The alarming nursing shortage
All sectors of the nursing workforce—telephone nursing, virtual nursing, in-person nursing—are facing the same staffing fiasco. The supply of registered nurses is shrinking as demand is growing. Patient care, patient safety, and positive patient outcomes are at risk—and something must be done about it.
There are many reasons for the current nurse staffing crisis. To list just a few:
- An aging nursing workforce.
- COVID-19 pandemic fatigue.
- Job dissatisfaction and nurse burnout.
- Fears about personal safety.
- Fewer new nursing students at nursing schools.
- Poor nursing administration.
Some nurses simply want better job opportunities: careers with less stress and higher pay. Many newer nurses, after just a year or two of practice, leave the nursing profession forever.
The supply of registered nurses in the United States is insufficient to meet the health needs of the aging baby boomer generation, the chronically ill, and high-risk patients. According to the American Nurses Association, the United States is short over 1.1 million RNs—and this number will only continue to grow over the next 20 years if action isn't taken.
Because of the current red-hot job market—a market in which many industries are desperate for workers—nurses who are disengaged or ambivalent in their current roles have powerful motivation to leave for greener pastures.
This is even with skyrocketing sign-on bonuses and fierce recruitment tactics from C-Suite health executives, who stay awake at night fretting about staffing. The nursing shortages threaten care quality, patient outcomes, and the American healthcare system as a whole.
The impact of the nursing shortage on patient care & health
The nurse staffing shortages have frightening implications for patient safety. Which is why increasing nurse staffing levels is at the core of most providers’ strategic goals.
Nursing shortages, if not addressed, risk the health of America's aging population, of nursing home residents, and of critically ill patients. The nursing shortage will also affect the patient experience of healthy young people who, when they go to the doctor's office or hospital, will experience long wait times and lower care quality.
Solving the nursing shortage isn't just the job of the Chief Nurse Executive or the American Nurses Association. It is the job of the entire healthcare C-Suite, who must commit the brain power and resources needed to increase nurse staffing levels.
Solutions to the nurse staffing crisis
Achieving appropriate staffing levels will require effort, resources, and creativity. Below I’ve listed 14 ways that hospitals, providers, and practices can reach safe staffing ratios.
#1: Recruit to retain
You should hire nurses with the greatest potential to succeed in the role. Nurses who are deeply devoted to patient care, patient satisfaction, and positive patient outcomes. Nurses who love the healthcare industry. Nurses who will be loyal to your organization for years to come.
#2: Recruit deliberately
When recruiting new nurses, look for certain traits:
- The ability to actively listen to patients.
- Personal experiences/anecdotes that required critical thinking.
- Time management and flexibility.
Use behavioral-based interview questions that assess the prospect's communication style, empathy, and problem solving skills. They should also demonstrate a commitment to putting patient care first.
Be upfront about job requirements and expectations. Nurse triage is often a 24/7/365 operation, so make the duties crystal-clear from the start to ensure there's no misunderstandings down the line. Tell the nurse if they will need to work on weekends, on holidays, or be on call. Don't leave out any details, even if those details aren't appealing.
Being upfront from the get-go ensures safe staffing and lowers the risk of nurse burnout. Nurses who aren't informed about the job requirements going in are usually the quickest ones to go out.
#3: Consult with current staff
Talk with seasoned nurses and other health professionals about the potential new hires, who are investments in the success of every healthcare organization. They can make or break health services, so it is essential to ensure—before hiring—that they will get along with other staff.
#4: Automate or offload tedious tasks
To keep the telehealth machine running, nurses often must navigate laborious processes. These administrative tasks exhaust and aggravate nurses, who’d much prefer to focus entirely on patient care.
Organizations that view registered nurses as professionals have greater success with recruitment and retention. Role expectations that allow RNs to practice at the top of their licensure demonstrate respect and value. Unappealing duties should be reassigned to unlicensed support staff—and the importance of teamwork should be emphasized.
