OPERATIONS MANAGEMENT COMMITTEE
Where Have All the Nurses Gone? An Exploration of the Nursing Shortage and Proposed Solutions Akiva Dym, MD, Kraftin Schreyer, MD FAAEM, and Anthony Rosania, MD FAAEM
A
s the COVID-19 pandemic continues to spike across the United States and around the new world, a new crisis has emerged within healthcare systems — critical shortages of nursing staffing. At this time, hospitals in regions all across the US are dealing with the significant challenge of severe nursing staffing limits, requiring hospitals to reduce patient capacity and even close entire units due to staff shortages. According to the U.S. Bureau of Labor Statistics, close to 1.1 million new nurses will be required to meet the clinical demand as well as replace nursing retirees.1 However, it is expected that the nursing shortage will continue for the foreseeable future. So, where are the nurses? There are multiple factors which are contributing to the current nursing shortage, some of which are COVID related but many others which have been developing for a longer period of time.
Another major force contributing to nursing staffing shortages is the aging workforce. It has been projected that close to 500,000 experienced RN’s will retire by 2022, which will have a major effect on the current levels of nursing staffing.5 And, while nursing enrollment has been steadily increasing, the current nursing school capacity is far lacking as compared to the current demand required. Thus, a combination of increasing retirees with a lower rate of graduate replacements will only worsen our current nursing shortage. Nowhere has the nursing shortage been noted as painfully as within our emergency departments (EDs). EDs around the country are routinely being forced to either close entirely or limit capacity due to nursing shortages. Lack of ED nurses has been shown to contribute to delays in care, longer length of stay, and increased walk out rates, all of which contribute to adverse patient outcomes.6,7 The high work demand and burnout within the ED environment is often a driver for nursing staff to leave the ED, making it challenging to find consistent and seasoned staffing within the ED. Facing this new reality of nursing staffing shortages, EDs will have to come up with innovative and creative staffing models and throughput models in order to ensure optimal capacity and function of the emergency department, while still maintaining high levels of quality and safety for our patients.
SO, WHERE ARE THE NURSES?”
Certainly, COVID has accelerated the nursing shortage. While the early stages of the pandemic were exhaustive leading to some nurses taking the opportunity to retire, most nurses stood fast through the burnout. But, continued COVID surges after the vaccine rollout proved to be too much for many. Nurses sought alternative options that were less stressful, safer for themselves and their families, or, more lucrative. With increased demand for nursing staff in certain “hot spot” regions, an increasing number of nursing staff are joining the socalled “traveler” staffing agencies which are willing to pay higher salaries and signing bonuses to ensure staffing in specific regions. The higher pay, up to $150/hour and signing bonuses upwards of $20,000, have caused large volumes of nurses to seek alternate nursing options, thus exacerbating shortages in other regions.1
In addition to the COVID factors, nursing shortages are also being driven by a shift of nursing staff into other clinical roles. One such shift is from bedside nursing to nurse practitioner roles. Over the last 10 years, the number of nurse practitioners has grown by double-digits year after year.2 There has been a continued drive from leading nursing organizations encouraging this transition, which has also accelerated the nursing shortage.3 Furthermore, many nurses are shifting from hospital-based roles to other clinical roles, such as out-patient clinic and long-term care, again, contributing to shortages within hospital practice.4
While it is important to ensure fair compensation, financial solutions can only do so much when there is a shortage of resources, especially if the financial solutions divert nurses away from the areas they may be needed most. We propose that physicians can do their part to improve the workplace environment for their nursing colleagues, and hopefully mitigate some of the current problems.
Physicians should additionally respond by encouraging the following: • Partnering with nursing leadership and organizations to develop a robust, multidisciplinary approach to workforce issues. • Engaging technology fully to offload cognitive and task burdens.
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