Nursing Shortage and Vulnerable Populations Article Peer Reviewed

• Loading metrics

Open Admission

Peer-reviewed

Research Article

Registered nurses' perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study

• Adel Tutuo Tamata,
• Masoud Mohammadnezhad,
• Ledua Tamani

x

• Published: May xx, 2021
• https://doi.org/10.1371/periodical.pone.0251890

Figures

Abstruse

Groundwork

Registered nurse has a vital role in delivering healthcare services to individual, family and community. One of the principal challenges that health system facing globally is the shortage of nursing workforce. Vanuatu as a Pacific county is besides facing the shortage issue and the impact on the registered nurses' performance.

Methods

A qualitative study was used to collect data from 25 registered nurses in iii randomly selected hospitals in Vanuatu between 4^th to 14^th September, 2020. A semi-structured open-ended questionnaire was used to collect data using face-to-face in-depth interviews. The data were transcribed and analyzed using thematic analysis procedure.

Results

Iv themes were identified including; Difficult working conditions, Reinforcing factors and Perceived risks. Sub themes for difficult working condition were heavy workload, lack of workforce and unusual working hours. Sub themes for reinforcing factors were lack of back up, lack of opportunities and advancement in nursing practice. Sub themes for perceived risks were stress, physical and mental risk, and social and family risks.

Conclusion

This study has identify factors affected shortage of electric current nursing workforce and the touch on information technology has on registered nurses. Broad themes and sub-themes were identified which highlighted the impact of nursing shortage to registered nurses and the effects on their functioning which includes stress or moral distress from work overload and lengthy hours shift which bear upon the nurses' physical, psychological, social, and family human relationship, and lack of leadership support. The findings can exist helpful to policy makers at the decision-making level to resolve the nursing workforce shortage and its effects in the time to come by refining and developing relevant policies that volition address and strengthen the nursing workforce to encounter the demand and improve commitment of quality health services to all individual.

Citation: Tamata AT, Mohammadnezhad G, Tamani L (2021) Registered nurses' perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative report. PLoS ONE 16(5): e0251890. https://doi.org/ten.1371/journal.pone.0251890

Editor: Kingston Rajiah, International Medical University, MALAYSIA

Received: February 25, 2021; Accepted: May 4, 2021; Published: May 20, 2021

Copyright: © 2021 Tamata et al. This is an open access article distributed nether the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data can be found at the Open up Science Framework (OSF): Factors affecting nursing shortage in Vanuatu (Mohammadnezhad, 2021) (DOI: 10.17605/OSF.IO/W7G8E).

Funding: The authors received no specific funding for this work.

Competing interests: The authors have alleged that no competing interests be.

Introduction

Registered Nurses (RNs) are valued professionals and found the largest proportion of nursing population. They play a very meaning part to ensure that effective quality care is provided in improving the health system [one]. In order to amend the health coverage and achievements of health targets, acceptable nurses are crucial as the effectiveness of the patient intendance depend on the availability of more nurses [2, 3].

While the globe has acknowledged nursing profession as vital in delivering healthcare services, one of the primary challenges faced today globally is the shortage of nursing workforce which has major bear on on nurses and causes severe furnishings on the nurses' functioning to provide quality of wellness care services and improving well-beingness of the global population [3–v]. The nursing shortage caused astringent stress or burned out which aggravate the problems on nurses to leave their job [1].

According to the World Wellness Organization (WHO), it was estimated that there volition exist a shortage of 7.ii million health workers to deliver healthcare services worldwide and by 2035 the demand of nursing will reach 12.ix one thousand thousand [6]. The inadequate supply of nurses has notably created many negative impacts not but on RNs but also on patient health-related outcome besides equally challenges to fight diseases and improving wellness, which causes increment workload on nurses and later results in decreasing the quality of nursing care [seven, 8].

There are many factors affecting the healthcare system equally a result of shortage of nursing workforce. These include decreased number of student nurse'southward enrolment in nursing program and increase number of early on retirement due to health trouble [3, 9]. However, one of the main factors reported in many countries is inadequate policies and workforce planning [10, xi].

In the Pacific Island Countries (PICs), the shortage in nursing workforce is becoming a common problem [9]. In Solomon Islands, Papua New Guinea and Vanuatu, the wellness worker density per 1,000 populations (mainly nurses and midwives) is far below the minimum threshold density (4.45 per 1,000 populations) to sustain basic health services [12]. In countries such equally Tonga, Samoa and Fiji, the main factors that trigger shortage of nursing staff includes very loftier rate of nurses' migration to other countries, particularly to Australia and New Zealand for better working conditions and for other potential opportunities. This has created challenges and gaps that needed to be identified to amend explore the extent of the nursing shortage and to address it promptly and efficiently [13].

In Vanuatu, nurses establish only 58% or 12.0 per 10,000 populations, which is below the WHO recommended ratio of 45 nurses per 10,000 populations [14]. Co-ordinate to the Vanuatu Ministry of Health (MoH) Annual Written report (2018), the number of retiree nurses in the side by side x years will go along to rise but volition be disproportionate to the qualified nurses graduated from the Vanuatu College of Nursing Education (VCNE) which condign a major problem for Vanuatu MoH to fill the vacant positions. This volition create more workload for nurses which will bear upon their performance. This written report sets out to explore RNs' perceptions on the touch on of nursing shortage of nurses and their operation in providing quality care in Democracy of Vanuatu in 2020.

