Nurse Staffing Shortage: Causes, Impacts, and Statistics

High turnover rates, nurse burnout, and an aging population are some of the many factors leading to a nurse staffing shortage. 

Unfortunately, nursing shortages are not limited to the United States; they are a global concern that jeopardizes patient safety.

The Nurse Staffing Shortage: A Background

According to the American Association of Colleges of Nursing (AACN), one million registered nurses in the United States alone will retire by 2030. Additionally, a recent study published in Wiley found that the global prevalence of nursing burnout was 30 percent. 

Given these concerning statistics, facilities need to confront the growing shortage head-on, but how? 

Since the nurse staffing crisis did not occur overnight (shortages date back to the early twentieth century), it will not be resolved overnight either. Nonetheless, there are steps that facilities can take to start tackling the nursing crisis today. First, let’s dig into what the shortage is and the largest causes.

What Is a Nursing Shortage? 

A nursing shortage occurs when more nurses are required to meet the demand for healthcare services. Many factors can cause nursing shortages, such as an aging nurse workforce, an aging population, and limited enrollment in nursing programs. 

Another component that adds to the severity of nursing shortages is nurse burnout. According to the American Nurses Association, nearly two-thirds of nurses experience burnout. Unmanaged, ongoing workplace stress may be the leading cause of nurse burnout.

Other factors contributing to nurse burnout and stress include the following: 

• Heavy workloads
• Low staffing levels
• Insufficient resources
• Lack of support from management
• General stress from the emotional demands of nursing

Nurse burnout can significantly impact patient care, leading to medical errors, delayed treatments, and overall patient dissatisfaction. Nurse burnout also threatens to perpetuate the nursing crisis by causing nurses to call out more often or even resign from their jobs. To combat this, facilities should develop a comprehensive and well-coordinated strategy to help address nurse burnout, among other causes that lead to staff shortages.

Nursing Shortage Quick Facts

Here are some facts that can help us put the nursing shortage into perspective:

• Nursing shortages can be traced back to the time of Florence Nightingale in the 1850s.
• Some researchers assert that there isn't a nursing shortage, but systematic reviews have emphasized that nursing shortages exist globally and negatively impact patient health-related outcomes.
• Due to stress, burnout, and retirement, about 100,000 registered nurses (RNs) left the nursing workforce during the COVID-19 pandemic, according to research by the National Council of State Boards of Nursing (NCSBN).
• Numerous variables affect nursing shortages, such as educational, managerial, and policy-making factors.
• The median age of RNs is 46 years. In addition, more than a quarter of registered nurses say they intend to leave nursing or retire within the next five years.
• An aging population (baby boomers) and an aging employed nurse population drive the demand for nurses in the United States.

Causes of the Nursing Shortage

There is no single main factor that causes nursing shortages. Nursing shortages are multifaceted and result from years of inefficient facility operations. However, some agree that the number one reason nurses want to leave hospitals is that staff-to-patient ratios need to be lower.

Not having adequate staffing levels on a facility floor can lead to nurse managers repeatedly asking nurses to fill in and work more hours. Consequently, long hours compounded by a lack of sleep and general strain from working in high-stress environments can exacerbate the already grave nursing shortage.

Facilities can implement proven strategies to prevent and mitigate nurse burnout effectively. In the meantime, facilities should also try to familiarize themselves with some of the primary causes of nursing shortages: 

• Workforce issues: Aging workforces (one-quarter of registered nurses report that they intend to leave nursing or retire within the next five years) and a lack of qualified nurses are all factors that currently contribute to the nursing shortage.
• Demand factors: An aging baby boomer population and increased demand for long-term care strain the healthcare staffing crisis in medical settings.
• Work environment issues: High-stress environments, high nurse-to-patient ratios, and a lack of professional advancement opportunities can worsen the nurse shortage. 
• Facility constraints: Budgets for healthcare can be exhausted due to rising costs related to high nurse turnover, increasing salary demands, and high overtime pay rates. 
• Education issues: A lack of nurse educators, high educational costs, and school-imposed student capacity limits aggravate the nursing shortage.

How the Nursing Shortage Affects the Healthcare Industry

Some of the more severe consequences of the nursing shortage include increased workloads for existing nurses, higher rates of burnout and job dissatisfaction, and lower-quality patient care. 

The following is a more in-depth explanation of how the nursing shortage affects the healthcare industry: 

Patient Care

The impact on patient safety is one of the main reasons facilities need to start taking nursing shortages seriously. Patient safety is compromised when healthcare organizations lack nurses with the proper knowledge, skills, and experience to deliver quality healthcare or when nurses are overworked. When nurses are overworked, they make more mistakes and provide less attentive care. Thus, the consequences of staffing shortages in nursing are overworked nurses, delayed patient treatments, patient dissatisfaction, and, at its worst, significant medical errors.

Nursing Staff

Nursing is already a challenging profession. When you add staffing shortages to the equation, nurses may feel depleted physically and emotionally. In addition, an increased workload and lack of facility support (i.e., no access to counseling services) could lead to feelings of burnout. 

