Examining the global nursing shortage crisis, and drawing from the experience in the Philippines, this article delves into factors impacting healthcare, from an aging population to the COVID generation's skills gap. It advocates for comprehensive strategies, including education reforms, community-based training, and global collaborations, to bridge the workforce gap and ensure patient care resilience.
In the realm of healthcare, nursing professionals play a pivotal role in ensuring the well-being of patients. They are the backbone of any healthcare system, providing round-the-clock care, administering treatments, and offering emotional support to those in need.
However, an ongoing challenge that healthcare organizations face, especially here in the Philippines, is the shortage of nursing staff. Given this, it is important that we turn our attention to the effects of nursing shortages on patient care and explore possible solutions moving forward.
The nursing shortage crisis has been a longstanding issue in the healthcare industry. Factors such as an aging population, an increase in the number of patients with complex medical needs, and the retirement of experienced nurses have all contributed to this challenge.
A major problem I see here in the Philippines is that there is an increasing trend of enrollment in nursing schools, but a decrease in both the graduation rate and in the boards performance. In 2020, we observed a dip in the number of local board passers, which may indicate a need to focus on how to better support not only those taking the boards for the first time, but especially those repeat-takers struggling to achieve their goals.
Notably, however, the production of nurses does indicate an increase. The 2023 Philippine Nursing Licensure Exams are anticipated to produce an additional 24,000 nurses, from estimates of 32,000 Board takers this year and a projected passing rate of 75%. All this to say that while the decline is unignorable, there are some positive projections on the horizon.
Another factor contributing to the nursing shortage, especially among South Asian and Southeast Asian countries, is the continued exodus of nurses outside the region. As a guidance for all, The World Health Organization (WHO) recommends a ratio of 27 nurses per 10,000 population. In the Philippines, for example, there are only 16 nurses per 10,000 right now. A Southeast Asian country like ours would need an additional 127,000 nurses to meet the WHO target—in contrast, by the end of 2021, we found that there were at least one-third of more than 900,000 registered nurses who were working outside the Philippines. The effect of this exodus was felt tremendously during the critical period of the COVID-19 pandemic.
The difficulties the health sector experienced in recent years don’t need belabouring. The lasting effects of the COVID lockdowns are evident in the “new generation” of nursing professionals in our industry today. Having missed out on hands-on experience and on-the-job training in live environments, most of them are coming to hospital bedsides with just virtual education and simulations, leaving them grossly unprepared.
We have observed a pronounced gap in nursing skills and other real-life competencies in the “COVID generation” of new nurses. Thus, there is a greater impetus for hospitals to invest in adequately training these new nurses before they can be deployed to the bedside.
In addition to the skills gap, hospitals in the Philippines also grapple with competition for nurses from the business process outsourcing (BPO) industry. BPOs heavily engage in health-related services like medical transcription, resulting in them vying for the same pool of nursing candidates sought after by hospitals.
A significant number of nursing graduates opt not to pursue opportunities abroad but instead choose to transition laterally into the BPO sector. While they remain within the country, they are not accessible for hospitals or healthcare positions. Only 53.5% of the nurses in the Philippines are actually active, while the rest are part of the BPO workforce, or pursuing businesses that generate more income for them. Traditional healthcare players like hospitals are at a disadvantage—unable to compete in terms of compensation, benefits, and work-life balance, they are forced to watch their nursing recruit pool dwindle. By the end of 2022, approximately 170,000 nurses in the Philippines were employed in both private and public health facilities within the nation. In contrast, over 290,000 licensed nurses had ventured into alternative career paths.
It is a hard reality, but we need to face the fact that we don’t have enough nurses. In the Philippines, we still haven’t returned to pre-pandemic levels where one school can produce as many as 12,000 graduates. The impact of the nursing shortage therefore means not only a lack of nurses in terms of quantity, but also a maldistribution.
Unfortunately, the effects of a nursing shortage go far and wide. Firstly, nursing shortages often lead to an increased workload for the existing nursing staff. This can result in exhaustion, burnout, and reduced job satisfaction among nurses. When nurses are overworked, their ability to provide the best possible care to patients is compromised. This can have serious consequences for patient outcomes.
A nursing shortage can also directly affect the patient’s experience when visiting a hospital. Insufficient nursing staff can lead to longer wait times for patients seeking care. Patients may experience delays in receiving essential medical attention, which can negatively impact their recovery and overall experience.