Most organizations know they must support their lawyers, doctors, and other highly-skilled workers with robust support technology and support staff. This same mindset needs to be applied to nurses. Fortunately, there now exists cutting-edge triage and call support software that automates many burdensome tasks, freeing nurses to perform at top-of-license. In turn, they are happier and more effective employees.
Organizations should incorporate technology and automation, whenever possible, into nurse workflows:
- Use cell phones to communicate in real-time so nurses don’t need to make constant trips to the nursing station for a call.
- Have support staff wear a tracking device. When an RN needs help, she then knows who is where and whether or not they are available.
- Provide electronic teaching materials—and discharge instructions—that can be easily accessed and printed.
If you’d like to read more about the current state of technology in nursing, check out my blog: “Nurse Triage & Telehealth Technology: A Symbiotic Relationship.”
#5: Consider registered nurses with restricted licenses
I worked with a Midwestern academic medical center that was committed to the recovery of employees who suffer with substance abuse. In collaboration with Human Resources and the Board of Nursing, we created a program where compromised staff nurses were given the opportunity to return to work as registered nurses in my Nurse on Call department—and they were paid accordingly.
#6: Broadcast the contributions of front-line triage nurses
- Publicize data, loudly and relentlessly, revealing the number of unnecessary and expensive emergency department visits that nurse triage call lines diverted to more appropriate and less costly sites of care.
- Emphasize that patients need nurses for clinical care—and that patients have come to rely on nurses for remote care.
- Quantify the savings accrued thanks to triage nursing.
- Advertise that more than 50% of patient encounters with triage nurses require no further action. It is one call and done.
- Elevate nurse triage and critical care nurses to a place of importance within the organization or hospital.
#7: Commit to communication
To empower nurses, nurse staffing managers and the nursing administration should ask their staff what they want out of their job duties. They should listen to any complaints/suggestions, and make changes accordingly.
It's critical for nurse leaders to inform the nursing staff about anything that may impact their job. No one likes workplace surprises or feeling left out.
On day one, give new nurses an orientation schedule and agenda. This demonstrates that you honor their time and respect their need for a work-life balance.
#8: Make compensation more than fair
Numerous studies have shown RN turnover rates continue to rise upwards of 17% (NSI, 2016), costing US hospitals over $17 billion annually and contributing to the current staffing crisis. The cost of replacing a single RN is $36k - $54k. In some expensive locales, it is $85k - 100k.
This staff leakage has severe consequences for hospitals and health providers:
- Temporary replacement expenses.
- Costs for recruiting and hiring new nurses.
- Lost productivity.
- Inadequate medical care, which can lead to poor patient outcomes.
Of the healthcare workforce, nurses are by far the largest discipline. They are also voted, year-after-year, as the #1 most trusted profession in the world.
And yet the compensation American nurses receive is not commensurate with the impact they have on patient care, hospitals, and the US health system as a whole.
What happens when compensation is low, or even just average?
- Nurse turnover increases.
- You are forced to hire someone at a higher salary.
- The knowledge and training you invested in disappears.
- It will take months of interviews, hiring, and training just to get back to baseline.
I recall being the Administrator of a 100+ RN nurse triage practice. I attended a leadership retreat, and I was told, by a non-nurse, that money is not a motivator for nurses.
If that is the case, why has the popularity and reliance on travel nurses and agency nurses skyrocketed?
Why are nurses leaving permanent hospital jobs for 13-week travel nursing assignments?
To stop the nursing shortage, nurses must be paid a wage commensurate to the high-value jobs that they perform.
#9: Reward longevity & excellence
Your most loyal and successful nurses need to know that they’re valued. Any turnover is unfortunate, but it’s especially important to hang onto employees who have faithfully served your organization or hospital for years or even decades.
Long-term employees crave recognition, so don’t hesitate to highlight milestones with special gifts. Better yet, throw full-blown parties or awards banquets to recognize major achievements.
Regular raises and increased allowances for time-off are equally important—or nurses may seek higher-paying positions outside of health.
Any effort to retain the most talented and passionate nurses will eventually be repaid tenfold. Let hard-working nurses know they matter. The stakes are too high for anything less than stellar treatment.
