Preventing the Looming Public Health Crisis - Nursing Shortage

Aetienne, BSN, MSN

Every nurse has personal reasons for leaving direct patient care or the nursing profession. However, a single problem for the nursing shortage cannot be identified, addressed, and resolved. The growing nursing shortage will result in a public health crisis without action. Major contributing factors require attention to avoid this crisis, with all parties affected proactively addressing the most evident causes.

A Public Health Crisis

Without action, the shortage of nurses will become a public health issue prompting the federal government to address the problem. Some worrisome statistics illustrate the severity of the nursing shortage. The median age of registered nurses is 52 years (NCSBN, n.d.). Nurses under 30 make up 14.8% of the nursing workforce (Minority Nurse, 2022) compared to 25.1% in 1980 (Ross, 2002). A lack of registered nurses will correlate with poor patient outcomes. High nurse-to-patient ratios and adverse patient outcomes such as higher morbidity and mortality rates will occur (Haddad, Annamaraju & Toney-Butler, 2022). Patient satisfaction will be lower, which affects reimbursement rates. Decreased funding for the organization trickles down to nurse staffing and salaries. Reduced staffing and compensation result in decreased nursing job satisfaction; this exacerbates the nursing shortage. Addressing this cycle will take a multifocal approach.

CONTRIBUTING FACTORS to NURSING SHORTAGE

Around 500,000 registered nurses will retire in the coming years, increasing the need for more than 1 million registered nurses to avoid the nursing shortage. The pandemic did not help an already fragile nurse staffing situation, causing some to retire early or leave nursing altogether (Martinovich, 2022). In addition, an aging workforce, nursing burnout, and decreased nursing faculty also contribute to the nursing shortage. The baby boomer population is aging, increasing the demand for nurses while the supply is insufficient to meet the need (Haddad, Ammanaraju & Toney-Butler, 2022). These are only a few factors that contribute to the nursing shortage. One will never know all the issues that create this situation since each nurse’s personal experiences, and reactions can be related to various causes. Seeing as the nation’s health will be negatively affected by this public health crisis, the nursing shortage, it seems evident that the country collectively develops solutions from that perspective. Solutions need to be created on a grand scale and commensurate with the impending public health crisis.

Shortages of physicians are impacting the nursing shortage. The decrease in primary care providers increases opportunities for advanced practice nurses (APRNs). APRNs are being integrated into the network of providers to help address the shortage (Spring Arbor University, 2019). It is an excellent opportunity for nurses to have autonomy and advance in their careers. However, the decision of some nurses to get the minimal bedside experience needed and then move on to graduate education and advanced nursing practice has negatively impacted the number of bedside nurses. Some students plan to briefly work at the bedside and move on with their career plans, leaving the need for a sustained supply of hands-on nurses unfulfilled. Many do not see bedside nursing as a destination but as a stop on the journey to fulfill their career goals (Kennedy, 2018).

Nurses have options to practice that extend beyond the bedside. Many nurses are becoming entrepreneurs. Others are working in administrative roles in nursing. Some have lost the desire to practice nursing due to their experiences before and during the pandemic. Compassion fatigue and burnout related to staffing ratios and workload were present pre-pandemic. The pandemic exacerbated those negative feelings about nursing and resulted in many leaving the field of nursing or pursuing administrative nursing roles. In addition, the hectic pace of caring for acutely ill patients and the uncertainty of individual and family safety also caused some nurses to stop working or leave their practice.

SOLUTIONS

Multiple factors contribute to the nursing shortage in addition to those stated. It is not realistic to pinpoint a blanket resolution to all the causes. A multifaceted approach is required to stop the looming public health crisis due to the nursing shortage.

Creative Nurse Recruitment Strategies

Creative nurse recruitment strategies can address the aging nurse population, nurses leaving the profession, and the low percentage of nurses under 30. Increasing diversity in the nursing workforce has been a goal of the American Association of Colleges of Nursing (AACN). The organization has researched the levels of diversity in nursing to include racial/ethnic backgrounds and the percentage of men practicing nursing. In addressing the nursing shortage, the AACN focuses on recruiting students from underrepresented minority populations. Diversity, Equity and Inclusion Group (DEIG) creation, Nursing Workforce Diversity grants, and the New Careers in Nursing (NCIN) Scholarship program were a few of the strategies implemented to address the nursing shortage (American Association of Colleges of Nursing, 2019). Increased efforts to recruit this population into nursing can positively impact the number of nurses working.

