Accepted: 20 May 2017

DOI: 10.1111/jonm.12510

ORIGINAL ARTICLE

A scoping review of nursing workforce planning and

forecasting research

Allison Squires PhD, RN, FAAN, Associate Professor1 | Virpi Jylhä PhD, Researcher2,3 |
Jin Jun MSN, APRN-BC, PhD Candidate1 | Anneli Ensio PhD, RN, Research Director, Emeritus3 |
Juha Kinnunen PhD, Professor3

1
Rory Meyers College of Nursing, New York
University, New York, NY, USA Aim: This study will critically evaluate forecasting models and their content in work-
2
The Nursing Research Foundation and The force planning policies for nursing professionals and to highlight the strengths and the
Finnish Centre for Evidence-Based Health weaknesses of existing approaches.
Care: A Joanna Briggs Institute Centre of
Excellence, Helsinki, Finland Background: Although macro-level nursing workforce issues may not be the first thing
3
Department of Social and Health that many nurse managers consider in daily operations, the current and impending
Management, University of Eastern Finland,
nursing shortage in many countries makes nursing specific models for workforce fore-
Kuopio, Finland
casting important.
Correspondence
Method: A scoping review was conducted using a directed and summative content anal-
Allison Squires, Rory Meyers College of
Nursing, New York University, New York, NY, ysis approach to capture supply and demand analytic methods of nurse workforce plan-
USA.
ning and forecasting. The literature on nurse workforce forecasting studies ­published in
Email: [email protected]
peer-­reviewed journals as well as in grey literature was included in the scoping review.
Results: Thirty six studies met the inclusion criteria, with the majority coming from the
USA. Forecasting methods were biased towards service utilization analyses and were
not consistent across studies.
Conclusion: Current methods for nurse workforce forecasting are inconsistent and
have not accounted sufficiently for socioeconomic and political factors that can influ-
ence workforce projections. Additional studies examining past trends are needed to
improve future modelling.
Implications for nursing management: Accurate nursing workforce forecasting can
help nurse managers, administrators and policy makers to understand the supply and
demand of the workforce to prepare and maintain an adequate and competent current
and future workforce.

KEYWORDS
human resources for health, nurses, scoping review, workforce forecasting

1 | INTRODUCTION continuing nursing workforce migration (WHO, 2010) make nurs-

ing specific models for workforce forecasting increasingly important.
Although nursing workforce forecasting may not be the first thing that Predictions of nursing shortages, workforce composition issues and
nurse managers and administrators consider during daily operations, the failures of past solutions to address those issues all support the
it is relevant to anyone involved in patient care given the direct link need for a comprehensive evaluation of the content of current fore-
nurses have to improved patient outcomes (Aiken et al., 2014). The casting models so that more precise methods and models can emerge.
current and impending nursing shortages in many countries and the Effective forecasting models mean that nurse managers can better

J Nurs Manag. 2017;1–10. wileyonlinelibrary.com/journal/jonm

© 2017 John Wiley & Sons Ltd | 1
2 | SQUIRES et al.

