LITERATURE REVIEW
ARTICLE ONE: Nursing shortages and international nurse migration
There has been concerns with regards to nursing shortages as well as nurse migration such as in the United Kingdom and the United States although such policies are not yet executed as a way of encourage nurse immigration and most likely, nursing shortages will lead to growth of foreign nurse immigration as it is a fact in the US. Thus, such understanding of factors that drive the migration of nurses is truly critical for example, as the USA exerts more pull on the foreign nurse workforce. There were researches made about the situation pointing to the UK nurses detailing such data and characteristics within the country giving value to the Nursing and Midwifery Council being in acquiring data on foreign nurse registrations in the UK between 1998 and 2002. It was found out that such shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK.
Therefore, there can be substantial idea believing that, poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labor and that, countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, there was such usage of model entailing that nurse migration represents a key addition to the growing but largely descriptive or anecdotal literature on the migration of nurses (Cited from, Buchan et al. 1994, 1997; Commonwealth Secretariat 2001; Mejia et al. 1979 in Ross, Polsky and Sochalski, 2005 p. 52-53). There was then, the identification of UK as host and source country for nurse migrants highlights the central role of the UK in the global trade in nurses. Then, the applying of conceptual foundation of the said model as relevant to the study of the migration of nurses as the nurse represents a migratory individual as well as the embodiment of services to be exchanged. Furthermore, there was extensive literature on migration describes individual and household decision-making and migration patterns between countries and does presumed that individuals would migrate when the present value of wages in the destination country exceeded the present value of wages in the home country by more than the direct costs of migration and the preference for remaining at home (Harris & Todaro 1970; Sjaastadt 1962 in Ross, Polsky and Sochalski, 2005 p. 242). From a family perspective, migration may be driven by an incentive to spread family earning potential across country boundaries (Stark & Bloom 1985 in Ross, Polsky and Sochalski, 2005 p. 250) Thus, there underscores the importance of developing an improved monitoring system so that the implications of these flows, both positive and negative, can be identified and managed as needed. US policy makers considering initiatives to attract foreign nurses should join the international dialogue on strategies to address the thorny economic and equity issues that migration entails.
ARTICLE TWO: The Impact of Nurse Staffing on Hospital Costs and Patient Length of Stay: A Systematic Review
There were researches that examine the relationships between nurse staffing, hospital costs and length of stay is varied using a range of methods and definitions. Moreover, such measurement tools for cost and length of stay makes it difficult to conclude with certainty the results of nurse staffing on hospital cost and length of stay. However, certain evidence reflected that significant reductions in cost and length of stay may be possible with higher ratios of nursing personnel in hospital settings. Sufficient numbers of RNs may prevent patient adverse events that cause patients to stay longer than necessary. Patient costs were also reduced with greater RN staffing as RNs have higher knowledge and skill levels to provide more effective nursing care as well as reduce patient resource consumption.
The outcome points that restructuring and increasing attention to costs, many hospitals have chosen to decrease their overall labor pool, including the number of full-time nursing positions (Cited from, Kunen, 1996; Norrish & Rundall, 2001 in Nursing Economics, 2007 p. 256), leading to documented significant negative effects to nurses’ health, well-being, and ability to provide quality nursing care (Cited from, Cummings & Estabrooks, 2003 in Nursing Economics, 2007 p. 256). There were efforts to enhance operational efficiency have led to changes in nurse staffing patterns, decreasing the number of registered nurses and replacing them with unlicensed assistive personnel (Cited from, Barkell, Killinger, & Schultz, 2002 in Nursing Economics, 2007 p. 256). Then, some authors examining the effects of reducing RN positions on patient outcomes report increased patient mortality (Cited from, Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005; Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002; Tourangeau, Giovannetti, Tu, & Wood, 2002 in Nursing Economics, 2007 p. 256); increased rates of failure to rescue (Cited from, Aiken, Clarke, Sloane, Sochalski, & Silber, 2002 in Nursing Economics, 2007 p. 256); and increased incidence of nosocomial infections, pressure sores, medical errors, and patient falls (Cited from, Cho, Ketefian, Barkauskas, & Smith, 2003; Kovner, Mezey, & Harrington, 2002 in Nursing Economics, 2007 p. 256). Generally, no clear recommendations were reported concerning the research design of included studies, or cost and LOS measures, both of which are important for decision making in health care organizations.
