Female Nurses and Midwives Shortage in Jordan: A Policy Analysis. Abdulqadir J. Nashwan, MSN, RN. The Hashemite University.

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1 Running head: FEMALE NURSES SHORTAGE IN JORDAN 1 Female Nurses and Midwives Shortage in Jordan: A Policy Analysis Abdulqadir J. Nashwan, MSN, RN The Hashemite University School of Nursing

2 Running head: FEMALE NURSES SHORTAGE IN JORDAN 2 Table of Contents A. Context: 1. Problem identification 2. Background 3. Stakeholders 4. Issue Statement B. Policy Goal/Options 1. Policy objectives 2. Policy Options and Alternatives C. Evaluation of Options 1. Evaluation Criteria 2. Analysis of policy alternatives D. Summary E. References

3 Running head: FEMALE NURSES SHORTAGE IN JORDAN 3 Abstract Nursing shortage is considered as a one of the most common worldwide challenge for policy makers in nursing discipline. A policy analysis paper intended to analyze the issue of female nurses and midwives shortage in Jordan considering the factors that affect the shortage in the Jordanian nursing society. Furthermore, the author described the previous, current and future strategies in order to overcome the issue of shortage in Jordan. Keywords: Policy Analysis, Nursing Shortage, Nurses, Midwives, Jordan. Problem Identification Nursing shortage is not a new phenomenon; according to the American Association of Colleges of Nursing (AACN) (2003) nursing shortage defined as the inadequate number of qualified nurses to meet the projected demands for nursing care within healthcare settings. In addition, World Health Organization (2006) defined nursing shortage as a situation where the demand for nurses is greater than the supply. According to The Nursing Workforce in Jordan which has done by the Jordanian Nurses Council (JNC) (2007) there will be a shortage of female registered nurses for the coming five years. The shortage in the number of female RNs was reaching its peak in 2009 which amounts to 3,351 female RNs. The shortage ranges between 2,572 RNs in 2012 to 3,351 female RNs in 2009.

4 Running head: FEMALE NURSES SHORTAGE IN JORDAN 4 Studies about the nursing shortage in Jordan are absent, thus it is asserted with caution that the nursing shortage is exacerbating in this country as many nurses are quitting the nursing profession or leaving to work outside the country (Mrayyan, 2007). Actually, one study has discussed nursing shortage in Jordan as a barrier, this study has carried out by AbuAlrub, which entitled Nursing Shortage in Jordan: What is the Solution? The study explored factors that affected nursing shortage in Jordan, and ended up with solutions to manage these factors. Background The healthcare system in Jordan is composed of 29 governmental hospitals, 56 private hospitals, 2 large university-affiliated teaching hospitals, and many primary care clinics which are directed by The United Nations Relief and Works Agency (Mrayyan, 2007). Many Jordanian nurses leave to work in Gulf countries, in Canada, and in the United States because of the higher salaries offered there, therefore; creating a nursing shortage locally, while many Jordanian nurses had left the nursing profession because of burnout and a non supportive work environment (AbuAlrub, 2007). Worldwide, there have been many changes in hospital settings including nursing shortage which leads to an increased workload, dissatisfied nurses and a tendency to leave the service, which in turn reflects negatively on quality of nursing services and patients outcomes (Mrayyan, 2007). Meanwhile; World Health Organization (2003) declared that the most critical issue facing health care systems is the shortage of the people who make them work. The impacts of nursing shortage on quality of nursing services and patients care was considered broadly in western literature; but there are absent studies that discussed the relationship between nursing shortage and quality of patients outcome in Jordan. Only

5 Running head: FEMALE NURSES SHORTAGE IN JORDAN 5 one study discussed this barrier in Jordan, specifically, nursing shortage in Jordan has carried out by AbuAlrub, which titled Nursing Shortage in Jordan: What is the Solution? The study explored factors that affected nursing shortage in Jordan, and ended up with solutions to manage these factors. Factors were categorized as: organizational, social, cultural, and economical factors. Organizational Factors The decline in the number of nurses was a result of slow salary increases; fewer women were selecting nursing careers, a decrease in the number of nursing faculties, and unattractive work conditions. Social Factors The social factors that affect nursing shortage include: the low salary of nurses as one of the major reasons for nurse's dissatisfaction and turn over and nursing is still seen as a woman s job and involving unclean duties. Cultural Factors The cultural factors includes families' rejection of a nursing profession for their daughters because of night shifts, and married nurses would leave their jobs, if their husbands can afford a good living, to focus on their maternal and spousal roles. Economical Factors Other factors that affected nursing shortage was economical factors which manifested by small number of nursing schools compared to large population in Jordan, minimal budget and funds to support education, and less high degree faculties of nursing in Jordan. Stakeholders

6 Running head: FEMALE NURSES SHORTAGE IN JORDAN 6 There exists a wide variety of stakeholders, including: Nurses and midwives Universities (Academic programs) Hospitals (Governmental/Private/Military) Ministry of Health (MOH) Ministry of Labor Ministry of Education Ministry of Higher Education and Research Jordanian Nursing Council (JNC) and Jordan Nurses & Midwives Council (JNMC) World Health Organization (WHO) Issue Statement How should the stakeholders come up with strategies and solutions to overcome shortage and migration of female nurses and midwives? Policy Goal/Options Policy Objectives Policy objectives include the following: Discussing and analyzing nursing shortage & labor migration issues taking into consideration Jordan s health system needs. Discussing national and international strategies/solutions to overcome shortage and migration of nurses and midwives. Establishing funding policies that are consistent with the demands of the current and future health care systems.

