The Nursing Shortage - The Crisis America's Nurses Are Facing

Every nurse that is asked about the American nursing shortage can attest to its effects. Our voices need to be heard before more nurses continue to leave the profession altogether. Nurses need resources to perform job duties and maintain wellness outside work. Nurses also need to feel truly valued, appreciated, and heard. Our jobs are demanding not only physically, but mentally, emotionally, and spiritually as well. I believe spreading awareness and objective information to health care providers and the general public will help cause the ruckus we need. Some of this article is grim, not on purpose, but to spread awareness. I am hopeful that nursing and the collaborative health care team will find creative ways to enhance nursing workforce development. Continue on to read about the nursing shortage and possible solutions!

Is There a Nursing Shortage?

Absolutely. There is no denying the nursing shortage across the United States. The nursing workforce is primarily seeing a decrease in bedside nurses. Registered nurses are the third fastest-growing occupation within the healthcare field. The US Bureau of Labor Statistics predicts that the nursing profession outlook will increase by 195,000 new RNs needed. The baby boomer generation is getting older and in need of more care. In March 2022 the American Nurses Foundation released a survey of the COVID-19 impact on staffing over the last two years, the data will surprise you (or not). In the survey, 52% of nurses claimed to be leaving or considering leaving their positions. Interestingly, one of the US's fastest-growing and most secure careers is experiencing a national crisis in staffing. Why is that? And why does it feel like no one but health professionals cares? What can we, as registered nurses, do to combat these issues? Keeping reading to find out.

The Severity of the Nursing Shortage

Prepandemic era the registered nurse workforce saw side effects of staffing issues. Occasionally, I would have to float to a different unit to help or take three patients in the ICU. Older nurses were retiring or leaving for less stressful jobs. Then good ole COVID-19 made its way.

In Becker's Hospital Review, Marcus Robertson explains hospital turnover rates and associated costs. Within the last five years alone, hospitals have seen nearly a 100% turnover rate in most areas. The average cost of constant turnovers? A whopping $5.2 to $9 million per year. Now, it's safe to say nursing care has merit. Hospital administrators should be seeing the value of nurse retention and training.

The pandemic exacerbated every strain and weakness within hospital facilities. Primarily the staffing crisis. You may ask, how come more nurses are leaving if there is a national crisis?! Well, there is a number of spinning plates when it comes to the ever-growing staffing crisis among registered nurses. So let's analyze this further.

Why are Nurses Leaving the Bedside?

This is a complex question with lots of deep dives. Firstly, let's talk about compensation. It's no secret that healthcare systems are a business with their eyes on the dollar sign. Easiest ways to cut back costs? Allegedly, nursing care. At face value, it's easy to write off the care nurses give. However, as the numbers have shown previously nurses are essential to a hospital's worth. Possibly spending slightly more on nurse retention and safe conditions could save hospitals millions of dollars every year.

On top of cutbacks... COVID patients are incredibly sick and need a higher level of care that requires specialized equipment. In layman's terms, more money than the typical patient. Majority of hospitals filled up to capacity and the hospital leader's response to this with a severe nursing shortage? Pile assignments high for the fewer nurses still left! Most hospitals did not offer their current staff any hazard pay. Maybe a measly few extra dollars to pick up more shifts to help or confusing bonuses. Travel nurses were hired to help. Staff nurses realized these agency nurses were being paid thousands of dollars a week to do the same job, so most staff nurses jumped ship. A noticeable lack of loyalty (rightfully so) in bedside nurses began during this time.

It was obvious that the 'healthcare heros' were expendable and not valued for their work or time. This lack of empathy from employers caused nurses to drop any loyalty they had for the corporations they worked for.

To make matters worse, most supplies to perform necessary patient care was on backorder or not accessible due to budgeting. When you mix short staffing with low supplies and old, out-of-date equipment, things begin to look bleak. Everything feels as though it's working against you and makes being a nurse ten times harder. What strikes deep is when the lack of resources begins to affect patient care. The spinning of the moral compass starts. When it boiled down to it, this factor is what lead to me debating on if I truly wanted to be a nurse anymore. I know I am not the only one who has been in this situation. In fact, most nurses that are asked will probably say the same thing.

