How to Rectify the Growing Nursing Shortage

Nursing shortages in the United States are not new, but the COVID-19 pandemic exacerbated the problem when it put an unprecedented strain on the healthcare system at large — and nurses in particular.

Traveling nurses help ease the burden by working with independent staffing agencies to fill gaps across the country by contracting with healthcare facilities in dire need of employees for a short-term assignment in exchange for higher-than-average pay (30 percent more than staff nurses, on average).¹ But traveling nurses come at a premium: High pay and low commitment don’t address the long-term problem, and things are expected to worsen over the next decade.²

The U.S. Bureau of Labor Statistics reports that employment of registered nurses (RNs) is projected to grow six percent between 2021 and 2031, with about 203,200 expected each year.³ According to the American Association of Colleges of Nursing (AACN), the problem is fueled by increased demand for nursing services from the aging population; a high number of retiring nurses that will continue over the next decade; and new employment opportunities for nurses at all levels. Further, the American Nurses Association (ANA) says that while attrition significantly contributes to the limited supply and availability of nurses, three other major factors exacerbate the shortage, including unhealthy work environments, heavy workloads and burnout and compensation dissatisfaction. ANA Director of Nursing Programs Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, urges, “Without swift and sufficient action, the nation’s nurses, patients and communities will continue to suffer.”⁴ Thankfully, hospitals, healthcare associations and nursing colleges are working diligently to address the myriad of issues causing the shortages.

Partnering to Solve Problems

ANA collaborated with AACN and other healthcare organizations to form a task force charged with identifying priority issues and developing short-term, actionable strategies that could help offset the ongoing crisis. The task force identified action items in six key areas:⁵

1) Healthy work environment. Elevate clinician psychological and physical safety to equal importance with patient safety, and investigate evidence related to scope of practice and minimum safe staffing levels for patients.

2) Diversity, equity and inclusion (DEI). Integrate DEI ideals.

3) Work schedule flexibility. Build a workforce with flexible schedules, shifts and roles.

4) Stress injury continuum. Address burnout, moral distress and compassion, and incorporate nurse well-being as an organizational value.

5) Innovative care delivery models. Implement a holistic delivery model.

6) Total compensation. Develop and formalize an innovative, customizable, transparent pay philosophy and program, and include benefits such as paid time off for self-care, wellness and wealth planning.

Strategies in Practice

According to the Society of Hospital Medicine, hospitals across the nation are implementing novel strategies to address the shortage and retention of nurses in local hospitals, including offering attractive compensation packages; providing desirable perks; implementing robust training and mentoring programs; and even utilizing nonclinical staff to perform peripheral patient-care tasks. Chatham Hospital in Siler City, N.C., Providence Medical Hospital in Mission Viejo, Calif., Anne Arundel Medical Center in Annapolis, Md., and Akron Children’s Hospital in Akron, Ohio, all exemplify what’s happening across the country.

Attractive compensation. Hospitals are increasing salaries and offering bonuses to keep their existing nursing staff. For example, Chatham Hospital increased nurse salaries by $2 per hour, then gave a 2.5 percent raise in January 2022. Nurses also received an incentive bonus of 2.5 percent at the end of October 2022. Akron Children’s Hospital offers bonus incentive pay programs to staff willing to work extra hours.⁶

Hospitals are also recruiting new nurses by offering attractive compensation packages and bonuses for working in high-need areas. Chatham Hospital began to offer sign-on bonuses for two-year commitments, plus relocation assistance for out-of-area candidates. Providence Mission Hospital offers referral bonuses to recruit experienced nurses. Chatham Hospital and Anne Arundel Medical Center offer tuition assistance programs.6

Desirable perks. Hospitals are improving benefits packages by reducing short-term disability waiting periods and giving staff members who work 24-hour workweeks full-time health benefits. Also, many reward nurses who work weekends. Some also offer the flexibility of part-time work and schedule accommodations to cater to the needs of their many nursing students.⁶

Training and mentorship. Chatham Hospital forged a strong relationship with a local community college with an RN program and is bringing back licensed practical nurses (LPNs) to inpatient and emergency department positions. Providence Hospital utilizes a program called Transition into Practice, which allows for on-boarding of more new graduate nurses with better retention and clinical skills after orientation. They also created a patient care technician role for nursing students. Akron Children’s Hospital created the Helping Hands Program in which nurses who work in nonclinical settings are offered refresher training so they can support care delivery at bedside, and they utilize nursing students as patient care assistants. Akron Children’s Hospital also has a 10-week nurse technology program for students from underrepresented groups, and it offers an accredited nurse residency program that supports new graduate nurses’ transitions to practice throughout the entire first year after graduation.⁶

Utilizing other staff. Nonclinical staff are increasingly used for essential nonclinical tasks to ease the burden on nurses. Educators and medical, nursing and pharmaceutical students are also helping fill gaps: They do everything from helping transport patients and lab specimens to delivering meal trays and emptying trash cans.⁷

Nursing Schools Are Strained, Too

Training new nurses to meet the need is easier said than done. Qualified nurse educators are also in short supply, which significantly limits class offerings and sizes. According to Robert Rosseter, chief communications officer at AACN, “Nursing schools must increase enrollment in programs that prepare nursing faculty, since the shortage of nurse educators is limiting the ability of nursing schools to expand new student enrollment.”⁸ As it stands, nursing schools cannot train enough new nurses to meet the significant need.

To help expand the pipeline into nursing, AACN convened the Nursing Community Coalition to advocate for increases in federal Title VIII funding, which provides scholarships to entry-level and advanced nursing students, as well as funding to schools to expand capacity.

AACN also works with practice leaders and corporate stakeholders to offer scholarships to students and funding to faculty. Rosseter says these entities are “needed to fund scholarships, support outreach programs to middle and high school students, provide space for student training, raise money for faculty recruitment and encourage ongoing nursing education.” He also encourages “working with partner organizations to highlight careers in nursing, including those requiring graduate level preparation.” Rosseter says AACN believes that all stakeholders, including federal and state governments, the business community, foundations and advocacy groups, must take a larger role in addressing this nationwide crisis.

All Hands on Deck

Unless the current and growing nursing shortage is rectified soon, over the next decade there will be decreased access to healthcare, the quality of healthcare will be diminished and certain services such as emergency departments will be temporarily or permanently closed. The call for action to rectify these shortages is now.