7 Running head: FEMALE NURSES SHORTAGE IN JORDAN 7 Developing policies, legislations, and regulations that provide steady funding to establish and support solid foundation for nursing education at all levels. Elaborating on partnership issues with national and international organizations relating to shortage and migration of nursing workforce. Policy Options and Alternatives Policy alternatives for resolving the issue of shortage and migration of female nurses and midwives in Jordan include the following: Do nothing Option (Status of quo): continue previous policies. Change Option I: amend the percentage of male to female students at 30:70 for the enrollment of students in universities through the joint policy committee between the Jordanian Nurses Council (JNC) and the Ministry of Higher Education. Change Option II: launch a national nursing campaign in order to encouraging young females to join nursing and to balance the workforce to meet the health service demands for female nurses. Change Option III: establish a fund to recruit female students from all over the country into the nursing profession. Evaluation of Options Evaluation Criteria Based on Patton and Sawicki s Basic Methods of Policy Analysis and Planning, the evaluation criteria for the alternative options should be as follows: Population benefits & costs Effectiveness

8 Running head: FEMALE NURSES SHORTAGE IN JORDAN 8 Equity Administrative feasibility Legality Political acceptability Analysis of policy alternatives (see Table 1) Analysis of Option I: In an effort to solve the problem of gender imbalances in Jordan, the JNC, through its joint policy committee between the JNC and the Ministry of Higher Education in 2006 and 2007 approved a percentage of male to female students at 30:70 for the enrollment of students in universities and raised the entry grade average of Tawjihi (the final year of high school) for BSN university programs to 70%. This will increase the number of female nursing student at the universities. Analysis of Option II: In response to the directions of Her Royal Highness Princess Muna Al- Hussein to promote nursing and its services, the Jordanian Nursing Council and its partners; (Princess Muna Scholarship Found for Nursing, Ministry of Health, Ministry of Education, Ministry of Higher Education and Scientific Research, Public and Private Universities, Royal Medical Services, King Abdullah the Second Development Office for Vocational Guidance, and Private Hospitals Association) launched a national nursing campaign on 25 May 2007 at the Jordanian Nursing Day. The campaign slogan Nursing the

9 Running head: FEMALE NURSES SHORTAGE IN JORDAN 9 Medal of Honor" aims at encouraging young women to join nursing, and to balance the workforce to meet the health service demands for female nurses. Within the campaign lunching ceremony a round table on shortage of nursing and midwifery was held in collaboration with Ministry of Health, World Health Organization, Ministry of Labor and International Labor Organization, titled Facing the Challenge of Shortage and Migration in Nursing and Midwifery. Analysis of Option III: A fund was established by Her Royal Highness Princess Muna Al-Hussein to enhance the development of nursing in Jordan in 2005 in order to recruit female students from all over the country into the nursing profession. Summary Jordan is indeed still faced with significant imbalances in its nursing workforce. Currently, Jordan faces an inadequate supply of new female nursing and midwives graduates. The problem of the shortage of female nurses was rooted in the past and will be aggravated in the coming years in the absence of the right scenarios for evaluating the supply and demand of nursing in Jordan. The nursing workforce is an industry that we need to recognize as it will be prosperous if we know how to play the'' investment game intelligently'' to contribute to the economy of the country. High quality nurses and a solid nursing education system as well as strong nursing leadership are the key areas for nursing excellence in Jordan.

10 Running head: FEMALE NURSES SHORTAGE IN JORDAN 10 Her Royal Highness Princess Muna Al-Hussein always tries to promote nursing in a high quality and encouraging young women to join nursing profession by overcoming the multiple socioeconomical and cultural barriers in the Jordanian society. References 1. AbuAlRub, R, (2007) Nursing Shortage in Jordan: What is the Solution, Journal of Nursing Scholarship, 23 (2): American Association of Colleges of Nursing, Nursing Shortage Facts Sheet. 3. Jordanian Nurses Council, (2007) The Nursing Workforce in Jordan: A Policy Oriented Approach. 4. Mrayyan, M. (2007) Nursing practice problems in private hospitals in Jordan: Students perspectives. Nurse Education in Practice 7, Patton, V., Sawicki, D. (1993) Basic Methods of Policy Analysis and Planning - Englewood Cliffs, Prentice Hall Practical principles for Beginning policy analysts (8-19 pp.) 6. World Health Organization, (2003) The world health report 2003: Shaping the future.

11 Running head: FEMALE NURSES SHORTAGE IN JORDAN 11 Table 1 Policy analysis scorecard: Female Nurses and Midwives Shortage in Jordan Alternatives Male to Female Students Ratio Amendment National Nursing Campaign Females Recruitment Funding Criteria Benefits & costs Effectiveness Equity Administrative feasibility Legality Political acceptability /1-4+/2-5+/1- Score for Each Alternative 4 2 4