In most other occupations it's possible for people to leave their jobs and not carry the day's work home with them. As nurses, we're constantly thinking about our patients, our day, and what we should have done differently or done better. On top of that, the unit or floor is short staffed and we go home knowing our coworkers and patients are potentially suffering. Work-life balance as a nurse is a fine line to balance. We need to go home and recharge, however, we feel guilty doing so. This is unacceptable. America's health care system should not be using guilt as a tactic to solve its staffing issues. This only adds to nurse burnout and turnover.

What Does This Mean for the Future of Nurses?

According to the US Bureau of Labor Statistics data, the nursing profession is expected to grow by 9% by 2030. With this statistic in mind, let's check out another number. According to the Revcycle Intelligence article written by Victoria Bailey, the National Association of Community Health Centers (NACHC) performed a survey that found nurses are the number one profession that experiences workforce loss. It is also stated that "Nearly 70 percent of health centers reported losing between 5 and 25 percent of their workforce in the last six months". Nurses are leaving faster than they can be replaced.

Speaking of replacing nurses, one of the many nursing fields that are impacted by this shortage is in nursing schools. Nursing school enrollment is not the issue, but the lack of nursing faculty. Nursing educators and clinicians leave due to insufficient pay, an inflexible work schedule, or disorganized working environments. Educational institutions need to find ways to retain nursing faculty to continue growing the nursing profession. This is just one example of the nursing shortage affecting the nursing workforce.

Another issue new nurses are facing is the lack of preceptors available or willing to train them properly. Graduate nurses are incredibly important! They're a fresh pair of eyes over systems and protocols. However, there is a difference between book nurse and real life. Most things are learned on the job and through time. It is vital that hospitals have great preceptors to help guide and teach new graduate nurses (or maybe nurses switching to a new specialty) in their job duties. Unfortunately, most hospitals don't compensate for orienting a nurse (or if they do, it's chump change). Also, due to nurse staffing, if there are 'two nurses' working together nurse leaders are compelled to give a training nurse a heavier patient load, which leaves little time for proper training.

Travel Nurse's Mark on the Shortage

Travel nurses are good for a short-term solution. Many health care professionals go to traveling because it's great financially and it's a great way to visit around the country. Travel nurses can help greatly while management is attempting to hire more staff or just need to buy more time for other solutions. When the COVID-19 pandemic hit travel nursing became increasingly popular and a huge relief for many hospitals and their staff! Are travel nurses a great long-term solution? No. What happened is now that hospitals are not as full of sick patients, the travelers are gone, and the nursing workforce remains skeletal.

Factors that can Change the Nursing Career

I hope by now, all that you have read helps you to understand the grave effects of the nursing shortages. It's a systemic problem throughout not just the US but globally. I've gone into a lot of detail about the issues we face and the impacts of those issues. Now, what can we as nurses do to help? Let's talk about some possible solutions to the American nursing shortages.

Zach Smith, the founder of Nurse Grid, posted on LinkedIn his ideas to solve the nursing shortage. Smith states, "Good preceptor environments are 🔑 to addressing the #nursingcrisis". Reading through the post he explains ways to make precepting more desirable for staff. One point that really stuck out was safe staffing ratios. If you are in the nursing community, you know that safe staffing is a hot take. As I mentioned earlier, orienting a new nurse while doing patient care is challenging. Having an unsafe assignment with too many patients under your care can further cause nurse burnout. There is little time for learning when you can barely keep your head above water. Management needs to stop giving nurses increased patient assignments just because they have perceived 'extra help'.

I know when I started in the ICU in 2019 it was incredibly overwhelming with a standard two-patient assignment. Thankfully, I had an amazing, knowledgeable preceptor who took the time to train me. Not only that, but I was working at a facility that understood the importance of proper training. I hardly ever had three patients, if I did the acuity of those three patients was low so I had time to perform job duties.