anticipate shortages and excesses of nurses and the subsequent conse- gender may have a significant influence on forecasting the nursing
quences to organizational operations when developing annual budgets. workforce via feedback loops between sociocultural attitudes toward
The main theory behind health workforce forecasting is the neo-­ women, gender targeted investments in human capital, fertility and
classical economic one: supply and demand (McPake et al., 2013). income with economic development demonstrating that even small
Key actors conduct health workforce planning and forecasting based investments in female education promote significant gains (Owen &
on current labour market supply and demand and try to make pro- You, 2009). Political systems, however, will influence the likelihood
jections for planning purposes. Historically, comparative analyses of that these inequality-­reducing measures will take place. Fielding and
health workforce forecasting studies have proven difficult to con- Torres’ (2009) work also emphasized that improved population health
duct. Researchers assume some set of common characteristics across increases economic stability. The availability of childcare services fur-
professional groups, yet rarely identify them (Bourgeault, Benoit, & ther contributes to women’s participation in the workforce and are
Hirschkorn, 2009). Another problem with comparative analyses is that the next step not only to sustain women’s workforce but also continue
factors, or combinations of them, used in the projection models may to increase it (IBRD, 2011). Additionally, womens’ increased partici-
vary widely because until recently, researchers have not used consis- pation in the workforce has been shown to reduce mortality indica-
tent analytic approaches for their projections (Spetz & Kovner, 2011). tors (Aspalter, 2008; Bambra & Eikemo, 2009). Furthermore, Self and
We propose that in terms of nursing workforce forecasting, sup- Grabowski (2009) showed that when malleable social institutions are
ply and demand for the nursing workforce has unique dimensions that reformed to promote gender equality and opportunity, economic de-
will affect labour market forecasting models. These unique dimen- velopment improves. Logically, the production of nursing personnel
sions are rooted in the female dominance of the nursing labour mar- should coincide with these improvements because of the female gen-
ket and the associated sociocultural factors that influence women’s der dominance in the profession.
formal participation in the workforce. Therefore, we seek to answer Thus, systems and policies that promote gender equity, access to
from this review these questions: (1) “What are the current forecast- education, reduced fertility and strengthening of professional institu-
ing models and nursing workforce planning policies?” (2) “How can/do tions will have a direct impact on the supply of nurses. Yet current
they help us in planning nursing workforce for hospital administrators research lacks longitudinal analyses of historical trends in health work-
and managers?” By answering these questions, we can also highlight force growth or decline that are tied to important socioeconomic and
the strengths and the weaknesses of existing approaches for nursing political events and traditional forecasting methods rarely consider
workforce forecasting in addition to discussing practical implications. these factors.

1.1 | An overview of approaches to forecasting 1.3 | Other key topics relevant to nurse workforce
for the health workforce forecasting
In an effort to help standardize approaches to making health workforce Few studies exist about several key topics related to the nurse work-
projections, experts identified six approaches to health workforce fore- force forecasting. The first is how to attract individuals into the pro-
casting (WHO, 2010). These include approaches geared toward population fession in a country. The concept of “recruitment” in the literature
needs, service utilization, health workforce-­to-­population ratio, service appears limited to the organizational level. The second is the basic ed-
targets, adjusted service targets and facilities-­based ones. Each approach ucational requirements necessary for successful entry and graduation
has its own assumptions and limitations that may influence outcomes. from nursing programmes. The educational composition of the nursing
Yet making specific and accurate forecasts for different health care workforce can vary widely in some countries. All of these have implica-
professionals requires not only a standardized approach to analyses, tions for nursing workforce composition—the mix of educational levels
but also an in-­depth understanding of the production dynamics unique within the profession and how those translate into frontline direct care
to each type of health care professional and the role of health labour provision roles (Riley et al., 2012). The factors previously described are
markets (McPake et al., 2013). One reason for this is that most health those directly associated with frontline service delivery. Macro-­level
workforce forecasting studies use the same set of variables for making factors, such as political systems and sociocultural influences, are likely
predictions, regardless of the professional group. Analyses also tend to drive nursing workforce supply yet remain under studied.
to group all professionals together, therefore losing findings unique
to professional groups (Bourgeault et al., 2009). Finally, imbalances in
the workforce are specific to the country where they occur and words 2 | METHODS
such as “shortage” may have different meanings in different places
(Zurn, Dal Poz, Stilwell, & Adams, 2004). This review updates and expands the results of the previous review of
the forecasting approaches published by O’Brien-­Pallas et al. (2001).
We used a scoping review approach to structure the review. A scop-
1.2 | Gender as a factor in nursing workforce
ing review aims to rapidly map the key concepts of a research area and
Gender and economic inequality and their impact on nursing sup- to identify the types of evidence available (Mays, Roberts, & Popay,
ply are topics that receive little attention in the literature. However, 2001) This technique is appropriate as we pose broad questions and
SQUIRES et al. | 3

