UICC World Cancer Congress 2006

There is a global shortage of nurses. Whether high resource or low resource, most countries simply do not have the qualified nurse workforce to contend with their emerging health problems let alone improve the health and well being of their people. It is worse for low resource countries where the ratio of nurses to patients is very poor. High resource countries generally have 10 times the ratio of nurses to patients as low resource countries. A similar disparity is found geographically between urban and rural areas. In some countries health care and nurses are only found in large cities.

Factors involved in the nursing shortage vary among countries. Globally demand outpaces supply. In low resource countries ineffective health care systems, the impact HIV/AIDS, the status of women and nursing, and international migration of nurses all contribute to some degree. In high resource countries factors include increasing health care demands as the population ages, advances in science bringing more and varied treatment options and, the primary factor, the aging nursing workforce with inadequate rates of replacement. For a time, increased opportunities for other careers for women and failure to attract people to nursing careers contributed to the building shortage however that is less of a factor currently as nursing enjoys robust applications from qualified perspective students.

There has been considerable discussion about the nursing shortage and initiatives to address it in high resource countries but only limited discussion and few initiatives to address the problem in low resource countries. The initial approach in high resource countries, such as the United States, has been to add a variety of incentives to attract, employ and retain nurses in the workplace. On the educational side the focus has been campaigns to build the image of nursing and recruit students, implementation of shortened and fast track educational programs, and offering expanded orientation and retention programs for new graduates. While these have all contributed to addressing the shortage to some extent, the need to increase the nursing pool is much beyond what these initiatives alone can fix. In order to truly address the shortage, the major response must be to increase the supply of new nurses for the workforce. The primary barrier to doing this is the equally compelling shortage of faculty in schools of nursing which is only now beginning to receive attention. The remainder of this presentation will be to focus on the faculty shortage in nursing and the factors that perpetuate it. Since there is little data available on factors related to the faculty shortage in low resource countries, the presentation will use the exemplar of the faculty shortage in the United States.

The faculty nursing shortage is rapidly growing and fueled by three primary factors. First, there are not enough nurses choosing academic careers. Faculty salaries are not competitive with salaries that can be made in clinical or administrative roles. Expanded advance practice clinical roles provide salaries that are at least one-third higher than faculty salaries. At the same time academic careers are demanding with both high teaching workloads and expectations for funded research programs and significant peer reviewed publications. Secondly, the professoriate is graying. Large numbers of senior faculty are on the verge of retiring not only creating a hard to fill open position but losing a senior faculty who also fills an important role in mentoring junior faculty. Finally, faculty in nursing have a shortened career span in which to contribute. The average age of an assistant professor in nursing is 50 years old. This is coupled with the average age of retirement at 62 years. Thus faculty, on average, have only 12 years of productivity.

Few initiatives have been implemented to address the faculty shortage. Attention needs to be turned to this to successfully expand enrollments in schools of nursing. This is essential to produce the number and ensure the quality of the nursing workforce. In addition, the push to rapidly educate and place new nurses in the workforce threatens the ability to prepare and recruit nurses into specialty practices such as cancer care. Those in the field of cancer need to give new attention to initiatives to provide specialty content and find innovative ways to draw high quality nurses into the specialty.