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The data sets used and/or analysed during the current study are available from the corresponding author upon request.
This study aimed to determine factors that influence the nursing workforce shortage and their impact on nurses.
This study applied a systematic review design.
Using Cochrane library guidelines, five electronic databases were systematically searched (Research 4life—PubMed/Medline, Scopus, Embase, CINAHL) from 2010–2021. The remaining articles with pertinent information were presented in a data extraction sheet for further thematic analysis. A Reporting Items for Systematic Reviews and Meta‐Analysis Flow Diagram was adopted and used. The studies published from 2010–2021 and in English language were examined and included in the systematic review.
Four themes were identified as factors influencing the nursing workforce shortage, including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge that roots in multiple causes such as individual, educational, organizational and managerial and policy‐making factors.
Keywords: nurse burnout, nurse retention, nursing shortage, nursing workforce, systematic reviewNurses are essential workforce and form the largest professional group, which comprises healthcare workforce within the healthcare system in contributing significantly in delivering quality healthcare services, and assisting in the improvement of health outcomes for individuals, families and communities either through preventative and curative measures (Alameddine et al., 2017; Drennan & Ross, 2019). Furthermore, they are profoundly valued professionals and frontline healthcare workers in the world's healthcare system not only in delivering effective quality care but also in improving the efficiency of the health system; therefore, the adequate number of nurses is crucial to strengthen the health system to improve health coverage and achievements of all health targets (Aboshaiqah, 2016; Alameddine et al., 2017).
While the world has credibly acknowledged nursing profession as vital in delivering healthcare services, one of the main challenges faced today is the shortage of nursing workforce, which causes severe compromise on the quality of healthcare services, and in improving the well‐being of the global population and in achieving universal health coverage (Adams et al., 2021; Alameddine et al., 2017; Kurjenluoma et al., 2017; Park & Yu, 2019; Yahyaei et al., 2022). This is due to disproportions between the number of existing nurses and those that are entering the nursing profession compared with the required number of nurses to meet the patient's needs (Hudgins, 2016). Many studies discovered that there are discrepancies in the supply of nurses to maintain the adequate number of nursing workforce in response to ageing population, retirement along with the new recruitment of nurses as well as in retaining the existing nurses, which made it difficult to respond to the growing demand (Adams et al., 2021; Alameddine et al., 2017; Heijden et al., 2019; Matsuo et al., 2021; Otto et al., 2019; Park & Yu, 2019; Yahyaei et al., 2022). For instance, 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 (Yun et al., 2010) and an estimate of 12.9 million deficit of skilled nurses and midwives by 2035 (Adams et al., 2021; Yahyaei et al., 2022). Furthermore, it is estimated that the shortage of nurses may exceed 500,000 by year 2025, while in Europe, 590,000 nursing vacancies are estimated by year 2020 (Valizadeh et al., 2016). Moreover, in South Korea, the shortage of nursing is very serious that the average number of nurses per 1,000 people is only 6.9 compared with the other organization for Economic Co‐operation and Development (OECD) member countries with 9.2 and above. Heijden et al. (2019) added that in most developed countries in European Union and others, the shortage of nurses in the next two decades is likely to worsen in response to the supply of nurses and the demand.
According to the World Health Organization (WHO) report, it was estimated that there will be a shortage of 7.2 million health workers to deliver healthcare services worldwide, and by 2035, the demand of nursing will reach 12.9 million (Adams et al., 2021). The impact of nursing workforce shortage is a huge challenge globally and is affecting more than one billion people, especially vulnerable populations such as women and children who badly needed the quality healthcare services (Aluko et al., 2019; Marć et al., 2019). The inadequate supply of nurses has notably created many negative impacts on the patient's health‐related outcome as well as challenges to fight diseases and improving health, which causes increased workload and stress levels on nurses and later results in decreasing the quality of nursing care, threatening the safety of patient and increasing the patient's mortality rate (Heijden et al., 2019; Leineweber et al., 2016; Matsuo et al., 2021; Valizadeh et al., 2016; Varasteh et al., 2021; Yun et al., 2010).
