Overcoming The Nursing Shortage
Nurses are a critical part of the American healthcare system, and they make up the largest set of professionals in the entire medical field. There are around four million nurses in the United States today, according to an annual World Health Statistics Report, but according to the US Bureau of Labor Statistics, our country needs more than 11 million additional nurses to avoid further shortages through 2026.
These numbers are staggering, but when you deconstruct the nursing shortage crisis, you can understand why it is occurring and some of the steps you can take to overcome gaps on your staff. The profession faces high turnover, inequitable work disturbing, excessive burnout (made worse by a global pandemic in 2020), a rush of nurses reaching retirement age, pay inequities, a generation of retiring nurse educators, and more. So, what can your facility overcome the healthcare worker shortage? It starts with understating the job market landscape.
2020 Turned Nursing Staff Gaps Into Staffing Chasms
It should come as no surprise that existing nursing staff gaps became chasms for many healthcare facilities in 2020. As COVID-19 stampeded across the country in surges and waves, hospitals, rehabilitation centers, long-term care facilities, testing facilities and clinics were in dire need of staff to meet patient demand and combat staff overwhelm. Those facilities turned to travel nurses to cover healthcare staffing shortages.
Throughout 2020, nurses were working longer shifts, extra shifts, and were allowed little time off, yet healthcare facilities still found themselves short-staffed. These facilities relied heavily on travel nurses with 13-week contracts and per-diem nurses who take daily shifts to fill in staff shortages. Some hospitals and care facilities even relied on the military to fill critical nursing and healthcare worker staffing gaps.
And in some places, even those measures were not nearly enough to cover staff shortages. In previous years, there had always been enough reserve nursing staff to cover short-term and geographically isolated issues like flu outbreaks, national disasters, strikes, etc. But a once-in-a-century global pandemic exposed the cracks in this system.
What was previously a just-in-time and cost-conscious solution to chronic nursing staff shortages has not been enough to cover exponential demand in multiple states at the same time. Hospitals are now attempting to attract travel and temporary nurses by offering as much as double the wages they pay their full-time staff, which is not a sustainable solution and threatens the morale of existing staff nurses.
According to the US Bureau of Labor Statistics, there were only 47,000 registered nurses and 17,000 licensed practical nurses working temporary jobs in 2019, not nearly enough to cover national demand fueled by the pandemic. In states where union contracts mandate specific staff-to-patient ratios, 2020 was an extremely challenging year.
Nursing Shortages In A Post-Pandemic World
Caring for patients during the pandemic has led to extreme burnout among front-line nurses, and many nurses quit their jobs for pandemic-related reasons. Some left due to stress, some due to their own COVID-19 infection, others were forced to leave work to care for children at home whose schools were shut down, and some nurses took the opportunity to retire in 2020 rather than deal with the stress and potential danger of working during a pandemic.
While some of these nurses will eventually return to the full-time clinical workforce post-pandemic, many will not, which will further exacerbate nurse staffing shortages. Some nurses will trade acute-care hospital work for private practice or specialties that they feel are safer, some will change careers entirely, and some may choose to stay out of the workforce to raise their families.
However, the pandemic also attracted many travel and per-diem nurses, and many of those professionals will continue to work on short-term contracts post-pandemic. Many travel nurses have been seen on the news saying that they chose travel nursing and per-diem during the pandemic to do the most good and to earn more than they could as a staff nurse.
These travel nurses have found that hospitals and other staff welcome them with open arms when they arrive at a new location to help cover shortages, and despite job-related stress, they look forward to the time off they can take between assignments to re-charge their batteries. Many nurses who tackled contract work for the first time will likely remain part of the nursing reserve staff for at least several years.
Combatting The Ongoing Healthcare Worker Shortage In Rural Communities
Rural communities have always been hit hardest by healthcare worker shortages. Large cities with vast hospital systems and university-run facilities have some issues retaining nurses and other clinical professionals, but those systems typically have a full pipeline of new talent to step in.
However, in small communities, especially rural communities and even smaller “frontier” communities, healthcare systems have an uphill battle when it comes to attracting and maintaining healthcare staff. And that battle has a serious impact on communities. According to a 2019 investigation by NPR, nursing and healthcare workers shortages have led to both the shutdown of rural hospitals and decreased life expectancy among residents in rural areas.
In that investigation, NPR looked at rural hospitals that have put recruiting on the forefront and successfully eliminated healthcare staffing shortages. Some of the strategies these hospitals have used include:
- Promoting the benefits of living in that specific community: Lower cost-of-living, lower taxes, greater access to outdoor activities, a slower pace for raising a family.
