Human Resources Specific to Healthcare: Staff Recruitment and Retention


The present essay explores the status of health care staffing in the United States, focusing on nursing shortages and the impact on employee recruitment and retention in the public health. The analysis is concerning the study by (Yeager & Wisniewski 2017). The paper first studies the background of nursing shortages in the United States and the laws and regulations around nursing employment. The third part of the paper discuses impact of nursing shortages on quality of care and public healthcare operations and the strategies to manage the impact.

Introduction and Background of the Issue

The report by Yeager & Wisniewski (2017) explores the status of the health care workforce in the United States, focusing on the nursing shortages and the influence on recruitment and retention of public health nurses. According to the article, the United States’ health care organizations are experiencing a persistent shortage of registered nurses (RN) and licensed practical nurses (LPNs). The two groups are responsible for a significant share of the health care provided in the U.S. country. The shortage of RNs and LPNs is projected to continue surging in the next decade across both public and private health agencies. Yeager & Wisniewski (2017) survey local health departments across the United States, out of which one-third estimated that they anticipated a shortage of nurses in public hospitals by 2017, and approximately one-quarter indicated having challenges in hiring qualified nurses (Yeager & Wisniewski 2017).

The study’s findings are consisted with that of U.S. Bureau of Labor Statistics projections, which estimate a shortage of about one million registered nurses in the U.S. by 2022. According to the U.S. Bureau of Labor Statistics, the national shortage of nurses is triggered part by the aging nursing labor force, nearly 40% of registered nurses over the ages of 50 years (Maalouf, Sidaoui, Elhajj & Asmar 2018). As the number of RNs nearing retirement continues to grow every year, hospitals and healthcare systems across the U.S. are faced with the problem of recruiting and retaining qualified personnel. Monahan (2015) examined the nursing shortage projections by 2025 using the demand and supply model for registered nurse shortage in the 50 states of the U.S. The researcher estimated a surge in demand for registered nurses by 26% in 2020 and a shortfall of about 53,000 RNs by the same year. Research indicates that approximately 14% of nurses in the U.S. are in view of quitting their jobs (Monahan 2015).The decision to leave their jobs is equally linked to a lack of participative administration and management support (Maurits, de Veer, van der Hoek, & Francke, 2015). The patients remain the end loser amid all these chaos.


As for the public hospitals, Yeager & Wisniewski (2017) argues that the primary challenge is that the government budget, in many cases, cannot compete with the reward offered in the private sector, thus hindering the recruitment and retention of qualified nurses. The problem is aggravated by today’s competitive employment environment, affected by the current shortage of registered nurse professionals (Yeager & Wisniewski 2017). Understanding the factors that affect public health nurses’ recruitment and retention is essential to inform the strategies to retain the current qualified workforce and fill the employment gaps in public health. The information is particularly significant in light of several nurse professionals’ looming retirement in the near future.

Laws and Regulations Affecting Nurse Recruitment and Retention in the U.S.

The shortage of nurses and patient care quality has been the subject of extensive debate for many years. The policymakers at the federal and state levels are beginning to take the issue seriously, enacting laws and regulations to address its impact. TheUnited States federal government, through the “Title 42 of the Code of Federal Regulations,” requires health care agencies certified to play a part in Medicare to have sufficient staffing qualified to provide quality care. However, the study shows that only about 14 states at the present address nurse employment in-laws. The regulation recommends that states should ensure adequate staffing in any hospital that take part in Medicare. However, the present law is equivocal in that the U.S. federal government allows states to enact their own specific laws concerning nurse staffing and patient safety (Shin, Koh, Kim, Lee, & Song, 2018). An integrative review by Shin, Koh, Kim, Lee, & Song (2018) discerned that legal criteria for optimal nurse employment universally are no doubt indispensable. In their study, the researchers noted that currently only 11 states are strictly following the nursing employment laws. For instance, California, New York, and Massachusetts proposed nurse-to-patient ratios according to the patients’ needs’ severity. Precisely, the state of California passed a law that necessitates minimum nurse staffing. The principle that all the intensive care units must arrange for 1:1 or 1:2 nurse-to-patient ratio (Shin, Koh, Kim, Lee, & Song, 2018), contingent on patients’ severity of care need, was adopted in Massachusetts.