Methodology

Written report pattern and setting

A qualitative study was used to gather information using face-to-face in-depth interviews from RNs in 3 hospitals in Vanuatu between 4^th to xiv^thursday September, 2020. The three hospitals were randomly selected among six hospitals that included Vila Central Hospital (VCH) in Shefa Province, Northern Provincial Infirmary (NPH) in Sanma Province and Lenakel hospital in Tafea Province. In-depth interviews are very powerful methods to permit participants to limited their view freely regarding their detailed personal experiences [15, 16].

Written report population and sample

All RNs in Vanuatu were considered as the study population and those who were currently working at the three selected hospitals with at least six months' work experience were included in this study. Those who were not willing to participate in the study were non-respondent. A purposive sampling was used to cull written report participants. The RNs were interviewed using contiguous, in-depth interviews until data saturation is reached. A full of 25 RNs were involved in this study.

Data collection tool

In-depth face-to-face interviews was conducted using a semi-structured open up-ended questionnaire to probe elicit information from the identified participants from both the target populations. Open-ended questions aimed for participants to express their personal experience freely [17]. The interview questions developed is based on relevant literatures and research studies that will fulfill the aim and the research question of the report. Vii questions were prepared and asked during in-depth interview to enable the participants to explain or discuss their perceptions about the research topic.

The demographic data form was also used to collect demographic characteristics regarding their gender, age, marital status, education level, work station and years of experience. The interview questions were checked by 3 experts in the relevant filed and also by iii RNs to make sure they are understandable and are in line with the research questions before conducting the interviews.

Written report procedures

Following the ethic approvals, all potential RNs in three selected hospitals were informed about the aim of study and were invited to participate. An information canvass was used to inform the participants about the purpose, procedure and nature of the report; duration of interview; the correct to participate; benefits and risks of the study; notification for decline or withdrawal at whatever fourth dimension from participating; informed consent and the interview procedure. They were informed that their information volition be confidential and they are allowed to leave the study at any time. Those who met the study criteria and were willing to participate were asked to sign a consent form. An organisation was made about the engagement, time and venue of the interview. A trained bi-lingual interviewer who signed a consent form was employed to deport interviews. Participants were asked nigh their preferred language to do interview before the interview. Those who preferred to speak in local linguistic communication were interviewed in Bislama language otherwise the English language language was chosen for the interviews. All interviews were audio-taped for transcription after.

Data direction and analysis

Cross translation was applied for translating the interviews that were in Bislama to English. All the interviews were transcribed by the primary researcher and were checked past the inquiry assistant to make sure they are transcribed accurately. The data were manually analyzed using thematic analysis process to identify the terminal themes. Thematic analysis is a method which involves identifying, analyzing, and reporting patterns of data and is widely used for analyzing qualitative research [18]. The participants' answers were read and re-read closely by the master researcher to divide into key words or phrases into their similar meanings and create codes. The transcribed results were later transferred to A4 paper. Then the coded information were sorted into themes and sub-themes based on the similar problems which formed the outcome of the study.

Ethics approval

Before proceeding to data collection, ethic approvals were obtained from the Higher Health Research Ethics Committee (CHREC) in Fiji National University (FNU) and from the Enquiry Ethics Committee in Vanuatu MoH. All participate were provided a consent course and the data sail. The participants were informed about the purpose of the study and ensures that their identities are bearding and the participants 'information and whatever other data would be kept confidential and protected.

Issue

Demographic characteristics of participants

Twenty-5 participants were involved in the in-depth interview (12 males and 13 females). With respect of age, xiv with age range <40 and six of the participant with the age range from xl–49, and 5 age ≥l, and 18 of them were married. Their educational level, 21 of them had their undergraduate qualification and 4 had their highest qualification as mail graduate level which includes post graduate diploma (Table 1).

Themes and sub-themes

The thematic assay constitute three major themes emerging; ane) Difficult working condition, ii) Reinforcing Factors, and 3) Perceived risks. Each theme had several sub-themes (Table two). The participants' reflection for each theme and sub-theme are further expanded and compared with other published studies. In this section, participants are presented with a "P" and cardinal number like P1, P2.

Difficult working atmospheric condition

The nurses believe that the weather where nurses' work tin have a major influence on their performance and the quality of care provided to patients include "heavy workload", "lack of workforce" and "unusual working hours".

ane. Heavy workload.

All the participants (25) working in the hospitals have confirmed that workload has been a challenge when there are extremely limited nurses to manage the patients on each shift. P3 stated that shortage of nursing and workload is seen throughout the hospital wards which exceed the number of nurses working per shift.

"Shortage of nursing is seen throughout the hospital wards and is a long-term issue where workload exceeds the number of nurses working in 1 shift".P3 (a 56-twelvemonth-old female person RN).

All the participants (25) also reported that the workload is increasing because of the high number of patients' admitted. P16 compared the population in the past with the current and stated that when the population increased, diseases as well increased that caused workload on nurses.

"In the past, the population was less but now the population increases due to the high number of disease cases that causes more than patients' admission and more workload to u.s. nurses".P16 (a 32-twelvemonth-old male RN)

Some of the participants (15) reported an inadequate number of nurses working in each shift too create challenges due to workload when other nurses on sick calls or almanac leave. P6 expressed the workload when just one nurse worked to cover for nurses who were on various leaves.

