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The nursing shortage is expected to increase by the year 2030. The U.S. Bureau of Labor Statistics foresees 194,500 registered nurse (RN) job openings every year until 2029.
There are key factors contributing to the nursing shortage.
- The lack of nurse educators resulted in 80,000 prospective nursing students being rejected from colleges last year.
- Community colleges have limited spots.
- The Great Resignation: Nurses are leaving the profession in droves either through retirement or choosing another career altogether.
What is being done? We spoke with three nurse executives and discussed which strategies they use to prioritize nurse retention and how other nurse leaders can also help.
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6 Innovative Ways Top Nursing Executives Are Surviving the Nursing Shortage
There are six proven strategies to increase nurse retention. These strategies include:
- Listening to nurses' concerns
- Prioritizing workplace culture
- Adjusting protocol to meet nurses' needs
- Increasing diversity and representation in nursing
- Addressing the need for more nurse educators
- Supporting nurses leading healthcare innovation
"The reality is that unlike no time before, you have the opportunity to make great changes that will impact the future of nursing," Rebecca Love, chief clinical officer at IntelyCare, says. "This is a very exciting time to be a leader in nursing."
1 | Listening to Nurses Concerns
Addressing the nursing shortage by simply listening to nurses' concerns is the first step in increasing nurse retention.
"Nurses want to feel their loyalty to a system is of value, and not as though it is actually being used against them," says Love.
A recent pain point due to COVID-19 is hospitals hiring travel nurses to cover staffing. Long-term nurses keep witnessing their facilities offering sign-on bonuses, three times higher pay, and flexibility with schedules. Meanwhile, loyal, long-term nurses know their compensation systems don't offer these benefits to them.
"Most nurses need to put in vacation requests six months in advance, which can easily be denied," says Love.
2 | Prioritizing Workplace Culture Increases Retention
For too long, healthcare facilities have been taking their employees for granted. This creates a negative company culture which can kill morale. Nurses don't want to feel as if they can simply be replaced. They want to feel supported, cared for, and appreciated. Facilities need to first start with their employees.
Mag VanOosten, president and chief clinical officer of UnityPoint at Home, a home health service, believes culture starts from the inside out.
"We care deeply about creating an easier, more personal work experience," VanOosten says. "We encourage our employees to build a family away from home with their colleagues while they make a real difference with patients every minute of every day."
A positive company culture and work environment can support:
- Work/life balance
- Nurses' mental health
- Career flexibility
At IntelyCare, Love says that happiness is the top priority for their employees and is at the core of their mission. They've seen this aid in retention rates.
"Our culture is critical, and we make sure that our frontline people know we hear, see, and value them," Love says. "We work double time to keep open communication and opportunities to everyone who works for us."
3 | Prioritizing Nurse Retention Levels
Retention needs to be the top priority for nurse executives. It's good for morale and, most important, patient safety. Chris Caulfield, chief nursing officer (CNO) and cofounder of IntelyCare, says decreasing shift length and overtime has proven to increase nurse retention levels at IntelyCare.
Caulfield further explains that it is essential to internally build out flexible per-diem pools of nurses to support this shift.
"The willingness to utilize outside resources (when needed) is essential to the new age of nurses who are requiring a higher work-life balance with their primary employers," Caulfield says.
Hospitals and facilities do offer monetary incentives to help attract nurses. UnityPoint, for example, has been successful in carrying out a critical-care retention bonus.
"The bonus rewards tenured nurses and keeps them on board for the critical months ahead," VanOosten says.
The home health service also offers shift differentials that provide financial incentives for team members to work "hard-to-fill" evening, night, and weekend shifts. The shift differentials help attract new candidates to fill open positions in their health system.
Other strategies include:
- Expanding referral bonuses
- Reducing dependence on travel nurse programs by increasing internal nurse float pool
- Investing in clinical leaders
4 | Increasing Diversity in the Nursing Student Body
Increasing diversity in the nursing student body is another way to combat the nursing shortage. Representation in nursing matters because it increases nursing retention and improves healthcare outcomes.
Unequal access to education, specifically for minority communities, is a well-documented barrier for students pursuing a nursing degree.
Another major barrier is cost. Caulfield calls on nursing foundations and organizations to combat the cost barrier through diversity-focused scholarships and financial aid for marginalized nursing students.
"With the rapidly increasing cost of education, nursing executives and healthcare organizations can actively get involved in their local nursing organizations and nursing foundations and support building scholarships specifically targeted towards diversity," Caulfield says.
Nursing schools are increasing diversity with new strategies, but the admissions process may need more attention. A school's admissions process may deny a diverse pool of students for several reasons.
"Addressing the application criteria will drive more acceptance of diverse applicants," Love says.
Love also points out that nurse executives can, and should, bring back diploma nursing programs within their own hospitals.
Hospitals used to be the largest producers of nurses in this country, and they can educate their own nursing workforce which matches their community demographics, Love says.