 The state of California has made an outstanding achievement in observing the nursing ration law. The law dictates a minimum ratio of at least one nurse to five patients and 1:2 for the Intensive Care Units on hospital wards. The ratios are higher compared to the period before 2004 when the law was enacted. No hospital has violated the policy, and the number of nurse professional seeking licenses increased by about 15% or more than 60,000 nurses after the passage of the nurse-to-patient ration law. The California hospitals incurred an estimated labor cost of $1 billion by 2008 to implement the mandatory nurse-to-patient ratios. The reported rate of nurse-license rate in California rose to more than 60% compared to other states between 2004 and 2008, alongside increased job satisfaction and reduced nursing turnover rates. California also reported effectively addressing the nurses’ workforce’s imbalance demand and supply due to older nurses’ aging and retirement (Shin, Koh, Kim, Lee, & Song, 2018).

            The current common feature of nurse staffing law in the U.S. is the minimum nurse-staffing strategy that must comprise direct-care nurses, with an exemption for assistive personnel and administrative staff. Every state is required by law to have in place a committee and develop a staffing place on a case-to-case basis. The nursing law in Washington, Illinois, Texas, and Washington requires at least 50-60% of the direct-care nurses to be included in the committees. Other states, such as Vermont, require that the public be notified of the nurse staffing information to satisfy the public’s right to know (Shin, Koh, Kim, Lee, & Song, 2018). Even though such laws as a nursing-to-patient ratio have proven to enhance hospitals’ efficiency, the current shortage of registered nurses in the U.S. and worldwide to take responsibility for public health and excessive workload is a growing issue for healthcare managers to deal with for some decades (Mehdaova 2017). To successfully shape the nurse-staffing administration, the nursing skill mix must incorporate deliberation of the educational background, competence, critical thinking, and clinical experience.

            Besides the nurse-to-patient ratio, there are other several regulations and laws instituted by the U.S. federal government to regulate and support strategies that reinforce a nursing workforce that focuses on recruitment and retention of nurses 2000. Such policies include the “Nurse Reinvestment Act of 2002″ and the “American Recovery and Reinvestment Act of 2009.” Another milestone in the nursing laws is the passage of the “Affordable Care Act (ACA) of 2010,” which has sections intended for the nursing workforce’s development and wellbeing. Besides the above regulations, the “U.S. Department of Health Resources and Services Administration (HRSA)” has created a “Nurse Education, Practice, Quality and Retention (NEPQR),” a program that awards certified health care facilities and schools of nursing to promote nursing education and improve the quality of care, and consequently increase the nurse retention capacity (Mehdaova, 2017). The action is a management response to the ongoing nurse recruitment and retention crisis witnessed in the U.S. and across the world. However, the study has proven that NEPQR implementation demands more patient care, technology advancement, and more administration, therefore driving up the demand for nursing (Mehdaova, 2017). The current decrease in nurses’ supply can also be attributed to the decline in nursing schools’ nurse student enrollment.

Impact of Nursing Shortages on Quality of Care and Public Healthcare Operations

            A growing body of studies, based in state and healthcare administrative data, indicates a correlation between shortages nurse staffing and the ever-increasing risks of adverse patient outcomes, including an increase in mortality. The continued shortages might also translate into increased labor costs and a decrease in the effectiveness and efficiency of care provided.  Because of the workforce shortage, nurses are forced to work for long hours and under stressful environments, translating into injury, fatigue, and job dissatisfaction. Nurses operating under such straining settings may be predisposed to medical errors and avoidable mistakes (Snavely, 2016). The resulting outcome is the deterioration in care quality, which translates into preventable complications, including emergency room overcrowding, increased mortality rates, and medication errors.

The introduction of the affordable care act (ACA) has significantly focused on the patient outcome, with pressure on the nurses to prove that they deliver effective care (Snavely, 2016). This implies that the demand for nurse practitioners (NPs) and advanced practice nurses (APNs) has also increased. Even though the phenomena favor job-seeking nurses, it also comes with some adverse consequences. The nurse shortage, an ongoing phenomenon in the U.S. long before ACA, means that nurses are becoming overworked with inadequate nurse-to-patient ratios (Snavely, 2016). The apparent outcome is the burnout and low quality of care, medical errors, and repeating avoidable mistakes.

            Patients suffer when the nursing workforce experiences the time-constraining impact of understaffing. With the continuous aging of the population, the scenario looks uninviting as about 80% of adults who are 65-years-old and above have at least one chronic disease, and over 65% have two or more chronic conditions. With the pattern, the fraction of the population that needs regular care will continue to exert pressure on the healthcare practitioners, leading to burnout and job dissatisfaction. The physicians are experiencing strain as well (Raghubir, 2019). With the affordable care act and health insurance schemes, there is the development of unmanageable equilibrium in the healthcare environments where the physicians are forced to reduce the amount of time spent with the patients to sustain a profitable bottom line. The nurses even more strain as some of the workload is transferred to them by the doctors (Mehdaova 2017). They must pick any vital missing record of the patient’s history that may have been revealed to the doctor.

