Nurse Staffing: A Crisis of Epidemic Proportions

To address the current nursing shortage, we must first address the reason that so many nurses are leaving the profession. Is it stress from witnessing death on a daily basis as was the case during the height of the pandemic, or burnout from working too many shifts during COVID? Everyone seems to think that COVID was the culprit that brought the heroes to the end of the rope. We, as nurses, know better. Could it be the lack of respect and the absence of support that nurses have experienced for the last two decades? Or maybe it is the exhaustive list of demands that are constantly changing but daily expectations in an already chaotic environment? Could it be the realization that neither the nurses nor the patients are safe in the profit-driven, revenue-focused environment that is healthcare today? Or could it be the numerous rules, regulations, unnecessary mandates, and subsequent punitive actions when events happen that are many times, not even within our control? Or could it be the lack of resources and support staff that have eroded steadily over the years, leaving the RN with more responsibility while taking care of higher acuity patients?

These circumstances must be addressed by healthcare corporations, otherwise, they will continue to search in vain for adequate, competent staff, and the number of medical mistakes will continue to skyrocket causing patients to suffer more harm. If the previous concerns are not addressed, then nothing will ever change. The nursing profession will continue to erode and patients will continue to endure egregious and preventable medical errors. Our society as a whole will suffer.

Focusing on reforming the work environment will go a long way toward improving nurse staffing. Concentrating on exemplifying a just culture, not just discussing the benefits in administrative meetings, will go a long way towards boosting the morale of staff. Either healthcare corporations will begin to attentively listen to the needs of their workers or the workers will be forced to demand change. Collective bargaining is a phrase that brings fear into the heart of every CEO.

In a perfect world, leadership will address those concerns and the work environment will become harmonious and organized, and the nursing profession will flourish. Then we can get down to increasing numbers of nurses in the workforce, right?

First of all, nursing schools should receive extra funding to ensure an adequate number of instructors, supplies and resources to educate new nurses. Currently, there is a waiting list at many universities and people are being turned away. This doesn’t even make sense when America is in desperate need of nurses.

In addition, nurses need scholarships to offset the cost of education. Nurses are offered loan forgiveness when they agree to work in underserved areas, which is a great incentive for the nurse and the healthcare system that will reap the benefits, but there need to be cost incentives for all nursing students, with a particular focus on African, Asian, Hispanic, and Native Americans, as well as recruiting more men into the profession. Currently, the majority of the workforce is white female, but expanding the diversity of the workforce is imperative, especially in light of the increasing diversity of our patients. Furthermore, many times they are the ones who are most in need of quality healthcare.

The expectation at schools of nursing is a PhD-prepared instructor. I most certainly think we need PhD level teachers in the academic setting. I also think we need more Master’s prepared instructors primarily to help with clinical instruction. We need a lot of them. Having instructors in the hospitals with nursing students would free up the staff nurse who is acting as preceptor. The staff nurse should not be expected to teach students. She has enough responsibility. Student nurses would have more opportunities for hands-on learning in the clinical setting. Ultimately, more instructors mean more graduate nurses entering the workforce.

In addition, more flexibility in the workplace is a must. Nurses need more time off from work, and we need more part-time nurses to fill in the gaps. I personally believe that 8-hour and 12-hour shifts should be offered, but I do understand the potential staffing nightmare that could ensue if everyone is working different hours. Nonetheless, I think there may be semi-retired nurses or nurses who need less work time because of families, who might be amenable to 8-hour shifts. Another necessity is true PRN staff, not just PRN staff that is expected to work 40 hours per week and float. Nurses who want to work occasionally should be available for sickness or vacation or times of high volume. That would help with the workload and the corporation would not have to provide costly benefits. Some nurses might like to have specific extended blocks of time out of work to be with school-age children or care for aging parents. This should be possible. COVID has demonstrated to all of us the importance of work-life balance. To allow nurses to take extended periods of time off, traditional agency nurses could be utilized or large hospital corporations could employ their own group of agency nurses to work all the different facilities within the system. They would have a workforce that is employed by the corporation and not an outside agency, but it would provide flexible staffing throughout the entire system.

Correcting the multitude of problems that have contributed to the staffing situation of today will never be easy or quick. Ultimately, every hospital and every healthcare conglomerate will need to address the concerns of nurses in a transparent, forthright, and open manner that will bring some resolution. Otherwise, the safety, quality, and cultural foundation of our entire healthcare system are in peril.

References

U.S. Nurses in 2020: Who We Are and Where We Work

What do nurses want?

Why Is There a Nursing Shortage?