Post-Pandemic Nursing Shortage: What It Means for Aspiring Nurses
Nurses are a critical part of the healthcare system. During the COVID-19 pandemic, many saw how much nurses contribute to the care and protection of patients.
What has also become evident is a growing nursing shortage. COVID-19 has highlighted the gaps in healthcare and created an increasing demand for bedside nurses. In the United States, it is projected that 1.1 million nurses are needed to replace retiring nurses by 2022. Globally, the need is closer to 13 million.
The shortage has pros and cons for nursing students. One pro is being able to find a job quickly after graduation. A key disadvantage, though, is that nursing programs have fewer openings. For students, this means acceptance into a program may be more challenging.
The nursing shortage has many consequences. First, let's address a few frequently asked questions before diving into what it may mean for prospective nurses.
Frequently Asked Questions on the Nursing Shortage
It's important to correct some misconceptions about what has caused the shortage and how it might affect healthcare. Identifying the challenges the nursing workforce faces may help with potential post-pandemic nursing solutions.
What Is Causing the Nursing Shortage?
- Aging population: An aging population has strained the workforce. Older adults typically have more than one chronic disease. Many illnesses that were once terminal are now considered chronic.
- Aging workforce: Nurses are also reaching retirement age. At the start of the pandemic, some nurses retired, and others were given an early retirement package, increasing the shortage.
- Nurse burnout: The consequences of nurse burnout on patient care may be severe. Data show that high workload, low staffing, and long shifts are triggers.
- Family obligations: The majority of nurses are women. According to the U.S. Bureau of Labor Statistics (BLS), 12.6% of working nurses are men. Villanova University reports 20% of its incoming nursing students in 2021 are men. With the lack of family care benefits, a high number of women nurses who are also working parents may cut back or leave the profession to raise their families.
- Nursing educators: There's a major bottleneck in nurse teaching. A shortage of nursing faculty limits the students a program can accept. Retirement, moving into the private sector, and a lack of incentives to become nurse educators affect the faculty shortage.
What Is the Current Status of the Nursing Shortage?
According to the American Nurses Association (ANA), more jobs will be available in nursing in 2022 than in any other profession. This shortage will have a significant impact on patient care. The BLS projects a 9% job growth rate for registered nurses (RNs) from 2020-2030, slightly higher than average.
The Department of Health and Human Services estimates at least seven U.S. states have the most severe nursing shortages. These include:
Even before 2020, there were statewide initiatives to address the shortage of bedside nurses and nurse educators.
What Does the Nursing Shortage Mean for Healthcare?
Several key factors affect staffing needs. These include the level of patient illness, patient number, and staff skills and expertise (seasoned nurses versus new graduates). Patient outcomes are affected by staffing shortages. High nurse-to-patient ratios can lead to medication errors and higher morbidity and mortality rates.
Staffing shortages, paired with a global pandemic, can increase nurse burnout and patient dissatisfaction. A staffing shortage also impacts the hospital's level of reimbursement. Though the pandemic created a massive need for more nurses, it also reduced funding for hospitals, resulting in staff layoffs.
At the pandemic's start, hospitals canceled elective surgeries to prioritize COVID-19 patients. Many non-COVID patients avoided hospitals. This led to decreased hospital funding and administrations furloughing nursing staff, further contributing to staffing shortages.
The Nursing Shortage on a Global Scale
Nursing shortages are not limited to the U.S. The International Council of Nurses (ICN) Policy Brief published in 2020 shows that 27.9 million nurses were working worldwide. However, the ICN estimates there was a shortfall of 5.9 million nurses.
Unfortunately, 89% of the shortages were in low- and lower-middle-income countries. Additionally, 17% of nurses expect to retire by 2030. The report shows that 4.7 million nurses are needed to maintain the current workforce. To address the global nursing shortage, 10.6 million more nurses must replace retiring nurses. (This 10.6 million estimate doesn't take into account the loss from COVID-19.)
Retirement is only one of the challenges. Each factor contributing to the nursing shortage must be addressed to help fill the gap.
Global Impacts of COVID-19 on the Nursing Shortage
COVID-19 has not only highlighted disparities in healthcare but further contributed to the nursing shortage. In 2020, healthcare professionals used technology to provide care for people at home such as telehealth nursing. While this helped expand the reach of healthcare, it cannot replace the care of a bedside nurse.
