Question

In 250 words or less, describe a situation in which foreign trained health care professionals were hired to address the short supply of US trained health care professionals; for example, shortages in physicians and nurses. In your description about the situation, please incorporate responses to the following:

1. Briefly describe a situation in which foreign trained health care professionals were hired to address a short supply of US trained health care professionals.
2. Finally, comment on the outcome of the situation (or its present state if not yet played out). Include at least one pro (benefit) and one con (obstacle) related to the outcome.

Answer 1

Healthcare systems around the world are in crisis. In both developed and developing countries systems are struggling to meet the needs of citizens. One of the most critical challenges these systems face is a shortage of healthcare professionals. The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes the generation and commercialization of goods and services lending themselves to maintaining and re-establishing health.

In developed countries, national healthcare systems periodically experience shortages of nurses or physicians. Usually these shortages are simply a function of demand growing faster than supply. This is most often corrected by introducing greater incentives into the labour market. By contrast, developing countries have long experienced chronic shortages of healthcare professionals. These shortages are usually rooted in a lack of resources that prevents the training or retraining of sufficient numbers of nurses, physicians, or other healthcare professionals. However, in recent years, a number of demographic and societal changes have combined to create significant and long-term shortages in both developed and developing countries. There is an almost universal shortage of registered nurses (RNs), caused by increased demand in the face of a declining supply. Many countries also face significant shortages of medical doctors (MDs).

The health care sector in the United States consists of an array of clinicians, hospitals and other health care facilities, insurance plans, and purchasers of health care services, all operating in various configurations of groups, networks, and independent practices. Some are based in the public sector; others operate in the private sector as either for-profit or not-for-profit entities. The health care sector also includes regulators, some voluntary and others governmental. Although these various individuals and organizations are generally referred to collectively as “the health care delivery system,” the phrase suggests an order, integration, and accountability that do not exist. Communication, collaboration, or systems planning among these various entities is limited and is almost incidental to their operations. For convenience, however, the committee uses the common terminology of health care delivery system.

The recruitment of healthcare workers from less developed countries has emerged as one of the main responses of developed countries to the shortage of healthcare professionals. The latter are increasingly being recruited for temporary or permanent positions abroad. Though some of this movement occurs between developed countries, most is from developing to developed countries. The globalisation of the labour market for healthcare professionals has major implications for individual practitioners, for healthcare systems, and for governments. Some of these implications are positive, including the opportunities for nurses and physicians to improve their professional and personal lives and for developed countries to address the shortages of RNs and MDs they face. There are also significant negative consequences, primarily the drain this represents on the ability of less affluent countries to provide adequate healthcare for their citizens.

Registered nurses are the single largest group of healthcare professionals in the United States. Despite that fact, there is still a growing demand for nurses both in hospitals and the community. Employment of registered nurses is projected to grow by as much as 16 percent by 2024, much faster than the average for all occupations, said the Bureau of Labor Statistics. Growth will occur for a number of reasons. Demand for health care services will increase because of the aging population, given that older individuals typically have more medical problems than younger ones. As such, nurses will be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. Also, the Patient Protection and Affordable Care Act (ACA) has opened the doors to health care access in numbers heretofore unprecedented, further increasing demand.

Even if it is difficult to assess accurately the extent of present and future shortages, various sources indicate that they are present and growing in most regions of the world. In the case of registered nurses, nearly every European country is experiencing a shortage. The reasons for shortages in less affluent countries are somewhat different from those in wealthier nations. Developing countries generally lack the resources to train an adequate number of nurses. They have fewer nurse-training programmes and fewer qualified nurse educators. Moreover, very low pay and extremely unsatisfactory working conditions make it difficult to attract and retain nurses. Insanitary conditions, lack of medicine, inadequate supplies and equipment, huge nurse-to-patient ratios, a shortage of physicians, and epidemics of HIV/AIDs and other serious illnesses all contribute to making the practice of nursing tremendously stressful in many developing countries. The factors contributing to the nursing shortage are multifaceted: a diminishing pipeline of new nurses due to a faculty shortage that has resulted in thousands of prospective students being turned away, steep population growth in several states, ACA providing increased access, and a baby boom bubble that will require intensive health care services. And these issues are occurring at a time when a significant number of nurses are retiring.

The biggest challenges facing healthcare are the demographic changes that are pushing expansion of the workforce and the time it takes to educate and train new health care workers to fill those needs. It seems that the shift away from LVNs and LPNs to RNs has exacerbated this in the hospital setting. We could expect a return to a larger team with clear roles would be helpful." Perhaps the most critical factor affecting the nursing shortage in the U.S. is nursing schools’ inability to increase enrollment due to a scarcity of nursing school faculty.

Other factors contributing to the nursing shortage include:

Hospital acuity. Acuity in hospitals has been on the rise due to the declining average length of stay and new technology that allows rapid assessment, treatment, and discharge.
Aging population. As a high percentage of Baby Boomers reach retirement age, their need for healthcare will grow and intensify.
Aging workforce. A significant segment of the nursing workforce is nearing retirement age. According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55 percent of the RN workforce is age 50 or older. Also, the Health Resources and Services Administration projects that more than one million registered nurses will reach retirement age within the next 10 to 15 years.
Workload and work environment. In response to health care cost pressure, hospitals have been forced to reduce staffing and have implemented mandatory overtime policies to ensure that RNs would be available to work when the number of patients admitted increased unexpectedly. An increased workload may affect the decision to enter or remain in the nursing profession.

Effects of Nursing Shortage on Patient Care
Due to the shortage, nurses often need to work long hours under very stressful conditions, which can result in fatigue, injury, and job dissatisfaction. Nurses suffering in these environments are more prone to making mistakes and medical errors. An unfortunate outcome is that patient quality can suffer, resulting in a variety of preventable complications, including medication errors, emergency room overcrowding, and more alarmingly, increased mortality rates.

Solving the Nurse Shortage Problem
A range of solutions has been offered as a way to solve the nursing shortage problem that include subsidized funding, wage increases, hiring minority and foreign nurses, and campaigns to improve the profession’s image.

Funding options. Many experts recognize the need to increase funding for nursing education, directed toward nursing faculty as well as students.

Nursing schools are forming strategic partnerships and seeking private support to help expand student capacity. For example, the University of Minnesota announced a partnership with the Minnesota VA Health Care System in June 2013 to expand enrollment in the school’s BSN program.

ACA includes loan programs both to nursing students and faculty that are designed to help alleviate the shortage.

• The Nursing Education Loan Repayment Program (NELRP) is a selective program of the U.S. Government that helps alleviate the critical shortage of nurses by offering loan repayment of up to 85 percent of outstanding loans to RNs and advanced practice registered nurses.
• The Nurse Faculty Loan Program (NFLP) is intended to increase the number of qualified nursing faculty to facilitate the education of nurses.

Higher wages. Another way to address the nursing shortage would be to devote resources toward increasing RN wages. This approach could affect recruitment as well as retention of RNs already in the workforce.

Increased minorities. Increasing the number of minorities who become RNs could bolster the supply of RNs and have the additional benefit of improving delivery of culturally sensitive care.

Foreign nurses. Hiring foreign nurses would be another way to address shortages in the United States. Proponents of this approach note that hospitals have relied on foreign nurses, often brought to the United States with temporary work visas, to address past shortages.

Improved image. Lastly, experts suggest a need to improve the image of nursing. Strategies range from encouraging nurses to communicate more frequently with the press about positive aspects of nursing to launching professional advertising campaigns promoting the profession.

In spite of these proposed solutions, with demand currently exceeding supply, the nursing shortage is not likely to diminish in the near term.