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Institute for Workplace Studies                 Professor Samuel B. Bacharach
School of Industrial & Labor Relations          Director, Institute for Workplace Studies
Cornell University
16 East 34th Street, 4th floor                  Stuart Basefsky
New York, NY 10016                      Director, IWS News Bureau
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OECD HEALTH WORKING PAPERS NO. 19

TACKLING NURSE SHORTAGES IN OECD COUNTRIES [14 March 2005]
Steven Simoens, Mike Villeneuve and Jeremy Hurst
http://www.oecd.org/dataoecd/11/10/34571365.pdf
[full-text, 58 pages]

SUMMARY
1. There are reports of current nurse shortages in all but a few OECD countries. With further
increases in demand for nurses expected and nurse workforce ageing predicted to reduce the supply of
nurses, shortages are likely to persist or even increase in the future, unless action is taken to increase flows
into and reduce flows out of the workforce or to raise the productivity of nurses.

2. This paper analyses shortages of nurses in OECD countries. It defines and describes evidence on
current nurse shortages, and analyses international variability in nurse employment. Additionally, a number
of demand and supply factors that are likely to influence the existence and extent of any future nurse
shortages are examined. In order to resolve nurse shortages, the paper compares and evaluates policy levers
that decision makers can use to increase flows of nurses into the workforce, reduce flows out of the
workforce, and improve nurse retention rates.

3. Although delayed market response may have been responsible for recurring cycles of shortages
and surpluses of nurses in the past, current and future nurse shortages in OECD countries appear to be
driven by a broader set of economic, demographic and sociological factors. In addition to delayed market
response, current nurse shortages seem to be caused by fewer young people entering the workforce, a
greater range of professional opportunities open to young people, the low social value given to nursing,
negative perceptions of nurse working conditions and an ageing nurse workforce. Furthermore, demand for
nurses has continued to increase due to ageing populations, increased consumer activism and rapid
evolution of medical technologies.

4. To date, little is known about the cost-effectiveness of different policies to ensure an adequate
supply of nurses. Both pay and conditions of service seem to influence flows of nurses into and out of the
workforce, and nurse retention. Pay has been shown to influence entry into nursing school, participation of
qualified nurses in the workforce, nurse retention, and exits from the workforce, although more work is
needed to quantify the impacts of pay on these stocks and flows. Improvement in conditions of service,
such as: offering flexible work and retirement arrangements; setting up family care initiatives; improving
workforce management policies; creating a supportive organizational culture; enhancing career
advancement prospects; also seem to have had some success in retaining nurses. Additionally, staffing
levels seem to play a role in recruitment and retention, with evidence emerging that minimum nurse-topatient
ratios are associated with reduced nurse turnover and increased nursing school intake. There is also
some research indicating that nurse shortages may be reduced by raising the proportion of nurses who are
registered, without employing more overall.

5. Although there are signs that nurse shortages are set to worsen in the near future if policy action
is not taken, this is not an inevitable outcome. Traditional policy responses that focus on one specific
aspect of flows in or out of the workforce or retention, however, are unlikely to suffice. Instead, this paper
points to the introduction of mixed policies that initiate innovative approaches to nurse education and
training, offer strong incentives to recruit domestic and foreign nurses, raise productivity and make pay and
conditions of service attractive enough to retain nurses of all ages.
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Institute for Workplace Studies *
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New York, NY 10016                      *
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# posted by SBasefsky : 1:01 PM