seek to identify gaps in the evidence base whilst summarizing research as data where analytic approaches consider the content and context
findings from the nursing workforce forecasting literature, rather than of the information in the study. We used directed and summative
to critically appraise the current state of the science. content analysis techniques to identify the key concepts and the
The period for this review was 2000–2016, limited to litera- types of evidence available from the broader literature. Directed
ture published after the O’Brien-­Pallas et al. study. The literature content analysis (DCA) starts with a theory of relevant research find-
search was conducted using keywords and various combinations ings as guidance for initial codes, looking for the presence of specific
listed in Table 1. Figure 1 illustrates the search engines and process. themes or categories pre-­determined by the research team (Hsieh &
Additional grey literature was searched from websites of international Shannon, 2005). The summative content analysis (SCA) technique
organizations, for example, the World Health Organization (WHO). creates categories from theoretical frameworks and codes the data
The selection was further limited to studies published in English from accordingly (Hsieh & Shannon, 2005). This technique allows the re-
countries that are members of the OECD because with few excep- search team to count the frequency with which something occurs
tions, the nursing workforce data quality is higher overall, challenges in the selected studies for an integrative review and quantify it.
related to socioeconomic development are fewer and political sys- Thus, rather than analysing the data as a whole, the text is often
tems tend to be more stable. This allows us to control, somewhat, for approached as single words or in relation to particular content. An
the inevitable contextual variations between countries. analysis of the patterns leads to an interpretation of the contextual
meaning of specific terms or content. Any of the three approaches
are useful when documents form the data source of an analysis
2.1 | Data analysis
(Miller & Alvarado, 2005) and are easily compatible with scoping re-
The studies served as our data and therefore, we drew from Miller views involving documents. For this scoping review, we chose DCA
and Alvarado’s (2005) recommendations for considering documents and SCA techniques to code the documents and to synthesize the
results to determine the common types of approaches used in nurse
forecasting studies. Drawing from neoclassical economic theory, our
TABLE 1 Search words
DCA coding used the concepts of “supply” or “demand” to code the
Search words and key words Boolean operator content of the articles.
Health care AND Four reviewers read and analysed the studies. Then the data were
Healthcare OR extracted to a spreadsheet using a codebook to guide the process.
Health services The excel sheet served as a data extraction form to transform the doc-
Delivery of health care
ument data into a structured format. Once coding was finished, we
Human resource(s)
Manpower then merged the identified supply and demand factors into common
Personnel themes and categories through a consensus based approach.
Staff
Employee
Workforce
Forecast* 3 | RESULTS
Planning
Model A total of 36 research publications (5 qualitative studies, 10 cohort
Simulation
studies, 21 reviews) were included for this study as shown in Table 2.

PubMed EBSCOhost Web of Science

Excluded:
duplicates (n=14)
Reference Potentially relevant
search (n=1) studies (n = 80)
Excluded:
Quality relevance (n=5)

Studies included in
the review (n = 75)

Grey literature Excluded:

Not nursing-related
(n= 7) relevance (n=45)
Studies included
(N=36)
FIGURE 1 Search process flow chart
4 | SQUIRES et al.

TABLE 2 Summary of the studies included in the review

Category of
Author (year) Location Objective S/D Study design

Original studies
Al-­Jarallah, Moussa, Hakeem, and Kuwait To project the future demand for nurses in Kuwait for S&D Qualitative
Al-­Khanfar (2009) the years 2007–2020 based on the period
1994–2006
Auerbach et al. (2007) USA To report the nursing workforce data and predict the S&D Cohort
future age and supply of RNs
Buerhaus et al. (2009) USA To examine the impacts of the recession on the current S&D Cohort
RN trends and future nursing workforces
Cramer, Duncan, Megel, and USA (Nebraska) To describe the partnership between a university and a S&D Cohort
Pitkin (2009) rural community and the process for addressing their
concerns and determining programme feasibility
Dickson (2002) USA (New To produce county-­by-­county forecasts of demand for D Cohort
Jersey) registered nurses (RNs) and licensed practical nurses
(LPNs), funded by Robert Wood Johnson Foundation
Hasselhorn et al. (2005) Multinational To investigate the reasons, circumstances and S Qualitative
(Europe) consequences surrounding premature departure from
the nursing profession in Europe
LaSala (2000) USA To explore the distribution of registered nurses in rural D Qualitative
and urban health care settings and to examine
recruitment and retention strategies and barriers; and
to analyse relationships between distribution of
nurses and recruitment and retention
Lavieri and Puterman (2009) British Columbia To describe a linear programming hierarchical planning S Cohort
model that determines the optimal number of nurses
to train, promote to management and recruit
Imison, Buchan, and Xavier (2009) UK Executive summary of health care workforce in London S&D Cohort
Rondeau, Williams, and Wagar Canada To investigate the impact that increasing human capital S Cohort
(2009) through staff training makes on the voluntary
turnover of registered nurses
Singh and Schwab (2000) USA To evaluate a model to determine which factors, S Cohort
attitudes and personal characteristics can predict
tenure of nursing home administrators
Spetz and Given (2003) USA To develop a simple forecasting model to predict the S Qualitative
needed wage increase to end the nursing shortage
Spitzer, Camus, Desaulles, and Multinational To examine the profile of nursing problems as global D Cohort
Kuhne (2006) (the “convergence” thesis) by comparing the changing
hospital contexts nursing has been confronting in 20
Western European countries between 1990 and 2001
Squires and Beltrán-­Sánchez Mexico To study the perspectives of Mexican nurses about S&D Cohort
(2009) their work environments to determine similarities and
differences to results from developed world studies
Volpatti, Leathley, Walley, and Canada To compare the correlation between midnight census S&D Qualitative
Dodek (2000) and actual nursing supply with the correlation
between time-­weighted nursing demand and nursing
supply
Discussion
Baumann (2010) Multinational To provide an international definition of a nurse and S&D Integrative
the importance of nursing health services data review
Beyers (2001) USA To describe the link between research and policy to Expert/
practice to strengthen leadership and utilization of opinion
nurses

