Nursing Shortage Threatens Health Care

A recent report by the Pan American Health Organization (PAHO) says that a shortage of nurses threatens the quality of health care throughout the Americas.

The supply of trained nurses in the Americas is not increasing nearly as fast as demand. © Armando Waak/PAHO

The nursing shortage in Latin America and the Caribbean is in part a result of deteriorating working conditions, the report says, while in the United States, the availability of professional nurses is declining as health services are becoming increasingly specialized.

Overview of the Nursing Workforce in Latin America, published earlier this year, notes that the pattern of nursing shortages mirrors other health inequities in the region. In Haiti, for example, there are only 1.1 nurses for every 10,000 inhabitants, compared with 97.2 per 10,000 in the United States.

"Fifteen countries have fewer than 10 nurses per 10,000 people, and the regional average is 30 per 10,000," notes the report.

Silvina Malvarez, a PAHO expert on nursing, adds: "There is also huge inequality in the geographical distribution of nurses. Most are concentrated in urban health centers that are more focused on curative care rather than primary health care or prevention."

In Guatemala, 70 percent of nursing personnel work exclusively in hospitals, and in Mexico, 55 percent. Meanwhile, community and rural health centers are left with serious shortages of nursing personnel.

According to studies by the World Bank, health care services in the region are heavily dependent on nurses. In Chile, nurses are responsible for 90 percent of well-child care in the national health services. In Belize, 90 percent of public mental health services are delivered by nursing personnel. In Nicaragua's Atlantic Coast region of Río Coco, 88 percent of outpatients are seen by nurses.

The impact of patient overloading is highlighted in a study published by the American Medical Association in the United States. It found that if a nurse's patient load is increased from four to five (during a single shift), the risk of patient death increases by 7 percent. The risk of death further increases proportionally to additional patient load.

According to PAHO's report, the impact of the nursing shortage is acutely felt in the English-speaking Caribbean. With English as their common language, trained nurses in these countries are in high demand in the United States and Canada. As a result, a large percentage of nurses left behind are nearing retirement, and 35 percent of nursing positions remain vacant.

The nursing brain drain is also being felt in South America. Peru's national nursing association reports that in the last four years, more than 5,000 nurses—15 percent of the nursing workforce—have emigrated, primarily to Spain, Italy, and the United States.

The U.S. Department of Health and Human Services estimates that the shortage of nurses in the United States will grow to 275,000 by 2010 and to 800,000 by 2020.

The increased demand for nurses is in large part due to growing life expectancy and population aging. Other contributing factors include the HIV/AIDS epidemic, particularly in the Caribbean, where rates of infection are second only to sub-Saharan Africa.

Part of the solution, according to the PAHO report, is more nursing education and training. The region needs both more and better trained nurses to ensure that the nursing profession remains a vital force. Also important is better planning and human resource management in the field.

The PAHO report also points to the need for nurses' participation in decision making about health care. "Nurses are increasingly charged with carrying out administrative tasks that reduce the time they can spend with patients, exacerbating the shortage problem," the report notes. Currently, key decision making about health is almost exclusively in the hands of doctors.