- Programs must provide hands-on clinical experiences monitored and evaluated by nursing faculty; the nursing faculty shortage strongly influences the ability to admit new nursing students.
- Nursing schools, hospitals, and state agencies are developing creative strategies to increase nursing staff and retain those who are hired.
- Many nursing programs have integrated virtual simulation and clinical simulation experiences to augment hands-on clinical training with patients.
Healthcare facilities across the nation have faced challenges in filling open nursing positions. Experts believe this challenge will continue through 2030, when the nursing shortage is expected to peak. The nursing shortage has a significant effect on clinical training experiences.
Institutions and state agencies are developing solutions to help nursing students find training sites to complete their nursing education. Explore how the nursing shortage impacts clinicals and how nursing students may find alternative clinical training sites.
The U.S. Nursing Shortage
The U.S. has experienced nursing shortages since the early 1900s. The current nursing shortage began in 2012 and is greater than before. The aging baby boomer generation is compounded by nurses in this generation who are retiring and the high number of nurses who left during the COVID-19 pandemic.
This shortage influences not only patient care but also the ability of nursing programs to accept and graduate nursing students. According to the American Association of Colleges of Nursing (AACN), nurse faculty shortages across the nation have limited student capacity at a time when society desperately needs more nurses.
The 2021-2022 AACN's report on enrollment and graduation from bachelor of science in nursing (BSN) programs found schools turned away 91,938 qualified applicants. The reasons listed included insufficient nursing faculty, classroom space, clinical preceptors, and clinical sites. The October 2022 AACN survey of 909 nursing programs found 2,166 full-time faculty vacancies.
Several factors have contributed to the nursing shortage and nursing faculty shortage. The primary reasons for turning away qualified candidates were a shortage of faculty, preceptors, and clinical sites.
The National Advisory Council on Nurse Education and Practice's 2021 report on the nursing shortage identified factors that underlie the inadequate number of nursing faculty. These factors include:
- High faculty workload, leading to burnout
- Lack of diversity among the faculty
- Salaries that are not competitive with clinical positions
- Poor understanding of the role and the contribution to the next generation of nurses
The nursing shortage challenge in patient care and faculty positions varies from state to state. States with the lowest local nurse employment include Utah, Washington D.C., Texas, Georgia, and Virginia.
How the Nursing Shortage Impacts Clinicals
A significant and growing nursing shortage influences clinical placement and training sites available for nursing students. Clinicals are mandatory for all nursing students to graduate from an associate, bachelor's, master's, or doctoral nursing program.
The number of clinical hours and expectations for performance are different for each level of nursing education. But the expectation is clear — programs can only graduate nurses if they have hands-on clinical experience with patient care.
While a shortage of clinical sites contributes to the issue, the shortage of faculty responsible for nursing students limits clinical experiences. This is critical to a cycle that contributes to the nursing shortage.
Potential Solutions to the Nursing Shortage
Schools, hospitals, and state agencies have noticed the challenge. Each has developed potential solutions to address the nursing shortage.
Schools and Universities
Many nursing programs and universities have developed creative strategies to increase the nursing candidates they can admit. Some began altering the admissions process. For example, programs like Florida State University and PennState anticipate rolling admissions will help ease the burden by attracting more students.
Other higher education institutions are opening new nursing programs, such as Dallas Community College. It has an associate nursing program and is expanding to open a BSN program by the fall of 2023. Other strategies include dual admission programs between two programs and the expansion of online programs.
More nursing programs are also offering accelerated BSN programs to candidates with a bachelor's degree in another area. An accelerated BSN program may be completed in two years or less, depending on the student and the nursing program.
Hospitals have also developed strategies to overcome the nursing shortage. Hospitals in Arizona are working to expand the preceptor training programs. This would help meet the need for clinical preceptors during nursing clinical rotations.
Although many hospitals have had to rely on travel nurses, some began offering sign-on bonuses and raising salaries to maximize recruitment and retention of consistent staff. Montana hospitals have been actively recruiting nurses internationally.