(Continues)
SQUIRES et al. | 5

Table 2 (continued)

Category of
Author (year) Location Objective S/D Study design

Bosworth et al. (2007) UK To disseminate new knowledge about workforce D Expert/

planning, its theoretical principles, good practice opinion
examples and its application to practice
Brewer (2005) USA To develop an algorithm to describe the trends in rural D Expert/
nursing workforce opinion
Buchan (2007) UK To highlight the impact of financial pressure on the S&D Integrative
current and future market of nursing workforce review
Clark and Cleary (2004) USA (North To describe the evolution of the North Carolina Nurse Unclear Expert/
Carolina) Workforce Planning Model, including regional opinion
planning alliances and a statewide consortium, and
the development of a statewide plan for nursing
Davies (2008) Multinational To describe the history and continuing development of S Integrative
(Europe) the “Bologna Process” whose aim is to create review
convergence of higher education across the European
Union by 2010 and to identify implications for
graduate nurse education and present opportunities
Dussault et al. (2009) Multinational To discuss the flows of health workers in the WHO S&D Integrative
(Europe) European Region (where to and from, why migrate, review
the magnitude of these flows, and the effects of the
health care systems of both source and recipient
countries)
Guttman, Cohen, and Moore Canada To describe accessible data sources for assessing S Expert/
(2009) maternal and child health care needs, details the opinion
limitations of a simple needs-­based approach, and a
more comprehensive and relevant outcomes-­based
HHR planning in Canada
Johnson, Billingsley, and Costa USA To report a study that identifies organisational S&D Expert/
(2006) characteristics explaining employee solidarity in the opinion
long-­term care sector
Lane, Fernandes Antunes, and Multinational To understand nursing community interactions with the S&D Expert/
Kingma (2009) various stakeholders that influence financial resource opinion
allocation in the public sector
Lin et al. (2008) USA To forecast the shortage of registered nurses (RNs) of S&D Integrative
the 24 Primary Metropolitan Statistical Areas (PMSA) review
and Metropolitan Statistical Areas (MSA) in California
Nooney and Lacey (2007) USA To validate HRSA’s nurse supply and demand models S&D Integrative
review
O’Brien-­Pallas, Baumann, Birch, Multinational To propose future challenges in health human S&D Expert/
and Tomblin Murphy (2000) resources for the home-­care sector. To discuss opinion
conceptual and practical approaches to future
planning of health human resources
O’Brien-­Pallas and Hayes (2008) Canada To examine empirical research and other published S&D Qualitative
sources to discuss nursing workforce issues, the
challenges of using health human resource research in
policy decisions and the importance of evidence-­
based policies and practices for nursing care and
outcomes
Reid and Weller (2010) Multinational To describe core competencies related to human S&D Expert/
resources planning and management globally opinion
Riportella-­Muller, Littlefield, and USA (Wisconsin) To examine the roles of nursing in addressing primary D Expert/
Libby (2000) care workforce issues in Wisconsin using a primary opinion
care workforce planning tool, developed by the
Bureau of Health Professions

(Continues)
6 | SQUIRES et al.

