Bensson Samuel, MD, PhD, DBA, CHCQM, CPE1 • Nicole Oliver, RN, BSN, MBA2
1Medical Director of Inpatient Services/Hospitalist Program, War Memorial Hospital, Sault Sainte Marie, Michigan
2Senior Director of Nursing Services, War Memorial Hospital, War Memorial Hospital, Sault Sainte Marie, Michigan
Samuel B, Oliver N. The US nursing shortage: opportunity to close the gap. Consultant. Published online July 15, 2021. doi:10.25270/con.2021.07.00004
Received February 27, 2021. Accepted March 2, 2021.
The authors report no relevant financial relationships.
Bensson Samuel, MD, PhD, DBA, CHCQM, 500 Osborn Boulevard, Sault Ste. Marie, MI 49783 (email@example.com)
As frontline health care professionals, registered nurses (RNs) play a critical role in the provision of patient care and support, as well as administrative duties such as recordkeeping and directing nursing care systems. Moreover, they ensure that hospitals and other health care facilities are in the best position to achieve their goals and missions. Although nursing is the largest health care profession in the United States, with approximately 3.8 million RNs practicing in 2020, the United States currently faces a shortage of RNs.1 It is projected that by 2022, there will be 100,000 new RN job openings per year—more than any other profession.2
With the ongoing COVID-19 pandemic, the growing aging population, and the increasing prevalence of chronic diseases, there is a strong need for more RNs now and in the future.
Current Trends in Nursing
Overall, the current and future shortage of RNs varies by state (Figure 1). The shortage of nursing in relation to the demand will only increase with time.3 A contributing factor to this shortage might be the age of RNs in the United States (Figure 2). The US Bureau of Labor Statistics projects that more than 500,000 RNs will retire by 2022, leaving a shortage of 1.1 million RNs across the country.2 Although the number of RNs is anticipated to increase 15% by 2026, the increase is not enough to close the gap.1
Figure 1. Supply and Demand of RNs by 2030
Figure 2.Age Distribution of RNs in the United States
In an effort to encourage medical students to join nursing programs, federal and state agencies, as well as universities, are offering incentives.4,5 NursingCAS, an American Association of Colleges of Nursing (AACN) strategy, provides a centralized nationwide registration for nursing students. In addition, financial incentives are being offered in some states to increase RN program registration.6
Another factor contributing to the trend in nursing might be the salary ranges, which vary by state, years of service, roles and duties, qualifications, and other factors (Table). Health care professionals are among the highest-paid occupations in the United States, but nurses do not rank as high as specialists.7 The annual mean wage for RNs is highest in California, Hawaii, Massachusetts, Alaska, New Jersey, Maryland, Rhode Island, and Washington8 (Figure 3). RNs in Central states, such as South Dakota and Missouri, receive the lowest annual mean wage.8
Figure 3.Annual Mean Wage of RNs by State, May 2020
The COVID-19 pandemic has also impacted the nursing profession over the past year. The US health care system is one of the hardest-hit industries by the COVID-19 pandemic. Since the onset of the pandemic in 2020, health care professionals have treated millions of patients with COVID-19.9 As frontline workers, RNs have had complex and increased responsibilities. Longer shifts, experiencing patients’ suffering, and scarcity of resources had a major impact on health care professionals overall and the RN retention rate specifically.10 Because of this, work-related stress, burnout, depression, low job satisfaction, and exposure to the virus have increased, leading to a higher turnover rate.10
Reasons RNs Leave and Proposed Solutions
Low salaries coupled with factors such as burnout, lack of work-life balance, and dual roles as parents are the major reasons why RNs leave their jobs. Currently, the average RN turnover is estimated to be 19.1%, which varies by region as well as the nursing specialty.11 The high turnover rate reduces the quality of health care services and limits hospitals’ operating abilities. Therefore, some solutions have been proposed.