Positive Public Perception of Nursing

Protecting society’s perception of nursing can encourage people to choose nursing careers and address the shortage related to retirement, people leaving nursing, and nurses pursuing careers in advanced practice and administrative roles. An individual's personal experience with nurses can positively or negatively affect their decision to choose a career in nursing. If a person has a negative experience in a hospital or clinic with a nurse, they may feel this is not a career field for them. For example, if a person finds their loved one was not treated well by their nurse, they may negatively view nursing. In contrast, a positive experience may motivate someone to become a nurse. Some prospective nursing students choose the nursing field after observing other nurses' work (Wu et al., 2015). Personal healthcare experiences can work both ways; experiences perceived as negative can prompt someone to enter the nursing field and practice in contrast to what they experienced.

Early Recruitment

Increasing the pool of registered nurses under 30 requires recruitment to start as early as possible. Reaching high school students early and exposing them to nursing can prompt them to choose this field. An example of this early exposure to nursing is a program implemented at a Rhode Island charter school. Students can participate in a four-year program starting in the 9th grade. The students work as certified nursing assistants and get a first-hand look into what nursing entails while gaining experience. The program focuses on an underrepresented group in nursing with a diverse group of urban youth from low-income backgrounds. Scholarships for nursing programs and student loan forgiveness are available to the participants (Rhode Island Nurses Institute Middle College, 2019). Implementing programs such as this can expose youth to the career of nursing and encourage them to choose the field. Increasing the number of registered nurses below the age of 30 can help lessen the impact of nurses moving into advanced practice roles, quitting nursing, and retiring.

Better Recruitment of Men

Using research-based methods to recruit more men to the field is vital. The societal view of men entering the nursing workforce is seen as unfavorable by some. Society sees nursing as a female-dominated workforce (Wu et al., 2015). This view has to change; increasing the number of male nurses can prevent a worsening of the nursing shortage. Primarily using female images to portray nurses is an obstacle; it promotes the idea that nursing is a career choice for females. Working to change societal views of nursing as a career predominantly for females needs to happen. The use of media with the inclusion of men can promote nursing as an acceptable career option for all. Using more male nurse representation on posters, school websites, and commercials can encourage people to accept nursing as a good career choice for everyone. Male nursing students may seek a diverse faculty, including some male instructors, and the opportunity to have mentorship programs tailored to the challenges male nurses face. Opportunities to work with male nurses in a clinical setting is another challenge for some men entering nursing programs (Zamanzadeh et al., 2013). Increasing faculty is a challenge, and recruiting male instructors may be even more challenging. Educational institutions must increase their efforts to recruit males into the nursing program. Diversifying the workforce with male nurses can increase the pool of nurses qualified to educate future nursing students and address the needs of male nursing students.

Better Access to Nursing Programs

One reason people may not enter the field of nursing is the lack of access to nursing programs. Decreased availability of nursing programs can be due to monetary reasons or a lack of nursing instructors to support the demand. Nursing schools declined 80,407 qualified applicants in 2019 due to a lack of classroom space. In addition, nursing schools lacked 1,637 qualified educators (Morris, 2022). In addressing the lack of faculty available to educate future nurses, more action by the government and universities can entice nurses to become nursing instructors. Though money is not always a factor, being a nursing instructor can have limited income potential compared to practicing at the bedside or in other nursing roles where pay is competitive with the community (County Health Rankings & Roadmaps, 2017). If colleges and universities do not have the budget to improve nursing instructors' pay, federally funded student loan forgiveness can help supplement nursing instructors’ compensation. Student loan forgiveness is a desirable benefit to many nurses in place of higher income. Student loan forgiveness is already an option for some that meet the requirements. More nurses may practice as educators knowing this benefit is available through broadening the eligibility criteria to receive student loan forgiveness. By developing requirements to receive student loan forgiveness to include more practicing nurses, they may consider a career as nurse educators. By offering generous federally funded grants to universities and colleges to support the hiring and salaries of additional nursing instructors, the hurdle of faculty shortages can be addressed. More instructors enable more students to enter nursing programs. More students in nursing programs result in more nursing graduates. More graduates increase the number of nurses working. The nation needs nurses. The federal government's action can facilitate this solution; some nurses will welcome this benefit and become nurse educators.

Competitive Salaries

Everyone desires compensation for the work performed. The responsibility of nursing someone back to health is nothing to take lightly. The education and licensure required to provide the care are evidence of the importance nurses play in maintaining the public's health. Nurses' salaries comprise a large part of an organization's budget. Employers will have to adjust nursing salaries to be competitive when hiring and retaining nurses. It seems common sense that if a healthcare organization does not have enough nurses, patient care and the bottom line will be negatively impacted. Putting nursing salaries at the forefront of planning would be logical to attract and retain nurses with well-deserved compensation for the knowledge and skills required to provide nursing services. If nursing salaries are not improved now, it will be inevitable later when the nursing shortage peaks. Higher wages may also attract people to nursing. Studying why people do not choose nursing when entering the healthcare field revealed that some see nursing as a low-paying, low-status job, affecting this career choice (Wu et al., 2015). Making compensation comparable to the level of responsibility expected can be the deciding factor for people considering the healthcare field. It is likely that if one enters the nursing field for the money, they will reflect at some point and wonder if they made the right decision. When a person responds to the call to help others as a nurse, fair compensation in conjunction with their calling helps get through those days when they wonder if it is worth it.