The shortage of nurse professionals also has financial implications for organizations. A healthcare organization must offer competitive salaries for nurses to attract and retain qualified staff. Also, as the shortages trigger frustrations and burnouts among the nurses, turnover rates increase, costing the healthcare industry an estimated $4 billion annually. Besides, investing in nurse retention is an essential cost that the healthcare organization cannot avoid. It estimated that the price to recruit, train, and retain a nurse for a job ranges from $80,000 to $100,000. The cost is aimed to create a workforce environment where nurse professionals feel respected, valued, and reduce burnout (Mehdaova 2017). The economic implication is the healthcare organizations save money and reduce the operating costs at the same time.

Strategies to Manage the Shortages of Nurses in the Healthcare Systems

Several administrative strategies have been proposed to address the gaps brought by the nursing shortages in the healthcare systems, which seems not to be ending soon. Nurse leaders who develop strategies to manage nursing shortages’ adverse impacts can improve the care outcomes, reduce costs, and increase revenues. Nursing leaders are required to lead the changes necessary to improve the care outcomes. Kundu & Lata (2017), in a study, introduced a three-factor-model for employee retention. The first factor is management support, which focuses on the management’s attitudes towards employee care. Such include how the organization managers respond to the employees’ concerns and acknowledge employees’ contributions. A positive attitude creates a friendly working environment. The second fact is the personal relationships, how nurses relate with coworkers, the respect among the workforce, and feeling when a nurse terminates employment. The third factor is the switching cost, the benefits nurse’s loss or gain when they change employers alongside finding another job (Kundu & Lata 2017). The nurse’s ability to solve problems, work relationships, setting priorities, work interactions significantly influences job satisfaction and ultimately continuing with employment.

Teamwork and Communication

A study by Moriel, Felix, & Quinlan (2017) emphasizes the significance of developing teamwork and communication programs to improve efficiency and quality in healthcare systems. Given the diverse nature of educational backgrounds and the nature of work executed by different providers and healthcare conducted by each staff, a strong team’s development is not always realized even in the absence of a nurse shortage. However, the study shows that teamwork and effective communication and problem-solving skills are necessary to manage the nursing shortage and reduce its impact on the workforce. Establishing a shared understanding among the nurses and the healthcare management of the challenges linked to the nursing shortage is a vital first step towards developing solutions to mitigate the impact (Moriel, Felix, & Quinlan 2017). Teamwork and communication partnerships in workforce development can help reduce burnout among nurses, a common problem associated with nursing shortages. Internal communication establishes confidence and enhances solid relationships between hospital executives and the staff. Healthcare administrators can organize a weekly rounding to connect with the staff in person, vial phone call, or email. The administrators can also consider quarterly workshops where nurses interact to exchange their ideas and experiences. Study shows that recruitment and retention approaches for the nursing workforce require understanding the caring motivation that motivates people into the profession and contributes to them remaining committed to serving in the field (Spaulding & Martin-Caughey 2015). Effective communication helps interactional equality and well-received by the workforce.

free essay typer



Hiring the Right Workforce

Nurse retention also begins by hiring the right workforce to create a communication partnership with colleagues from the start. The process starts during the interview with potential employees. In research by Knight (2018), the participants revealed that as healthcare administrators, they work closely with the nurses to develop a good communication partnership and facilitate teamwork, providing staff with chances to participate in leadership projects. Open and transparent communication is a useful tool that managers use to enhance employee satisfaction. For a long time, open-door policies have proven to lay a friendly platform for the workforce to voice their concerns and distress to manage areas that need improvement (Knight 2018).

Increasing Employee Engagement

Keeping the nurses involved and having them be part of the organization’s decision-making is another practical approach to reducing the impact of workforce shortages. It is more of shared leadership that can be most likely to boost morale to work. The most important aspect of encouraging staff engagement is to provide them with adequate resources required to discharge their duties effectively. Spaulding & Martin-Caughey (2015) maintain that healthcare managers and administrators should strive to share leadership programs to encourage staff engagement. Engagement increases job satisfaction and the desire to stay in the organization, thus helping to address the current nursing shortage crisis (Spaulding & Martin-Caughey 2015). Nursing staffs who express higher levels of job satisfaction are more likely to be psychologically engaged in the job area and show more outstanding commitment to the organization.

