High staff turnover rates, nurse burnout, and an aging population are just 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.
In states such as Washington, Georgia, and Michigan, the nursing workforce is expected to decline while the demand for skilled healthcare practitioners will continue to grow. California will witness the largest shortage of nurses, with a projected deficit of 65,000 nurses by 2037.
The impact? Already worn-out caregivers will be even more susceptible to burnout, a.k.a. compassion fatigue, which will drastically reduce the quality of patient care.
The solution? Several promising solutions exist, such as offering nurses more flexibility and better working conditions or adopting flexible staffing models, could remedy—and are already alleviating—the nursing shortage.
In the end, “solving” the nursing shortage will take a multifaceted approach to ensure that a nurse is at the bedside of every patient in need. Read on for a look at how that could happen.
What is a nursing shortage?
A nursing shortage occurs when more nurses are required to meet the demand for healthcare services. There is an ongoing shortage of nursing professionals both throughout the United States and internationally, caused in part by aging nurse workforces, aging populations, and limited enrollment in nursing programs.
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 Online Library 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.
Let’s dig further into what the shortage is and what is causing it to worsen.
What is causing the nursing shortage?
There is no single main factor that causes nursing shortages. Nonetheless, research shows that the following issues are major contributing factors to chronic understaffing throughout the healthcare industry:
1. Turnover and staffing shortages in nursing
Some experts agree that the number one reason nurses want to leave hospitals is that patient-to-staff 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 increase turnover and exacerbate the already grave nursing shortage.
2. An aging population and nurse workforce
Another major factor is the aging nurse workforce, which is compounded by an aging population of patients who require more healthcare services. As a result, an aging baby boomer population and increased demand for long-term care strain the healthcare staffing crisis in medical settings.
In addition, 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.
3. Financial constraints
Budgets for healthcare at facilities may be exhausted due to rising costs related to the following:
- High nurse turnover
- Increasing salary demands
- High overtime pay rates
- Emergency care and unexpected events
These financial constraints may make it impossible for facilities to hire and retain enough nurses to meet the growing healthcare demand for patient services.
4. Higher nursing education issues
A lack of nurse educators, high educational costs, and school-imposed student capacity limits aggravate the nursing shortage.
Limited enrollment in nursing programs is also a growing issue, and various barriers make it difficult to inspire nurses to earn a degree and clinical experience. Some of these obstacles include the following:
- Insufficient clinical placements for students
- Long program durations
- High tuition costs (a Bachelor of Science in Nursing (BSN) degree can cost between $25,000 to $120,000 or more)
5. Nurse burnout and compassion fatigue
Another component contributing to the severity of nursing shortages is nurse burnout. According to the American Nurses Association, nearly two-thirds of nurses experience burnout. One significant factor contributing to nurse burnout is ongoing workplace stress.
Ongoing workplace stress can be influenced by the following components:
- Heavy workloads
- Low staffing levels
- Insufficient resources
- Lack of support from workforce management
- General stress from the emotional demands of nursing
But how serious are these issues really?
All these factors are leading to nurse turnover at an alarming frequency.
An early study from 2016 showed that 43 percent of newly licensed nurses who worked in hospitals left their jobs within three years. A more recent study from 2023 shows that the average turnover rate of all registered nurses (RNs) in U.S. hospitals stood at 18.4 percent.
Turnover rates surpassing 10 percent are considered bad, so this latest data indicates a concerning trend in nursing. Nursing shortages and high turnover rates directly affect not only the health and wellbeing of nurses but also the safety and care of patients.
Nurse burnout can significantly impact patient care, leading to medical errors, delayed treatments, and overall patient dissatisfaction. These issues also threaten to perpetuate the nursing crisis by causing nurses to call out more often or even resign from their jobs.
What recent legislation and other efforts are under way?
There have been some efforts within lawmaking to address the nursing shortages, with particular efforts to tackle severe nurse burnout.
In 2022, a bill known as the Lorna Breen Act was signed by former President Biden to combat nurse burnout and suicide. This bill was inspired by the untimely demise of an emergency physician who committed suicide early in the COVID-19 pandemic. The act allocated $100 million for hospitals and health systems looking to prioritize mental health among healthcare providers.
Facilities are also stepping up in their efforts to crush the nursing shortage by offering better work conditions, such as allowing nurses to choose their own schedules.
One example is using float or talent pools to provide additional support for internal staff nurses. Contracting per diem or PRN nurses is an excellent strategy to account for unexpected absences or increased patient demands.
Nursing shortage statistics and facts
Here are some facts that can help put the nursing shortage into perspective:
- Nursing shortages can be traced back to the time of Florence Nightingale in the 1850s.
- Recent reports predict that 1.2 million new registered nurses will be needed by 2030 to address the nurse shortage.
- According to research by the National Council of State Boards of Nursing (NCSBN), about 100,000 registered nurses left the nursing workforce during the COVID-19 pandemic due to stress, burnout, or retirement.
- 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.
- Numerous variables affect nursing shortages, such as educational, managerial, and policy-making factors.
- The median age of RNs is 46. More than a quarter of registered nurses say they intend to leave nursing or retire within the next five years.
- Those born between 1946 and 1964, known as baby boomers, make up the majority of the nation's population over 65. The percentage of the population over 65 is higher than it has ever been. This generation increasingly requires medical services for age-related conditions, and this high demand for medical services is one of the main drivers of the nursing shortage in the United States.
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 principal 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 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 and high patient census levels. Nursing shortages can also cause inadequate access to healthcare services, further exacerbating healthcare disparities in rural hospitals.
Over time, low staff retention and compromised patient 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
Solutions and 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 involve getting to the root of the problem—a lack of nurses. One short-term strategy is to contract temporary workers, such as per diem nurses.
Contracting qualified per diem nurses can promote staffing efficiency by distributing the workload fairly among nurses. This type of approach uses contingent staffing to fill gaps in coverage, which mitigates nurse burnout and ensures safe nurse-to-patient ratios.
The following are other short-term strategies for effectively addressing a nursing shortage:
- Flexible scheduling: Flexible scheduling can enable nurses to select 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.
- Incentive programs: Offering incentive programs can improve nurse retention by rewarding nurses dedication. Incentives include employee recognition and rewards, employee wellness programs, and tuition reimbursement.
Although these efforts can effectively address immediate staffing needs, they also are important long-term strategies.
Long-term strategies
One of the goals of long-term strategies is to ensure short-term initiatives are sustainable and effective. Additionally, below are some examples of long-term strategies that facilities can implement to reinforce nurse retention:
- 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.
- 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: Offering counseling services, stress management resources, and mentorship programs for nurses is an excellent long-term solution for combating nursing shortages. 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?
“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
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.
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.
The bottom line
The first thing that facilities can do to recruit and retain nurses is enhance their work conditions and start taking care of their nursing workforce. From there, anything is possible.
Want to learn more? Find out how Nursa helps healthcare facilities and professionals address the nursing crisis with its healthcare staffing platform.
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