Factors Affecting Recruitment of Nurses to the Republic of Nauru Hospital- A Qualitative Study

Introduction
The global shortage of health workers especially nurses and midwives represent 50 percent of the current shortage in health workers, so nursing shortage is one of the main challenges faced worldwide today which causes deteriorating health care provisions. Barriers in poor leadership and management, poor governance, poor career training and career development, and poor organizational culture are related factors responsible affecting nursing recruitment to the hospitals and has an impact on nurses and patient’s health-related outcome. The aim of this qualitative study to explore the perception of registered nurses, human resource staff and health executive staff on factors affecting recruitment of registered nurses to the Republic of Nauru Hospital.
Methodology
The qualitative study was used to gather information using five (5) focus groups discussion (FGD) amongst 25 Registered Nurses (RN) and 1 Health Executive (HE) at the Republic of Nauru Hospital and 1 Human Resource (HR) staff under Chief Secretary Human Resource & Labor Division is responsible for recruitment of positions established under the Nauru Public Service. The data were collected through semi-structured open-ended questionnaires and were audio-recorded and was analysed by using thematic analysis process. Ethical approval was obtained from the College Health Research Ethics Committee (CHREC) in Fiji National University and from the Deputy Secretary of Health and Medical Services, Nauru.
Results
The study was comprised of 27 participants, which include 25 RN and 1 HE, and 1 HR. From the respondents amongst the focus groups RN, most of all the respondents (96%) were female and 4% were male. The respondents from HE was a female, and in the HR 100% was a female. The themes identified in the study were categorized into broad themes and sub-themes according to each target groups’ perspectives on the factors affecting recruitment of nurses to the republic of Nauru Hospital and the overview of barriers and resolutions to resolve recruitment issues to alleviate the shortage of nurses. There were Two broad themes, and 6 sub themes were identified from results amongst the registered nurses. These included
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Themes 1) Incompetent leadership and the Sub themes included poor human resource systems and management, lack of administrative capacity and support, power and conflict lead to bullying, poor governance structure and framework and Discrimination and biasness. Theme 2) Ineffective training strategies and programmes subthemes are ineffective and inappropriate training agenda. There were four (4) broad themes, and seven sub themes was identified from results amongst the health executive. These included themes 1) incompetent leadership Sub themes included poor collaboration and coordination and power play. Theme 2) Poor Governance and sub themes included no accountability and ownership, poor health laws and lack of human resource policy in health. Theme 3) Lack administrative capacity and support Sub theme was non-conducive environment. Theme 4) Competition and the sub theme is limited nurse supply. And finally, themes and sub themes were identified from the results among the Human Resource Staffs which were four broad themes, and nine sub themes were three. These included Theme1) Lack of Human Resource Networks. Sub theme included Lack of linkage in information systems Theme 2) lack infrastructure and capacity. Sub themes is Lack of Infrastructure, workforce, capacity, and capabilities. Theme 3) Lack of Human resource laws for health perspective and sub themes Iincluded lack of policies, procedures, and guidelines. Theme 4) overview of barriers and resolutions identified to resolve nursing recruitment issues to the republic of Nauru Hospital were to strengthen inter country arrangements, networking, regional and international links, build a strong Human resource and develop Huma resource capital, capacity, and training.
Conclusion
The nurses at the Republic of Nauru hospital have sound knowledge about shortage of nurses and have identified that recruitment was an issue and have identified factors that affected the recruitment of nurses to the republic of Nauru hospital as well as resolutions were mentioned to improve the recruitment to alleviate nursing workforce shortage. The findings of this study would be useful and helpful to Human resource staffs, directors and the managers at the decision-making level or policy makers to improve the recruitment issues to improve and alleviate nursing workforce shortage in the future. Moreover, further research is required to further determine the in-depth effects of a broader concept in nursing workforce shortage on patients and the intervention to address it more efficiently and effectively.