Concerns of a nationwide nursing shortage have loomed for decades, and the COVID-19 pandemic only fast-tracked the profession toward crisis.
Nursing is integral to safe healthcare delivery, and the threat of a nursing shortage should concern everyone.
When it comes to patient safety, nurses are the nervous system of a hospital. They sense, perceive, connect, communicate, and solve. Critical to patient safety, appropriately staffed nursing staff protects patients through decreased mortality rates, reduced duration of hospitalization, and decreased preventable errors, such as falls or infection [1].
Despite being the country’s largest healthcare profession [2], nurses overwhelmingly feel undervalued, understaffed, and underappreciated. And after Covid-19, they’re walking away from the bedside.
This Mayo Clinic study from 2021 surveyed the pandemic’s impact on clinicians. They found that 1/3 of surveyed physicians and nurses planned to reduce work hours within a year, and approximately 40% of nurses planned to leave their current jobs within two years [3]. Why? Stress, burnout, and heavy workload.
Nurses who are leaving the bedside aren’t retirement age. Analysis from 2022 found that the total number of registered nurses decreased by more than 100,000 between 2020 and 2021–the most significant observed drop in the past 40 years. Many were under 35 and employed in hospitals [4].
The nurses who should be the profession’s future are leaving it behind.
The threat of a shortage existed before Covid-19. The pandemic poured salt in the profession’s wounds. This American Association of Colleges of Nursing (AACN) reviewed a nursing workplace survey from 2022. It indicated that the median age of a registered nurse is 46 and estimated that a quarter of nurses plan to retire or leave the profession over the next five years [5].
By 2030, there will be an estimated exodus of one million nurses into retirement [6].
This is detrimental to patient safety. Experienced nurses leaving the bedside leave a large and dangerous void. New nurses and physicians rely on the knowledge, expertise, and intuition of experienced nurses. These intangibles, combined with their ability to lead, mentor, and educate, are challenging to quantify and replicate.
While nurses continue to retire from or leave the bedside, the demand for quality healthcare only increases. Modern medicine means longer life expectancies, resulting in increased hospitalization utilization and geriatric care.
According to the U.S. Census Bureau, as baby boomers age, they will outnumber children for the first time in the country’s history, and by 2034, there will be 77 million people who are 65 years old or older [7].
As baby boomer nurses leave the bedside, they’ll find themselves as patients in an overwhelmed, understaffed healthcare system.
There is no straightforward answer to this imminent shortage. You might think, can’t hospitals hire more nurses? Unfortunately, it isn’t as simple as that.
Demand for Nurses is Growing Faster Than Supply
According to the AACN, nursing school enrollment can’t meet anticipated demand [5]. Nursing college programs and their resources are finite.
The AACN’s report showed that schools often reject qualified applications due to inadequate faculty, professors, clinical sites, clinical preceptors, and budget constraints [5]. This means that even with increased interest in nursing education, nursing programs cannot churn out new graduate nurses quickly enough to fill job openings.
Still, new nurse recruitment isn’t practical if you can’t retain them.
Early in the pandemic, nurses pushed their fears aside to care for patients under immense pressure and uncertainty. Nurses are at the patient’s side more than any other clinician, assuming the highest burden of risk for disease transmission. Still, nurses answered the call and remained dedicated to the profession.
Supply shortages left frontline healthcare workers lacking basic personal protective equipment (PPE), like masks, gloves, and gowns. In 2020, the World Health Organization called for a 40% increase in production in response to dangerously low supplies of PPE, putting frontline workers’ health in jeopardy [8].
Nurses found themselves understaffed, overworked, and under-appreciated. Insufficient nurse staffing negatively impacts both patients and nurses. Staffing concerns during the pandemic plagued the profession, raising stress and decreasing morale.
A study published in Nursing Outlook examined the impact of insufficient staffing and higher nurse-to-patient ratios. As seen in the pandemic, higher nurse-to-patient ratios contribute to a higher degree of burnout, increased job dissatisfaction, and higher intent to leave [9].
This 2022 COVID-19 impact survey released by the American Nurses Foundation and the American Nurses Association showed that 52% of nurses are considering leaving their current roles. Why?
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- Insufficient staffing
- Work negatively impacting health and well-being
- Inability to deliver quality care
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A staggering 6 out of 10 nurses report feeling burnt out, and three out of 4 nurses report feeling stressed, frustrated, and exhausted [10].
These aren’t the concerns of a small minority. This is endemic to the profession.
Unsurprisingly, the pandemic prompted many nurses to explore opportunities beyond traditional bedside nursing. The profession provides many opportunities: ambulatory centers, outpatient departments, school nursing, aesthetic nursing, administrative nursing, and telehealth and remote work.
As more appealing nursing positions pull nurses away from the bedside, urgent healthcare executive action and governmental involvement are necessary to keep hospitals functioning.
The AACN is currently focused on solutions to the impending shortage through such measures as:
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- Advocacy for federal legislation and increased funding for nursing education
- Program development aimed at nurse development and retention
- Applying innovation in nursing programs, such as accelerated education pathways like BSN and MSN programs
- Working with organizational partners to encourage interest in the career [2]
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As we approach this crisis, certain regions will feel the shortage’s impact more directly. These predictions are partly due to population data showing an aging population that will outnumber the nursing supply. This study shows 37 out of 50 states will experience significant shortages [11]. This will negatively impact safe and quality patient care and nursing morale.
For nurses, the professional outlook is a double-edged sword.
You’ll almost definitely be hired, but there’s no guarantee that your job won’t push you out of the profession.
Sources:
1 The Nurse Staffing Crisis | American Nurses Association | ANA
2 Nursing Workforce Fact Sheet
3 COVID-Related Stress and Work Intentions in a Sample of US Health Care Worker
4 A Worrisome Drop In The Number Of Young Nurses
6 How Should We Prepare For The Wave Of Retiring Baby Boomer Nurses?
7 2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers
8 Shortage of personal protective equipment endangering health workers worldwide
10 Pulse on the Nation’s Nurses Survey Series: COVID-19 Two-Year Impact Assessment Survey
11 United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit
- Is Nursing Heading for Collapse? - January 15, 2024