"Workload is besides much as almost of the time just two nurses working in each shift is not enough, if one staff on sick exit or annual leave then we must double the shift". P6 (a 34-twelvemonth-old male RN)

Four participants stressed the ratio of nurses to patients admitted in the infirmary in Vanuatu equally a huge difference which affects nurses' operation compared to the other countries. P14 stated:

"Uh…. when we expect at the ratio of nurses to patients in Vanuatu which is 1:10 or one:15 compared to other countries of which they have ane:iv, in that location is a huge deviation. One ward receives on average of twenty to 30 patients at i time but only 2 to 3 nurses piece of work on ane shift which is also much for one nurse to perform his or her duty effectively".P14 (a 33-year-one-time male RN)

20 participants accept the same responses due to the nursing shortage they experienced in their workstation, that they neglected a lot of their duties and responsibilities as a registered nurse. P8 reported that the impact of shortage prevents him to perform his duties and responsibilities such as home visits and other bedside nursing care which likewise affects the quality of care the patients required.

"Bear upon of shortage prevents me from performing some of my duties and responsibilities such as habitation visits and follow-upwardly care to patients with chronic illnesses. Bedside nursing and wound care or wound management are as well not done regularly, which can have a great impact on patients' health". P8 (a 43-yr-old male RN)

2. Lack of workforce.

Increased workload compared to less number of nurses working in the hospitals causes nurses' concrete burnout leading to job dissatisfaction as expressed past all 25 participants. P11 expressed the result of lack of workforce to his well-being.

"Workload is besides much in the hospital wards and we cannot do all our work at i fourth dimension……I ordinarily experienced tiredness and exhaustion and not interested to work due to incomplete jobs seen each day". P11 (a 37-yr-onetime male person RN)

Thirteen of the participants responded that the increased workload does not correspond with the number of nursing staff in the health facilities peculiarly with increased number of patients admitted and less number of nurses working. P8 stated that the number of workforce does not lucifer with the number of workload from increased admission.

"Few nurses do non lucifer with the increased workload today. For case, increased number of admissions with but 2 staff working per shift is a great claiming to us".P8 (a 43-year-quondam male person RN)

Other participant added:

"Shortage in my ward with merely ii nurses in one shift is not enough compared to the number of patients admitted specially when we have the critical patients that need shut supervision in the ward". P22 (a 53-year-old female RN).

Furthermore, eight participants stated that preparation and enrolment take meaning furnishings to the shortage on the nursing workforce due to a unmarried nursing higher in the country with limited number of student nurses' enrolment. P6 said that lack of workforce is due to inadequate enrolment from the nursing college each yr.

"One nursing higher is not plenty to railroad train more nurses to take an adequate number of nurses in the workforce. Furthermore, the decreased number of intakes to simply 30 per year is not plenty". P6 (a 34-year-old male RN)

Conversely, 7 participants stated that lack of nursing workforce is due to irregular nursing enrollment in the nursing college in the past.

"The reason for having a shortage of nurses frequently is due to uhm……no regular nursing intake from the VCNE each year. In the past 15 years, nursing college always have regular intakes each yr fifty-fifty if the number of intakes is less, nosotros withal have continuous graduation of nurses each twelvemonth with a practiced supply of nurses in the hospital to piece of work and provide care. Nowadays, the intake occur every 2 or 3 years. P20 (a 33-twelvemonth-former female RN)

Few of the participants (iv), reported that the other reasons for lack of workforce is nurse turnover. P24 stated that the workforce is afflicted especially when nurses leave their profession and look for other jobs elsewhere due to too much pressure from work.

"Workforce is afflicted when nurses leave their profession and look for other jobs elsewhere. They left due to too much piece of work load and not enough time to rest". P24 (a 42-year-old female RN).

3. Unusual working hours.

Working long shift hours up to 12 to 16 hours or double the shift due to not plenty staff to do shift work especially when staff on sick leave or on annual leave causes physical and emotional exhaustion and besides affects quality patients' care. P21 expressed the reasons for long hours shift and its impact to the nurses and to the patient.

"About of the time we spend long shift hours of work east.g. 12 to 16 hours or we double the shift due to not enough staff in the ward to practice shift piece of work when we don't have plenty staff and when staff are on ill exit. It is and so tiring and causes a lot of stress to almost of us who work long hours which also impact the quality care provided to patient".P21 (a 42-year-old female RN)

15 of the participants who normally work shift stated that they used to work double shift especially during the night where only few nurses were working. P17, an experienced nurse expressed that double shifts especially at night is common in the infirmary wards when nurses on duty unexpectedly on ill leave which significantly affect the nurses' physical well-beingness.

"Double shift is a common practice in the wards especially when in that location are not enough nurses to piece of work or when a working colleague is on sick leave. This causes much stress to u.s. nurses due to tiredness". P17 (a 64-year-old female person RN)

Five senior nurses responded that occasionally they work 24 hours to assist nurses in the ward when more than critical patients are admitted or during an epidemic. P3 stated that every bit a senior in charge nurse, they committed to work 24 hours when lack of nurses to take care of increased patient access

"It is our duty every bit senior nurses to assist the nurses in the wards when more disquisitional patients are admitted or during disease outbreak and work for 24 hours. It is quite tiring but nosotros accept no selection considering it is function of our responsibilities". P3 (a 56-year-old male RN)

Iii participants responded that during natural disasters, where a lot of nurses are unable to attend work and more patients admitted, they have to work extra hours during the day and during the night. P22 expressed her experience during natural disasters where she has to work on unusual hours to intendance for the casualties and aid nurses in the wards.