RNs are choosing other, better-paying positions or roles over those that offer lower salary, which may mean relocating out of their home state. (Figure 3). The supply of nurses was not evenly distributed, with the smaller hospitals experiencing greater shortages explained partially by the lower salaries.12 Another factor is better employment contracts that offer higher hourly rates, including contracts with travel nurse companies. Many RNs are also returning to school to obtain a nurse practitioner certification, which offers better salary and often better benefits such as vacation time, retirement match, and continued education assistance. From 2019 to 2020, only 39,000 new nurse practitioners had graduated.13
As a solution to this issue, institutions can consider providing a retention bonus. Research suggests that retention bonuses help RNs feel that they are valued by their employer, as well as boost morale and foster loyalty.14 Although the COVID-19 pandemic has caused financial challenges for the health care sector, organizations that have a culture of providing merit bonuses such as end-of-year, years-of-service, or employee-of-the-month bonuses should consider still doing so. Additionally, offering current staff a recruitment bonus can help hire more RNs, as well as improve current staff engagement and satisfaction.
Burnout contributes to more than 50% of workforce turnover in all industries.15 In nursing, many factors contribute to burnout, including managing complex patients, administrative duties and responsibilities, treating and managing the aging Baby Boomer generation as well as the growing prevalence of chronic diseases, and working long shifts16 with little sleep. Many health care facilities across the country are understaffed, which has led to an increase in workload for other health care providers.17 As such, the nurse-to-patient ratio is unbalanced.18
One solution to this issue is to consider increasing the number of ancillary staff, who can provide support to RNs.19 Utilizing certified nurse aids or care technicians is key to supporting RNs and allowing them the time to devote to quality patient care, while maintaining the basic needs of the institution.
About 1 in every 10 US adults spends more than 40% of their time at work.15 RNs also struggle to balance work and life, especially those who are parents. For RNs with children, balancing homeschooling during the COVID-19 pandemic with their nursing duties and responsibilities has been a challenge because of the long shifts mandated during the pandemic. Lack of work-life balance results in stress, which is an occupational hazard that can escalate to mental and physical issues.20
To alleviate this stress, institutions should consider implementing work-life balance practices such as flexible working hours, additional paid time off, or leisure perks to promote social time with friends and family. It offers an environment away from the workplace to mentally decompress.21 Institution leaders can consider facilitating a self-activated approach as well. Cultivating a training program that focuses on avoiding burnout can be a starting point for addressing RNs’ needs and creating an effective work-life balance.
Connecting with family is important and can be a tool to mentally destress. However, the COVID-19 pandemic had caused closures of childcare and daycare facilities, which was another challenge faced by RNs who are parents. When parents do not have childcare available, their stress level increases and job productivity decreases. For parents who are RNs, this also leads to a higher occurrence of medical errors.22 To better integrate work-life balance, institutions should consider offering daycare services so that working parents know their children are safe.15
The shortage of RNs is detrimental to the US health care industry as a whole. Not only does the shortage affect productivity in the institution and patient care and satisfaction, but it also increases the burden on other health care providers and contributes to burnout throughout the industry. As a long-term solution for the shortage crisis, stakeholders in the nursing industry and individual institutions should consider implementing RN retention strategies.