Some countries have encouraged retired nurses to return as a volunteer nurse or reinstate their licence to help relieve the nursing shortage. Some have even mandated inactive nurses back to the bedside.
An ICN survey found that nearly 90% of national nurses' associations were concerned that heavy workloads, burnout, and stress were factors for the growing nursing shortages. Nurses were either retiring or moving into the private sector where stress was lower.
Infection rates and deaths are also contributing factors to the nursing shortage. Because of their close contact with patients severely ill with COVID-19, millions of nurses have also been infected. Nearly 3,000 deaths have been recorded in 60 countries. In the U.S., after 12 months, there were 3,561 deaths of healthcare workers; 32%, or 1,136, were nurses.
The ICN estimates that as a result of all contributing factors up to 13 million nurses are needed to fill the gap.
COVID-19 Is Increasing Nurse Burnout
No job or career is stress free. Every decision a nurse makes may impact the lives of their patients.
COVID-19 has added to this stress. The ICN expects the added burden will increase burnout and post-traumatic stress disorder, which "could have potentially significant detrimental effects, especially on the nursing workforce."
Nurse burnout is a mental, physical, and emotional state of exhaustion, often triggered by work-related stressors. Nurses who experience burnout initially feel detached and disengaged. As the condition progresses, they may begin to use food, drugs, or alcohol to cope. Some nurses have physical symptoms, such as headaches or stomach problems.
Nurse burnout can lead to health conditions like insomnia, heart disease, high blood pressure, and Type 2 diabetes. Burned-out nurses risk providing low-quality care, leading to mistakes and even death. One study from Marshall University found that when nurses took care of more than four patients in a shift, there was a higher correlation of burnout and a 7% increase in mortality for each additional patient.
An online survey found a key contributor to burnout during COVID-19 was a decreased feeling of well-being. The survey also evaluated staff resilience, or "the ability to cope with and adapt positively to adversity." Several factors were associated with decreased well-being, including a low measure of resilience, feeling personal protective equipment was inadequate, and believing the workload had increased.
A study from India found that the higher a nurse's resilience, the lower the risk of burnout. The ICN report expresses significant concern over the burden that COVID-19 had placed on the healthcare system, writing:
"In January this year, ICN raised significant concerns about the mass trauma that is being experienced by nurses during COVID-19 pandemic, and the medium to long term effects that trauma will have on the nursing workforce. These issues and risks combined do not bode well for long-term nurse retention in an already overstretched and vulnerable workforce. The COVID-19 pandemic has the potential to increase the number of nurses reaching the point of burnout, and increase the number leaving the profession, which could have a damaging impact as early as in the second half of 2021."
Hostile Working Conditions Fueled by COVID-19
During the COVID-19 pandemic, nurses faced spikes in workplace physical violence and verbal abuse as patients' families felt helpless with sick loved ones in the hospital.
One study researched nurses' experiences with workplace violence. The researchers used an online survey of RNs working in hospitals to calculate the frequency of physical violence and verbal abuse from February to June 2020. The purpose was to help describe the type of violence that nurses may be experiencing during the pandemic.
They found 44.4% nurses reported physical violence and 67.8% reported verbal abuse. The rate of violence was higher in nurses caring for COVID-19 patients than in nurses who did not care for COVID-19 patients. The researchers recommend that hospital administrators recognize nurses' increased risk of workplace violence and the urgent need to carry out preventive strategies.
Another data sampling of nurses working in Iran found similar results. Researchers measured "incivility" in nurses working in seven training hospitals. Some nurses reported that patients' families were uncooperative because of their lack of knowledge of healthcare practices. Once educated, their behavior seemed to change.
The interviews also revealed that emotional and physical abuse has increased during the pandemic, elevating an already stressful environment.
What the Shortage Means for Future Nurses
It might appear as if the shortage opens the field for nursing graduates to find a job right after school. However, there is good and bad news. Job opportunities will differ depending on the geographical area.
Many states with significant shortages have rural areas where it may be difficult to attract experienced, skilled nurses. Job opportunities may also depend on experience and skill level.
The Shortage Impacts Nurse Working Conditions
Nursing shortages have a high impact on working environments, patient outcomes, and the long-term health of nurses, leading to longer shifts and higher nurse-to-patient ratios. This shortage increases stress, fatigue, and the risk of injury to nurses. It can also reduce patient care.