I have experienced spending all day and night for one whole calendar week during tropical cyclones to expect later patients as more nurses were unable to come to work". P22 (a 53-yr-old female RN).

Reinforcing factors

The nurses quoted during the interviews that "lack of support" and "lack of evolution opportunities and advancement in nursing practice" were reasons for depression motivations in their performance and job retention.

one. Lack of back up.

Well-nigh respondents (13) reported that lack of back up from the leaders causes low working morale and low motivation. P15 stated that the leaders in the infirmary management haven't provide much support to the nurses.

"We always confront our nursing managers or clinical supervisors concerning problems in our work place such as poor working equipment needing replacement and poor working environment simply they always requite excuses and no action taken seriously which affects our morale of work…." P15 (a 35-year-onetime male RN)

Some other participant added:

"We hardly see the managers or supervisors doing regular visitation to support nursing staff and to assess nurses work performance, this causes low staff motivation". P14 (a 33-yr-old male RN)

All nurses (25) responded that lack of family unit back up is mutual due to working overtime and coming home late from work. One participant (P21) reported that they don't receive any support from the family peculiarly when they came home late from work

"When I came abode very belatedly from work my family got angry with me. I don't receive whatever support from my family. They fifty-fifty forced me to quit my job due to coming home tardily from work every day". P21 (a 42-year-erstwhile female RN)

Some other participant added:

"Even my family unit don't want to give me food due to frustration of continuously coming home late from work." P16 (a 32-year-erstwhile male person RN)

Virtually of the participants (fifteen) have expressed their frustration due to lack of financial back up from the MoH peculiarly special allowance for working overtime and others. P1 stressed that she has been working for more than 20 years but she hasn't received any fiscal support apropos their overtime package or other allowance or incentives apart from their normal wages which affect their motivation to perform duty effectively.

"I work for many years just I don't receive any financial support from the health government autonomously from my piffling salary regarding extra responsibility allowances or overtime allowances or any incentives". P1 (a 56-year-former female RN)

Other participant added:

"Even our working status is on contract bases for and then long due to positions not approaching for which affects our benefits and job insecurity". P11 (a 37-year-sometime male RN)

ii. Lack of development opportunities and advancement in nursing do.

All participants (25) stated that lack of evolution opportunities to accelerate in nursing practices and career pathways are common issues that cause thwarting within the working environment. P24 expressed her disappointment that she works for quite a long fourth dimension in the infirmary but chances to advance in her knowledge is very slim and don't accept the opportunity to expand her knowledge and skills in nursing practice.

"I am very disappointed considering I worked in the hospital for many years doing the same routine job as usual and I still remain the same usual nurse…. I don't receive any promotion because I don't take whatsoever opportunities to accelerate in knowledge and skills in nursing practices". P24 (a 42-twelvemonth-quondam female person RN)

Another participant added:

"I haven't seen any effective career pathway for nurses adult past managers for further trainings to upgrade nurses' knowledge and skills for advancement in our clinical practice". P4 (a 34-yr-old male RN)

All the participants stated that most of them don't take any chances for professional person development. P18 responded that most nurses perused their training from the Vanuatu nursing higher with a diploma level and haven't had any chances to upgrade to a higher level of qualification.

"Most of us nurses graduated from the nursing college with a diploma of nursing but we don't have changes to upgrade to a college level of qualification or to up skill our-selves". P18 (a xxx-yr-erstwhile female RN)

Another participant added:

"Our skills in nursing practice need to be upgraded in lodge for united states to advance with our clinical practices. It is very adept to accept regular in-service training but it never happens on regular bases, in order to go on us updated with our nursing practice skills". P2 (a 34-yr-old male RN)

Other nurses reported that specialty training is as well necessary to up skill nurses and advance in their clinical exercise in the speciality area simply merely few nurses had given the chances in the past to attend those training.

"Vanuatu needs more than specialized nurses to provide quality care to different types of patients however, merely few nurses had been given the chances to take upward those preparation which is all the same needed for more nurses to take specialize training to provide constructive and quality care needed". P3 (a 56-year-old female RN)

Perceived risk

The nurses quoted during interviews that "stress" and "physical and medical risks" were reasons that affect nurses and increased the chances to quit their profession.

i. Stress.

Bulk of the participants (xx) accept worked in the infirmary for more than than 5 years and reported that they have experienced the bear on of shortage of nursing personally. P5 reported that stress causes a major event on nurses due to workload and also threatens her job.

"I experienced tiredness, stress and non satisfied with my task each day due to piece of work overload. I normally go home late due to long hours of work and no fourth dimension for my family which affects my family relationship. Even my family unit asked me to look for another health facility to work which has less workload". P5 (a 31-year-old female RN)

Four of the participants stressed the effects of work overload and overtime due to nursing shortage causes stress and frustration and violence at dwelling.

