The United States needs more nurses.
Even before the COVID-19 pandemic hit, there was a national shortage of registered nurses. The coronavirus exacerbated the crisis by triggering widespread burnout in the healthcare field, among other issues. Now, the country is in a situation where it needs to somehow bring hundreds of thousands of new people to the nursing profession in a few short years. Can this crisis be solved? And if so, what are the keys to a brighter future? In this white paper, we will explore the nursing shortage, what led to the current crisis, and how the healthcare industry can implement the kinds of sweeping changes that might help bridge the gap.
According to the American Nurses Association (ANA), the U.S. has about 4.3 million registered nurses. The Bureau of Labor Statistics (BLS) has projected some 194,500 average annual openings in the profession between 2020 and 2030. That number factors in an overall growth in the number of nurses that the nation needs and retirements and other departures from the industry. Overall, BLS predicts that the U.S. will need about nine percent more nurses in 2030 than it had in 2020.
Some states expect to have bigger problems with nursing shortfalls than others. For instance, the Health Resources and Services Administration is projecting that California will have a "supply" of 343,400 registered nurses in 2030, compared to a "demand" of 387,900 – a shortfall of 44,500 RNs. Georgia, meanwhile, is only projected to be about 2,200 nurses short by 2030. Other states project to outstrip the number of nurses they need: North Dakota is expected to have 9,900 registered nurses compared to an actual need of 9,200. Despite the variation in numbers, though, the prediction is that the country as a whole will have a considerable net deficit between the amount of nursing support it needs and the amount of nursing support it will actually have.
The need for new nurses is such that, several years ago, the ANA predicted that there would be more registered nurse jobs available in 2022 than in any other profession. Said another way, while a labor shortage affects virtually every sector in the American job market, the nursing supply is uniquely strained.
While COVID-19 and worries about overburdened healthcare systems have made the conversation about a nursing shortage quite a bit louder, though, that doesn't mean the shortage is new. On the contrary, healthcare experts have been talking about a nursing shortage for years, long before anyone knew a pandemic was on the horizon.
There are a few reasons that a nursing shortage has been brewing in the U.S. for quite some time. Some of them are simply related to changing national healthcare needs. For instance, the aging of the Baby Boomer population is creating a level of need for healthcare services that is unprecedented in the history of this country. The youngest boomers were born in 1964, meaning every person in that generational demographic – some 71.6 million people, per U.S. Census data – will be 60 or older by the end of 2024. That aging trend will demand more healthcare resources, including more registered nurses.
While an aging population was always going to pose an unavoidable hurdle for the national healthcare system, other vulnerabilities in the sector also pre-date the pandemic and could have been avoided with better foresight. Specifically, some healthcare experts say poor working conditions triggered the registered nurse shortage.
"Before the COVID-19 pandemic, informalization of nurses' employment and working conditions were unfair and harmed their health," posit the writers of a scholarly article published in the journal Human Resources for Health. The article outlines issues ranging from gender pay gaps to lack of written contracts that affected nurses' job security, economic status, and overall physical and mental health – not just in the U.S. but around the world.
During the COVID-19 pandemic, the abovementioned problems only spiraled and grew, pushing some nurses to a breaking point. Those post-COVID conditions may explain the exodus of many nursing professionals from the profession and the healthcare field as a whole. Here are some of the conditions that have become especially problematic in healthcare environments since the start of the pandemic.
Pay disparity in nursing is nothing new, but it is arguably still one of the top factors that account for why nurses are leaving the profession. The aforementioned Human Resources for Health article notes that, while 89 percent of all nurses worldwide are women, female nurses are also statistically underpaid compared to their male counterparts. In the U.S., for instance, the average female nurse earns only 91 percent of what the average male nurse does. Moreover, according to Healthcare Dive, the gender pay gap for registered nurses actually widened during the pandemic. In 2020, male RNs were only earning $7,297 more per year, on average, than their female counterparts. In 2021, the pay gap had increased to $14,000.
A more general pay disparity underlined this gender pay gap during the pandemic: The discrepancy between what nurses were asked to do and what they were paid. Nurses were on the front lines of the pandemic from day one and were repeatedly touted as "heroes" in the early days of the COVID-19 pandemic. Their work involved interfacing with and caring for patients directly, every bit as much as what physicians were doing. The difference is that, per BLS, registered nurses in the U.S. have a median pay of $77,600 per year. Comparatively, physicians earn a median wage of $208,000 annually.
