The causes of the shortage of professional nurses are many and varied. On one level, the personnel shortage itself is also a cause because the stresses introduced into the practice of nursing by over-work (resulting from the personnel shortage), in turn, causes many more nurses to leave the profession (Scherer, 1987, pp. 1284-1290).
The stresses associated with the contemporary practice of nursing also lead to an increase in the rate of burn-out among professional nurses (Brenner and Wrubel, 1988, pp. 1072-1075). Burn-out, in turn, is a crucial factor in the development of performance impairment among professional nurses. Burn-out is a relatively common phenomenon in many fields of endeavor; however, it is particularly acute in the nursing practice. Burn-out, together with the actions of personnel before this point is reached, lead to high rates of personnel turnover, decreased levels of productivity, and declining quality levels in duty performance--impaired nursing. These factors cause severe managerial problems for health care delivery institutions, increased patient risk, and significant disruptions in the lives of the professio