"Work overload and work for long hours causes a lot of stress and frustration where I don't take enough balance, no time to relax, and not enough quality time for my family unit which causes frustration and violence in my home". P23 (a 53-twelvemonth-former female RN)

Other participants (12) added:

"Stress is the result of tiredness and non enough residuum peculiarly when the ward is full and less nurses working and you have to double the shift". P12 (a forty-year-quondam female person RN)

2. Concrete and mental risks.

Some participants (vi) stated that work overload and work for long hours causes more than physical and medical risks

"Shortage of nurses affects our concrete body very badly. We experienced back pain and back injury for trolleying patients to the theatre and to other diagnostic units……and nosotros felt tired and cannot provide the best quality nursing care to our patients". P20 (a 33-yr-onetime female person RN)

Other concrete risks which was reported by all participants (25) is when they don't have enough fourth dimension to balance and eat or drink due to too much work load and limited nurses. P24 expressed that they don't have plenty time to residue and eat during busy times which impact her physical body and her wellness.

"About of the fourth dimension our ward is decorated and those times I don't have enough fourth dimension to rest and eat or even drink which affects my physical health". P24 (a 42-year-old female person RN)

Workload with only few nurses causes a lot of medical risks on nurses' health and clinical functioning which leads to early retirement or were granted early retirement due to medical reasons. One participant stated:

"A lot of nurses in our hospital exit their job and most of them were granted early retirement due to medical health reasons which prevent them to continue with their job". P11 (a 37-year-old-female)

Another participant added:

"I worked about 20 years now and I have medical issues which affect both my lower extremities and I take requested to take my early on retirement considering I won't be able to piece of work with the current health conditions. My wellness weather will non simply bear upon my well-being just volition likewise affect my clinical nursing performance". P7 (40-year-old-female RN)

Near nurses (15) reported that high job demands increment physical and mental health problems. P9 mentioned the affect of stress to concrete and mental problem on nurses

"Stress affects our mental health when we are exhausted due to piece of work overload which prevents united states of america to think properly which also increases the chances to make mistakes". P9 (a 56-twelvemonth-old female RN)

Another participant added:

"When we accept too many patients and lack of skills particularly for united states of america inexperienced nurses, it affects united states psychologically besides which tin bear on our operation". P5 (a 31-year-old male RN)

3. Medical risk.

One of the respondents stated that medical errors are i of the common risks that occur due to stress from working long hours or work overload.

"I have experienced the result of stress that causes loftier chances of errors in our work station which threaten the lives of the patient. Some prevented errors are the outcome of work overload and long hours of work which prevent nurses from perform their duties effectively and increase the chances to make mistakes". P2 (a 34-year-old male person RN)

Iv participants reported that medical errors were seen in their work station due to physical and psychological stress where they gave incorrect medication to the patients.

"Few times I gave incorrect medication to patients because I can't think properly due to tiredness and exhaustion or sometimes I gave the correct medication but I don't explain it well to the patient especially the dose, fourth dimension and route of assistants". P4 (a 34-year-former male)

Another participant added:

"Near of the time due to frustration and too much workload I don't practice infection control rules and regulations which cause more medical hazard to my patients". P11 (a 37-year-old male RN)

4. Social and family hazard.

Nurses experienced social and family risks when they have high volume of pressure and when patients are not receiving services immediately, they cause mischief to nurses and their families. P12 expressed his fear when patient and relatives were frustrated due to patients' non receiving care or service immediately and threaten her family.

"I experienced virtually times especially when nosotros have less nurses working in one shift in the emergency section when I and even my family were threatened when patients' relatives got angry with me for not attending to them immediately or not treating them well every bit expected. Sometimes they threatened me and my family as well". P12 (a 40-twelvemonth-old female person RN)

Another participant added:

"Occasionally I get frustrated from work due to pressure and when I bring frustration to my home, information technology causes domestic violence in my abode. This causes much run a risk to my family". P6 (a 34-twelvemonth-sometime male person RN)

Give-and-take

Prompted by the findings from the RNs in Vanuatu on the nursing shortage, it impacted the health service delivery throughout the Vanuatu population [14]. Although the Vanuatu MoH has been implementing strategies in the past to address the issues, the shortage of nursing is all the same evident with the current nursing workforce shortage of more than 400 where Vanuatu MoH is nonetheless unable to fill the shortage gaps [fourteen]. The electric current study findings have reported the impact of nursing shortage on the nurses and their performance in providing quality care.

Difficult working conditions

The working conditions for nurses accept major influence on the nurse's operation and the quality of care provided to patients due to job dissatisfaction. The findings emerged with the condition which includes workload due to high patients' admission, lack of workforce and unusual working hours. Several studies accept shown that job dissatisfaction always emerged along with poor working atmospheric condition due to workload and lack of workforce [19, 20].

Information technology is obvious that the workload in the wellness facilities inside the MoH health arrangement has been a long-term effect and become a claiming when few or limited number of nurses who care for the large number of patients admitted, and workload exceeds the number of nurses working in each shift. The maximum number of nurses working per shift is two to iii nurses according to the findings, which is not effective to provide a quality care needed for nurses and patient's condom. Although the managers within the infirmary setting are enlightened of the workload bug, they have no meliorate solutions to accost the workforce shortage as information technology become a major claiming across the country that needs effective planning and policy directions from the policy makers at the authorities level. Studies stressed that work load is becoming a major cistron when at that place are inadequate number of nurses working compared to the demand [21, 22]. Other studies from other developed countries likewise reported that inadequate policy direction and planning has huge impact on nursing population including nurses' workload [5, 23]. The difference is that our report participants have experienced shortage and its impact while working in the infirmary and might take limited noesis well-nigh the policy and planning direction of Vanuatu MoH.