"Worn-out nurses hit the road for better pay", reads an NPR headline from October 2021. The story talks about how nurses, tired of being undervalued, are taking the nursing shortage as an opportunity to sell their skills to the highest bidder. That trend has manifested in the trend of "travel nurses," or nurses who are paid a premium to travel to (and work temporarily at) hospital systems facing severe staff shortages and/or COVID surges. Per the NPR article, some traveling ICU nurses can make as much as $10,000 per week.
Health and Safety Concerns
In April 2022, experts at the University of Michigan shared a unique stance on the current situation with nursing: "There's no nursing shortage—there's a shortage of safe, supportive working environments." In an article published by the New England Journal of Medicine, two U of M nursing faculty members – Deena Kelly Costa and Christopher Friese – argued that hospitals are largely to blame for their own nursing shortages for failing to provide safe working conditions. Specifically, Costa and Friese identified several common pandemic-era working conditions – shortages of PPE, "wildly unsafe workloads," and combative COVID patients – that make the nursing job harder, more dangerous, and more physically and mentally damaging than it needs to be.
One commonly cited statistic says that approximately one in five healthcare workers has quit their jobs during the pandemic. The number could ultimately prove to be even higher in the case of registered nurses. Per a McKinsey study from February 2022, 32 percent of RNs surveyed in the fall of 2021 "said they may leave their current direct-patient care role." The last time McKinsey conducted the same survey, some 10 months earlier, only 22 percent of RNs were thinking about leaving their jobs.
That large-scale exodus of healthcare workers, combined with the waxing and waning cycle of COVID and its surges, creates situations where hospitals don't have enough staff to provide full services. A January 2022 report from Becker's Hospital Review indicated that "just over 19 percent" of all hospitals in the U.S. are experiencing "critical staffing shortages." That means that more than a thousand of the nation's 6,000-plus hospitals are currently understaffed.
Shortages impact patients by delaying critical services, increasing wait times, and just generally reducing access to quality care. They also increase the risk of overburdened staff, leading to a higher risk of burnout. In turn, more burned-out healthcare workers are leaving the industry, thus creating a vicious cycle of problems for the overall medical system in the U.S. Furthermore, staff with higher workloads are more likely to make mistakes that lead to negative patient outcomes.
Over Capacity Hospitals
As COVID-19 has continued to linger, the question of hospital capacity has become an ever-present worry for many Americans. While hospital utilization has varied quite a bit throughout the pandemic – and with it, the number of hospitals at or approaching capacity. During surges, many hospitals have found themselves with strained capacities. Those capacity strains put more of a burden on hospital staff that are oftentimes already overburdened, thus exacerbating threats of burnout and malpractice.
Some of the factors that have led to the nursing staffing shortage are unavoidable. The aging of the boomer population was always going to create an unprecedented public health reckoning in the U.S. The COVID-19 pandemic, meanwhile, has shaken up every facet of modern life, with impacts that reach far beyond healthcare. Nursing is not even the only profession facing a massive labor shortage. On the contrary, by changing the way Americans work – and causing many people to reassess what they value in life – COVID-19 has created a job seeker's market unlike ever before.
Still, as the pandemic stretches on and as other health worries appear on the horizon, there is no question that the healthcare industry needs to find a way to solve its nursing shortage. Fortunately, there are strategies that hospitals across the country could start implementing immediately to change the narrative.
The pandemic has shined a very bright light on the dangers that nurses face every day. It's forced nurses to work in risky conditions, for long hours, with huge levels of stress, and facing heartbreaking tragedy at every turn. It also puts nurses at odds with certain patients and families whose views on COVID-19 conflict with the medical consensus. These factors have understandably created a situation where many nurses question whether they want to stay in the nursing profession long term.
As we have seen with travel nurses, though, people are willing to do this work for the right price. The situation hospitals are in, while complicated, is ultimately just an equation of supply and demand. When demand for something is high, but the supply is low, it is a simple fact of economic law that prices will go up. Right now, the demand for qualified registered nurses is extremely high, and the supply is relatively small. As such, hospitals need to look for ways to increase nursing wages to attract and retain talent and compensate nurses for the demanding work they do.