A shortage of nurses can lead to compromised patient safety, lapses in monitoring and providing timely interventions—all of these increasing the risk of medical errors. Ensuring patient safety is non-negotiable, and nursing shortages can put patients at risk.
Addressing the nursing shortage, both in the Philippines and globally, is a complex issue that involves various strategies for the short-term and long-term planning:
1. Education and Training
Expand Nursing Programs: Right now, one immediate measure I can see being implemented both locally and globally is increasing the capacity of nursing schools to admit and train more students. Investments must be made in strengthening nurse competency training programs, while also reversing the brain drain to ensure retention of senior nurses. This also includes hiring more faculty, expanding facilities, and developing more robust training programs. Right now, the supply side issues are aggravated by the Nurse Educator shortage. Prioritizing education will also consequentially mean higher percentages of takers also passing the nursing board exams.
Community-Based Training: Another short-term solution that can be explored are partnerships between private hospitals and the government, where both can invest more in the implementation of training programs in rural and underserved areas, encouraging nurses to work in these locations post-graduation.
2. Working Conditions and Incentives
Improve Working Conditions: While this may take more time for planning, adjustments, and logistics, it is also crucial down the line to enhance the working environment for nurses by ensuring reasonable workloads, adequate staffing, and access to necessary resources and equipment. As nurse staff stability affects all stakeholders (patients and doctors) and the cost of care and legal issues, it is crucial to maintain the senior versus junior nurse ratio to address the complexity of care.
Competitive Salaries and Benefits: This may also be a long-term strategy because of so many factors, but it's worth exploring how hospitals could adjust and offer more competitive salaries and benefits to retain existing nursing staff and attract new recruits. This can include health insurance, retirement benefits, and opportunities for professional development. Right now, Filipino nurses leave because salaries are not “living” wages, and do not allow nurses to meet basic needs. While it will be difficult to truly match the economic equivalent of a foreign currency, healthcare players can find ways to offer more holistic and well-rounded compensation and benefit packages to augment the monetary difference.
Career Development Opportunities: It is also immensely vital that hospitals, government and even schools provide clear pathways for career advancement, including specialization options, leadership training, and continuing education. There is a need for more efficient and effective targeted on-boarding initiatives, while also streamlining on-boarding processes and enhancing nurse retention strategies.
3. Policy and Legislation
Government Support: The leaders of the medical field must also all come together and advocate for governmental policies that support the nursing profession, including funding for nursing education, research, and practice.
Regulatory Reforms: It may seem like an insurmountable task to do away with all the red tape, but efforts must also be made to reform regulations to streamline the accreditation of foreign-trained nurses and facilitate their integration into the local workforce.
4. Retention Strategies
Work-Life Balance: For retention, I also think it will go a long way if hospitals can implement policies that support a healthy work-life balance, such as flexible scheduling and mental health support. This is made all the more important as the Millennials and Gen Z workforce are increasingly aware of the importance of mental health.
Mentorship Programs: Nurses should never feel that they are alone in their work. I believe more senior members in the field can work to establish mentorship programs for new nurses to aid in their professional development and adjustment to the workplace. There should be continued efforts with Nursing Retention & Engagement Programs and determining and maintaining optimal staffing levels to achieve efficiency and growth.
Recognition and Appreciation: For a good morale boost, it is also helpful to regularly recognize and appreciate the contributions of nurses through awards, public acknowledgments, and other incentives.
5. Global and Local Collaboration
International Nurse Exchange Programs: I believe there can be more efforts made within the international nursing community to encourage exchange programs that allow nurses to gain international experience and bring new skills back to their home countries.
6. Technology and Innovation
Leverage Technology: In the Philippines, I see this as a big room for improvement. Our hospitals must learn to utilize more advanced and developed forms of technology to improve nursing education and practice, such as through online training programs, immersive simulation labs, and telehealth services.
Innovative Healthcare Solutions: Related to the previous point, I believe that it falls on us leaders in the medical field and health sector in the Philippines, to encourage innovation in healthcare delivery that can make efficient use of nursing resources, like nurse-led clinics and community health programs.
In closing, we must recognize that our pursuit of solutions to the nursing shortage is not just a strategic imperative—it is a testament to our unwavering commitment to quality patient care and the well-being of our healthcare professionals that tirelessly serve our community. By exploring and championing both short-term and long-term solutions, and ensuring they are implemented in accessible and sustainable ways, we leaders have the power to shape a future where healthcare is not just a service but a beacon of hope, driven by a robust and resilient nursing workforce.
