Ethical Issues in Patient Care Arising from Nurse Shortages and Proposed Strategies: A Narrative Review
akhlāq-i pizishkī i.e., Medical Ethics,
Vol. 19 (1404),
25 September 2025
,
Page 1-13
https://doi.org/10.22037/mej.v19i-.49616
Abstract
Background & Aim: The global nurse shortage is a problem caused by an imbalance between the supply and demand of nurses. One issue exacerbating by this shortage is the ethical dilemmas in patient care. Nurses face ethical dilemmas when they are unable to deliver optimal care due to constraints. This study was conducted with the aim of reviewing solutions for ethical challenges in patient care caused by a shortage of nurses.
Methods: We conducted a comprehensive search across multiple databases including PubMed, Medline, Google Scholar, SID, Magiran, using Persian and English keywords related to the shortage of nurses, patient care, healthcare workforce, demand for health services, and ethical challenges. The search was limited to the years 2000-2024. After reviewing the titles and abstracts and carefully studying selected articles, 7 articles were selected.
Ethical consideration: In all stages of writing the present research, while respecting the originality of the texts, honesty and trustworthiness have been observed.
Results: Ethical dilemmas in nursing practice encompass medication errors, adverse clinical events, balancing patient benefits and risks, communication limitations, neglecting ethical and human connections, transmitting negative emotions to patients and families, and personal sacrifices by nurses. Addressing these challenges involves modifying organizational policies and procedures and considering nurses' job experiences as effective strategies.
Conclusion: The articles highlighted key strategies including effective human resource management, accurate cost estimation and financial allocation, enhancing work environment structure and conditions, empowering nurses, ethics-focused training, strategic policy-making, and practical implementation of these strategies. Implementing these strategies can help alleviate nurse shortages and ethical dilemmas in patient care.
- Patient Care
- Ethical Dilemmas
- Health Workforce
- Quality of Health Care
- Nursing
How to Cite
References
Abbaszadeh A, Abdi A. Nursing shortage challenge: A serious threat for the health system: A review study. Community Health Journal. 2017;9(1):37-47.
Buchan J, Aiken L. Solving nursing shortages: a common priority. Journal of clinical nursing. 2008;17(24):3262-8. [Persian]
Goldfarb MG, Goldfarb RS, Long MC. Making sense of competing nursing shortage concepts. Policy, Politics, & Nursing Practice. 2008;9(3):192-202.
Cheraghi MA, Ghiyasvandian S, Aarabi A. Iranian nurses’ status in policymaking for nursing in health system: a qualitative content analysis. The open nursing journal. 2015;9:24-15.
Rangriz H, Moosavi SZ. General Health Policies And The Effect Of The Shortage Of Nurses In Iranian Hospitals: A System Dynamics Approach. 2014;2(7):64-43. [Persian]
Erlen JA. Wanted—nurses: ethical issues and the nursing shortage. Orthopaedic Nursing. 2004;23(4):289-92.
Lynn MR, Redman RW. Staff nurses and their solutions to the nursing shortage. Western Journal of Nursing Research. 2006;28(6):678-93.
Ludwick R, Silva MC. Errors, the Nursing Shortage and Ethics: Survey Results. Online journal of issues in nursing. 2003;8(3):14.
Mrayyan MT, Hamaideh SH. Clinical errors, nursing shortage and moral distress: The situation in Jordan. Journal of Research in Nursing. 2009;14(4):319-30.
O'Donnell C, Markey K, O'Brien B. Guiding nurse managers in supporting nurses in dealing with the ethical challenge of caring. Journal of Nursing Management. 2022;30(7):2357-61.
Peterson CA. Nursing shortage: not a simple problem-no easy answers. Online journal of Issues in Nursing. 2001;6(1):1.
Davis S, Schrader V, Belcheir MJ. Influencers of ethical beliefs and the impact on moral distress and conscientious objection. Nursing Ethics. 2012;19(6):738-49.