While healthcare organizations are looking at nursing wages, they should take some time to assess whether they have a clear gender pay gap among nursing staff. Since women make up a statistically disproportionate share of the nurses in the U.S., the industry cannot afford to alienate that demographic. Finding ways to shrink or eliminate the pay gap and pay women what they deserve is a crucial step toward avoiding a nursing crisis in the future.
H3: Improved Onboarding, Training for New Nurses
The "informalization" of nursing has created various problems in the profession, not the least of which is the way hospitals approach onboarding their new nurses. Having a strong system in place for training new hires on the policies and protocols of a healthcare environment is crucial to ensuring their future success. Even qualified nurses can falter if they don't know how their workplace operates, and the fact is that not all hospitals operate the same way. Designing a detailed and easily replicable onboarding plan will give new nurses the tools they need to succeed.
Make sure that detailed background checks, license checks, and reference checks are also a part of the hiring and onboarding process. One risk that hospitals cannot afford to take is cutting corners in their hiring because they are desperate for new nurses. A thorough vetting process can identify a long list of potential red flags, from a revoked license to a history of stealing drugs from the hospital storeroom. In healthcare, good background checks can save lives, prevent costly medical malpractice cases, and avoid huge public relations fiascos.
H3: More Competitive Benefits Plans
Higher pay is perhaps the top incentive hospitals can offer to make themselves competitive in recruiting new nurses, but it isn't the whole picture. On the contrary, the benefits package is just as important as the salary for many job seekers. Providing plenty of PTO, for instance, is essential for any nursing job. Especially in recent years, nursing has been an incredibly stressful and exhausting career. Making sure their new jobs provide plenty of time off to relax, have fun, and decompress will likely be a top priority for most nurses for the foreseeable future.
Other benefits are important, too. Nurses are risking their own health to care for COVID patients, which means they need and deserve need top-tier health insurance coverage. As for retirement benefits, RNs, on average, retire at the age of 58, earlier than most professions. The earlier retirements are often due to the work's physically and mentally demanding nature. Good benefits to make a pathway toward early retirement feasible are understandably attractive to most registered nurses.
H3: Better Retention Practices
Looking beyond the traditional benefits package is one of the smartest things that hospital organizations can do to keep the nursing talent they do have. Look for ways to create clear paths for advancement internally so that nurses interested in senior or management roles have a roadmap for how to get there. Support continuing education to help your nurses grow and make sure they bring the most value to your organization that they can. Offer tuition reimbursement to help nurses pay for their degrees or pay off their college loans. Create an Employee Assistance Program (EAP) to give your nurses access to the mental health support that many RNs need during COVID. Provide childcare options to make sure your workplace caters to young families. Most of all, foster an environment that supports nurses wherever possible.
H3: Responsible Health and Safety Practices
Think back to what the U of M nurses said about how the nursing shortage was mostly a mirage and that the actual problem was the lack of hospitals offering safe working conditions. Hospitals need to do anything they can to make sure this sobering judgment does not apply to their workspace. That might mean making sure there is plenty of PPE on hand, or it might mean implementing patient-to-nurse ratios and making sure nurses are only working overtime in rare, exceptional circumstances. Remember: the best way to keep the nurses you have is to keep them happy, and that commitment starts with keeping them safe and healthy.
The nursing shortage is not going to disappear overnight. Finding a way to bridge the gap between how many nurses this country has and how many it needs will require years of hard work and buy-in from countless different players. Ultimately, though, the work starts with the individual hospitals. By providing a safe, supportive, positive place for nurses to work, healthcare organizations can slow the exodus of qualified nurses. That work could prove challenging, too, and may involve a wholesale shift in how we think about and value nurses as part of the healthcare system. However, the work can be done, and with the strategies outlined in this white paper, it can start right now.
Between the COVID-19 pandemic, an aging boomer population, and an across-the-board labor shortage, the country is currently facing an unprecedented shortfall in registered nurses. With many healthcare professionals exiting the industry entirely, the problem only worsens as the pandemic drags on. It's clear that hospitals need to find a way to turn the tide and start retaining and attracting nurses like never before. But how can they do it?
In the latest white paper for backgroundchecks.com, we look at the roots of the nursing shortage, the perfect storm of factors that are making the situation such a national crisis, and the strategies hospitals can start implementing right now to change the narrative. Download your copy on backgroundchecks.com today!