Love further suggests nurse executives can:
- Support nursing programs at community colleges
- Lobby for the expansion of licensed practical/vocational nurse (LPN/LVN) and associate-degree nursing programs
According to the 2018 National Sample Survey of Registered Nurses, most RNs have a bachelor's degree or higher. In their 2008 survey, minority nurses were more likely to pursue nursing baccalaureate and higher degrees.
Another strategy to increase diversity in the nursing student body is to provide seamless bride programs so students can easily enter nursing schools through certificate or technical school programs. Bridge programs include the following:
- Emergency medical technicians
- Paramedic to RN
- Surgical technicians
- Pharmacy technicians
- Anesthesia technicians
If nurse executives support the expansion of entry-level LPN/LVN and associate-degree nursing programs, and hospitals continue to provide competitive tuition reimbursement benefits, we will no doubt see an increase in nurses pursuing higher degrees. This will improve retention and create a more highly qualified and skilled nursing workforce.
5 | Addressing the Need for More Nurse Educators
There is a need for more nurse educators to help navigate the nursing shortage. The post-pandemic nursing shortage of nursing educators is a real concern. Some argue there isn't a nurse educator shortage at all; nurse educators just aren't compensated enough.
For universities, the cost to hire nurse educators is yet another barrier to the nursing shortage.
"Nursing programs are extremely costly to universities," Love says. "I believe studies show the cost of nursing school is 2-3 times greater than the cost of business school."
Love also points out that nurse educators working in nursing programs typically have a master's degree or higher. While she can appreciate this, Love believes clinical experience is just as valuable.
To combat the need for more nurse educators, Love suggests reaching out to nurses who are retiring. They often have years of experience and a rich nursing knowledge to educate the nursing workforce.
"This could be an effective way to extend the life cycle of such a valuable asset in the nursing profession," she says.
VanOosten praises the nurse residency program initiation at her facility. The program offers recent graduates a dedicated program focused on the unique dynamics of care in the home.
According to the American Association of Colleges of Nursing, nurse residency programs have a proven record of:
- Empowering nurses
- Increasing nursing retention
- Improving patient satisfaction
"[It also provides] our health system an opportunity to cultivate relationships with regional nursing education programs," VanOosten says.
6 | Using Innovation to Address the Nursing Shortage
When it comes to addressing the nursing shortage, innovation is key. Healthcare is in need of a major overhaul, and technology is a solution.
"CNOs who take an approach of trialing new technologies and proven practices that support providing a 'flexible workforce' will best address the nursing shortage and decrease retention levels," Caulfield says.
But not all innovation needs to involve technology. Other innovative ideas include personalized educational opportunities for nurses or providing tailored educational opportunities.
VanOosten points out that through their nurse residency program, they fill in the gap and meet the needs of the communities they serve.
"Training and preparing future nurses in the field where they are most needed is proving to be an effective combination of learning and care delivery that addresses a vital need," VanOosten says.
Nurse Leaders Can Find Ways to Survive the Nursing Shortage
Finding ways to survive the nursing shortage can be challenging for some nurse leaders. Navigating and executing strategies is difficult and can be costly. Nurse leaders shouldn't feel discouraged but hopeful in wanting to change the outlook for the future of the nursing workforce.
"Be bold, brave, and strong. Own your decisions around your nursing workforce. Challenge the status quo," Love advises.
Other strategies to increase retention include:
- Polling your employees frequently and asking for ideas and feedback
- Asking nurses to rate their shifts
- Creating shared-governance decision-making models
VanOosten suggests forming meaningful relationships throughout your team and community.
"The best way to overcome your unique challenges is to listen actively to concerns, provide support as much as possible, and continually look for new ways to solve problems," VanOosten says.
Meet Our Contributors
Chris Caulfield, CNO
Chris Caulfield is the chief nursing officer and cofounder of IntelyCare. Caulfield cofounded IntelyCare as a way to reduce nurse shortages by creating an on-demand, app-based scheduling solution. Caulfield is an award-winning nurse innovator and entrepreneur who is passionate about changing the way nurses work.
Rebecca Love, RN, MSN, FIEL
Rebecca Love joined IntelyCare as chief clinical officer in August 2021. Love founded HireNurses.com, was the first nurse featured on TED.com, and started the nation's first nurse innovation and entrepreneurship program at Northeastern University School of Nursing. She also hosts the Outcomes Rocket Nursing podcast and is dedicated to empowering nurses to be at the forefront of healthcare innovation and entrepreneurship.
Mag VanOosten, RN, President and Chief Clinical Officer, UnityPoint at Home
Mag VanOosten joined UnityPoint at Home in June 2016 as vice president. In 2018, she was promoted to president and chief clinical officer, leading UnityPoint at Home's clinical and business operations. Prior to joining UnityPoint at Home, VanOosten served in executive roles throughout the country in the home care, hospice, palliative care, and public health industries.
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