Healthcare workforce shortages today are unprecedented. Some hospital leaders fear the worst is yet to come.
That's because as nurses quit in droves — with some leaving to take higher-paying traveling nurse positions or opting for early retirements — replacing them is becoming increasingly difficult. With many other nurses dropping the profession because of the mental of physical toll of being on front lines of the pandemic for two years, it's almost mission impossible for many health systems to fill staffing holes.
Projections from the Bureau of Labor Statistics estimate U.S. healthcare organizations will have to fill almost 200,000 open nursing positions every year until 2030, with many of those slots resulting from the need to replace nurses who leave for different occupations or retire.
"This is a bigger workforce shortage than we have ever dealt with," said Gay Landstrom, senior vice president and chief nursing officer of Trinity Health, a nonprofit system with 88 hospitals nationwide.
While some systems anticipate many nurses who are leaving now will eventually return, staff shortages — already forecast to occur over the next decade even before the pandemic began — likely will persist, driven mainly by an aging nursing population, hospital officials say.
A large chunk of the most experienced senior nurses are set to retire over the next two decades, as the average age of a registered nurse in the U.S. in 2020 was 51 years old, according to a survey from the National Council of State Boards of Nursing.
While interest in healthcare professions like nursing hasn't waned, shortages of nursing educators and sites to get clinical hours pose imminent challenges to the pipeline of new nurses in particular.
Some systems are boosting benefits and propping up their own internal staffing agencies to keep nurses in house at least for the short to medium term. Others are looking to bolster partnerships with academic institutions to better strengthen their pipelines in the years to come.
"The role of the nurse needs to be an enticing one," Landstrom said. "We need to have enticing jobs that aren't completely exhausting."
Nurses under attack
Throughout the pandemic, surveys have increasingly found widespread stress and burnout among the healthcare workforce. Some nurses say their jobs are now less satisfying, and for some it's untenable as persistent staffing shortages make it difficult to adequately care for patients.
More than a third of nurses recently surveyed by staffing firm Incredible Health said they plan to leave their current jobs by the end of this year, citing burnout and high-stress work environments. Higher pay elsewhere is the top reason for taking another position, the poll found.
Nurses in the survey also said verbal and physical violence is on the rise, with half attributing that to COVID-19 guidelines and the other half citing longer wait times and other issues caused by a lack of staffing.
Shortages of other ancillary staff like nursing assistants, patient care assistants and others are worsening the problem and restricting nurses from practicing at the top of their licenses, Landstrom said.
"We have to do a much better job of developing those nursing assistants and a steady flow of that pipeline, as well as the RNs," she said.
Nursing schools don't have enough teachers or slots
While the profession has been battered by the pandemic, the fallout from the outbreak didn't curb the number of students pursuing nursing degrees in 2020, the most recent year that data is available.
Entry-level baccalaureate, master's and Doctor of Nursing Practice programs saw enrollment increases in 2020 of 5.6%, 4.1% and 8.9%, respectively, according to a survey from the American Association of Colleges of Nursing. Enrollment in those programs has risen continuously for the past 15 years, according to the AACN.
At the same time, about 80,000 qualified applicants were turned away from nursing programs in 2020 because of resource constraints, namely shortages of clinical sites and faculty.
"I think we're going to have enough people who want to be nurses, but I think the challenge is going to be getting them through nursing school," said Rita Wise, director of the Pennsylvania College of Health Sciences' nursing program.
Faculty shortages are largely driven by the fact nursing educators need master's degrees, and master's-prepared nurses often choose to work in higher-paying roles in hospital settings or other clinical agencies rather than teach, Wise said.
In addition, nursing students need experience in actual clinical settings. Opportunities for student nurses to get clinical hours needed for graduation fell early in the pandemic as hospitals grappled with personal protective equipment shortages, though they've slowly returned.
Nursing schools reported a limited availability of clinical sites as the top reason they turned away qualified applicants, according to an AACN survey in late 2020.
At the same time, there's little incentive for hospitals and other practitioners to open their doors to students who require extra time and training, taking resources away from current staff, especially amid today's shortages, Wise noted.
Medicare currently helps some providers recover costs for taking students under their wings, though not all programs qualify, she said.
Provider groups like the American Hospital Association have called on Congress to expand those programs as pandemic-driven shortages persist.
Health systems still are seeking to form partnerships with nursing schools and other academic institutions two years after the pandemic began as concerns around their pipelines of future staff grow.
"We need to really be working in partnership with academic organizations beyond what we have done in the past," Trinity's Landstrom said.
Transitioning students from nursing programs to working for an organization can be jolting, especially amid increased staff turnover, and shouldn't be the case, she added.
In the past, hospitals and nursing schools worked together more closely than they do today, though the pandemic is spurring greater collaboration between the two, Craig Laser, clinical associate professor at Arizona State University's College of Nursing and Health Innovation, said.
Hospitals and nursing schools today are "talking much more than they were before about supply and demand," Laser said.
Pennsylvania College of Health Sciences' Wise knows firsthand that this type of cooperation can pay off. She graduated nursing school in the early 1990s and as a student had a paid internship at a local hospital, where she later went to work for 19 years.
"They definitely did get a return on the investment," she said.