Sadat Hoseini AS. Wisdom Nursing a Practical Model for Caring Based on Islamic Texts. Iranian Journal of Nursing Research. 2019;14(3):48-55. [Persian]
World Health Organization. Nursing and midwifery [Internet]. Geneva: World Health Organization; 2024. [cited 2024 Jul 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery.
Jafarinahlashkanani F, Eydivandi Z, Shafiei M, Maraghi E, Moradi Kalboland M. Evaluation of the Facilitating and inhibitory factors of Professional Ethics standards’ obsrvance in nursing care from the perspective of nurses. Iranian Journal of Medical Ethics and History of Medicine. 2020;13:155-67. [Persian]
Larijani TT, Fathi R. Nursing shortage and ethical issues: a narrative review. Iranian Journal of Nursing Research. 2018;13(2):50-7. [Persian]
Hashmatifar N, Mohsenpour M, Rakhshani M. Barriers to moral sensitivity: viewpoints of the nurses of educational hospitals of Sabzevar. Journal of Medical Ethics & History of Medicine. 2014;7(1):1. [Persian]
Hoseini-Esfidarjani S-S, Negarandeh R. A new view towards resolving the nursing shortage challenge. Hayat. 2017;23(3):196-200. [Persian]
Nasiri A. The relationship between perceived organizational support and work engagement and its dimensions in nurses of educational hospitals in birjand. Nursing And Midwifery Journal. 2022;19(10):762-72. [Persian]
Zali M, Ghofrani M, Orujlu S. Nursing Human Resource Management Facing Covid-19: An Integrative Review. 2022;10(4):38-48. [Persian]
Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P. A nursing shortage–a prospect of global and local policies. International nursing review. 2019;66(1):9-16.
Azimi H, Rezapour-Nasrabad R, Borhani F, Sadat-Hoseini AS, Momeni M. The model of solving ethical challenges with nursing based on faith in God: a new model for nurses to care during epidemics. BMC nursing. 2024;23(1):538. [Persian]
Karimian R, Rahnama N, Karimian M, Janbozorgi A. Ergonomic evaluation of the risk of suffering from musculoskeletal disorders in nurses with quick exposure check (QEC) and the effect of 8-week selected corrective exercises and ergonomic occupational intervention on their exposure rate. Journal of Advanced Biomedical Sciences. 2015;5(2):210-8. [Persian]
Zakeriyan A, Monazam MR, Mohrez H, Soltani Gerdfaramarzi R, Asghari M, Ghaemiyan N. Relationship between knowledge of ergonomics and work-place conditions with musculoskeletal disorders among nurses of two Iranian hospitals. Occupational Medicine Quarterly Journal. 2012;3(4):19-25. [Persian]
Shahnazdoust M, Maghsudi SH, Tabari R, Kazemnegad E. Relationship between nursing burnout and occupational support. 2012;20(80):49-59. [Persian]
Dabaghe Z. Baljani E, Ranjbar N, Rezaee Moradali M. Investigating the relationship between organizational support, Co-Worker support and perceived supervisory support with new graduated nurses' job performance. Quarterly Journal of Nersing Management. 2023;11(4):48-56. [Persian]
Kangasniemi M, Pakkanen P, Korhonen A. Professional ethics in nursing: an integrative review. Journal of advanced nursing. 2015;71(8):1744-57.
Gharib M, Ghashghaizadeh N, Omidian F. Designing a Model of the Antecedents of the Development of Nurses' Professional Ethics. Health. 2023;6(4):208-18. [Persian]
Shields L. The nursing shortage and developing countries: an ethical dilemma. Wiley Online Library; 2005. p. 787-8.
Montani F, Courcy F, Giorgi G, Boilard A. Enhancing nurses' empowerment: the role of supervisors' empowering management practices. Journal of Advanced nursing. 2015;71(9):2129-41.
Negarandeh R. Facing nursing shortage: a complex challenge. Hayat. 2015;20(4):1-4. [Persian]
- Abstract Viewed: 43 times