Understanding Human Resources Wastage in the Nursing Shortage: Lessons Learned from

Chinese Nurses Leaving Nursing Practice

Junhong Zhu, Shiela Rodgers, and Kath Melia
Athens Journal of Health – Volume 5, Issue 3 – Pages 195-212
www.athensjournals.gr

Abstract

By discussing the lessons learned from a Chinese nurses leaving nursing practice, this
paper reports on the currently neglected issue of nursing wastage in the nursing shortage in
China. The nursing shortage needs to be understood locally and resolved globally. However, a
lack of understanding of the root causes and consequences of nurses leaving nursing practice in
their home countries has impeded the implementation of effective strategies in resolving nursing
shortage nationally and worldwide. This qualitative study draws on the grounded theory
approach. In-depth interviews with 19 nurses who had left nursing practice were theoretically
sampled from one provincial capital city in China. Managerial and organizational support from
the current Chinese nursing workforce management to retain qualified nurses is lacking. While
hospital managers claim that nurses’ voluntary leaving is an individuals’ problem rather than an
institutional problem, participants view their leaving nursing practice as the way to pursue
personal freedom and value in response to their dissatisfaction and stress in nursing. The lessons
from Chinese nursing perspective indicate that nursing wastage may not only occur when nurses
choose voluntary leaving, but also happen when they resort to passive staying. The wastage of
nursing human resources in Chinese Grade Three hospitals is arguably the most pressing nursing
crisis in regards to the nursing shortage nationwide. The study suggests that nursing wastage may
be avoided if nurses have greater autonomy to achieve more reasonable career prospects, thereby
ensuring nurses’ professional value and contribution to be properly rewarded with managerial
and organizational support.

Reactions and Learning Insights

Nursing shortage has been a problem worldwide as evidenced by the recruitment of

countries such as the United States of America and the United Kingdom from other countries
such as the Philippines. Therefore, developing countries where these countries recruit their
nurses suffer more. The population of the world is increasing, thus, a higher demand for nurses is
of great need. The problem that was discussed in this study is a problem that the world is facing
today especially for developing countries like the Philippines. The Philippines is one the largest
producers of nurses. They say that wherever you go, you can find at least one nurse. I believe
that nurses from the Philippines are one of the best nurses you can find. An innate sense of care
and being patient advocates are the things that make Filipino nurses stand out aside from of
course the skills that Filipino nurses have. It is saddening however, that nurses in the Philippines,
most of the time, are not given the proper protection and compensation that they need that
equates to the workload they have. This is one of the many reasons why Filipino nurses choose
to be away from their loved ones and work overseas.
 As per the study, respect from the supervisor and the feeling of value reduces the
respondents’ intention of leaving their job. I believe that this is true not only in healthcare but
also for other works as well. Acknowledgement of one’s contribution to the organization is one
way to make an employee feel valued. It gives employees the feeling that what they say or
suggests are being considered by their supervisors. I believe that communication between the
supervisor and the employee will determine the attitude of the employee towards the
organization. Effective communication within and amongst the organization will increase job
satisfaction. Moreover, the leadership style that the supervisor adapts is also crucial. One
leadership style will work for others while other styles might not necessarily work that is why it
is very important for supervisors to choose the leadership style that they will utilize in the
organization.

Another category that emerged from the gathered data is losing Enthusiasm in
Promotion. The participants verbalized that they think that the limited opportunities for
promotion were not openly acknowledged under the bureaucratic management system. I am
surprised that even in China, networks and social resources is a thing. The administration’s
favorite and/or the people that the administration knows are the ones being listed first for
promotion – that even if how hard and good you work, if you are not preferred by the
administrator, you will not likely be promoted very soon. The Philippines also have such issues
especially if you wanted to enter a government institution. People always say, “It’s not how
much you know but who you know”. I hope that in the future, people would stop normalizing
such things because most of the time, deserving and qualified applicants are not being
considered. Furthermore, the interpersonal conflicts between the nurse manager and the staff
nurse could be one of the reasons for inaccurate performance evaluation. In response to this, staff
nurses try to balance these conflicts in order to provide harmony in the organization. However,
this may have a negative impact when it comes to effective team work.

In the Philippine setting, nurse wastage is high while nurse turnover is low. Experienced
nurses choose to move overseas for a better opportunity in their chosen field. Better
compensation and benefits persuades these nurses to apply abroad because they wanted to
provide a better life for their family even if this means not being with their families for a long
period of time. Hence, the support from the government for an increase in compensation and
benefit package for Filipino nurses would greatly help in the retention of nurses in the
Philippines. Retention means a better health care delivery as scarcity of nurses will be resolved.
As long as employees are satisfied, wastage is unlikely to happen. To maintain job satisfaction of
employees, nurse managers and administrators should look on the gaps why nurses are
dissatisfied and think of solutions to fill in these gaps.

Opportunity for professional growth is one way to help in the retention of nurses.
Employees should be given the chance for a career growth. This will not only be beneficial for
the nurses themselves but for the organization as well. The skills and knowledge that they
acquire during seminars, trainings, and workshops will be used to provide a quality health care
for the patients. Patient satisfaction, in my opinion, is an accurate way to evaluate clinical care. A
high patient turnover means that employees are providing the best possible care that the patients
need. Furthermore, employees perform at their best when they are satisfied with their job.
 I did a research study on job satisfaction of staff nurses at the institution that I am
currently working at as a requirement for one of my courses in masters. The results showed that
the staff nurses are highly satisfied on their supervisors and work environment among others but
moderately satisfied to areas such as benefits, provision of trainings and compensation.
Moreover, job satisfaction has a relation to the delivery of quality health care. This means that if
an employee is dissatisfied with his or her current work, his or her job performance will be
affected. A happy employee means a happy organization. Every organization should remember
that human resources are the backbone for every successful organization. Thus, giving
importance and value to employees should also be considered.

In conclusion, further research studies should be conducted in order to enlighten nurse

managers and administrators about the gaps that need to be filled in order to minimize nurse
wastage. Nurse turnover is okay, however, the cost of nurse turnover is higher than retention of
nurses because the organization needs to provide trainings and orientation. Nurses also need to
be valued and have a feeling that they are part of the organization in order for them to be
comfortable with their work environment in general. I believe that participation in hospital
affairs and being respected by the administrators will reduce intentions of resigning. I believe
that the pandemic made people understand the importance of nurses. And I hope that the
Philippine government would also give importance to health as how they give importance to
safety.