There are many factors affecting the healthcare system as a result of the shortage of nursing workforce. If these factors are not addressed promptly and appropriately, the number of people requiring quality nursing care will continue to be affected and the primary goal to improve and protect the health of the individual will continue to be a challenge (Matsuo et al., 2021; Valizadeh et al., 2016). These include the decreased number of student nurse's enrolment in nursing programme due to a lack of proper planning and funding availability and the increased number of early retirement due to health problem (Alameddine et al., 2017; Alshmemri et al., 2013; Barnett et al., 2010; Valizadeh et al., 2016). In Japan, the declining birth rate and increased population causes the inadequate number of workforce (Matsuo et al., 2021). Furthermore, in Thailand, the rapid migration of nurses due to poor working environment and conditions is the main cause of nursing shortage in the country (Nantsupawat et al., 2017). While in Singapore and other developed countries, job dissatisfaction remains the main reason for nurses' migration (Aeschbacher & Addor, 2018; Alshmemri et al., 2013; Hung & Lam, 2020; Leineweber et al., 2016). Furthermore, in Lebanon, the nursing workforce suffers due to the high migration rate of new graduating nurses with Bachelor's degree to other countries just few years after their graduation due to brain drain (Alameddine et al., 2017). However, one of the main factors reported in many countries is inadequate policies and workforce planning (Abhicharttibutra et al., 2017; Amadi, 2015; Marć et al., 2019; Mehdaova, 2017). Frequent shortage of nursing in a healthcare system to provide services may lead to stress and burnout, which will affect nurse's performance and increase the chances of medical errors, especially in patient's treatment, clinical care and laboratory tests (Aboshaiqah, 2016; Hung & Lam, 2020; Matsuo et al., 2021; Otto et al., 2019; Park & Yu, 2019; Varasteh et al., 2021).
More literatures on the shortage of nursing are from the western studies with only few from the Pacific island countries. It is important to get a better understanding on the specific factors that affect shortage in the region to have a meaningful strategy to resolve the current shortage of nursing workforce. The aim of this review is to explore the key factors that are most affecting the shortage of nursing workforce and to identify areas for future research.
This systematic review study was conducted using Cochrane library guidelines. Five relevant databases were used to reach studies including Research 4life—PubMed/Medline, Scopus, Embase, CINAHL using search terms applicable to specific databases. “Booleans” operator was also used in the search strategy such as (AND and OR) to acquire best information between the following keywords: “Nursing workforce,” “Nursing staff,” factors, determinants and shortage. These were used to locate relevant studies that explore the factors affecting the shortage of nursing workforce and the issues affecting nurses and patient health outcomes.
All types of studies (qualitative, quantitative and mixed‐method) globally were considered in this review to extract the relevant articles among nurses in hospital settings and other health facilities. The studies published from 1 January 2010 to 31 August 2021 and in English language were examined and included from peer‐reviewed journals, published books and WHO reports with full text available that were related to the nursing workforce shortage and were suitable to support the current research study.
Systematic review studies and studies that their full text was not available were excluded. The information on shortage in other disciplines such as nurse aids, physicians and allied professionals are also excluded from this study.
The selection process begins by checking all the titles and abstracts of the articles to identify pertinent articles. After the abstracts, the full texts on the remaining articles were checked to see whether they are applicable to the current research study. The articles were also checked for duplication articles or studies and only articles that suited the inclusion and exclusion criteria were downloaded and saved for use. The bibliography of all the remained studies was also checked to find some other articles that are published but were not in the selected databases. Moreover, 42 articles altogether were retrieved, which addressed the factors that influence the shortage in nursing workforce, its impact on registered nurses and the recommended interventions and measures to resolve the nursing workforce shortage. All the selected articles were then grouped under the major themes. A Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) Flow Diagram in Figure 1 was adopted and used as a preferred reporting item for systematic reviews (Moher et al., 2009).
Article search and selection process
