The nursing shortage and the impact on patient safety in rural nursing


The impacts of nursing shortage are manifested in the rural setting and they ultimately affect patients’ safety. This paper aims to present the many causes of nursing shortage and how they specifically impact the conditions of patients. In doing so, a realization on the actions which need to be taken to address the problem is what this paper will ultimately achieve.

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The nursing shortage and the impact on patient safety in rural nursing

            The current and imminent condition of the nursing shortage in the United States is a complex issue besetting the profession and which the government and other concerned sectors must address. Nursing shortage is attributed to several factors but it is already apparent that it is due to the fact that the American population is aging and this is aggravated by the alarming reality of a low turn-out of nurse practitioners or NP as well as a plunge in the supply or production of domestic nursing professionals. It is also undeniable that nursing shortage has already resulted into alarmingly negative impacts to public and private health care in general. Additionally, the scarcity of NPs has specifically affected the rural setting where the profession is mostly needed. This is because the nursing profession in rural areas is more affected by the said condition and that a poor health of a rural setting is mixed up with the community’s financial and social interests. Ultimately, the concealed implication of nursing shortage in the U.S. is its possible fatal outcome for patients in hospital facilities as manifested by the mounting poor health or sickness and eventually casualty among Americans.

If nursing shortage continues in the future, it is expected to endanger the financial strength of public and private hospitals and patients’ access to health care program. Additionally, the shortage tends to provoke negative reactions from patients as their waiting times will rise, the quality of heath care will be lessened and NPs’ abilities or skills to guarantee the required patients’ results will be doubtful. These are aside from the eventualities that people may lose trust in medical facilities or institutions and the power of the health care system to address to give out or address the health care needs of patients. Lastly, apart from fact that the nursing organization will have to be ready for aging and lesser NPs, nursing educational facilities will be limited with smaller population of nursing students and the industry will have to survive the escalating requirements put on an older and reducing nursing labor force (NAS Recruitment Communications, 2008).

Nursing Shortage, an Overview

            According to the Oncology Nursing Society or ONS, while the condition or trend of nursing shortage is an existing extraordinary problem in the United States, it is estimated to likewise beleaguer in the coming years. This scenario will be eventually reflected or manifested worldwide. Citing the estimate made by the Health Resources and Services Administration or HRSA in 2007, ONS reported that the country’s nursing scarcity is likely to increase to be in excess of one million nurses after a decade. Additionally, approximately all American states will suffer lack of NPs in unstable levels in about five years from now. The Society made the statement after taking into consideration that the problem has gone through its 10th year last year, regarding the condition the longest nursing scarcity in the last five decades. ONS has also noted that despite NPs’ increased employment trend in almost 185,000 public and private hospitals from the middle of 1990s up to the early 2000, its has not proven or assured that the nursing shortage has ceased to exist. In fact, nurses themselves acknowledged that the nursing shortages in their respective hospitals are placed at more than 80 percent of Registered Nurses (RNs) or NPs (Oncology Nursing Society, 2007).

            In particular, the NAS Recruitment Communications identified the underlying causes of the nursing shortage. This includes the increasing demand or requirement for Nursing Practitioners or Registered Nurses which, in turn, is contradictory to the fact that the supply for nurses is falling. There is also less population or students studying the profession or entering the field. In effect, a lessened number of people being into this discipline indicate that the workforce is now aging. The said factors are aside from the fact that nurses are leaving their profession in favor or better compensation and opportunities in other fields (NAS Recruitment Communications, 2008).

            Meanwhile, in its Position Statement, the American Association of Colleges of Nursing or AANC stated that the past occurrence of nursing shortage is totally different with the condition of the current nursing shortage which is alarmingly valid. In general, the contemporary nursing shortage is manifested through lesser or decreased number of RNs or NPs coming into the workforce and eventually having a job in public and private hospitals. In today’s condition, there are also serious nursing shortages in particular geographic locations and that nurses are not ready enough to address patients’ specific areas of concerns such as the necessity to adjust to the mounting demands of the health care setting. In effect, there is now a mounting realization or awareness that the provision of supposedly prepared and skilled NPs or RNs in truly not enough to address the requirements of a mixed and big population. It is also unfortunate to note that the deficit in nurses is expected to seriously increase in the next two decades (American Association of Colleges of Nursing, 2005).

