Table 1. The results extracted from studies on nursing shortage in the world and in Iran .
Authors | Country | Causes | Strategies |
Aboshaiqah, 2016 (25) | KSA | Unsuitability for women, public’s negative view, challenging work environment, and foreign labor force | Educating and awarding degrees to attract and improve people's perspective toward nursing, using media to achieve public’s familiarization, and improving working conditions |
Abhicharttibutra et al, 2016 (26) |
Thailand |
Inadequate education, inconsistency between education and employment, performing no nursing tasks, social changes, and economic growth |
Increase of nursing education, and changing health systems policymakers |
Snavely, 2016 (27) |
USA |
Job abandonment and employment in other professions, aging and retirement, shortage of faculty members, and aging population |
Increase of employment rates |
Abbaszadeh et al, 2015 (24) |
Iran |
Aging population, inappropriate student recruitment policies, immigration, lack of faculty members, insufficient salaries, low social status, unwillingness to work, negative perception of nursing as a woman’s occupation, and lack of understanding of the role of a nurse |
Increase recruitment and retention of existing workforce, deploy nurses in other positions such as schools, increase job satisfaction, improve public’s perception of nursing, support Nursing Organization, familiarize society with the role of a nurse, optimize the work environment, increase nursing student admissions, and increase salaries |
Atashzadeh et al, 2014 (28) |
Iran |
Dissatisfaction with profession, poor management, and improper social status. |
- |
Rangriz et al, 2015 (1) |
Iran |
Low employment rates, job change due to job burnout |
Reduce the recruitment process and increase employment rates |
Soudagar et a l, 2014 (29) |
Iran |
Unwillingness to work because of being male, aging, stressful wards, contractual employment, and lack of interest |
Transfer of nursing personnel among different wards and improve employment status of contract-based nurses |
Ebadi et al, 2014 (30) | Iran | Immigration, recruitment in office jobs, job abandonment, job burnout, low salaries, opening of new centers, medical advances, increase in the number of elderly people, improper social status, and long working hours | Increase salaries and create financial incentives |
Cox et al, 2014 (31) |
USA |
Aging of nurses and patients, insufficient recruitment, new nursing students, inadequate training of nursing students, and insufficient salaries |
- |
MacLean et al, 2014 (32) |
USA |
Job abandonment due to improper planning, poor financial incentives, inappropriate geographical distribution of nurses, and the migration of nurses |
Improvement of health care infrastructure, use of computer technology, change of tasks, and use of inter-professional care groups |
Barnett et al, 2010 (19) | Australia | - | Increase of nursing departments/faculties and nursing student admissions, improvement of public's perception of nursing, improvement of professional self-image, decrease of students' withdrawal, encouragement of nurses' return, increase of nurses' entrance and prevention of migration, changing workforce combination and reduction of reliance on RN nurses, recognition of nurses' roles, improvement of salaries and the work environment, provision of independence and professional power, flexible work schedules, improvement of the structure of clinical work, increase of retirement age, reduction of occupational risks, and insurance against risks and mistakes |
Duvall et al, 2010 (33) |
USA |
Management problems, stress, physical needs, inadequate training, lack of faculty members, and hospital environments |
Strategies related to causes |
Flinkman et al, 2010 (34) |
Finland |
Job abandonment, professionalism and organizational commitment, job satisfaction, low salaries, low probability of progress, and contradiction between work and life |
- |
Yun et al, 2010 (35) |
China |
Inequality in pay and employment conditions of physicians and nurses, and immigration |
Improvement of health care system to increase retention, creation of strong educational infrastructure, and enhancement of public's perception |
Zarea et al, 2009 (21) |
Iran |
Decrease of employment, hospitalization only, centralized system and lack of independence, human resource planning, lack of position for graduated nurses, job change, immigration, low salaries, low social status, reluctance to enter nursing, consideration of nursing as a women's job, lack of job valuation, negative attitudes toward women's work at night, the inability of girls to enter nursing, job abandonment of girls after marriage, low job security, poor working conditions, high workload, conflicts with doctors, management problems, lack of support from the work environment, unspecified tasks, and equipment shortages |
Support of the Nursing Organization, increase of employment rates, improvement of the public's perception using media, increase of financial benefits, improvement of working conditions, and improvement of the quality of professional life |
Fox et al, 2009 (36) |
USA |
Demographic imbalance, transfer of education from hospital to university, lack of faculty members and reduced university student admission, a variety of job opportunities along with restricted conditions for nursing restricted entry requirement, job abandonment, stressful work environment, shifts, occupational problems and diseases, new technology, imbalance in biological rhythms and life plans, lack of support against mistakes, decrease of salaries, repayment of the student loan at work, and job abandonment |
Redesigning technology and the work environment to provide care to many patients while there are few nurses, employment of new nurses, performance-based payment |
