Nursing shortage solutions are happening — because they must

The 2022 National Nursing Workforce Study, released by the National Council on State Boards of Nursing (NCSBN) in April 2023, showed the impacts of COVID-19 on nursing in the U.S. — and the results were not surprising. The nursing workforce is still grappling with shortages that are causing serious challenges for health care organizations and the nurses who remain.

These difficult circumstances call for innovative approaches to safeguard care quality and protect nurses from overwork and burnout. Health care organizations need to take innovative and strategic approaches to overcome the challenges of the current health care landscape, and nursing shortage solutions are one of the first needs to address.

Nursing workforce survey findings

The NCSBN survey included a randomized national sample of more than 300,000 licensed RNs and LPNs/LVNs from data collected throughout 2022. This biannual study serves as a resource to inform workforce planning and support safe, effective patient care. Findings from 2022 revealed the extent to which the pandemic worsened the national nursing shortage and the continued net loss of nurses, both of which have created an increasing urgency to find solutions.

Continued staff scarcity and impacts

The survey results included the following data points:

• Approximately 100,000 registered nurses and 34,000 licensed practical and vocational nurses left the workforce specifically due to the COVID-19 pandemic.
• 41 percent of RNs now have a mean age of 36 and less than 10 years of experience.
• 62 percent of nurses reported an increase in workload during the pandemic.
• Half of survey respondents reported feeling emotional fatigue or burnout multiple times per week, with over one-fourth reporting that they felt “at the end of their rope.”
• 800,000 RNs and 184,000 LPNs/LVNs indicated they are likely to leave nursing by 2027 — roughly 20 percent of total licensed nurses in the U.S.

The study authors suggested that the projected percentage of nurses who said they are likely to leave in the next three to four years could change if policymakers and leaders find solutions to foster resilience, sustainability, and safety in nursing.

How health care organizations can respond

When looking at organizations that have begun to recover from the pandemic and suffered lower staff loss, it is not coincidental that they had already focused on high reliability and resilience as core values. These organizations planned for disruption, creating a flexible infrastructure and building their ability to pivot quickly.

While leaders cannot predict the next crisis, they can create contingency plans and build a strong foundation to prepare for the unexpected. The Baldridge framework, for example, builds on core values and concepts relating to performance excellence. It uses a systems perspective, along with agility and innovation, to embed principles that can help carry organizations through difficult times with a common set of goals and values.

For organizations that did not fare as well, now is the time to begin working on strategies to improve their ability to respond to current challenges. They can begin by assessing their current state and developing models that will work with their culture. Many organizations are including new staffing models that are hybrids of older models. For example, some are continuing to support their existing workforce but also looking at new approaches, such as expanding internal resources, float pools, and PRN nursing, which could especially help rural hospitals.

Nursing workforce demographic shifts

The 2022 survey also revealed changes in nursing workforce demographics caused by the loss of more than 200,000 total experienced RNs and more than 600,000 LPNs/VPNs in the U.S. in the two years since the 2020 survey.

The median age of RNs fell from 52 to just 46. The median age of LPNs/VPNs fell from 53 to 47.

• The number of RN respondents self-reporting as a member of a minority group was 20 percent, with the number of Hispanic/Latino RNs nearly doubling to 6.9 percent. LPNs/LVNs self-reported as 34 percent racial minority, with 11.5 percent Hispanic/Latinx.
• The number of male RNs increased nearly 2 percent to 11.2 percent, a continuing increase from 8 percent in 2015. Male LPNs/LVNs increased from 8.1 percent to 10.2 percent.
• Education levels shifted, with more than 47 percent of RNs reporting that a BSN degree qualified them for their first U.S. nursing license, a jump of over 5 percent since 2020 — more than double the increase from the previous two-year survey period.
• Median self-reported pre-tax earnings for RNs increased from $70,000 to $80,000 since 2020 and from $44,000 to $50,000 for LPNs/LVNs.
  
  

How to leverage a changing nursing workforce

Demographic shifts in the nursing workforce along with the increasing need to bring more nurses into the profession require changes in how the nursing talent pipeline is developed. Establishing a strong community will be key to generating interest in the nursing profession among young people just beginning to consider their career choice.

To reach these potential nurses, health care recruiters should consider proactive approaches such as visiting high schools to offer shadowing and work programs where students can become part of an organization. Providing college opportunities and partnering with local institutions to educate students about nursing career paths can also build interest and participation among younger cohorts.

Medscape reported in 2023 that nursing school enrollment has dropped for the first time in 20 years. We can no longer expect to recruit from an existing pool of nurse graduates. We need to reach potential nurses much earlier — before they have even considered nursing school.

Visible role models can help bring young people into the profession by sharing stories about helping others, such as how volunteering and shadowing nurses in a hospital setting can impact career choice.

Additional nursing shortage solutions

Organizations should also consider strategies such as bringing retired nurses back as virtual preceptors, seeking suggestions from current nurses, providing resources and support, and using non-clinical resources to lighten administrative burdens.

The American Hospital Association’s  2023 Workforce Scan suggested expanding training options in the community, helping launch more nursing programs, recruiting globally, enhancing inclusiveness by creating psychologically safe and welcoming environments, recruiting for cultural fit, and setting up an in-house staffing agency.

For retention, the report suggested employing “smart onboarding” to ensure clinician well-being and engagement, providing flexible job options such as remote work and variable staffing models, investing in upskilling, advocating for increased federal funding for nursing programs, providing nontraditional support such as employee housing or loan forgiveness, and adding creative compensation benefits such as incentive pay.

Maintaining the same strategies that worked in the past will no longer sustain health care organizations. Regardless of the nursing shortage solutions chosen, it is imperative to expand the scope to address challenging workforce statistics and contribute to a more hopeful future.

About the author

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, vice president, quality, Relias, has been a registered nurse for over 30 years and is a certified professional in health care quality, a Lean Six Sigma Black Belt in Healthcare, and has served as an examiner for the Tennessee Center for Performance Excellence. She assists health care organizations with strategic solutions to impact clinical outcomes and optimize organizational performance.

NRHA adapted the above piece from Relias: Healthcare Workforce Enablement Solutions, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.