This opens the opportunity for the nurses to become U.S. citizens but contributes to a shortage of nursing staff in other countries. Self Regional Healthcare Hospital has developed a scholarship and apprenticeship program for certified nurse assistants to help support the nursing staff.
Hospitals and healthcare systems in Texas have collaborated to offer scholarships, fellowship programs, and free education. The hospitals are focused on nurse recruitment and retention efforts, also offering psychological first aid and "code compassion" programs to address stress and burnout.
Several states have used federal COVID-19 aid to boost hospital nurse staffing. Other states have invested money in expanding nursing education. Arizona has allocated $15 million and Washington has invested $38 million in expanding nursing programs.
The changes instituted across states, programs, and hospitals may help improve staffing ratios and ease entry into nursing programs.
Find Alternative Clinical Experience
Students in online nursing programs may have to think "outside-the-box" to find alternative clinical training sites to meet the program requirements. The Commission on Collegiate Nursing Education defines clinical practice nursing experience as a planned learning activity that offers students opportunities to understand, perform, and refine professional competencies at the appropriate program level.
One of the largest changes in nursing education has been the introduction of virtual simulation labs. In 2018, 65% of the current nursing programs were in the process of adopting virtual simulation labs for nursing students.
At the time, nearly half of those also anticipated adding virtual reality labs within five years. These options have extended the ability to offer students greater clinical options. Researchers believe these virtual simulations can improve knowledge retention and clinical reasoning skills.
These are hands-on opportunities for students to work with "fake" patients or mannequins to practice their skills. The mannequins have lifelike functions so students can practice taking a pulse, inserting an intravenous line, or listening to lung and heart sounds.
Alternative Clinical Settings
To get hands-on patient care experiences, students may need to expand the search for alternative clinical settings as a nursing student, such as:
- Urgent care centers
- Dialysis units
- Psychiatric facilities
- Hospice centers
- Residential nursing centers
- Veterans Administration hospitals
- Acute care drug rehab facilities
- Free-standing birthing centers
- Vaccination centers
- Home healthcare
- Infusion nursing
- Outpatient clinics
- Community health center
- Mobile clinic
- Ambulatory surgical center
- Rehabilitation center
65% of nursing education programs adopting virtual simulation. (2018). https://www.wolterskluwer.com/en/expert-insights/65-percent-nursing-education-programs-adopting-virtual-simulation
Andrew S. (2021). Traumatized and tired, nurses are quitting due to the pandemic. https://www.cnn.com/2021/02/25/us/nurses-quit-hospitals-covid-pandemic-trnd/index.html
Apprenticeship program for nursing shortages. (n.d.). https://scha.org/best-practices/apprenticeship-program-for-nursing-shortages/
Clinical practice experiences FAQs. (2016). https://www.aacnnursing.org/CCNE-Accreditation/Resources/FAQs/Clinical-Practice
Kelliher R. (2022). Meeting the need: How nursing schools are addressing the RN shortage exacerbated by COVID-19. https://www.diverseeducation.com/health/article/15288476/meeting-the-need-how-nursing-schools-are-addressing-the-rn-shortage-exacerbated-by-covid19
McCarthy R. (2022). FSU hopes to address nursing shortage by attracting more students to its program. https://news.wfsu.org/wfsu-local-news/2022-07-06/fsu-hopes-to-address-nursing-shortage-by-attracting-more-students-to-its-program
NACNEP report - preparing nurse faculty, and addressing the shortage of nurse faculty and clinical preceptors. (2021). https://oadn.org/news/nacnep-report-preparing-nurse-faculty-and-addressing-the-shortage-of-nurse-faculty-and-clinical-preceptors/
Nursing faculty shortage. (2022). https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage
Padilha JM et al. (2019). Clinical virtual simulation in nursing education: Randomized controlled trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447149/
The 2021 American Nursing Shortage: A data study. (2021). https://www.usa.edu/blog/nursing-shortage/
Van Dyke S, et al. (2022). Area hospitals working to combat widespread nursing shortage. https://communityimpact.com/dallas-fort-worth/keller-roanoke-northeast-fort-worth/health-care/2022/06/23/area-hospitals-working-to-combat-widespread-nursing-shortage/
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