ARTICLE THREE: Patient Safety and the nursing shortage: A national concern (President’s Message)
In the last issue of ASPS News (Cited from Summer, p. 6 in Plastic Surgical Nursing, 2006 by Marcy Dienno), it was said that various organizations ask ASPSN to endorse initiatives concerning healthcare, health policy, patient safety, and other related issues. Aside, ASPSN has joined forces with the Americans for Nursing Shortage Relief (ANSR) Alliance and that ANSR has submitted numerous letters to policy makers in Washington asking them to support Nurse Workforce Development Programs at the Health Resources and Services Administration, by increasing the proposed funding for this program. Studies have demonstrated that a shortage of qualified nurses has a direct impact on patient safety. Then, such report being issued during May 2002 by The New England Joumal of Medicine have found that America’s nursing shortage directly affected patient care by correlating to longer lengths of stay and increased incidence of urinary tract infections, upper gastrointestinal bleeding, pneumonia, shock, and cardiac arrest (Cited from, ANSR, 2006a in Plastic Surgical Nursing, 2006 by Marcy Dienno).
According to the American Association of Colleges of Nursing, who conducted a survey of 423 nursing schools, 32,617 qualified applicants to entry-level baccalaureate programs were turned away in 2005 (ANSR, 2006c in Plastic Surgical Nursing, 2006 by Marcy Dienno). When looking at all nursing programs, the National League for Nursing estimates that number to be close to 147,000 (Cited from, Fiscal Year 2007 Appropriations, 2006 in Plastic Surgical Nursing, 2006 by Marcy Dienno). Currently, there are fewer than 20,000 full-time faculties in a system that needs approximately 40,000 to fill the gap and the shortage is expected only to worsen as faculty age continues to climb.’ Nurses are often the first line of defense, using detailed assessment skills to detect early signs of a developing complication. The need to maintain realistic nurse to patient ratio is critical to maintaining the quality of care that every patient deserves adhering that the mission of ASPSN is to promote high standards of plastic surgical nursing practice and patient care through education, exchange of information, and scientific inquiry. In an attempt to increase patient safety, the American Nurses Association, in collaboration with the Institute for Healthcare Improvement, has instituted a campaign called Saving 100,000 Lives. Certain campaign aims to educate nurses and others on ways to enhance patient safety in hospital settings (Cited from, Nursing World, in Plastic Surgical Nursing, 2006 by Marcy Dienno). Although it was a step in the right direction, many patients are seen outside the traditional hospital setting, and this program should be expanded to involve patients in all patient care areas. It can be that, the best way to improve patient safety outcomes is to capture, analyze and review the data collected at each institution and on a national level. Furthermore, whether nurses work independently or as part of a team, they know that communication across disciplines is essential to coordinated, timely and safe patient care. True, that people must be willing to use or develop systems that create checks and balances aimed at limiting the number of human errors made by a human healthcare professional.
ARTICLE FOUR: The shortage of registered nurses in monopsony: A new view from efficiency wage and job-hour models
Amicably, it has been argued that a monopsonist would like to hire more workers at the equilibrium wage that he or she offers as the labor market equilibrium in monopsony is being characterized by “reported vacancies.” Thus, the property is claimed to be perfectly consistent with the persistent shortage of registered nurses. Truly, by means of utilizing Solow’s (Cited from, Solow, 1979 in American Economist, 2002 by Lin, Chung-Cheng) efficiency wage monopsony model and a job-hour monopsony model, there showed that a monopsonist may not report vacancies since the labor market equilibrium in monopsony may be in a state of excess labor supply. Aside, as a consequence, certain theoretical explanation of the shortage of registered nurses must be found beyond the simple textbook monopsony model. However, such popular textbooks (Cited from, Ehrenberg and Smith, 1991, pp. 77-79 in American Economist, 2002 by Lin, Chung-Cheng) have introduced this explanation for the observed shortage of registered nurses and public school teachers in small towns. There intends to express that the monopsony explanation can be misleading, and thus the theoretical basis of the shortage of registered nurses must be found beyond the simple textbook monopsony model. The presence of consequence dealing with equilibrium unemployment saying that a monopsonist will not report vacancies and whether or not a monopsonist will report vacancies, rather than being merely due to the firm having monopsony power, will depend on the fact that the quantity demanded for labor exceeding its supply. Then, the existence of positive relationship between the wage and work effort can be attributed to the firm’s desire to save turnover costs, prevent shirking, avoid adverse selection, and maintain work morale. Therefore, in labor market, shortage exists because the wage is below the market-clearing level. The fatal difficulty with the competitive model is that the model cannot provide an explanation as to why the market wage will not rise to eliminate the excess demand.
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