Nursing, Ethics, and Healthcare Policy: Bridging Local, National and International Perspectives

Nursing, Ethics, and Healthcare Policy: Bridging Local, National and International Perspectives

Marilyn Jaffe-Ruiz (Pace University, USA), Sarah Matulis (Pace University, USA) and Patricia Sayre (Pace University, USA)
DOI: 10.4018/978-1-60960-174-4.ch014
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This chapter examines and analyzes ethical problems associated with the global nursing shortage, the international recruitment of nurses, and the strategies healthcare systems and governments use to minimize the impact of the nursing shortage within their borders. An argument is made that a more appropriate solution to the U.S. nursing shortage is not to pull from already burdened systems, but rather to recruit and provide financial aid to potential nursing students, especially underrepresented and economically disadvantaged students, from within the United States. Implications for migration, education, and healthcare policy are explored. Resulting challenges for nursing leadership and demands on nursing education are addressed, as well as approaches for addressing the issues of providing safe patient care, a satisfying work environment, and professional development.
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Today there is a wide-ranging shortage of nurses (Buchan & Calman, 2004) and (Kline 2004). That adequate nursing care is a requisite for improving healthcare outcomes worldwide is widely recognized and cannot be overemphasized (Buerhaus, et al., 2005a) and (Chenowethm, Jeon, Goff, & Burke, 2006). The nursing shortage severely impedes the development of world health because nurses are the basis for any healthcare system’s ability to provide health services. First, the primary role of nurses is to meet their patients’ healthcare needs, while acknowledging, respecting and supporting their patients’ values (Chenowethm, Jeon, Goff, & Burke, 2006). Additionally, nurses are vital to improving patient outcomes and enabling patients to utilize medical treatment from their providers. Consequently, this shortage looms as one of the biggest obstacles to achieving improved health and well-being for the world’s population.

The nursing shortage severely impedes the implementation and development of a feasible means to improve healthcare and address health disparities worldwide. It is important to note the imbalance in the nurse-to-population ratio, which highlights the scope of the shortage. Though nurses are the ‘front line’ in most healthcare systems, and their contributions are essential to meeting a minimal standard of healthcare and development goals, there is increasing evidence of nurse supply/demand inequality in many countries, which prevents meeting even the minimum standard of care.

Focusing on specific regions helps to highlight the global discrepancies of the nursing shortage. Europe, for example, has the highest ratio of nurses-to-population and it is 10 times greater than the lowest ratios of Africa and Asia. The average ratio in North America is, likewise, 10 times that of South America. The nurse-to-population ratio in the Caribbean varies from island to island, but is higher on average than Central or South America (Buchan & Calman, 2004.)

Even within a single region, there are discrepancies that need to be evaluated. Within Europe, for instance, Scandinavia has an average nurse-to-population ratio that is twice that of southern Europe. Greece, Portugal and Spain report much lower ratios than Scandinavian countries. Many countries in Africa, Asia, and Latin America are finding it especially challenging to retain a minimal level of nurses in their workforce to keep hospitals and clinics operational. Even within a single nation the nurse-to-population ratios can vary from less than ten nurses per 100,000 people to more than 1,000 nurses for 100,000 people – a difference of one hundredfold. The low availability of nurses in many countries is further exacerbated by a geographically uneven distribution, with even fewer nurses available in rural and remote areas than in cities. Adding to the discrepancy, skills and staff mixes vary among organizations, regions, and countries, and there is no “optimal” mix of nurses that countries may expect to achieve soon.

In the United States, the nurse-to-population ratio is approximately 825 nurses for 100,000 people according to the findings from the 2004 National Sample Survey of Registered Nurses, the latest of such surveys to be released to-date (Health Resources and Services Administration, 2006). The Health Resources and Services Administration study Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020 calculated an anticipated 20 percent shortage of nurses by 2015, and a 29 percent shortage by 2020. The current shortage in the United States is expected to reach 12 percent in 2010 (Health Resources and Services Administration, July 2002).

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