Breaking the nursing shortage cycle

Has there ever not been a nursing shortage? Historically, the shortage has been cyclical, with some points in time of recovery. The United States has experienced nursing shortages periodically since the early 1900s. The mid-1930s are considered the official start of the nursing shortage when a combination of World Wars, economic recessions and healthcare related events increased the demand for registered nurses (RNs). According to the National Library of Medicine, Nursing shortages have been cyclic events during the 1970s, 1980s and early 1990s, with the current shortage expected to last through 2030.

Most recent projections forecast a nursing shortfall of 1.6 million qualified nurses by 2026, which may even worsen as the issues related to extreme work conditions during the pandemic continue to work their way through care facilities. All of this has taken a tremendous toll on hospitals and clinics as they try to work their way out of a vicious cycle. During the height of the pandemic and after, increased expenses related to travel nurse staffing have pushed many hospitals to the brink.

To solve staffing shortages, most nurse leaders say they “implement float pools and a mix of full-time, part-time and contingent or contract nurses. A majority of nurse leaders, 68%, are specifically turning to the use of travel or contingent nurses to fill the gaps that come from full-time nurses’ departures, according to the report.”

With the profession in a constant state of understaffing, is it any wonder that concerns over nurse burnout and skyrocketing turnover have dominated the current shortage discussion? The newest concern is that the turnover issues are no longer contained to the floor or bedside nurses. In fact, a new report by AMN Healthcare indicates that more than one-third of nurse leaders, such as CNOs, are planning to leave their leadership roles in 2024.

But Wait, It Gets Worse

Certainly not ignored, but less discussed is the impact the nursing shortage is having on patient outcomes.

1. Decreased Quality of Care: With fewer nurses available to provide care, patients may experience delays in receiving necessary treatments, medications or assistance with activities of daily living. This can result in decreased overall quality of care, as nurses may be stretched thin trying to attend to a higher number of patients, leading to potential lapses in attention or oversight— and, yes, it contributes to nurse burnout and job dissatisfaction.
2. Increased Nurse-to-Patient Ratios: As the nursing shortage persists, nurse-to-patient ratios often increase, meaning each nurse is responsible for caring for more patients simultaneously. Higher nurse-to-patient ratios have been associated with adverse patient outcomes, including increased mortality rates, higher rates of medical errors and greater risk of healthcare-associated infections. In fact, one study showed that 57.4% of nurses reported making a medication error in the past year.
3. Impact on Patient Safety: Adequate nursing staff levels are essential for ensuring patient safety. Nurses play a critical role in monitoring patients, recognizing early signs of deterioration, administering medications safely and preventing adverse events.

In so many ways, this part of the issue is the most bitter pill to swallow. Why? Because we know nurses only want to help people. A patient’s health being impacted by understaffing is quite literally the last thing a nurse wants to see happening.

A Cure for What Ails You

The issues that created the nursing shortage are complex, and the solution is equally complex. To find real solution to the shortage dilemma, we must consider the cyclical nature we’ve seen historically in workforce shortages and present out of-the-box ideas focused on breaking that cycle. Here, we examine one solution that can provide short-term relief.

Begin Onboarding Nurses Early

We believe shortsightedness regarding the recruitment and retention of new nurses has exasperated the shortage. The hallmark of those who choose healthcare as a career is that they genuinely want to help people. They are motivated by their belief systems and how things they do make themselves and others feel.In this context, cultural fit and belief in the organization are paramount to new nurse retention. So, how can a hospital or care provider showcase their culture? We believe it is during the clinical experiences offered to student nurses.

Deep partnerships with nursing colleges allow for a custom clinical program that allows the student to fully understand and embrace your culture. Making friends, feeling invested in the organization and feeling comfortable with your policies and practices all contribute to a smooth onboarding process and can improve new nurse retention.

“We have worked hard to foster deep partnerships between our organization and Concorde. We do this because the clinical experiences we offer students at Saint Francis Healthcare are an incredible recruiting opportunity for us to fill our nursing pipeline.

Our extern program allows nursing students to join our team in a paid nurse extern role after one semester of nursing school, offering up to two years of clinical experience through externship rather than the typical 8-12 week onboarding for new hires. This extended period yields numerous benefits for both students and the hospital. Students gain valuable hands-on experience that enhances their studies, helps them prepare for the NCLEX and boosts their confidence as new healthcare professionals in a hospital setting.

For the hospital, the advantages are equally significant. During the externship, we get to know the individual’s work style and suitability for the hospital environment while providing comprehensive onboarding training. Nurse externs become familiar with the facility layout, departments and operational procedures.

By contributing to their growth as nurses, we establish a solid foundation for positive employer-employee relations and aid in retention efforts. This mutually beneficial arrangement creates a win-win situation for all stakeholders, including our patients. The benefits of this approach are invaluable and contribute to a harmonious work environment,” stated Saint Francis Healthcare Market Director of Education Shaska Graham, MSN, RNC-OB.

Keeping nurses longer, even a few months longer, has a tremendous impact on patient outcomes and a hospital’s overall financial health.

Consider that an increase of just one full-time RN per 1,000 inpatient days was associated with a 4.3% decline in patient mortality. Nursing turnover costs range from $44,380 to $63,400 per nurse. This one-two punch in actual dollars and the immeasurable value of life make this an issue that cannot be ignored.

There is no silver bullet to solving the nursing shortage, but we believe starting with thoughtful and compassionate programs that treat new nurses with high regard is the place to start.

Learn more about workforce solutions models that address nursing shortage