The Nursing Shortage: Why Are Nurses Leaving?

By Zack Janiel
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The Nursing Shortage: Why Are Nurses Leaving?

Nurses are an important part of the healthcare system and represent the largest group of healthcare professionals. The country’s 4.3 million nurses work in every aspect of healthcare and are vital in delivering care, closing health disparities, and improving the country’s health.

The COVID-19 pandemic has shed light on the work nurses do to care for and protect patients. The pandemic has also revealed a growing nursing shortage in the United States and across the globe. A recent report from the World Health Organization shows that the world may be short of 5.7 million nurses by 2030.

This post examines the causes for this growing lack of nurses, when it began, the states most impacted by the shortage, the possible effects of fewer nurses, and the potential solutions to end this crisis.

 

What’s in this article?

  • When did the nursing shortage begin?

  • Which states lack nurses?

  • What caused the nursing shortage in the US?

  • What does a lack of nurses mean for healthcare?

  • The Way Forward

  • Final Thoughts

 

When id the nursing shortage begin?

The United States has experienced nursing shortages periodically since the 1900s. Various factors, including economic downturns, world wars, and retirement waves, have led to each nurse deficit. However, the current scarcity of nurses, first announced in 2012, is greater than ever experienced by the country.

According to the American Nurses Association (ANA), more jobs for registered nurses will be available through 2022 than in any other profession in the United States. The US Bureau of Labor Statistics further projects that more than 194,500 additional nurses are needed annually from 2020 to 2030.

A 2018 study also projected that a shortage of registered nurses will spread across the country between 2016 and 2030. The United States is also looking to suffer a shortage of over 500,000 nurses by 2030

 

Which states have a nursing shortage?

It can be confusing to analyze shortage indicators at the state and national levels because the employment statistics of registered nurses vary by region and demographics. Some states have a surplus of nurses, while others struggle to fulfill their local populations’ basic needs.

A state-by-state analysis published in the American Journal of Medical Quality forecasted the RN shortage to be most intense in the South and the West.

Topping the list of states projected to have the highest nurse deficit by 2030 is California, which faces an estimated scarcity of 44,500 RNs. Following California are Texas (with an estimated shortage of 15,900), New Jersey (projected deficit of 11,400), and South Carolina (predicted shortage of 10,400).

Meanwhile, Florida tops the list of states with the lowest need for additional nurses, as the state has an estimated surplus of 53,700 RNs by 2030. Following Florida are Ohio (with an excess of nearly 50,000 RNs), Virginia (estimated surplus of 22,700), and New York (predicted surplus of 18,200).

A report released by the National Center for Health Workforce Analysis revealed that the scarcity of nurses would impact rural communities more than metropolitan areas. Only 16% of RNs live in rural areas, where they serve over 52 million Americans who live there.

 

What caused the nursing shortage in the US?

Higher demand for nurses and low supply have caused a deficit in nurses. However, the list of factors contributing to the lack of nurses in the workforce is much more extended. They are enumerated below:  

 

Rising Care Demand of an Aging Population

The country has a larger population over 65 years old than ever before. Composed primarily of baby boomers, this demographic has grown rapidly in the past decade. Its population has increased a whopping 73% in the past eight years, jumping from 41 million people in 2011 to 71 million in 2019. The United States Census Bureau estimates this number to rise to 73 million by 2030.

This aging population requires more health services due to age-related conditions. Improved and accessible healthcare has also lengthened lifespans, stretching the timeframe when patients need these services. This high demand for health services is straining an already overwhelmed healthcare system.  

 

Aging Nursing Workforce

Like the populations they serve, the nursing workforce is also aging. Nearly half of all RNs are now over the age of 50. A 2015 study predicted that over one million RNs will retire from the workforce between 2021 and 2030, cutting away a quarter of nurses from the workforce. As these seasoned nurses go, they take with them years of accumulated knowledge and nursing experience.

During the COVID-19 pandemic, many nurses were also given early retirement packages as many hospitals had reduced income because of patient aversion to medical facilities and fewer elective procedures. With this reduction in income, hospitals were forced to reduce their employees to stay afloat. Many nurses opted to retire early even when they wouldn’t have planned to otherwise.  

 

Lack of Resources to Train New Nurses

Like many registered nurses set to retire by 2030, many RN educators are also nearing retirement. This leaves nursing schools without a strong pipeline of teachers who can teach a new generation of registered nurses.

