In the first three blogs of the Covid-19 series, we discussed COVID as a disease as well as the specific and long-lasting effects it has had on children, their healthcare, safety, and education.  The next few blogs will focus on how healthcare has changed during the pandemic and specifically, how COVID is affecting nurses and the profession of nursing in general.

Before we can talk about the changes COVID has led to we need to discuss nursing as a profession.  Nurses are a critical part of healthcare and make up the largest section of the workers in the health professions.  Many outside of healthcare may not be aware that there was a nursing shortage WAY before the world was struck by this virus.  According to the World Health Statistics Report, in 2018 there were approximately 29 million nurses globally, with 3.9 million of those individuals in the United States.  At that time, The American Nurses Association (ANA) stated that more registered nurse jobs will be available through 2022 than any other profession in the United States and The US Bureau of Labor Statistics projected that 11 million additional nurses were needed to avoid a further shortage. And that was PRIOR to COVID.  The demand has only increased while the actual workforce is continuing to decrease.  So, why was there such a shortage in one of the world’s most respected professions?

The causes are numerous and issues of immense concern.  The largest one is that the world’s population is aging, with the baby boom generation entering the age of increased need for health services. Currently, the United States has the highest number of Americans over the age of 65 than any other time in history. In 2011, there were 41 million Americans over the age of 65.  In 2029, the last of the baby boomer generation will reach retirement age increasing that number to approximately 78 million.  By 2035, more than one in five people in the US will be aged 65 and older, and members of this group will head one in three households.  In addition, by 2035 the number of people aged 80 and over will reach 24.2 million.  This means for the first time in history, the US will have more 65-and-older residents than children.

As the population ages, the need for health services increases. The reality is that older persons do not typically have just one morbidity that they are dealing with, but more often have multiple diagnoses and conditions that require them to seek treatment. As technology and treatments increase, the population as a whole is also surviving longer causing an increased use of health services as well. Many disease processes that were once terminal are now survivable for the long-term. Treating these long-term conditions outs an additional strain on the healthcare workforce. 

Like the populations they serve, the nursing workforce is also aging. There are currently more than one million registered nurses older than 50 years, meaning one-third of the workforce could be at retirement age in the next 10 to 15 years. This number includes nurse faculty, and that presents its own unique problem, training more nurses with fewer resources. A decrease in nursing faculty leads to enrollment limitations, limiting the number of nurses that a nursing school can generate. Decreased and limited faculty can also decrease the overall quality of the nursing program leading to a decline in class, graduates and those who pass the NCLEX exam to begin work as a nurse.  

Also related to nursing programs is the concern regarding students having adequate “hands on” experience or clinical hours.  These hours of experience are critical to the development of a competent nurse.  In addition to the decrease in the numbers of faculty and students, clinical placements have long been difficult to obtain.  For the nurses/nurse practitioners involved, precepting students (both nurse and nurse practitioner) takes more time and responsibility at a time when they are already stretched too thin with more workload and stress than ever before leading to far less nurses being willing to take nursing students.  Unfortunately, there are some nursing students that have graduated in the last year who were not able to have any in person clinical hours and with the recent variant, this may likely continue. How does one develop the ability to communicate with patients, learn better assessment skills and more with virtual and or solely skills lab rotations? 

These are just a couple reasons for the nursing shortage that began YEARS ago and prior to COVID.  Our next blog will discuss a few more critical issues that have led to the global shortage.  

Sources

Nurse Burnout: Risks, Causes, and Precautions for Nurses

Nursing Shortage Factsheet

Nurse Retirement Wave Hits

The nursing faculty shortage: Is there hope?

Nurse Faculty Shortage Fact Sheet

Burnout in nursing: a theoretical review