Table 2 (continued)

Category of
Author (year) Location Objective S/D Study design

Simoens et al. (2005) Multinational To analyse the trend of nursing shortage in OECD S&D Expert/
countries by defining and describing evidence and opinion
analyses international variability in nurse employment
Terry (2008) USA To examine the definition of demand to appropriately D Integrative
develop a usable demand model for nursing review
Nancarrow, Roots, Grace, Moran, Australia To synthesize the findings from this programme to S Integrative
and Vanniekerk-­Lyons (2013) identify and codify mechanisms associated with review
successful workforce redesign to help inform other
large workforce projects
Bienemy (2015) USA (Louisiana) To report a nursing workforce forecasting model S/D Review
developed in Louisiana

S, supply; D, demand.

Seventeen of the studies were classified as original research or case policy, educational subsidies or incentives, wages, delivery of health
studies presenting a forecasting model employing multiple analytic care, society in general will further affect the supply of health
approaches. The other characteristics of the included studies are professionals.
listed in Table 3. We present our findings based on how the docu- Supply is also affected by attrition out of the profession altogether
ments conceptualized demand, supply and other factors influencing and migration (rural to urban, domestic to international). The reasons
nursing workforce forecasting. for attrition vary across countries. Internal to organisations, in the ma-
jority of leavers exiting medical and surgical positions, with a signifi-
cant minority leaving critical care areas, the main reason was to pursue
3.1 | Demand
other employment in nursing.
Generally, the literature defined demand for professionals as the num- Further adding to the conceptual dimensions of supply was the
ber of jobs, by filled or vacancy rates, a practice consistent with tra- role of migration. Both domestic and international migration play dif-
ditional forecasting methods. Demand models are usually based on ferent roles in shaping supply and demand. Rural areas continue to
vacancy numbers, but others suggest they are not realistic numbers have trouble recruiting and retaining nursing personnel in most coun-
of the labour force needed (Terry, 2008). Additional common demand tries around the world. Emigration means nurses and midwives search
factors identified in the analysis included demographic growth and for better opportunities by leaving their country. Other prominent rea-
change, health policy and related legislation, technological change, sons for leaving were to travel abroad and to pursue further studies in
burden of diseases, service and provider utilization, relevant service nursing (Hasselhorn et al., 2005).
quality standards, organizational efficiency, skill mix, individual provider
performance, public demand and expectations and means of financ-
3.3 | Turnover and its role in shaping supply and
ing (Auerbach, Buerhaus, & Staiger, 2007; Lin, Juraschek, Xu, Jones, &
demand for forecasting purposes
Turek, 2008; Nooney & Lacey, 2007). The demand side outflow of the
workforce also drives the need for replacement workers and is related A unique influence emerged from this analysis and that was the role of
to the supply side outflow. turnover as an under accounted for influence in forecasting. Turnover
results from a variety of factors, most of those grounded in organi-
sational characteristics (Mowday, Porter, & Steers, 2013). The find-
3.2 | Supply
ings suggest that organisational characteristics affect both supply and
The concept of supply is easier to address in studies and thus, demand. Negative characteristics increase demand because of high
most of the studies discussed nursing workforce supply issues. turnover rates and increased intention to leave. Positive characteris-
Conceptual uses of supply were also largely consistent with the tics decrease demand because retention is increased.
traditional economic use of the terms. It includes the numbers of
new entrants, the capacity to produce more, fewer or different
3.4 | Factors with indirect relationships to
types of health workers in the future and to recruit them into the
forecasting
health services industry (Nooney & Lacey, 2007). Outflow from
the nursing workforce includes the loss rates through retirement, Other variables emerged from the analyses as potential influencers
emigration, death or pre-­retirement leaving (Dussault, Fronteira, & on forecasting. No study actually factored them into the analyses
Cabral, 2009; Hasselhorn, Muller, & Tackenberg, 2005). According but they were frequently mentioned as related factors in discus-
to Auerbach et al. (2007) future changes in economy, immigration sions. Some of these variables are also indirectly related to turnover.
SQUIRES et al. | 7

TABLE 3 Characteristics of studies nursing workforce. Overall, the synthesis of these results shows that