1. Nursing Fact Sheet. American Association of Colleges of Nursing. Updated April 1, 2019. Accessed June 30, 2021. https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet
2. Workforce. American Nurses Association. Accessed June 30, 2021. https://www.nursingworld.org/practice-policy/workforce
3. US Bureau of Labor Statistics. Registered Nurses. Occupational Outlook Handbook. Updated June 2, 2021. Accessed July 13, 2021. http://www.bls.gov/ooh/healthcare/registered-nurses.htm
4. Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P. A nursing shortage - a prospect of global and local policies. Int Nurs Rev. 2019;66(1):9-16. https://doi.org/10.1111/inr.12473
5. Improve Your Admissions Process. American Association of Colleges of Nursing. Accessed June 30, 2021. https://www.aacnnursing.org/NursingCAS
6. Nursing Shortage. American Association of Colleges of Nursing. Updated September 2020. Accessed June 30, 2021. https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage
7. 25 highest paying occupations in the U.S. Investopedia. Published June 10, 2021. Accessed June 30, 2021. https://www.investopedia.com/personal-finance/top-highest-paying-jobs
8. Occupational Employment and Wages, May 2020: 29-1141 Registered Nurses. U.S. Bureau of Labor Statistics. Updated March 31, 2021. Accessed June 30, 2021. https://www.bls.gov/oes/current/oes291141.htm
9. Schutz V, Shattell M. Impact of COVID-19: what does it mean for nurses and health systems? J Psychosoc Nurs Ment Health Serv. 2020;58(8):2-3. https://doi.org/10.3928/02793695-20200707-01
10. Giménez-Espert MDC, Prado-Gascó V, Soto-Rubio A. Psychosocial risks, work engagement, and job satisfaction of nurses during COVID-19 pandemic. Front Public Health. Published online November 20, 2020. https://doi.org/10.3389/fpubh.2020.566896
11. Lockhart L.Strategies to reduce nursing turnover. Nurs Made Incred Easy. 2020;18(2):56. doi:10.1097/01.NME.0000653196.16629.2e
12. Serow WJ, Cowart ME, Chen Y. Hospital perspectives on nurse employment. In: Cowart ME, Serow WJ, eds. Nurses in the Workplace. Sage Publications; 1992: 117-120.
13. 2020-2021 enrollment and graduations in baccalaureate and graduate programs in nursing. American Association of Colleges of Nursing. Published 2021. Accessed July 13, 2021. https://www.aacnnursing.org/Store/product-info/productcd/IDSR_21ENROLLBACC
14. Leonard K. Importance of compensation in the workplace. Chron. Updated March 1, 2019. Accessed June 30, 2021. https://smallbusiness.chron.com/importance-compensation-workplace-38470.html
15. Montañez R. Burnout is sabotaging employee retention: three things you must know to help. Forbes. Published online June 5, 2019. https://www.forbes.com/sites/rachelmontanez/2019/06/05/burnout-is-sabotaging-employee-retention-three-things-you-must-know-to-help
16. Wake up to the facts about fatigue. KRONOS. Published 2018. Accessed June 30, 2021. https://www.kronos.com/resource/download/24266
17. Nurse burnout: risks, causes and precautions. The University of St. Augustine. Published July 2020. Accessed June 30, 2021. https://www.usa.edu/blog/nurse-burnout
18. Gutsan E, Patton J, Willis WK, Coustasse-Hencke A. Burnout syndrome and nurse-to-patient ratio in the workplace. Paper presented at: 54th Annual MBAA Conference; April 18, 2018; Chicago, IL. https://mds.marshall.edu/mgmt_faculty/196/
19. Balasubramanya B, Nisha C, Ramesh N, Joseph B. Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they? Indian J Occup Environ Med. 2016;20(1):44-47. https://doi.org/10.4103/0019-5278.183844
20. Jennings BM. Work stress and burnout among nurses: role of the work environment and working conditions. In: Hughes RG, ed. Patient safety and quality: an evidence-based handbook for nurses. Agency for Healthcare Research and Quality; 2008. https://www.ncbi.nlm.nih.gov/books/NBK2668/
21. Mullen K. Barriers to work-life balance for hospital nurses. Workplace Health Saf. 2015;63(3):96-99. https://doi.org/10.1177/2165079914565355
22. Melnyk BM, Tan A, Hsieh AP, et al. Critical care nurses' physical and mental health, worksite wellness support, and medical errors. Am J Crit Care. 2021;30(3):176-184. https://doi.org/10.4037/ajcc2021301
How can we solve the problem of nursing shortage? ›
The nursing shortage cannot be solved unless higher education institutions train more nurses. Research and interviews with experts present ample evidence that capacity within higher education is significantly lower than what is needed.How is the US nursing shortage being addressed? ›
In response to this national shortage, states have examined a variety of options to recruit and retain nurses. Specific policy levers include loosening licensing requirements, changing scope of practice laws, bolstering educational programs, and offering monetary incentives.What are the reasons for nursing shortages in the United States? ›
- Rising demand to provide care for an aging population.