Plus, nurses who have to make up for gaps in coverage have to work longer hours. Not only does working long hours take a toll on a nurse's physical health, but it can also significantly disrupt a nurse's work-life balance. Physical and emotional exhaustion, combined with a lack of recreation outside of work, can cause many nurses to leave their profession for good.

Healthcare Systems and Public Health

When there is a shortage of nurses, healthcare facilities may need to offer incentives to retain existing nurses. Retention efforts may involve offering higher wages, higher overtime pay, or sign-on and retention bonuses, leading to significantly higher staffing costs. Moreover, when a facility needs more staff, its medical team may respond poorly to health emergencies.

Nursing shortages can also cause inadequate access to healthcare services, further exacerbating healthcare disparities in rural hospitals. Over time, low staff retention and compromised care quality caused by nursing shortages can lead to the public losing trust in healthcare institutions.

"Improving nurse retention is not an insurmountable task but requires commitment, a willingness to listen, and an investment of time, energy, and finances."
- How to Improve Nurse Retention: 7 Tips to Get Started

Strategies to Address the Nursing Crisis

Addressing nursing shortages through proper staffing is vital in ensuring a facility can provide safe and attentive patient care. Therefore, facilities must implement strategies that prevent the negative consequences of nursing shortages, such as increased workload, compromised patient care, and burnout. Here's a look at short-term and long-term strategies that address the nursing crisis and can help move a facility in the right direction: 

Short-Term Strategies

Practical and short-term strategies for handling nursing shortages are to get to the root of the problem—a lack of nurses. One short-term strategy for handling a nursing shortage is to contract short-term workers such as per diem nurses. 

Contracting qualified per-diem nurses can help close the staffing gap and distribute the workload fairly among nurses, preventing nurse burnout and ensuring safe nurse-to-patient ratios.

The following are other short-term strategies for effectively addressing a nursing shortage: 

• Flexible scheduling: Providing flexible scheduling can enable nurses in selecting shifts on their own terms, promoting a healthier work-life balance. 
• Public policy as an emergency response: Public policies are essential in mitigating the potential impacts of public health emergencies. These policies often provide resources, guidelines, and crisis staffing to help hospitals effectively manage emergencies, such as disasters, disease outbreaks, or nurse staffing shortages. 
• Telehealth expansion: Telehealth expansion can address nursing shortages by increasing access to healthcare and reducing the need for in-person visits by offering patients healthcare services using tech-based applications and systems. 
• Incentive programs: Offering incentive programs can improve nurse retention by rewarding a nurse's dedication. Incentives include employee recognition and rewards, employee wellness programs, and tuition reimbursement.

Long-Term Strategies

One of the goals of long-term strategies is to ensure short-term strategies are sustainable and effective. Additionally, below are some examples of long-term strategies that facilities can implement to reinforce nurse retention:

• Increase nursing school enrollment: Healthcare facilities providing financial support for education, such as tuition reimbursement, may attract more individuals to the nursing profession. This proactive approach addresses immediate staffing challenges by offering incentives to nurses and promotes a sustainable long-term staffing solution. 
• Listening to nurses' concerns: A long-term solution for nurse retention is ensuring nurses feel seen and heard in the workplace. A facility, therefore, should be receptive to feedback and provide tangible solutions for change in response. Similarly, by actively listening to nurses, facilities can foster a positive work environment, strengthening team bonds and promoting collaboration and teamwork.
• Investing in support systems: An excellent long-term solution for combating nursing shortages is offering counseling services, resources for stress management, and mentorship programs for nurses. Such support systems can help alleviate some of the stress that comes with the general nature of nursing and help nurses stay motivated to keep showing up to work.

What Does the Future of Nursing Hold?

‍For the time being, nurse staffing shortages are not going anywhere. In fact, between 2020 and 2030, the U.S. Bureau of Labor Statistics predicts that there will be an average of 194,500 openings annually for registered nurses. The future of nursing, therefore, is bright for an aspiring nurse looking for a challenging but promising career. 

“But the focus on “right now” and “what’s next” distracts healthcare leaders from facing the hard facts: Nursing shortages are a complex phenomenon that began to take shape even before WWII and have continued to challenge hospitals and healthcare facilities for 90+ years. And unless leaders expand their perspective and go beyond solutions suggested in the 1930s—like incentivizing students to attend nursing school rather than incentivizing nurses to remain in the workforce—healthcare organizations will be hard-pressed to make a sustainable difference.”
- Curtis Anderson, CEO and Founder of Nursa

At the same time, nurses need to feel supported in their work. After all, a rested and happy nurse will be more motivated to stay in their profession, which can also help mitigate nursing shortages. 

‍So what's the bottom line? The first thing that facilities can do to attract, retain, and enhance the working conditions for nurses is to start taking care of their nursing workforce. From there, anything is possible, and the future of nursing appears more optimistic than ever.Want to learn more? Find out how Nursa helps healthcare facilities and professionals address the nursing crisis with its healthcare staffing platform.