A recent report by the American Association of Colleges of Nursing discovered that over 80,000 qualified nursing applicants were turned away from bachelor’s and graduate degree programs in 2020 because nursing schools in the country lacked qualified faculty, clinical study sites, and classroom space.

The AACN also reported that the enrollment increase in entry-level baccalaureate programs in nursing in 2019 is only 5.1%. This increase is not enough to meet the projected demand for nursing services.  

 

Stress and Burnout

The pandemic isn’t the only reason nurses are currently experiencing high stress and burnout. Even before the pandemic, nurses were already saddled with working long hours, making urgent life-altering decisions for their patients, and dealing with the ever-present threat of verbal and physical abuse from irritable or agitated patients. Combined with the increased pressure of addressing the coronavirus pandemic, it is not difficult to imagine how the stress of the job can force nurses to leave the profession.  

What does a nursing shortage mean for healthcare?

Since nurses make up half of the healthcare workforce, a lack of skilled nurses entering and staying in the profession has far-reaching consequences on patient care and other professionals in the healthcare team. A lack of nurses can lead to a higher risk of burnout for more nurses, a higher risk of medication errors, and longer wait times for required care.

 

Higher Risk of Nurse Burnout

With additional nurses leaving due to burnout, nurses who are left behind are spread thin and made to care for an increasing number of patients. Insufficient staffing further raises stress levels, impacting job satisfaction and driving more nurses to change or leave their careers.

 

Higher Risk of Medication Errors

Patient outcomes are affected by staffing shortages. High nurse-to-patient ratios can lead to medication errors and higher morbidity and mortality rates. Studies also revealed that a patient’s risk for infection increased by 15% when a unit was understaffed. Fewer nurses caring for many patients can also increase readmission rates in pediatric areas.

 

Extended Wait Time for Care

A shortage in staff at any medical facility also results in longer wait times for patients. Compounding this problem is an aging population demanding care for their age-related conditions. With more patients coming in for medical assessments and treatments, extensive wait times and brief visits with the nurse and other healthcare personnel may soon be the norm.

 

The Way Forward

The nursing shortage is a complex problem that requires a comprehensive solution. More strategies and practices need to be examined and implemented today. Advances in nursing education, improvements in the nursing work environment, and advocacies for policies supporting safe staffing and workplace health and safety can all help address this growing healthcare crisis.

 

Improving Access to Education

Education is the bedrock of increasing the nursing population. Programs should be created to incentivize students to enroll in nursing school, complete their studies, and continue their education to advance their skills and careers. Encouraging more nurses to pursue graduate-level credentials will also add to the pool of highly skilled nurses who can serve in leadership roles, advanced patient care units, and the academe.

Aside from financial incentives, flexibility is also critical in recruiting and retaining nursing students, especially working nurses who need to fit their studies into an already busy schedule.

 

Workplace Accommodations

Aside from improving compensation and benefits packages, providing a safe and healthy working environment should also be prioritized by healthcare institutions hoping to retain their nurses. Medical facilities can increase nurse retention by examining the root causes of nurses departing their careers. When nurses feel appreciated, encouraged, and supported by upper management, they are more likely to stay and provide better patient care. An environment that empowers and motivates nurses is necessary to rejuvenate and sustain the nursing workforce.

With modern technology melding with healthcare delivery, there are also more avenues now for nurses to continue their work in creative ways. Telehealth and travel nursing have increased career development and growth opportunities in nursing. Compact licensing options and nursing agencies have also increased the scope where nurses can practice.

 

Lobbying Policies

Nurses also need to advocate for changes at the local and federal levels. The American Nursing Association closely monitors, analyzes, and acts on federal legislation, policies, and rulemaking involving the nursing workforce, work environment, shortage, and practice authority. They are currently working with legislators on various key topics, including workplace health and safety and appropriate staffing. The ANA also provides an RN Activist Toolkit with action plans that nurses can use to support the profession.

 

Final Thoughts

No healthcare system can function without skilled nurses. The COVID-19 pandemic in the United States has pushed the reality of the current nursing shortage into the spotlight. With a better understanding of what factors bring about nurse scarcity and how we can improve the situation of nurses across the country, we can hope to shift the tide.

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