Nurses can be educated and trained in patient care till they are blue in the face, but if hospitals do not supply appropriate supplies, resources, and equipment it's all a fruitless effort. Some personal examples of working without resources... I have been in intense situations where I was worried about patient outcomes and my license. There was one travel assignment, in particular, I was working in ICU. On nights there is only one intensivist for five ICUs. Not only that, but hospitals did not provide CHG soap for baths, IV pumps constantly were out of order, etc... No amount of money in the world is worth it when a patient begins to crash and no working IV pumps are available. Or your patient has central, arterial, or ECMO lines and you have no way to appropriately sanitize the patient and worry about the risk of infection leading to sepsis. Working under those conditions mentally, emotionally, and physically drain you as a nurse. I did the best I could and constantly threw myself into work. If I wasn't working I thought staff and patients would suffer. Till I realized I am one person and can't physically change protocols myself. We need our nursing community to speak up. There is power in numbers. Go to management and state your concerns, physically show them, or pull out evidence-based articles to back up your statements. More often than not supervisors and directors will help when this type of information is brought to them. Some cases are not this fortunate, and staff has to go up their chain of command. Just like we advocate for our patients we must advocate for ourselves, at least for our patient's health and safety. If nurses are working in unsafe conditions and feel like their concerns are not being listened to, send OSHA or JACHO your concerns.

A number of media outlets have covered the nursing strikes happening all around the country. While it seems the broken health care systems are starting to be recognized by the public, there is still a huge gap in understanding. The media coverage told a fraction of the story regarding these strikes. Nurses were on strike for safe workplace conditions. Starting with staffing ratios. In the Washington Post, Benny Matthew explains how working in the emergency room he can have 15-20 patients to himself. The standard patient ratio for an ER nurse is 4. As nurses, we know these conditions are not few and far between.

Nurse-to-patient ratios continue to be a massive pain point within health care systems today. Nurses are forced into unsafe situations for 12+ hours each shift and then hospital admins wonder why nurse turnover continues to rise year after year. However, are mandated ratios a realistic solution to the problem? My personal experience with unions and mandated ratios might shed more light on my hesitancy.  I had a mostly great experience working in a union! There were mandated ratios, I was able to have four breaks each shift, I never stayed past 12 hours, etc. There are some flaws in the system. I was in ICU with my standard two patients. Halfway through the day, one patient under my care was started on CRRT (dialysis). CRRT patients were (by the union laws) required to be one-to-one. Unfortunately, there was no extra ICU trained staff to assume care of either one of my patients.

I agree CRRT patients should be one-to-one, but because of the nursing shortage, I was left in an unfortunate position and mandated ratios did not help my case. To succeed in safe ratios, nurses and health care providers need to brainstorm creative long-term solutions. Kathleen Bartholomew wrote a LinkedIn article showing her take on mandated ratios. Bartholomew writes, "If you are going to fight, fight for the real thing: autonomy and power. The only person in an organization who is qualified to decide staffing levels is the charge nurse". She explains that bedside nurses need to fight for their voices to be taken seriously, when we need help we mean it. Bartholomew another interesting take, patient acuity should be reassessed every four hours and staffed appropriately. In an ideal world, of course, I agree with these statements. Of course, these are what every bedside nurse desires. Is it feasible in today's health care system? Not quite. But Kathleen's open conversation to solutions to the nursing shortage crisis starts a ripple effect allowing nurses to snowball off these ideas or think of new ones!

Conclusion

It took me weeks to write this article. I went back and forth constantly because this is such an important topic for myself and my fellow peers. I wanted to get every detail right, to show not only nurses, but the whole community the gravity of this new type of pandemic, the nursing shortage. While I finally have the article in a spot I'm happy with, I realized, nursing is a team effort. I know my experiences and truths, but I want to call out to the nursing community. Tell me your experiences and ideas about the nursing shortage through the Share Your Story link. Through our typeform, you can submit your story, experience, idea, etc.

We can keep treating symptoms all we want, but until we understand the infection we can't find a cure.