One approach of sharing leadership is using the nurse workforce’s staffing committee who work alongside the management and get engaged in decision-making concerning nurse staffing. Creating such an engaged and positive work atmosphere helps employees stay and is considered one factor for longevity (Spaulding & Martin-Caughey 2015). Healthcare administrators and managers should also strive to ensure the nursing workforce’s independence to enhance work engagement. The workforce is happy with the job and feels devoted to the firm, their probability of leaving the company diminishes. Organization leaders who create a working environment where staff can interact freely, speak, and share knowledge can retain top nurses. The hospital leaders must create an environment where the nursing staff is free to speak up without the fear of being ridiculed (Maurits et al., 2015). Feedback and input are essential in an organization to understand the employee outlooks to establish a positive environment that enhances staff wellbeing and reduces turnover.

Training and Employee Development

There is also the need for the health administrators and managers to create training and development opportunities for nurses to motivate and retain top talent in the organization. The training and development approach includes capability and skills development, career development, and education certification. Career development is a critical element for training and employee development that can translate into retention. It has proven to increase organizational commitment, an essential pillar for leaders to retain to talented nurses (Mabaso & Dlamini, 2018). Besides, the administrators can also provide education and certifications that improve employee knowledge and, consequently, enhance performance. Study shows that staff who achieve certifications and advanced education are better positioned to excel in their area of work and stay longer with the organization (Antony, 2018), which is a win-win scenario for staff and the organization. Besides, advancing employees’ knowledge and skills also increase their productivity.


This essay explores the status of the health care workforce in the United States, focusing on the nursing shortages and the impact on employee recruitment and retention public health nurses according to the study by (Yeager & Wisniewski 2017) and laws government nursing employment. The U.S. is experiencing a persistent shortage of registered nurses (RN) and licensed practical nurses (LPNs), resulting in nurse burnouts and high turnover rates. Persistent nursing shortages result in adverse patient outcomes, including an increase in mortality. The continued needs might also translate into increased labor costs and decrease the effectiveness and efficiency of care provided. Strategies for managing the impact of nursing shortages and increasing workforce retention include developing an effective teamwork and communication strategies, promoting employee engagement, and hiring the right workforce, and staff training and development.


Antony, M. R. (2018). Paradigm shift in employee engagement: A critical analysis on the drivers of employee engagement. International Journal of Information, Business and Management, 10(2), 32-46. Retrieved from

Kundu, S. C., & Lata, K. (2017). Effects of supportive work environment on employee retention. International Journal of Organizational Analysis.

Maalouf, N., Sidaoui, A., Elhajj, I. H., & Asmar, D. (2018). Robotics in nursing: a scoping review. Journal of Nursing Scholarship, 50(6), 590-600.

Mabaso, C. M., & Dlamini, B. I. (2018). Total rewards and its effects on organizational commitment in higher education institutions. SA Journal of Human Resource Management, 16(2), 1-8. doi: 10.4102/sajhrm.v16i0.913

Maurits, E. E., de Veer, A. J., van der Hoek, L. S., & Francke, A. L. (2015). Factors associated with the self-perceived ability of nursing staff to remain working until retirement: a questionnaire survey. BMC Health Services Research, 15(1), 356.

Mehdaova, E. A. (2017). Strategies to Overcome the Nursing Shortage. Walden University.

Monahan, J. C. (2015). A student nurse experience of an intervention that addresses the perioperative nursing shortage. Journal of perioperative practice25(11), 230-234.

Moriel, D., Felix, K., & Quinlan, P. (2017). Roles and responsibilities: Asking nurses and physicians what they know, do not know and want to know about the other’s profession. Journal of Research in Interprofessional Practice and Education, 7(1), 1-18. doi.10.22230/jripe.2017v7n1a253

Raghubir, A. (2019). A Thematic Analysis of Nurses’ Experiences with Open Visiting Hours on Medical Units (Doctoral dissertation, Université d’Ottawa/University of Ottawa).

Shin, J. H., Koh, J. E., Kim, H. E., Lee, H. J., & Song, S. (2018). Current status of nursing law in the United States and implications. Health Systems and Policy Research, 5(1), 1-7.

Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economics, 34(2), 98-101.…-a0452050018

Spaulding, S., & Martin-Caughey, A. (2015). The goals and dimensions of employer engagement in workforce development programs. Washington, DC: Urban Institute.

Yeager, V. A., & Wisniewski, J. M. (2017). Factors that influence the recruitment and retention of nurses in public health agencies. Public Health Reports. Sage Journals. 132(5), 556-562. doi: 10.1177/0033354917719704