Country of origin of the studies conceptually, supply and demand for the nursing workforce occurs
on three levels: individual, organisational and regional/national (see
USA (n = 16)
Table 4). The language of the literature suggests that organising con-
Canada (n = 5)
cepts of demand around categories emphasizing the individual (de-
UK (n = 2)
mand for entry, demand for work, gender identity), organisational
Multinational, Europe (n = 4)
(service-­based demand) and regional/national (epidemiological, po-
Multinational (n = 6)
litical system, economics, institutions). The multidimensional and pro-
Others (n = 3) fession specific conceptualization of supply and demand differs from
Types of studies the traditional literature that largely emphasizes the role of the health
Original research or case studies presenting a forecasting model services delivery organisation in supply and demand. All of these
employing multiple analytic approaches (n = 15) conceptual aspects of forecasting will influence the practice of nurse
Review papers or papers presenting a specific viewpoint on the managers and similar administrators.
issue (n = 21), often at a “macro” or national level and based on
To begin, we know individuals “demand” to enter the nursing pro-
experts’ opinion without adequate supporting evidence
fession and the local context drives the phenomenon. For example,
Buchan, O’May, and Dussault (2013) described a variety of high-­
These variables included Gross Domestic Product, a country’s invest-
income country nursing labour market changes after the 2008 global
ment in health, degree of public and private investment in health, and
economic crisis. When economic crises draw more people back to
emigration rates. Only one study mentioned violence and harassment
school to study nursing because it is perceived as a more stable form
as significant issues related to nurse supply and turnover (Simoens,
of employment than many service sector jobs, the demand for nursing
Villeneuve, & Hurst, 2005).
education increases.
In an economic crisis, however, upon graduation, an oversupply of
3.5 | Gender and forecasting models nurses then occurs because there are not enough jobs to match the
number of graduates due to reduced income into the health care sys-
Another dimension emerges in a study by Buerhaus, Auerbach, and
tem. The literature subsequently reflects hiring delays for new graduates
Staiger (2009) in the USA that illustrates gender based employment
(Holtom, Tidd, Mitchell, & Lee, 2013). Furthermore, in tighter job mar-
trends should be factored into forecasting modelling. That study as-
kets, employers seek to hire graduates from the best programmes; so
sumed that supply rates would decrease during child rearing years for
how long it takes a new graduate nurse to get a job may reflect the pro-
a period of 15 years, based on past trends. It shows a need for three
gramme’s quality reputation. Changes in hiring practices can also reflect
age-­based cohorts when forecasting. This may explain greater drops
market shifts that favour more highly educated nurses, with current hir-
in numbers in the 35–49 year range (Buerhaus et al., 2009). However,
ing trends among hospitals in some countries shifting toward exclusive
because social policies including maternity leave and access to chil-
hiring of bachelor’s prepared nurses (Benson, 2012; Xue, Smith, Freund,
dren’s day care services vary from country to country, these need to
& Aiken, 2012). Effectively, too many nurses can create an increased
be taken into account when forecasting models are formulated.
demand for quality practitioners because organisations can afford to be
more selective about hiring. Nurse managers could anticipate having an
4 | DISCUSSION influx of applicants during these times and organisations may experi-
ence the luxury of choosing only the most highly qualified candidates.
This paper provides new information about how supply and demand Yet when the economy stabilizes and more people seek health
should be conceptualized for forecasting studies in relation to the care services, demand for more nurses (from employers) increases and

TABLE 4 Thematic breakdown of supply and demand in the nursing workforce

Supply Demand

Individual Public image of nursing Local job market

General career options for women International job market
Childcare services Local population health profile
Career mobility within the profession
Organisational Quality of work environment Quality of work environment
Management Management
Regional/National Access to education Number and types of places of employment
Women Population health profile
Individuals from lower socioeconomic status
Social policy around gender
8 | SQUIRES et al.