- Older nursing workforce approaching retirement.
- Shortage of trained nurse educators and faculty.
- High turnover rate.
In the mid-1930s, reports of an emerging nurse shortage began surfacing throughout the United States. Mercy Hospital School of Nursing class of 1936Many in the health-care field greeted news of this shortage with surprise.What are the solutions for shortage? ›
- Expedite Parts. ...
- Improve Forecasting. ...
- Improve Lead Time Accuracy. ...
- Eliminate Single Point Failures. ...
- Develop a Shortage Attack Team (or better shortage management processes) ...
- Improve Supplier Collaboration. ...
- Ensure accurate inventory data. ...
- Regularly update PFEP.
Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities; and. Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs.Why should we care about the nursing shortage? ›
Nursing Shortage and Medical Errors
The nursing shortage contributes to both patient care and outcome. High patient-to-nurse ratios have a direct impact on medical errors. An increase in a nurses workload paired with stress puts a patient's care at risk.
Nursing shortages have been a problem for decades and will persist well after Covid-19 subsides. Not only is the US population aging, but nurses themselves are getting older. Some researchers estimate that 1 million registered nurses will retire by 2030.What is a good thesis statement for nursing shortage? ›
Thesis Statement Research suggests that the nursing profession faces shortages because of insufficient potential educators and high turnover in the sector.Which factors affect the nursing shortage? ›
- Low salaries for educators compared to clinicians;
- Age-delayed trajectory of nurses obtaining higher levels of education;
- Late point in career development for entering educative roles;
- Inability to fill open faculty roles;
How does the nursing shortage affect the economy? ›
The nursing shortage also has financial impacts on healthcare institutions. Nurses' salaries must be competitive to attract applicants. As the shortage fuels burnout and frustration among nurses, turnover rates increase, reportedly costing the healthcare industry at least $4.2 million a year.What state has the biggest shortage of nurses? ›
California has the worst nursing shortage in the United States. It's predicted that by 2030, California will be in need of over 44,000 nurses. Other states with major hospital staff shortages include New Mexico, Vermont, Rhode Island, West Virginia, and Arizona.Is there a true nursing shortage? ›
The Bureau of Health Workforce projects that California will face the largest nursing shortage of any state, with a projected shortfall of 44,500 nurses by 2030.How would you define the nursing shortage? ›
A nursing shortage means that there is a high demand for registered nurses, but there are not enough qualified individuals to fulfill the demand. This means we are lacking skilled nurses who can provide critical and essential care for patients in need.How can the government solve the problem of shortage in the market? ›
Supply chain with regulations. On the demand side, because supply shortages can be caused by panic buying, the government can regulate consumer purchasing by limiting the quantity of a product that can be bought to the essential value. We call this purchase regulation.How will you solve the problem of shortage and surplus? ›
If a surplus exist, price must fall in order to entice additional quantity demanded and reduce quantity supplied until the surplus is eliminated. If a shortage exists, price must rise in order to entice additional supply and reduce quantity demanded until the shortage is eliminated.How can staff shortages be resolved? ›
- Invest in training. ...
- Expand the search. ...
- Consider taking on apprentices. ...
- Rethink the workforce. ...
- Focus on staff retention.
The six key actions to implement the medicine shortage-reducing strategies are: (1) initiate a biannual forum for hospitals and industry; (2) establish a medicines substitutes information service operating nationally; (3) share information on likely changes to hospital usage; (4) reform stock allocation strategies; (5) ...What drug is currently in shortage 2022? ›
On October 12, 2022, FDA posted a shortage of the immediate release formulation of amphetamine mixed salts, commonly referred to by the brand name Adderall or Adderall IR, on our drug shortage website.How can we reduce the cost of medicine in the US? ›
- Generic Medications. ...
- Different Medication Choice. ...
- Different Pharmacies. ...
- Coupon Savings. ...
- Patient Assistance Plans. ...
- Don't Skip Important Medications.