With few number of nursing staff compared to high workload, causes a lot of pressure and physical burnout to nurses. There are factors that contributed to lack of workforce identified by participants who include low educatee nurse enrolment or irregular grooming provided by the nursing college. Although the nursing college enrolled nurses continuously for the last 30 years, the number of output is so limited and does non match with the increased demand. Other wellness leaders besides supported the fact that depression enrolment in the nursing college is condign obvious when looking at the electric current increment number of aging population of nurse inside the MoH. Studies from other countries stated that low enrolment have significantly contributed to lack of workforce which touch nursing and their profession in the futurity [four, 24]. The shortage were identified past the participants from the low number of nurses distributed and work in each of the hospital.

In this study it was plant that nearly of the nurses working in the hospital had experienced long shift hours up to 12 to xvi hours or double the shift due to not plenty staff to do shift work or when other nursing staff on ill calls or annual exit. The nurses stated that long working hours is very stressful which affects their work performance and also as their social and family relationship. The nursing managers and senior clinical supervisors aware that nurses normally piece of work on unusual hours when non enough staff to do shift work, and accept noticed moral distress on nurses which affects nurses' motivation to perform the job effectively. In other industrialized countries, one tertiary of the nursing workforce has irregular or unusual working hours which significantly affects the nurses' health and patient outcome [25]. Furthermore, pressure of working long hours contributed to nurses leaving their profession from task dissatisfaction and poor working environment. Study have shown that nurses leave their job due dissatisfaction with working condition in a stressed environment such as irregular working hours [26, 27].

Reinforcing factors

Findings shows that lack of support and lack of development opportunities and advocacy in nursing practice were reasons for low motivations which affects nurses' performance.

Most nurses reported that lack of back up from the managers and supervisors causes low working morale and low motivation to perform duties finer. Although the nursing managers and senior clinical staff are experienced in their position, nurses still haven't received total support for the leaders. This includes no regular visits and no deportment to nursing staff complaints or grievance. It is evident due to areas that yet to be resolved and need urgent actions from the managers. Studies show that nurses needed attending from the managers and supervisors to identify areas that needs urgent or serious attention or early detection of any problems that might occur among nurses and their piece of work performance [20, 28].

Near of the nurses stated that lack of development opportunities to accelerate in nursing practices is one of the common bug that create thwarting on nursing staff within their working environments. Nurses believed that when opportunities to accelerate is left as well long or no attention from their superiors, it causes low motivation that leads to low operation that will certainly let nurses to leave their job. Although the HR at the national level develop career pathway for nurses, nigh nurses are not given whatsoever chances to advance in their profession or chapters building equally role of their professional person development, which is also reflected on the level of Education on demographic information where the highest level for near nurses is diploma of nursing. A study in Iran has shown that lack of opportunities to advance in nursing and lack of professional vision towards nursing, cause discrimination among nurses and dissatisfaction which causes nurses intended to go out their profession [21]. According to the RNs personal characteristics, more than 50% have completed undergraduate studies with diploma of nursing equally their highest level of nursing which reflect lack of professional vision to upgrade nurses to higher level which might results to low motivation in the workplace.

Perceived take a chance

The findings perceived that stress and medical risks impact nurses that increase the chances to quit nursing profession.

Stress has major effect on nurses non only with concrete exhausted merely also has an outcome on social and family human relationship. Stress afflicted nurses due to workload and overwork which significantly affect the quality of intendance provided to patients too. Majority of the RNs who piece of work in the infirmary might experience the bear upon of shortage of nursing personally because they take worked for more than v years. If stress was managed promptly, information technology will forestall exhaustion, task satisfaction and improve patients' quality care. Although studies have shown that stress affect all nurses due to worldwide nursing shortage, the nursing managers and leaders in Vanuatu, who have in contact with nurses regularly must accept ameliorate understanding of stress and its relationship and also its symptoms in society to manage stress effectively [29, 30]. It is important for Vanuatu MoH to prefer stress management procedure by other countries in order to identify and management stress among nurses effectively.

Findings have shown that work overload and long hours' work causes serious threats to nurse'south concrete health. Furthermore, finding shows that nurses experienced injuries and other medical conditions while performing service. Furthermore, majority of the RNs take been granted early retirement due to medical reasons that might be due to piece of work overload or poor working conditions. The challenges of having nurses gone on early on retirement is when not enough nurses for replacement, even so nurses with medical reasons need to go out their profession equally they will negatively impact patient's care and also their well-being. Studies supported that mental and physical health of nurses has significant effects on the quality of intendance provided to the patient [30, 31]. On the other hand, other studies supported that senior nurses leave their profession before their retirement age due to medical reason and is necessary for patients' condom to decrease bloodshed [32, 33].

Furthermore, stress associated with nursing shortage has a pregnant bear upon on patients' care in the infirmary which causes much health risks and increase the risk of medical errors and lack of quality care up to a required standard. Findings show that, Vanuatu nurses were able to piece of work under pressure, but medical errors can still be experienced at the workplace. Studies confirmed that medical errors are associated with nurses' psychological stress and other health risks due to work overload [8, 31].

