An Ethical Dilemma of Nursing Staff Shortage


This study addresses the ethical dilemma of the nursing shortage in the US. The US has been having nursing staff shortages periodically since the 1900s and is expected to have a major crisis by 2029 if nothing is done. Thus this study has applied the ethical dilemma decision-making model to find a solution. The most effective solution is importing nurses from other countries to serve the short-term goals and train more nurses in the long term. These two methods can address the US nursing problem and ensure quality healthcare is given to its patients.

Description of the Dilemma

Nursing staff shortage is a major issue in America affecting the healthcare sector. The United States has experienced nurse staffing shortages periodically for a long period since the 1900s (Haahr et al., 2019). The increased demand for healthcare services across the country has brought significant staffing shortages. One of the main topics discussed in healthcare facilities is asking nurses to care for more patients due to the growing nurse staffing shortage (Shah et al., 2021). This study will address the ethical issue of nursing shortage by viewing the issue through various perspectives, analyzing the dilemma through the ethical dilemma decision-making model, and discussing the nursing role in addressing the issue.

Nursing staff shortage is a social issue caused by the increased demand for healthcare services, the growing population of aging individuals, and the retirement and burnout of the existing nurses. Due to the healthcare reforms, there is increased demand for healthcare services that have increased the number of persons who can access healthcare (Morley et al., 2020). The Affordable Care Act has ensured that more people can afford healthcare insurance and can now seek healthcare services. The other reason is the growing population of older adults in America, especially baby boomers (Haahr et al., 2019). Thirdly, a high number of nurses will be retiring in the next ten years. The average age of US nurses is fifty years which implies that nurses, too, will be getting old and retiring, leaving gaps to fill in their occupation. This shows that the nursing shortage is a problem that should be addressed as soon as possible to avoid more adverse challenges in the future.

The problem of nursing staff shortage has brought an ethical issue; nurses are wondering how they can fulfill their ethical responsibilities to patients when there are inadequate nurses. The nurses are expressing moral distress and job dissatisfaction and cannot provide quality healthcare services to patients due to the nursing staff shortage (Ma et al., 2021). This brings an ethical issue: nurses are battling to care for themselves or the patient because having many patients to treat brings burnout and low-quality patient outcomes.

Nurses are required to offer spiritual assistance to patients, especially during end-of-life. These may include connections to their religions, patients’ philosophies, and connections to the environment, which help patients to understand the reason for their existence. Spiritual care is provided mostly during end-of-life care; thus, due to nursing staff shortages, there is not enough time to provide patients with this essential care (Shah et al., 2021). In most cases, patients are left to die alone because the nurses have other patients to take; therefore, due to the increased demand, they cannot provide spiritual care affecting the automatic habit and training.

The problem of nursing staff shortage has brought economic turmoil to healthcare providers. Most hospitals use billions of dollars to retain nurses by offering them high salaries, repaying nurses’ student loans, and signing bonuses (Haahr et al., 2019). Some healthcare providers have been forced to seek services from outside countries. However, due to political issues, there have been issues issuing Visas to student nurses coming to practice in the US. This shows that nursing staff shortages are an economic challenge to healthcare facilities.

The nurse staffing shortage has a negative impact on healthcare organization. As US healthcare systems seek to increase patient care quality, nursing staff shortages lead to more adverse outcomes. These may include increased mortality, poor quality outcomes, reduced positive health outcomes, and inadequate patient care (Gebreheat & Teame, 2021). Thus, the nurse staffing shortage hinders healthcare organizations from meeting their financial and healthcare outcomes. They are unable to provide quality care when there are inadequate nurses.

The issue of nursing staff shortage has been politicized in the US. This includes importing services from outside countries and introducing more nursing schools to cap the looming demand. The American Nurses Association has been calling on Congress to address the nursing staffing shortage (Shah et al., 2021). One of the issues they want to address is the overhead costs connected to staffing agencies. In addition, the agency has asked the government to prioritize patient safety and reduce the restrictions on visas of nurses who are being imported to provide services to the country.

Chronic staffing shortage causes moral distress to nurses in some instances. This is whereby nurses do not do the right thing due to institutional constraints. Understaffed nurses will likely not undertake ethically legal processes because they lack enough time to give patients specialized services (Morley et al., 2020). For instance, when healthcare hospitals were overwhelmed during the COVID-19 pandemic, the patients were not given end-of-life care because of the shortage of nurses and the high demand for their services; hence left to die on their own. Although the nurses knew this was morally wrong, they did not have an option because they had other lives to save.

Nursing staff issues have created public legal implications in the US. According to the US policy, the public is allowed to view nurse data, and they are aware of the nursing shortages in the country. In previous years, healthcare facilities have been subjected to lawsuits regarding the understating of nurses in their facilities (Haahr et al., 2019). These lawsuits result from poor nursing care, which may lead to death, bedsores, injuries, and resident wandering. When the victims win the cases, healthcare providers must pay hefty fines to the patient’s families, making healthcare provisions very expensive. Thus, the shortage in staff nursing has become a serious ethical issue in the US that needs to be addressed.

