The faculty shortage in nursing: Global implications
Article Outline
The real test is what a leader does when the opportunity presents itself. Opportunities are often lost without hard work. On the other hand opportunity seized and developed with a good outcome creates numerous future opportunities.
—Rheba de Tornyay, RN, EdD, FAAN
The last issue of Nursing Outlook featured an article by Allan and Aldebron1 that provided a comprehensive overview of strategies used in the United States to address the faculty shortage in nursing, a fundamental factor contributing to the current nursing shortage. As one reads reports about the global nursing shortage, one wonders what parallels there might be in that article for our colleagues from other countries and whether there are any lessons learned in the United States that can be applied globally. This would be especially important in countries in Southeast Asia and sub-Saharan Africa, where diseases such as malaria, tuberculosis, and HIV/AIDS have dramatically increased disease burden and a concomitant demand for nurses.
Although the faculty shortage in the United States is a challenge created by a myriad of factors that will have to be addressed, the issue seems insurmountable when viewed globally. One disadvantage in assessing the global need for nurses is the lack of consistent and accurate data in many countries related to the supply of nurses and nurse faculty. It is difficult to obtain information on the number of nurses who have graduated, those actually practicing, those who have migrated, and those whose health has been compromised by the very diseases affecting their patients. As in the United States, schools of nursing across the world have stretched their sparse faculty resources to the limit to increase the number of students, while observing that many times there is a lack of available positions for their graduates in some countries. In addition, the migration of their best and brightest nurses as a result of poor working conditions and low wages compounds the problem. The ethics and challenges of this widespread migration of nurses to developed countries has been described elsewhere, including a paper by the American Academy of Nursing Expert Panel on Global Nursing and Health.2
In countries faced with dramatic increases in disease burden in the general population, scarce resources are often used to address even more basic needs such as food, whereas other resources are squandered because of poor infrastructure, corruption, and other factors.3 This leaves little to no funds to educate direct care nurses let alone prepare more nurse faculty critical to maintaining the current supply.
The World Health Organization, in an effort to improve the healthcare workforce, primarily in developing countries with high disease burden, recently advocated task shifting, or the redistribution of “tasks” to other members of the healthcare team.4 Although the intent was to improve workforce capacity in resource-limited settings by shifting tasks to less specialized workers, it has had some unintended consequences.5 These include, but are not limited to, the creation of substantial burden for direct care nurses and those who educate them in many settings.
Allan and Aldebron1 describe four major initiatives that have been implemented in the United States that could be used to frame a global approach to this critical issue. These are (1) advocacy, (2) educational partnerships, (3) academic innovations, and (4) external funding including philanthropy, public funds, and healthcare investments in higher education. Can these be used to frame potential solutions for the global faculty shortage? If so, who should be involved in moving these forward? And what outcomes should be measured to evaluate their effectiveness?
The answers to these questions reach far beyond any one editorial. What we would propose is a systematic approach to this issue leveraging existing partnerships and forging new ones across nurses, nursing organizations, and academic institutions in all countries. No one organization represents all nurses in the world. Even the International Council of Nurses (ICN), which represents many countries, does not currently include China or India—two of the most populated countries in the world that are struggling to address challenges of nursing shortage.6
Allan and Aldebron1 suggest there are three logical next steps in the United States. Similar steps could be considered to address the global shortage: (1) examine strategies across and within countries that have worked, (2) consider what outcomes are desirable, and (3) set up a structure to collect consistent, accurate, and comparative data across countries that can be used to examine and track the problem.
We would propose that two additional steps are needed. The first is that we need to specifically identify the desired outcome, what it would take to get there in terms of womanpower (in most countries, nursing is dominated by women), and how much it would cost to achieve the outcome. The second is a “Call to Action.” A number of US nursing organizations, including the American Academy of Nursing (AAN) and the Council for the Advancement of Nursing Science, have focused their conferences on global health issues this year. Many schools of nursing in the United States have developed international partnerships with nurses in academic programs in other countries, international student and faculty exchanges have become commonplace, and efforts to build nurse and nurse faculty capacity are underway. But individual and disconnected efforts are not enough! We must consider collaborations across institutions or consortia devoted to one goal (eg, faculty development). The AAN and ICN could play critical roles in answering this Call to Action. The resolution to our faculty shortage throughout the world is a necessary (but not sufficient) step to addressing increasing demands for direct care nurses. The rich expertise, creativity, and diversity of thought of faculty from around the world can and should be brought to bear on this seemingly insurmountable challenge. Our own resources in the U.S. are stretched in terms of both talented faculty and funding to support these partnerships. It is time now for nurse leaders in the United States to reach out and partner with each other, our colleagues in other international organizations, and in countries without formalized structures, to hold a worldwide summit that will focus on developing real-time, pragmatic, resource sharing efforts to address the global faculty shortage.
References
- . A systematic assessment of strategies to address the nursing faculty shortage, U.S.. Nurs Outlook. 2008;56:286–297
- . American Academy of Nursing Expert Panel on Global Nursing and Health: White paper on global nursing and health. J Transcult Nurs. 2007;18(4):305–315
- . Innovations in Health Service Delivery. Washington, DC: World Bank; 2003;
- . Task Shifting: Rational Distribution of Tasks among Health Workforce Teams. Global Recommendations and Guidelines. 2008;Geneva, Switzerland
- . Building a qualified global nursing workforce. Int Nurs Rev. 2008;55(3):241–242
- International Council of Nurses (List of members). http://www.icn.ch/addresslist.htmAccessed November 17, 2008
Barbara Smith, PhD, RN, FAAN, is Professor and Associate Dean for the Research School of Nursing, University of Maryland, Baltimore, MD.
Marion E. Broome, PhD, RN, FAAN, is Professor and University Dean, School of Nursing, Indiana University, Indianapolis, IN.
PII: S0029-6554(08)00309-6
doi:10.1016/j.outlook.2008.11.001
© 2009 Mosby, Inc. All rights reserved.