COVID-19 embittered many nurses, who grew frustrated that they were not given hazard pay for putting their lives at risk. Health organizations with aggressive retention strategies have since implemented quantifiable rewards and incentives for staff—which is a step in the right direction.
Current nurses have seen increases in pay and bonuses, and many new nurses receive incentives when they accept the position. Hospitals that offer incentives for nurses who work overtime—and for nurses who take on more responsibilities—can reduce turnover rates.
To retain and attract more nurses, additional incentives include:
- Tuition assistance for nursing school.
- Tuition reimbursement for nursing school.
- Sending nurses to seminars and conferences.
- Offering internal training opportunities.
- Offering CE programs onsite.
#10: Utilize career ladder model for rapid, attainable advancements and wage increases
The American Nurses Association recommends the following nurse staffing ladder:
- Level 1: Entry-level RN.
- Level 2: An RN who practices independently and can function as a charge nurse, or as a preceptor to new nurses and students.
- Level 3: An RN who demonstrates high-level capability aligned with the organization's professional practice model.
#11: Create a community
To achieve safe staffing levels, the health organization, hospital, or medical practice needs to build a positive relationship with the nursing staff—which means creating a friendly and healthy work environment.
This can be accomplished by building a "we're in this together" teamwork culture—and through community events such as holiday parties. The work culture should feel like a family environment; an environment where everyone belongs, and where everyone's input is valued.
#12: Trust nurses to do their jobs
Rectifying the nursing shortage crisis will require giving nurses sufficient autonomy over their practice in all settings. This means trusting the nurse's skills.
Hospitals and health organizations should make an effort to keep their aging nurse workforce in active and direct care roles. This means redesigning certain job duties so that they can be successfully performed by older nurses.
The American health system must stop taking nurses for granted. It contributes to a toxic work environment, and it makes nurses feel unappreciated and undervalued.
Like any professional in any industry, nurses want to know their employer cares about them and their needs. Employers must be advocates for nurses.
#13: Work-life balance
It's imperative that nurses, given their high-stress job, have an excellent work-life balance. Ask your nurses what would be an appealing augment to hourly compensation, whether that be a gym membership, a weekly yoga class, doggy daycare, or after-work happy hours.
These perks help nurses achieve a healthy work-life balance, which in turn makes them happier and more effective employees in the long-run.
Introducing greater flexibility into what is often a rigid work structure/schedule can also improve morale.
#14: Recycle talent
Reach out to your health organization's pool of recent nurse retirees. Provide hands-on training for these nurses, so that they are confident when they reenter the workforce.
Offer unique, age-specific benefits and perks such as fitness classes or tickets to local plays/exhibits.
Older nurses are likely to have a diverse range of skills and advanced practice or specialist qualifications. They all have irreplaceable experience. Policies need to be in place to enable these nurses to be active members of the health workforce. These policies include:
- Understand the workforce profile and employment needs of older nurses by conducting surveys, focus groups, and nurse labor market analysis.
- Create flexible work opportunities that are specifically designed for older nurses.
- Ensure that older nurses have equal access to relevant learning and career opportunities.
- Redesign job duties to relieve heavy workloads and stress.
- Provide job enrichment opportunities that will optimize the contributions of older nurses.
- Offer a pay and benefits system that meets older nurses’ needs—and that rewards their experience.
- Utilize older nurses in specialist roles, in mentorship roles, and in preceptor roles.
- Maintain succession planning, which enables knowledge transfer and leadership development.
- Support retirement planning options, and, when appropriate, flexible pension provision.
The nurse staffing crisis is curable
The staffing conundrum has been brewing for years—but it wasn’t until Covid-19 hit that it exploded into a full-blown calamity.
Thankfully, the nursing shortage is solvable. It simply requires willpower, resources, and imagination. Technological innovations, such as AI-powered triage software, will also play a crucial role in rectifying the situation.
The nursing crisis affects us all. Every American needs, or will need, health services. It’s imperative we solve this problem before it’s too late.