- Incentives: Bonuses, relocation assistance, and even assistance with new home renovations are some of the ways rural hospitals are sweetening the pot.
- Mission-focused recruiting: Showcasing the fact that healthcare workers at all levels can have a major, positive impact on the community.
- Paid sabbaticals: Allowing staff up to ten weeks of paid leave to work abroad or in other underserved communities.
- Leveraging travel and per-diem staff: Rural hospitals are building in budget dollars to continually rotate in contract-based staff to help close nursing shortages.
Not every strategy will work in every rural healthcare system, but one thing is certain. Rural hospitals and clinics must think outside the box to recruit and retain nursing and healthcare staff to combat ongoing staff shortages.
The Aging Population Is Contributing to Nursing Shortages
The Baby Boomers have helped to contribute to the healthcare worker shortage in this country for some time, and because they are living longer, they will continue to require significant resources.
Each year, more than 3.5 million Boomers approach retirement age, and by 2029, the last round of boomers will exit the workforce, and there will be more than 71 million Americans aged 65 or older. These older Americans will live longer than their parents, but they will also be plagued by more chronic illnesses than their parents. Diseases that were deadly a generation ago are now able to be managed and treated effectively but doing so requires extensive resources across multiple medical disciplines.
These older folks are also choosing to stay home and put off entering a care facility as long as possible. They either live independently or move in with their adult children. This shift is creating shortages in home-health settings, as well.
The Growing Nursing Shortage In-Home Healthcare
Currently, home-health services is one of the fastest-growing sectors of healthcare, followed by the ambulatory services sector that includes outpatient surgical centers, clinics, private practice, urgent care, imaging centers, dialysis facilities, cancer clinics, and more.
These services are struggling to compete with hospitals and other healthcare facilities to attract and retain staff. There is a perception among healthcare workers that home health is less lucrative than working in an onside facility, and unfortunately, that perception is often the reality. Many nurses and healthcare workers also shun home health as a career path because they will often work alone, without the social interaction, support, and camaraderie of working in a facility.
Overcoming the home healthcare staffing shortage won’t be easy with so many obstacles to overcome. However, there has been some investment in finding ways to attract more nurses and skilled clinical workers to the home health field.
Some states are working to expose undergraduate and practical nursing students to community-based care, offering incentives to groups that provide those students with internships and clinical externship opportunities. Nursing groups are also advocating to allow Advanced Practice Registered Nurses with full practice authority and to remove much of the red tape that patients and families must go through to secure home health services.
There is also a push to pay nurses for what they do, rather than where they work. Many home health nurses provide complex care. For example, lots of home-health patients are on ventilators, and those nurses perform the same tasks as ICU nurses yet are not paid nearly as much. By closing some of these gaps in pay and autonomy, it will be possible to attract more nurses to home health and to close the nursing shortage in the field.
Nurses Are Retiring, Contributing To The Ongoing Nursing Shortage Crisis
It’s not just the patient population that is aging. Nurses themselves are aging and are retiring in vast numbers. Nearly one-third of all registered nurses will enter retirement age in the next ten-plus years. This means that the nursing shortage will expand beyond staff nurses and will reach into nurse managers, nurse leaders and nurse educators.
Many of these retiring nurses have master’s and doctorate degrees, making them difficult to replace. Moreover, as faculty retire in nursing schools, schools are forced to reduce enrollment numbers to ensure they have enough nurse educators on staff to teach effectively. This means that there will likely continue to be a shortage of people entering nursing school.
Will It Really Be Possible To Overcome the Nursing Shortage?
Given so many obstacles, overcoming the nursing shortage will continue to be an uphill battle. And while individual facilities and individual nurses can do their best to try and attract more nursing students to the field, they will have to stay focused on keeping their individual facility fully staffed.
Doing that requires a laser focus on recruiting. Improving the culture of facilities to attract strong nurses, paying competitive wages, offering ample time off, and even supporting nurses approaching burnout can help boost recruiting and retention. To overcome nursing shortages, facilities will also have to continue to sweeten the pot with incentives.
It will also be necessary to build in budget dollars for per-diem and travel nurses to close immediate healthcare staff gaps, but that won’t be enough. Healthcare facilities would be wise to partner with an effective and efficient nursing staffing company that can handle the day-to-day sourcing and scheduling of those contract-based nurses and allied health professionals.
If your healthcare facility is looking for such a partner, BOS Medical Staffing is ready to help. Since 2008, BOS Medical Staffing has brought talented nurses, therapists, and medical administrators together with top healthcare facilities. Contact BOS Medical today to talk about customized staffing solutions that can help you overcome your nursing staff shortages.