Majority of senior health system execs say nursing shortage is critical, poll finds. What are they doing to address it?

Yet another survey of health system higher-ups shows workforce challenges are front of mind, though most executives reported their organizations haven’t adopted key nursing asks such as flexible scheduling or staffing ratios to draw in more talent.

Specifically, 94 out of 100 senior health system executives polled by healthcare career marketplace Incredible Health in May described their nursing shortage as “critical,” and just over two-thirds said they don’t have adequate nursing staff to handle a large-scale health crisis.

Ninety-three of the respondents said their system leaned on travel nurses to meet demand. Most executives reported that these workers make up a quarter of their entire nursing staff, and more than 40% said more than a quarter of their on-staff nursing workforce had less than a year of tenure at the organization.

Nearly all of the executives said they had plans in place prioritizing permanent nursing staff over temporary workers. Still, how far the organizations are going to secure those permanent hires might not please nurses.

Sign-on bonuses were first and foremost among the ongoing recruitment methods cited by the executives (35%), followed by higher nursing salaries (26%) and improved patient-to-staff ratios, according to the survey.

Here, Incredible Health cited a prior survey of 3,000 nurses who use its platform, only a third of whom said they felt fairly compensated in their roles. Patient-to-staff ratios, meanwhile, have been a frequent and contentious bargaining point between nursing unions, healthcare employers and policymakers.

Another potential misalignment between health system employers and the younger nursing cohort is on flexible staffing. Four in 5 of the responding executives said they’d heard requests for more flexible scheduling from younger nurses, yet only 11% of the respondents said their organization had it on offer.

“Few hospitals are looking to flexibility as a hiring differentiator, and are focusing more on compensation,” Incredible Health CEO and co-founder Iman Abuzeid, M.D., wrote in the company’s report. “On a similar note, despite a quarter of nurses pointing to limited career advancement training and opportunities as a reason they would leave nursing before retirement, many health systems are not prioritizing these programs and opportunities as a hiring and retention method.”

Speaking broadly, executives said they more frequently see these types of demands from the nursing workforce’s younger cohort.

They said that 78% of younger nurses request increases as opposed to 48% of older nurses and that younger nurses more often are seeking specialized roles (54% versus 14%) and career advancement opportunities (74% versus 8%). All the while, executives more often reported “a reduction in loyalty and tenure” among younger nurses (79%) compared to older nurses (21%), according to the report.

The pool of nurses available for systems to hire appears to have constricted during the pandemic, according to industry surveys and other data. Nearly 100,000 registered nurses were estimated to have left the field during the COVID-19 pandemic and almost 800,000 intend to follow them out by 2027, the National Council of State Boards of Nursing said in April.

Higher workforce expenses have also been an oft-cited pressure on hospital and health system finances during the past couple of years. Hospital labor costs increased 20.8% from 2019 through 2022 on the back of a 258% spike in contract labor expenses, according to the American Hospital Association. The responses to Incredible Health’s survey also echo an annual poll from the American College of Healthcare Executives that ranked workforce hurdles as the top headache for community hospital CEOs for two years running.