Analyzing the Issues Using the Ethical Dilemma Decision-Making Model

The Ethical Dilemma Decision Making Model provides guidelines on critical thinking and planning resolutions for ethical dilemmas. The main aim of the model is to ensure that healthcare providers provide the best ethical resolution to problems (Gao et al., 2021). This model has six main steps which are used in providing the solution. The first step is identifying the ethical problem, which includes succinctly stating the ethical question and considering all the aspects of the problem. The nursing shortage creates a dilemma in the nursing field whereby it challenges their beliefs and practice by making them choose unethical models to fulfill their duty (Gao et al., 2021). For instance, nurses may have to choose between providing quality care to some patients while ignoring others or treating all patients and giving them inadequate care to ensure each one of them has felt some relief.

The second step is collecting information to help them to make informed decisions. This information may be regarding the ethical dilemma, the people affected, and the values in conflict (Gao et al., 2021). In this case, the information collected may be regarding the negative cases that have occurred due to nursing shortage. This may include the number of deaths, severe accidents, and other irregularities in various healthcare facilities due to nursing shortages. In this case, the nursing staff shortage has led to higher morbidity, errors, and high mortality rates in the US.

The third step is stating available options, which includes brainstorming alternative methods which can be used to eradicate the problem. In this case, some available options include recruiting and training more students to become nurses, increasing the number of training colleges that provide nursing teaching, or importing labor from other countries where nurses are willing to work in the US. These are some of the methods that would help curb the shortage before the situation grows out of hand.

The fourth step is the application of ethical principles, which include autonomy, non-maleficence, beneficence, and justice. Regarding beneficence, healthcare providers are supposed to act in the patient’s interest and thus should take every legal action to ensure that nurses are adequate (Gao et al., 2021). Since the training takes some time, acting in the patient’s best interest is to hire already trained nurses to curb the shortage as the systems continue to train more nurses. Non-maleficence means healthcare providers should not cause any harm to the patient; thus, recruiting existing nurses from other countries ready to work in the US would minimize the harm caused to patients by delaying and waiting for US nurses to be trained. On the contrary, the importation of nurses may lead to low-quality services offered, which is the main challenge affecting the importation of nurses.

The fifth step is making the decision based on the previous framework. According to the previous framework, the best option which can be used to eradicate the problem of nursing staff shortage is to recruit nurses from other countries (Gao et al., 2021). This includes providing visas for nurses willing to work in the United States. However, the nurses have been given some training to ensure that they provide healthcare services according to the policies and healthcare system of the US. Since this is a short-term goal, the government should hire more personnel and train them to ensure adequate nurses in the future.

The sixth step is the implementation of the decision, which involves taking the decision that has been upheld and putting it into action. In this case, the government and healthcare systems will require moral courage to actualize the plan. This process needs harmonization between government and healthcare systems to roll out an effective plan of importing nursing labor into the US and ensuring that they work according to the standards.

My Nursing Role in Eliminating Ethical Issues Identified

As a nurse, I have a significant role in eliminating the ethical issue identified. One of the most effective ways would be by advocating for the provision of more nurses in the US healthcare system. This can be done by highlighting and showing the challenges experienced due to the inadequate nursing staff, such as working extra hours, staff burnout, and an un-proportional patient-nurse ratio, which leads to low-quality care. I will be writing articles about the problems that the nursing shortage has caused in the US healthcare system. In addition, I will push the hospital management to find a solution by bringing out the problem of nursing staff shortage in the meetings with the management. I will engage with the governor through the local health ministry to highlight the issue to the higher authorities. Finally, if the situation persists, I will mobilize other nurses to conduct peaceful demonstrations until the problem is solved. All these actions will be done in the interest of the patients to ensure they get quality services.

My role to “… serve God and humanity” as a Change Agent for the Ethical Issues

One of the main motives for me to join nursing is to serve God and humanity. I believe it is my role to do my best to ensure that I serve God by providing quality healthcare services. God calls nurses to serve his people by utilizing the gift He has given them (Harris & Tao, 2021). Thus, as a result of this principle, I am willing to work extra hours to ensure that I provide my patients with the best care. Although sometimes the service may be overwhelming, I ensure I provide quality care to all patients regardless of race, color, and social status. Sometimes, if I see some nurses overwhelmed by the patients, I choose to intervene and help because it is the most effective way to provide service to God and humanity. This shows that I love my service to US citizens and would be willing to sacrifice the most to ensure that healthcare is delivered effectively.


The problem of nurse staff in the US has been occurring periodically since 1900, with the last one being highlighted during the COVID-19 pandemic. This shows that there is a need for a permanent solution to address the challenge of the nurse shortage. Nurse shortage leads to adverse health outcomes, high mortality, and morbidity rates in the healthcare sector. One of the immediate solutions that can be taken to address the issue is importing nurses from other countries who are willing to work in the US. Since it is a short-term solution, there is a need for the US to recruit and train more nurses and bring them into the system. This will help address the issue and ensure that every patient gets optimal care, hence improving healthcare outcomes in the US.


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Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2019). Nurses Experiences of Ethical Dilemmas: A Review. Nursing Ethics, 27(1), 258–272.

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