Nursing shortage looms large and projected to intensify in next 18 months: report

A national nursing workforce report is advocating for dramatic action to better support the nation’s nurses amid the current staffing crisis during the global COVID-19 pandemic.

The new survey informs healthcare leaders on addressing the nursing shortage and improving retention, as 92% of respondents indicate that the nurse labor shortage will intensify in the coming 18 months.

More than 300 nurse leaders in the U.S. participated in the survey detailed in the report conducted in late 2021 by Wolters Kluwer in collaboration with UKG.

“The nursing shortage was really being amplified by the pandemic,” the report’s co-author Anne Dabrow Woods, chief nurse of Wolters Kluwer, Health, Learning, Research and Practice, told Fierce Healthcare.

“When you looked at the numbers, we knew that nurses were moving from one position to another, away from the bedside,” Woods said. In addition, she noted that nurses from the baby boomer generation were retiring.

The report notes that “for decades, industry experts have been sounding the alarm on a nursing shortage. But challenges have transformed into a full-blown crisis.”

It also highlights the fact that “the pandemic has brought a confluence of new realities and ongoing trends: there are simply not enough nurse graduates because of a combination of fewer clinical preceptors, limited classroom space, lack of clinical sites, and just not enough faculty.”

The report continues by noting “higher patient acuity, combined with fewer nurses at the bedside, has turned nurse-patient ratios upside down. And the reality is that not only nurses are leaving the bedside; unlicensed assistive personnel (UAP) have been leaving their hospital roles, too, thereby increasing the registered nurse (RN) workload. The question remains: What is the path forward?”

Burnout and stress from working throughout the COVID-19 pandemic are taking a major toll on nurses, with more than one-third (34%) of nurses saying it's very likely that they will leave their roles by the end of 2022, according to a recent survey by technology-based nursing hiring platform Incredible Health. About 4 in 10 cited burnout and a high-stress environment as the reason for their desire to leave. Nurses also cited benefits and pay as the second leading reason (27%) for quitting their jobs.

To correct course and ensure optimal care for patients, the report assesses current and future states of nursing labor models while shedding light on prospects for change across care settings. It also provides a snapshot of how nurse staffing and care delivery models have evolved to deal with the profound challenges stemming from COVID-19 and a worsening labor shortage.

“Current staffing and care models were not working during the pandemic,” Woods said. “There simply weren’t enough nurses or support personnel to care for the upsurge of patients that came into healthcare organizations.”

Survey results reveal disconnects between nurse leaders’ perception of short- and long-term challenges and their organizations’ current or planned strategies to respond to today’s nursing crisis. Potential levers for change include staffing levels, workforce flexibility and resiliency, and technology implementation to optimize productivity.

The report recommends that nurse leaders take a more active role in understanding the challenges on the front lines to guide future strategies. This approach can help change the current trajectory while enhancing workplace satisfaction and quality of care delivery.

For instance, most hospitals use “a primary RN model,” in which a registered nurse cares for multiple patients with the help of assistive personnel. But that model wasn’t working well when nurses had to oversee a high number of very sick patients during the pandemic, Woods told Fierce Healthcare. Nonetheless, she added, organizations were hesitant to switch over to a team model of care, where an experienced registered nurse is freed up from the burdens of patient care to more effectively supervise other personnel providing direct care to patients.

Other specific findings suggest that leaders encounter challenges with retention and recruitment, with 58% of respondents noting that they don’t expect to hire additional staff or create new roles due to financial constraints. Instead, they’re concentrating on retaining their current workforce.

However, Woods said, both recruitment and retention are “equally important” to put a dent in the nursing shortage.

Adoption of alternative care models is lagging. Although acute and ambulatory settings have been slow to welcome new models of care, success with float pools during the pandemic presents an opportunity for expansion. In the acute setting, 92% of respondents plan to implement or increase float pools in the next 18 months.

There is also a lack of flexibility for nurses. Respondents generally expect few changes in shift duration after the pandemic, even though burnout has been widely reported. The average shift remains 12 hours for nurses in acute and post-acute settings and eight hours in ambulatory settings.

For nurse leaders, “it’s just easier to fill your holes using 12 hours or eight hours,” Woods said, even though nurses preferred other scheduling options. Still, “organizations were not quite willing to make that shift because it made it more challenging on their end.”

Despite the foreseen nursing shortage, few experts could have imagined the unprecedented effects of COVID-19 on this workforce, Woods told Fierce Healthcare.

“The most important thing is to implement a safe work environment for the nurses,” she added. “How to do that is to make sure you have an adequate number of competent staff to care for the patients.”