studies begin to project regional or national shortages. Logically this the nursing workforce in order to create and contribute to evidence-­
is where the trends change. At the organisational level, articles de- based policies.
scribing programmes for how to attract and retain nursing personnel
abound. Retention policies are resurrected and reworked for the new
shortage phase. Nurse managers will once again find themselves des- 6 | LIMITATIONS
perate to hire qualified candidates.
Migration dynamics appear to bridge both the individual and or- A major weakness across the studies is that scenarios were modelled
ganisational drivers of demand, influencing supply and demand from over 20 years and made too many assumptions with poor data. The
the organisational level to the regional one. Although nurse manag- accuracy of projections, which are based on expected changes in pop-
ers may not be able to change the individual drivers of demand, they ulation characteristics and economic factors, depend upon the qual-
can directly and indirectly influence these trends at the organisational ity of data sources (McQuide, Kolehmainen-­Aitken, & Forster, 2013).
level. Poor management, for example, can drive emigration because Data accuracy issues, therefore, raise questions about the ability to
of poor retention (Squires & Beltrán-­Sánchez, 2013). Alternatively, produce accurate forecasts of such complex and dynamic human sys-
hospitals with good working conditions and effective management tems. Another problem with demand based skill forecasting is that it
practices will retain workers and attract them. Regions with increased assumes no differences between RN level nursing roles, when in fact,
population growth or that have weathered economic shocks better specialties may have very different skill and forecasting needs. For en-
may have more jobs and try to attract nurses to work in regions out- suring an adequate skill mix in the workforce, policymakers need stud-
side of where they were educated. ies specific to nursing assistants, RNs, specialized RNs and midwives
Thus, organisationally driven demand evolves from how well the to enhance the precision of forecasting methods (Bosworth, Wilson,
health system is managed and is the traditional point of forecasting & Baldauf, 2007).
because organisations are the main employers of nurses. Health care Additional study limitations include our use of only studies pub-
organisations that are well managed tend to have less demand for lished in English. This may have eliminated other forecasting exam-
nurses because retention levels are high, while those that are not have ples that used other methodologies. Notably, none of these studies
high turnover rates and poorly rated work environments (Morgeson, addressed gender factors in their modelling approaches so that factor
Delaney-­Klinger, & Hemingway, 2005). Yet the analysis here indicates may be under-­accounted for in our analyses. Finally, the analytic intent
that organisations may also drive supply in two ways. First, it will dis- to focus on supply and demand in the directed content analysis may
courage nurses from seeking employment there. Second, they may have also limited our findings.
increase the rates of burnout and turnover which could result in in-
creased rates of nurses leaving the profession altogether. Nurse man-
agers, therefore, play a critical and, possibly, underestimated role in 7 | CONCLUSIONS
influencing nursing workforce forecasting dynamics.
Nursing workforce forecasting methods need more comprehensive
evaluations of their methodological underpinnings to achieve accurate
5 | IMPLICATIONS and clear understanding of the factors driving the supply and demands
of the workforce. The findings demonstrated that policymakers and
Accurate nursing workforce forecasting can help nurse managers, researchers may see demand as based on simple quantitative service
administrators and policy makers to understand the local supply and related factors. This leads to a bias toward utilization-­based models as
demand dynamics of the nursing workforce. Organisational leaders a predominant approach, potentially leading to workforce forecast-
should contribute to efforts designed to prepare and maintain a com- ing models that may mislead nurses managers and administrators. In
petent current and future nursing workforce by understanding the local addition, nurse managers actually are the key players in refining the
contexts such as factors related to turnover and issues related to gen- forecasting models as they are best equipped to have more accurate
der. Nurse managers are the best equipped and situated to understand understanding and to capture the effects of local contextual influ-
the context of their nurses to prepare for the shift in the workforce. ences on forecasting techniques. This review of the current nursing
The current and impending nursing shortages in many countries workforce forecasting is salient in today’s imbalanced nurse labour
(WHO, 2010) make nursing specific models for workforce forecasting market. The nursing shortage has been a chronic issue in the USA
increasingly important. Despite over two decades worth of efforts to as well as around the world. A comprehensive and reliable forecast-
examine workforce forecasting, existing models continue to oversim- ing model for the nursing workforce is necessary to anticipate the
plify the complex nature of workforce migration. This review highlights changes in the demographics of nurses in the years to come. Better
the need for a closer look at migration patterns at the practice level models mean that nurse managers can better plan their hiring needs.
to create more effective and applicable forecasting models more on
the ground level for nurse managers and administrators. Importantly,
ET HI C AL AP P ROVAL
nurses with management experience who work in centralized health
care systems need to understand the supply and demand dynamics of Ethical approval was not required for this paper.
SQUIRES et al. | 9

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