Morgan et al, 2009 (37) |
USA |
Reduction in the number of nurses, elimination of nursing position, inadequate education, insufficient assessment of patient's needs, and inadequate support |
Increasing professional autonomy, working in a patient-centered environment, paying attention to employees' successes, increasing education of patient and employee, and increasing managerial support and supervision |
Buchan et al, 2008 (20) |
USA |
Inappropriate work schedules, limited resources and supply reduction, poor implementation policies, poor retention and return of nurses, inadequate support |
- |
AbuAlRub, 2007 ( 38 ) |
Jordan |
Low salaries compared to high workload, decrease in women’s choice of nursing, decrease of the number of faculty members, unattractive working conditions, low social status, and decrease in the number of departments/faculties |
Doing research on the factors enhancing nurses' retention, improving public's perception through the media, increasing the number of nursing faculties and nursing student admissions, and allocating scholarships for nursing students |
Langan et al, 2007 (39) | USA | High workload, new technologies, lack of job security, insufficient support, family responsibilities, retirement, unclear personal reasons, lack of physical strength and ability, and lack of sufficient incentives |
Increase of salaries, improvement of working conditions, creation of rest breaks, provision of health insurance, and provision of attractive supportive facilities |
Oulton, 2006 (40) |
Canada |
Aging population, globalization and growth of private sector, increased demand for care, high workload, insufficient support, violence, stress and burnout, wage differentials, lack of participation in decision making, and changes in human resources approaches |
Changing major health policies, improving improper internal distribution and preventing migration, and appropriate nursing leadership |
Gassert, 2006 (41) |
USA |
- |
Using alternative methods to compensate for the lack of faculty members and low number of student admissions such as using clinical faculties, simulated learning environments, and clinical information systems |
Lynn et al, 2006 (6) |
USA |
- |
Developing professional nursing leaderships, increasing support and communication with managers, creating training opportunities for nurses, eliminating compulsory overtime, increasing salaries, employing new nurses and increasing nurses to patient ratios, engaging nurses in problem solving, simple and effective documentation, flexible work schedules, establishing kindergarten, reducing off-duty activities, and improvement of nurses' retention |
Lynn et al, 2005 (42) |
USA |
Job abandonment, financial status, organizational commitment, and low job satisfaction |
- |
Hooshmand et al, 2004 (43) |
Iran |
Job abandonment, failure to meet individual needs, low salaries, non-academic nursing position in the community, and lack of attention and support from authorities |
- |
Ulrich, 2003 (44) |
USA |
- |
Increasing job safety, reducing stress, preventing non-nursing tasks, developing flexible work schedules, improving salaries, encouraging people to enter nursing, increasing education, employing greater numbers of men and minorities, and using various occupational grades |
Janiszewski, 2003 (45) |
USA |
Aging nurses, decrease of admission, changing working conditions, and negative perception of nursing |
Increasing employment rates, having access to unemployed and immigrant nurses, permanent education, nurses' retention, and improvement of public's perception of nursing |
Ross, 2002 (5) |
USA |
Managed care, restriction of costs, aging nurses, decrease of number of nurses, aging population, and the need for more care |
Increasing student admissions, improving nurses' retention and working conditions, acceptable patient to nurse ratio, and increasing salaries |
Murray, 2002 (46) |
USA |
Aging nurses, decrease of admissions, increase of job opportunities for women, changes in the care delivery system, job burnout, and improper public’s perception of nursing |
Salaries increase, clinical leadership development, flexibility of work schedules, scholarships and tuition reimbursement programs, male nurse recruitment, changes in department curricula to increase outcomes, and nurse to patient ratio improvement, Occupational risk reduction and occupational safety increase, increase of support, using new technology , deploying nurses from other countries, participation of nurses in decision making, and improvement of the public's perception of nursing using media |
Meadows, 2002 (47) |
USA |
Aging nurses, decrease of university students, and lack of job satisfaction |
Employing young workforce, men, and minorities, improving public's perception of nursing, especially in schools, retaining existing nurses, using clinical information systems, auto-prescription of drugs, computerized physician order entry, computerized documentation |
Lee, 2002 (48) | USA | Aging nurses, decrease in supply, and increase in demand | Designing work environment using information technology and ergonomics, patient-centered staffing, hospital collaboration with faculties, and employing men and minorities |
Zimmermann, 2000 (49) |
USA |
Aging nurses, decrease in admissions, increase in job opportunities and choices, increase in need for nurses, changes in demographic characteristics of the community, the desire of older nurses for part-time work, and changes in care delivery systems |
Improving the employment and retention of nurses, deployment of unemployed and immigrant workforce, enhancing public’s perception of nursing, overtime, changing the work environment, collaboration of nurses with different grades, and taking into account a mandatory ratio for employees |