Another effect of understaffing is nurses quitting because of heavy workloads and the stress of caring for dying patients. According to one estimate in 2018, the cost of turnover per nurse was $44,000.
Before the pandemic, the nursing shortage's most significant factors were aging, burnout, wage disparities, and regional needs.
Some Regions Have Higher Demand for Nurses Than Others
The fastest growth potential are in the West and Mountain regions of the U.S. Some experts anticipate slower growth in the Northeast and Midwest regions. This aligns with the U.S. Health and Human Services' list of states with the largest nursing shortage gap. As the population ages, there will also be growth potential in areas with high retirement populations. This includes Florida, California, and Texas.
Despite regional differences,the BLS estimates the overall growth rate for nurse practitioners to be an outstanding 52% from 2020-2030. This is much faster than the average job growth rate. While there continues to be a shortage of bedside nurses, the BLS estimates the growth rate for RNs to be 9% during the same decade, just above average. This may be a result of challenges faced in nursing education.
Interest in Nursing School Increases, but Applicants Are Turned Away
The pandemic seemed to inspire a career in nursing. According to a study from the American Association of Colleges of Nursing (AACN), student applications surged. Enrollment to bachelor of science in nursing (BSN), master of science in nursing (MSN), and doctoral nursing programs in fall 2020 increased.
While the interest was high, 80,521 qualified applicants could not be admitted. They included:
- 66,274 who applied to BSN programs
- 1,376 to RN-to-BSN programs
- 8,987 to MSN degree programs
- 3,884 to doctoral programs
Applicants were not accepted primarily because of a shortage of teaching faculty and clinical sites for nursing students.
According to AACN, nursing schools turned away 80,407 qualified applicants in 2019 for some of the same reasons like a shortage of clinical and classroom space. Another report identified a shortage of 1,637 educators in 892 nursing schools. Many of the empty faculty positions required or preferred a doctoral degree.
There Are Global Initiatives to Increase the Nursing Workforce
The ICN has encouraged national nurses' associations and governments to address the nursing shortage. According to their estimates, 74% of associations have reported that their countries are committed to addressing the problem, and 54% are addressing the need to retain working nurses.
Nursing associations have recorded a 20% increase in the number of nurses who left the profession in 2020. This raises concerns about the emotional and physical trauma experienced by nurses during the pandemic and increases the expected nursing shortage gap.
Additionally, there will continue to be a 3-4 year gap in the nursing shortage before new graduates are ready to enter the field. During this period, national nursing associations worry that the added workload and stress will increase the number of experienced nurses who leave.
Changes Need to Be Made to Ensure On-the-Job Safety for Nurses
The stories of front-line nurses caring for COVID-19 patients have inspired many to apply to nursing programs and join a career that focuses on the care and protection of others. To close this shortage gap, the ICN has made several suggestions:
- Protect the safety and well-being of the current and future nursing staff
- Provide psychosocial support to bedside nursing staff
- Commit time and finances to long-term strategies that increase the number of nurses in the workplace
- Invest in the recruitment, retention, education, and training of nurses
- Improve wages and working conditions so local nurses do not leave for high-income countries
- Prioritize fair pay for all nurses
Nurses Can Advocate for Changes Too
Nurses need to advocate for changes at the local and federal levels. To that end, ANA has developed an activist toolkit with action plans nurses can use to support for their profession.
ANA offers one-click options of writing to legislators to encourage change or thank them for their efforts. Top federal priorities include the opioid epidemic, workplace violence, safe staffing, and health system transformation. Nurses can learn more about each effort through the site.
The Post-Pandemic Future Remains Uncertain
The future of the nursing shortage is uncertain. Higher than expected numbers of nurses are leaving the profession from:
- Rising stress that triggers burnout
- Physical and verbal abuse in the workplace
There is a massive increase in job growth for nurses and nurse practitioners, so nursing jobs are and will continue to be abundant. Although the pandemic has inspired many to apply to nursing programs, many schools do not have the clinical sites or faculty to accommodate applicants.
If you are experiencing the symptoms of burnout, don't wait until the situation is so bad you must quit. Instead, take these self-care steps for nurses and avoid getting burned out.
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