Study strengths

The study is a loftier quality report and the kickoff study that was conducted in the Republic of Vanuatu among the registered nurses. The study rigors was followed from conducting the study, data collection and information analysis. The study will do good the Vanuatu ministry building of health by enabling the policy makers to refine and develop relevant policies to address and strengthen the nursing workforce to run into the need and better delivery of quality health services to all individuals in both urban and rural settings.

Study limitations

There were some logistic limitations in terms of conducting interviews or reach the study participants easily due to was unable to Covid-xix pandemic. Information technology was not possible to study other hospitals in Vanuatu to extract more than information due to time limitation.

Decision

This written report has identified many key factors that contributed to the shortage electric current nursing workforce and the bear on it has on RNs which needs to be addressed promptly to resolve the shortage of nursing workforce Vanuatu in the coming years. Broad themes and sub-themes were identified which highlighted the impact of nursing shortage to RNs and the effects on their performance. The studies showed that stress or moral distress from work overload and lengthy hours shift impact the nurses' physical, psychological, social, and family relationship.

The recommendation to aid the Vanuatu authorities through the Ministry of wellness to accost chronic shortage of nurses is, the regime should invest on establishing a much bigger nursing higher to increase its yearly intake in nursing, to have interim plan to address the current shortage of nurses and review the whole nursing situation and nurses distribution, and to promote nursing in all the secondary levels of didactics.

Acknowledgments

We would like to give thanks all the written report participants and those who were very supportive for their valuable time and participation in the interview.