What will happen if the nursing shortage is not addressed? ›
If this shortage is not addressed, patients may experience more negative health outcomes. Studies, such as Spetz's 2011 article in Medical Care, show that higher nurse staffing protected patients from poor outcomes.What is the biggest problem in nursing today? ›
“Staff shortages brought about by cost-cutting decisions, an aging population, increased patient complexity and need, and an aging workforce place stress on working conditions for nurses and affects patient care and overall outcomes,” the ANA says.
The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system.Will nurses be replaced in the future? ›
Robots and automated tech will essentially just be another tool for nurses to bring increased efficiency to their jobs, and while there are many exciting developments coming out of the healthcare tech industry, including those that make nurses jobs easier, it's probably safe to say that you won't be out of a job ...What challenges will nurses face in the future? ›
Burnout, Compassion Fatigue, and COVID-19
Epidemic burnout was recognized long before COVID-19, and with countless nurses slogging away on the front lines for over a year, we must be on increased lookout for burnout in ourselves and our colleagues.”
According to the report, as many as 13 million more nurses may be needed by 2030; the world's current nursing workforce totals approximately 28 million. The report explains that taking action to sustain and retain workers could minimize the shortage.What are the future trends in nursing? ›
A projected shortage of is poised to impact the industry. The U.S. Bureau of Labor Statistics (BLS) projects 9% job growth for registered nurses (RNs) and 45% job growth for nurse practitioners, nurse midwives, and nurse anesthetists between 2020 and 2030.What is a good topic for nursing Research? ›
- Antibiotics impact on childhood immunities.
- Effects of childhood exposure to environmental pollutants.
- Effects of second-hand smoke inhalation in early life.
- Ethics of pediatric care.
- Genetic factors of diabetes in children.
- Has neonatal care improved in the last 50 years?
- Trend #1: Nurse shortage will continue. ...
- Trend #2: Nursing jobs numbers will continue to increase. ...
- Trend #3: Increased use of online nursing programs. ...
- Trend #4: Nurses will need higher education, focused on BSN degrees. ...
- Trend #5: The rise of telemedicine.
- An aging baby boomer population. ...
- The Affordable Care Act. ...
- Nursing faculty falling behind. ...
- Experienced nurses exiting the workforce.
How do nurses help the economy? ›
Nursing also provides services with economic value—nursing care generates payment to hospitals, home health agencies, nursing homes, clinics, and other providers; nurses help to decrease hospital lengths of stay, prevent illness, errors, complications and readmissions, all of which saves money for providers and health ...How do nurses contribute to the economy? ›
The value of national productivity when nurses help patients recover more rapidly is conservatively estimated at $231 million (or $1700 per additional RN per year). Medical savings (before increased nursing labor costs) is estimated at $6.1 billion (or $46,000 per additional RN per year).Which country needs nurses the most? ›
- Canada. Average Annual Nursing Salary: $71,590. ...
- Switzerland. Average Annual Nursing Salary: $85,927. ...
- Australia. Average Annual Nursing Salary: $75,000. ...
- Ireland. Average Annual Nursing Salary: $42,000. ...
- United States. Average Annual Nursing Salary: $75,300. ...
- Chile. ...
- New Zealand. ...
The San Jose — Sunnyvale — Santa Clara, California, metro area pays RNs the highest-average salary in the United States. According to BLS data, RNs in San Jose — Sunnyvale — Santa Clara metro area make $155,230 annually, which is $72,480 higher than the national average.Which state has the lowest salary for nurses? ›
As of 2021, Hawaii tops the list at 119.3, while Mississippi comes in lowest, at 87.8. Adjusting each state's average RN salary by its cost of living index gives us a potentially more accurate means of comparing where nurses get paid the most.Why nurses are leaving the profession? ›
Unprecedented stress brought on by the COVID-19 pandemic has prompted many nurses to leave the profession early and retire from their current positions. This is on top of those who are already close to retirement age. Most nurses have decided to retire early due to physical and emotional demands.What state needs nurses the most? ›
California tops the list with an estimated 44,500 deficit in registered nurses, nearly three times the deficit in the next shortest state. Texas, New Jersey and South Carolina will lack more than 10,000 RNs; Alaska, Georgia and South Dakota will each be short several thousand.How can we improve nursing care? ›
- Show respect. ...