Job Satisfaction Improvement

Nurses' job satisfaction is essential to retaining nurses. Retention of nurses in the field can positively impact the nursing shortage. Nurse satisfaction surveys should be administered and reviewed, and valid concerns addressed. Nurses can find a lack of leadership engagement as the "cherry on top" for leaving the profession. Nurses may feel they are not supported or appreciated after giving all they can to their patients and the organization. Though there are two sides to the story, with organization leaders trying to balance the administrative aspect of the role and the human element of being a manager, not enough consideration is given to the human resources that make the care happen. Organizations should take action to improve nurses’ job satisfaction ratings. Taking action to address nurses' concerns can prove beneficial to retention rates. Retaining nurses in the profession helps in managing the nursing shortage.

Inclusion of Nurses in Decision-Making

In addition to patient care needs, the impact an organization's decision has on nurses must be at the forefront. It is often said that changes are made without asking the staff that will be affected. Including front-line nursing representation in decisions that will affect patient care and nursing duties should be the standard. Nursing leadership should utilize emotional intelligence and know its importance in leading others. Getting buy-in from nursing staff is more effective in maintaining morale while achieving organizational goals. When nurses feel they have a voice, it benefits both leadership and nursing staff and positively impacts nursing retention rates.

Increased Support for Novice Nurses

Nurses newly recruited to the field should receive ample support to continue practicing. Bullying in nursing has existed for some time. Organizations have brought light to the issues, and some have provided training to staff to increase awareness of its impact. It is understood that seasoned nurses were once novice nurses and needed the help of others to develop their practice and become experts in their field. When do nurses who fine-tune their craft become nurses who do not have time to mold new nurses? Anyone that has been a preceptor knows that the challenge comes when nurses have to manage their patient load and be a preceptor for a new nurse. It could be that the workload and precepting are more than a nurse can reasonably manage. In these instances, communication between leadership and the nurses is critical. Nursing administration must acknowledge the workload placed on preceptors and ensure ample opportunity and time to train new nurses adequately. These considerations can impact a new nurse's decision to stay in nursing and the retention of nurses who train them by meeting the needs of both. Recruitment and retention are vital in preventing the nursing shortage.

CONCLUSION

Retired nurses, active nurses, and those that have chosen to leave the field must be vested in working towards resolutions to the looming public health crisis, the nursing shortage. They have first-hand knowledge of the importance of having adequate nursing staff. The rapidly approaching public health crisis will impact everyone, and healthcare consumers should also be concerned. Will there be enough nurses to provide bedside care in hospitals, nursing homes, and acute care clinics at any given time? Will putting the problem on the next person ensure safe, quality care for all when needed? Given the uncertainty with which most could answer these questions, efforts made on all levels (community, state, and federal governments) must ensure the quality and quantity of registered nurses available meet the communities needs. Increasing incentives and nursing education access, respecting the discipline in the workplace, fairly compensating nurses, and promoting inclusion of everyone in the nursing field are actions that must be taken to reverse the impending nursing shortage. Nursing and community leaders and elected officials must be proactive by acknowledging the impending health crisis. The time is now for planning and implementing solutions to change the course of care that will result from the nursing shortage. Being reactive is not an option.

References

American Association of Colleges of Nursing (2019, April 1). Enhancing diversity in the workforce.

County Health Rankings & Roadmaps (2017, November 14). Financial incentives for new nursing faculty.

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. ((2022, February 22). Nursing shortage. National Library of Medicine.

Kennedy, M. S. (2018). Nurses at the bedside-Who will be left to care? American Journal of Nursing, 118(2), 7.

Martinovich, M. (2022, January). The nursing shortage is a national problem. How we can solve it. Science of Caring.

Minority Nurse (2022). Nursing statistics.

Morris, G. (2022, April 27). Post-pandemic nursing shortage: What it means for aspiring nurses. Nurse Journal.

NCSBN (n.d.). National nursing workforce study.

Rhode Island Nurses Institute Middle College (2019, October 2). Starting nursing careers in high school.

Ross, J. (2002). A looming public health crisis: The nursing shortage of today. Journal of Perianesthesia Nursing

Spring Arbor University (2019, September 1). The nursing shortage and what you need to know.