References

1. ane. Toh Yard, Ang E, Devi MK. Systematic review on the relation between the nursing shortage and chore satisfaction, stress and exhaustion levels amid nurses in oncology/haematology settings. 2012;
   • View Article
   • Google Scholar
2. 2. Aluko JO, Anthea R, Marie Modeste RR. Manpower chapters and reasons for staff shortage in primary health intendance maternity centres in Nigeria: A mixed-methods study. BMC Wellness Services Research. 2019; 19(ane), ten. pmid:30616598
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
3. iii. Pourvakhshoori Due north, Norouzi K, Ahmadi F, Hosseini M, Khankeh H. Nurse in limbo: A qualitative report of nursing in disasters in iranian context. PloS ONE. 2017; 12(7), e0181314. pmid:28759598
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
4. 4. Alshmemri M, Shahwan-Akl 50, Maude P. Job satisfaction of Saudi nurses working in saudiarabian public hospitals. 2013; Retrieved from http://researchbank.rmit.edu.au/view/rmit:23815
   • View Article
   • Google Scholar
5. 5. Alameddine Thou, Chamoun Northward, Btaiche R, El Arnaout N, Richa Northward, Samaha-Nuwayhid H. (2017). The workforce trends of nurses in lebanon (2009–2014). PLoS Ane. 2009–2014; 12(8, Art. e0182312), 10–12:8, Art. e0182312<10. pmid:28800618
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
6. vi. World Health Organization (WHO). Global health workforce shortage to reach 12.9 million in coming decades. 2013; Bachelor on: http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/
7. seven. Heijden B, Mahoney CB, Xu Y. Impact of job demands and resources on nurses' burnout and occupational turnover intention towards an age-moderated mediation model for the nursing profession. International Journal of Ecology Research and Public Wellness. 2019; pmid:31195753
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
8. 8. Leineweber C, Chungkham HS, Lindqvist R, Westerlund H, Runesdotter Southward, Smeds Alenius 50, et al. Nurses' practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study. International Journal of Nursing Studies. 2016; 58, 47–58. pmid:27087297
   • View Article
   • PubMed/NCBI
   • Google Scholar
9. 9. Barnett T, Namasivayam P, Narudin DAA. A critical review of the nursing shortage in malaysia. International Nursing Review. 2010; 57(1), 32–39. pmid:20487472
   • View Article
   • PubMed/NCBI
   • Google Scholar
10. 10. Abhicharttibutra M, Kunaviktikul W, Turale South, Wichaikhum O, Srisuphan Westward. Analysis of a authorities policy to address nursing shortage and nursing education quality. International Nursing Review. 2017; 64(1), 22–32. pmid:27046433
    • View Article
    • PubMed/NCBI
    • Google Scholar
11. eleven. Amadi E. Healthcare leaders' perceptions nearly the nursing shortage: A qualitative collective case study available from Dissertations & Theses @ Academy of Phoenix. 2015; Retrieved from https://search.proquest.com/docview/1747438477
12. 12. Aiga H. Adapting workforce density threshold to WHO's new antenatal intendance recommendations. The Lancet. 2020; 395(10217), 27. pmid:31908275
    • View Article
    • PubMed/NCBI
    • Google Scholar
13. 13. Negin J. Australia and New Zealand'southward contribution to pacific island health worker brain bleed. Australian and New Zealand Journal of Public Wellness. 2008; 32(6), 507–511. pmid:19076739
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
14. 14. Ministry of Health (MOH). Workforce Evolution Plan 2019–2025. Building capability and leadership. 2019; Port Vila, Vanuatu.
15. 15. Mehdaova E. Strategies to overcome the nursing shortage. Available from ProQuest 1 Academic Eastern Edition. 2017; Retrieved from https://search.proquest.com/docview/1980418660
    • View Article
    • Google Scholar
16. sixteen. Edem I, Banton B, Bernstein M. A Prospective Qualitative Report on patients' perceptions of endoscopic endonasaltranssspenenoidal surgery. 2013; Retrived from: www.ncbi.nlm.nih.gov
    • View Article
    • Google Scholar
17. 17. Hung SY, Stanley KK. Contextual Factors Affecting Occupational Turnover amid Registered Nurses in Public Hospitals in Hong Kong: A Qualitative Descriptive Study. International Journal of Ecology Research and Public Health. 2020; xi(3), 2521–2535.
    • View Article
    • Google Scholar
18. 18. Braun V, Clark Five. Thematic analysis. The Periodical of Positive Psychology. 2017; 12 (3), 297–298. pmid:27706869
    • View Article
    • PubMed/NCBI
    • Google Scholar
19. nineteen. Chan ZCY, Tam WS, Lung MKY, Wong WY, Chau CW. A systematic literature review of nurse shortage and the intention to leave. Journal of Nursing Management. 2013; 21(4), 605–613. pmid:23406374
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
20. 20. Liu W, Zhao S, Shi L, Zhang Z, Liu Ten, Li L, Ni 10. Workplace violence, task satisfaction, burnout, perceived organizational back up and their furnishings on turnover intention amid Chinese nurses in tertiary hospitals: A cross-exclusive written report. BMJ Open. 2018; 8(half-dozen), e019525. pmid:29886440
    • View Article
    • PubMed/NCBI
    • Google Scholar
21. 21. Valizadeh L, Zamanzadeh V, Habibzadeh H, Alilu 50, Gillespie M, Shakibi A. Experiences of Iranian nurses that intent to exit the clinical nursing: A content analysis. Journal of Caring Sciences. 2016; 5(two), 169–178. pmid:27354981
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
22. 22. Yang H, Lv J, Zhou X, Liu H, Mi B. Validation of work pressure and associated factors influencing infirmary nurse turnover: A cross-sectional investigation in Shaanxi province, china. BMC Health Services Enquiry. 2017; 17(1), 112. pmid:28158979
    • View Article
    • PubMed/NCBI
    • Google Scholar
23. 23. Souza Norma ValériaDantas de Oliveira, Gonçalves Francisco Gleidson de Azevedo, Pires A. d. S., & David Helena Maria Scherlowski Leal. Neoliberalist influences on nursing hospital piece of work process and organization. RevistaBrasileira De Enfermagem. 2017; lxx(5), 912–919. pmid:28977215
    • View Article
    • PubMed/NCBI
    • Google Scholar
24. 24. LeVasseur S Qureshi K. International Endodontic Journal. 2019; 52(S1), 3–41. pmid:31602655
    • View Article
    • PubMed/NCBI
    • Google Scholar
25. 25. Rheaume A, Mullen J. The touch on of long work hours and shift work on cognitive errors in nurses. Journal Nursing Management. 2017; pmid:28857317
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
26. 26. Nantsupawat A, Kunaviktikul W, Nantsupawat R, Wichaikhum O, Thienthong H, Poghosyan 50. Effects of nurse work surround on job dissatisfaction, burnout, intention to leave. International Nursing Review. 2017; 64(ane), 91–98. pmid:27882573
    • View Article
    • PubMed/NCBI
    • Google Scholar
27. 27. Kakemam E, Raeissi P, Raoofi Due south, Soltani A, Sokhanvar , Visentin DC, Cleary M. Occupational stress and associated risk factors among nurses: A cross-sectional report. Gimmicky Nurse: A Periodical for the Australian Nursing Profession. 2019; 55(2–3), 237–249. pmid:31334691
    • View Article
    • PubMed/NCBI
    • Google Scholar
28. 28. Buerhaus PI, Donelan Yard, Ulrich BT, Norman 50, DesRoches C, Dittus R. Impact of the nurse shortage on hospital patient intendance: Comparative perspectives. Health Diplomacy. 2007; 26(3), 853–862. pmid:17485766
    • View Article
    • PubMed/NCBI
    • Google Scholar
29. 29. Guo Y. Speeding upwards development of the nursing profession and promoting human being health in people's republic of china. International Periodical of Nursing Scientific discipline. 2017; iv(1), 5–7. pmid:31406709
    • View Article
    • PubMed/NCBI
    • Google Scholar
30. 30. Batran A. Work Related Stress amidst Saudi Nurses Working in Intensive Care Units. Open Journal of Nursing. 2019; 9(eleven), https://doi.org/10.1080/17517575.2019.1569264
    • View Article
    • Google Scholar
31. 31. Wang C. C., Whitehead 50., & Bayes Southward. The real 'toll' of report in Australia and the ramifications for Prc, Australia, and the Chinese nursing students: What do these three players want? A narrative review. Globalization, Societies and Education. 2017; fifteen(5), 590–606.
    • View Commodity
    • Google Scholar
32. 32. Uthaman T, Chua TL, Ang SY. Older nurses: A literature review on challenges, factors in early retirement and workforce retentiveness. London, England: SAGE Publications. 2016; https://doi.org/10.1177/2010105815610138
33. 33. Sirisub P, Suwannapong N, Tipayamongkholgul Thou, Howteerakul N, Noree T. Intention to extend working life amid thai registered nurses in ministry of public health: A national survey. Nursing Enquiry and Practice. 2019; 7919404–11. pmid:31316829
    • View Article
    • PubMed/NCBI
    • Google Scholar

daytrompair.blogspot.com

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251890

Share this post