- Express gratitude. ...
- Enable access to care. ...
- Involve patients' family members and friends. ...
- Coordinate patient care with other providers. ...
- Provide emotional support. ...
- Engage patients in their care plan. ...
- Address your patients' physical needs.
- Step 1: Identify and Define the Problem. ...
- Step 2: Analyze the Problem. ...
- Step 3: Develop Solutions. ...
- Step 4: Analyze and Select the Best Solution. ...
- Step 5: Implement the Solution. ...
- Step 6: Evaluate the Solution.
In nursing internationally, problem-solving skills (PS) have been introduced as a key strategy for better patient care . Problem-solving can be defined as a self-oriented cognitive-behavioral process used to identify or discover effective solutions to a special problem in everyday life.
How can the nursing sector be improved? ›
Some of these include mainstreaming of nursing education with medical education, instituting common entrance exams, review and revision of Indian Nursing Act, institution of a nursing practice act, reducing income disparity, improving nurse – patient ratio in hospitals to improve their work life balance, grooming ...How can the US improve healthcare? ›
- Focus on Improving Health. ...
- Tackle Racial Disparities. ...
- Expand Telehealth and In-Home Hospital Services. ...
- Build Integrated Systems. ...
- Adopt Value-Based Care.
They Use Their Experience to Advocate for Others
Nurses use their voice and experience to advocate for patients within their health-care team, ensuring they get the care they need. Nurses also play a key role in shaping hospital-wide policies for approaches that help patients and their families.
Nursing shortages lead to errors, higher morbidity, and mortality rates. In hospitals with high patient-to-nurse ratios, nurses experience burnout, dissatisfaction, and the patients experienced higher mortality and failure-to-rescue rates than facilities with lower patient-to-nurse ratios.What are the 7 problem-solving techniques? ›
- Identify and define the problem.
- Come up with possible solutions.
- Evaluate the options.
- Choose the best solution.
- Implement the solution.
- Evaluate the outcome.
According to Roach (1993), who developed the Five Cs (Compassion, Competence, Confidence, Conscience and Commitment), knowledge, skills and experience make caring unique. Here, I extend Roach's work by proposing three further Cs (Courage, Culture and Communication).What are the 4 types of problem-solving strategies? ›
- Guess (includes guess and check, guess and improve)
- Act It Out (act it out and use equipment)
- Draw (this includes drawing pictures and diagrams)
- Make a List (includes making a table)
- Think (includes using skills you know already)
Some barriers do not prevent us from finding a solution, but do prevent us from finding the most efficient solution. Four of the most common processes and factors are mental set, functional fixedness, unnecessary constraints and irrelevant information.What are the 4 types of problem-solving? ›
Book Review: Four Types of Problems
- Type 1: Troubleshooting. ...
- Type 2: Gap from standard. ...
- Type 3: Target condition. ...
- Type 4: Open-ended.
Pursuing new job roles
“Nurses with baccalaureate education often step into leadership positions early in their career,” Hawkins says. This can include RN jobs in different or more specialized departments, management positions, educator roles, or advanced practice registered nurse (APRN) titles.
What are some opportunities for improvements in healthcare? ›
- Collect Data and Analyze Patient Outcomes. If you can't measure it, then you can't manage it. ...
- Set Goals and Commit to Ongoing Evaluation. ...
- Improve Access to Care. ...
- Focus on Patient Engagement. ...
- Connect and Collaborate With Other Organizations.
The U.S. Bureau of Labor Statistics (BLS) projects 9% job growth for registered nurses (RNs) and 45% job growth for nurse practitioners, nurse midwives, and nurse anesthetists between 2020 and 2030. Both percentages are significantly higher than the 8% average growth projected for all professions for the same period.