            AACN further reported that the real number of nursing shortage is not easy to measure in number. This is because RNs in the U.S. now cover the biggest population among health care providers or medical professionals. Citing statistics provided by the U.S. Department of Labor and from several researches regarding the nursing sector signify that there has been a stable growth in the number of nurses landing jobs at hospitals hence it appears that there are enough NPs or RNs to perform the nursing tasks. However, the said conventional employment estimates are misleading and insufficient to determine the extent of what it really happening the in the health care profession. This is because studies tend to show that the ideal nursing supply, demand and requirement have already been changed by discrepancies in the systems of health services, insurance reimbursements and according to traditions and way of life in different regions. In short, how, where and the manner of payment of care systems are factors that precisely affect the requirement for nursing services. This is aside from the fact that the aging general population and mounting necessity for administration and care of lasting health conditions indicate that the general need for nurses will definitely be multiplied (American Association of Colleges of Nursing, 2005).

Nursing Shortage in the Rural Setting

            The rural societies in the United States are expected to bear more the harmful or damaging impacts of nursing shortage compared to the situation in the cities. This is for the reasons that nurses working in a rural setting are usually short from economic or financial resources in order for them to rival their city-based counterparts. This situation holds true with the employers of NPs or RNs who are likewise based in rural communities hence they also lack such resources. Additionally, nurses are generally educated and trained in urban facilities and settings thus they become unprepared or are having difficulty in adjusting or adapting into rural environment or non-urban medical facilities. Moreover, the rural setting is dependent with non-hospital backgrounds even to a bigger scope as compared with the backdrop of the city. Most importantly, rural nurses are unfairly recognized or even underpaid despite of the nature of their jobs which requires them to perform multi-tasking because of the various limitations in their respective rural hospitals. In effect, city-base techniques which stress competitive benefit may unintentionally aggravate the condition of nurses working in rural setting (National Center for Frontier Communities, 2004).

Patients as the Ultimate Victims

            In a Policy Brief, Anderson (2007) stated that above all the impacts of nursing shortage, the patients fall prey to the concealed effects of such condition. According to Anderson, the aging American population and low supply of nurses has resulted into the advent of nursing shortage which brings fatal implications particularly for American hospital patients. He cited general analysis of medical literature which discovers that scarcity of NPs or RNs at public and private hospitals is resulting into a mounting casualty and sickness for American people. In addressing the problem, Anderson said that even a wage increase is not enough to solve the shortage. He explained that it is best for policymakers to consider two practical solutions to lessen the implications of nursing shortage. These include increasing nursing educators and nursing educational facilities as well as increasing immigration requirements to allow the entry of foreign-based or foreign-national nurses. In the end, Anderson stated that immigration proposal along is not sufficient to address nursing shortage. While it can improve the condition, the harmful and even fatal effects of the scarcity to the condition of patients may still remain and continue to harm people needing medical and health care as well as the profession in general (Anderson, 2007).


            The field of nursing is supposed to be offering many benefits to its practitioners and the patients. However, the existing nursing shortage has continued to harm the profession, its professionals and ultimately the hospital patients have became the unwilling victims of such situation. Since there is now a realization on the general extent of nursing shortage, it is just but appropriate that concrete actions are done and efforts are made to save the profession from further deterioration. For one, it is time to reexamine nursing in the rural setting in order for the nurses in that community to be motivated to work harder and not leave their jobs. Additionally, there should be collective effort from all concerned sectors such as the government to alleviate the condition of nurses in rural public or private hospitals. In doing do, it is not only the nurses who are being provided with assistance but the ultimately the patients particularly in rural communities who are in dire need of medical attention and health care system.


American Association of Colleges of Nursing. (2005). Strategies to Reverse the New Nursing Shortage. Retrieved October 7, 2008, from

Anderson, S. (2007). Deadly Consequences: The Hidden Impact of America’s Nursing Shortage. National Foundation for American Policy. Retrieved October 7, 2008 from NFAP database.

NAS Recruitment Communications. (2008). The Nursing Shortage. Retrieved October 7, 2008, from

National Center for Frontier Communities (2004). Addressing the Nursing Shortage: Impacts and Innovations in Frontier America. Retrieved October 7, 2008, from

Oncology Nursing Society. (2007). The Impact of the National Nursing Shortage on Quality Cancer Care. Retrieved October 7, 2008, from


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