satisfactions, levels of psychological well-being and perceptions of hospital functioning. Some suggestions for more successful approaches to cost reductions are offered.