In our previous blog, we began discussing some of the factors that have led to the critical and worldwide shortage in the nursing profession. This blog is a follow-up to that and explains several other important reasons why there weren’t enough nurses PRIOR to COVID. In the upcoming blogs, we will explore some of the methods that various entities utilized to try to assist and augment the shortage when COVID began.

As the need for healthcare has risen, nurses are being asked to take care of more patients at one time and these patients are “sicker” thus, requiring more time to care for them and more nursing tasks to complete. Requirements for required, appropriate, safe and legal documentation has also increased leaving nurses with less time to have direct patient contact. The increased and inequitable workload has led to a large decrease in the of worker satisfaction. That coupled with the increased level of violence against nurses and the growing level of burnout is causing many, including new graduates, to change positions or leave the profession entirely.

Turnover in nursing seemed to be leveling off prior to COVID but is increasing faster than ever before. As of 2021, the national average for turnover rates is 8.8 % to 37.0%, depending on geographic location and nursing specialty. Units of higher acuity have up to 6% more turnover than regular medical-surgical or lower acuity and specialty areas. Unfortunately, as the healthcare needs continue to rise (especially with COVID), we need even more nurses in these intermediate, step-down and critical care area. Nursing has one of the highest turnover rates of any profession. This turnover leads to financial concerns for facilities. In the US, for every 1% of nursing turnover, it costs healthcare facilities upwards of 306K per year due to costs of recruiting, hiring and training.

Continued turnover only contributes to the global nursing shortage. Increases in turnover means that the remaining nurses are more stressed, overworked and dissatisfied which leads to more turnover. It is a vicious cycle that we need to stop. Nursing shortages affect the level of care nurses are able to give. It leads to errors and increased morbidity and mortality rates. In hospitals with high patient-to-nurse ratios, nurses experience burnout and dissatisfaction, and the patients experienced higher mortality and failure-to-rescue rates than facilities with lower patient-to-nurse ratios. Despite this knowledge, when staffing is short, ratios go up to meet the need.

Another factor in the nursing shortage problem is that nursing is still a profession that is majority female. As many of them are practicing during childbearing years, nurses will cut back or leave the profession altogether after they have children. Some may eventually return, but others may only return part-time or to a new job or profession.

The pandemic has only exposed these underlying issues and has created new ones such as recruitment; educational preparation, upskilling of incumbent workers, retention and well-being of current nurses, and understanding of the migration of the nursing workforce and pipeline. The effects of the COVID-19 pandemic on the nursing workforce were felt dramatically and will continue to affect nursing and thus, all aspects of healthcare for the foreseeable future. Increasing efforts to recruit a diverse group of potential nursing students, institute a coordinated workforce data collection system, and modernize state statutes, regulations, and rules related to nursing education, licensure, and scope of practice need to be initiated to respond to this pandemic and future disasters. Future work should all focus on tracking, trending, funding, and creating innovative interventions to support the nursing workforce pipeline both during the pandemic and in the recovery phase. Finally, much work needs to be done to pass legislation for limit the patient to nurse ratios as well.

In our next blog we will explore methods that different entities used to try to help nurses and combat the extreme shortage once COVID hit.