The healthcare industry has for the past few years been sounding an increasingly urgent alarm about the dearth of nursing staff. What is already a taxing career was made even more demanding by the COVID-19 pandemic, leaving an estimated shortage of more than 7,500 nurses, which is expected to increase to between 15,000 and 24,000 this year.
With fewer nurses to divide the workload, more falls to a dwindling number of people. Further exacerbating the issue is that nurses are leaving the profession in droves due to burnout. As the average age of the population climbs ever higher, something needs to be done urgently.
The government has introduced a number of measures to address the issue, culminating in a 12-point incentive program approved in September last year. An annual injection of NT$18 billion (US$575.9 million) over seven years hopes to add at least 67,000 nurses to the workforce by 2030.
This would be done primarily by giving additional bonuses to nurses for taking night and graveyard shifts, to healthcare institutions for meeting nurse-to-patient ratio goals and to schools for training nurses. The test to become a registered nurse would also be held more often and revised to better reflect the practical skills needed. Less detailed are plans to use technology to ease workloads and recruit mentors for new nurses.
Although the program seeks to prioritize incentives, punishments would also eventually be introduced for medical institutions that fail to meet government-mandated nurse-to-patient ratios. On Friday, the Ministry of Health and Welfare detailed the ratios expected of different types of institutions that are to take effect in March, as well as the bonuses nurses are to receive from this month for working late shifts. For a regular schedule of 21 working days, nurses would receive NT$6,400 to NT$21,000 extra per month under the scheme.
All of these changes are welcome, but seem unlikely to make much of a dent. Lowering the ratio sounds great in theory, but hospitals that are already finding it hard to hire are unlikely to have much luck meeting the goal, at least in the short term. Penalizing them for failing to meet the ratio might make the matter worse, especially for smaller hospitals.
Bonuses for working night and graveyard shifts also threaten to alienate dayshift nurses and would make swapping shifts even harder. Meanwhile, giving less money to nurses in smaller hospitals — even though they have heavier workloads — is likely to exacerbate the shortage in regional hospitals. Offering additional income of NT$400 to NT$600 per evening shift and NT$600 to NT$1,000 per graveyard shift might not be tempting enough to attract anyone into the workforce, whether returning or new. For those with families to care for, an extra few hundred dollars cannot make up for the time missed by having to work an erratic schedule.
As for the exam changes, that only 61.3 percent of registered nurses were still practicing as of last month shows that testing is not an issue at all.
Aside from the debilitating schedule and workload, nurses also regularly cite the work environment as a top reason for leaving the profession. A work culture that valorizes seniority means that many senior nurses stick newcomers with the worst jobs and decline to mentor them. No amount of incentives would see success if a workplace remains toxic. On the other hand, the job could be both welcoming and purposeful if colleagues are encouraged to help each other.
Yet even if the Cabinet’s plan itself does not fix the problem, putting billions behind a detailed scheme sends an important message to nurses that their work matters, and they deserve care and compensation. Hopefully, hospitals and the people within them will follow suit to make nurses feel as appreciated as they deserve to be.
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