What Will it Take to Fix the Nursing Shortage?
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Nursing shortages are serious business for everyone involved. It’s serious for patients; it logically follows that having less health care professionals on the job leads to poorer patient outcomes, and studies bear that out:
Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes… Some adverse patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality.
But it’s also serious for nurses. Less total nurses means an ever-growing amount of work is spread out over an ever worsening nurse/patient ratio; that means more work for any individual nurse. It means harder, longer hours in a job that’s never been considered easy. Studies that check in with nurses find that the vast majority of them answer in a way that indicates they are - as you’d expect - under an awful lot of stress.
In the March-April 2005 issue of Nursing Economics, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%).
A nursing shortage, in short, isn’t something anyone can afford to be unconcerned about. On one hand, it’s as serious as life; people’s survival is inextricably linked to adequate care. On the other hand, it affects lives even where it doesn’t threaten them; where the shortage causes longer hours and worse scheduling, nurses bear the load. Talking about what is causing the issue and potential solutions is important.
The Implications of Age and The Baby Boomers
When we talk about synergy, it’s usually hopefully; we tend to think of it as good things compounding with other positives to create results larger than the sum of the individual factors. But more often than we’d like we also see a synergy of negative factors where various bad things pile up to make an even larger problem.
The most relevant example of that here is one of the larger chunks of our population reaching retirement age. This first and foremost means that a large portion of our population is set to need an increasing amount of care:
The shortage threatens to collide with the impending retirement of the baby boomers, all of whom will be 65 years old by 2030, said the survey titled "A Challenging Decade Ahead." People over 65 are hospitalized three times as often as middle-aged individuals, according to the Center for Disease Control and Prevention.
But it also has another equally negative effect; we are about to lose a large amount of nurses as those from the baby boomer generation reach retirement themselves:
A third of the nurses who took the survey are baby boomers and 20% of survey takers said they planned to retire in the next five years. More than a quarter, 27%, said they were unlikely to be working at their current job in a year.
A less obvious implication of this is that we are also about to lose a large chunk of what are by-and-large our most experienced nurses. These are the nurses that have been in the industry the longest, have the most experience and know the most as a group. Nurses in the age-cohort below them will of course step up, but there’s necessarily less of them.
Nurses are Burning Out
Nursing is inherently hard work, and there has never been more demand for their time. As noted above, some of this demand comes from demographics, but COVID-19 has stretched an already burdened labor force even further. Health care facilities are battling the effects of their burnout by increasing pay:
The average annual salary for registered nurses, not including bonus pay such as overtime, grew about 4% in the first nine months of the year... That is up from the 3.3% increase in average annual nurse wages in all of 2020 and 2.6% growth the year before the pandemic, according to the U.S. Department of Labor.
This is a good step to take, but it’s apparently not enough; the same article reports that turnover is higher despite increases in pay:
Nurse turnover rates have increased to about 22% this year, compared with an annual rate of around 18% in 2019, the last year before the pandemic, says Premier.
Turnover rates don’t necessarily indicate nurses leaving the profession entirely. But those numbers look bad, as well:
About 20% of health care workers have quit during this period, he said, and 4 out of 5 of those who remain say that staff shortages have affected their ability to work safely and to satisfy patient needs. Research estimates that burnout cost the health care system about $4.6 billion a year before the spread of COVID-19, Dzau said, and that number has surely risen since then.
Looking for Solutions
As negative as all this is, solutions are certainly possible. Increasing pay is certainly a good step, but some health care facilities are going beyond that in terms of looking for solutions. From the WSJ article quoted above:
The Providence system, which has raised some nurses’ wages to keep their salaries competitive, is offering nurses more time off and greater schedule flexibility to combat burnout, new career development opportunities and other non salary perks to attract and retain staff, Mr. Till said.
These actions hit on some of the more subtle, complex aspects of the issue: It’s not just pay, or just the hours. It’s a combination of schedule, exhaustion, salary and perhaps a dozen other issues working together to make things difficult, and any real solution has to address all these things.
Not only do these issues have to be addressed adequately enough to convince the nurses currently in the industry to stay (and, make no mistake, they are humans with real limits like any of us) but also to convince the next batch of potential nurses to pursue the field; it has to look like a good enough job to be worth the years of difficult and expensive education it takes to qualify for the position. And that’s if they can even get into nursing schools, which are facing shortages of their own in finding educators willing to take a pay cut to teach.
How Clipboard Health Helps
Clipboard Health doesn’t claim to be able to solve all these problems, but we do help; and this help comes in a variety of forms:
Of course,
Compensation. As we’ve previously spoken about, Clipboard does its best to even out imbalances between the demand for nurses (and what’s expected of them) and the pay they are offered. We feel that better-compensated nurses are more likely to stay in the field, and that being correctly valued makes it easier to do good work.
Schedule. Nobody benefits when a nurse burns out and leaves the field; it’s one more vacancy for a health care facility to try and fill, one less caretaker for the vulnerable and ill, and significantly one more nurse changing plans and looking for work outside of their preferred industry. Giving nurses the ability to control their schedule and make healthy, sustainable choices for themselves is a huge part of what we do, and a positive factor for nurses necessarily making hard choices.
Working conditions. Not all health care facilities can move quickly to make the kind of changes nurses need to see. Giving nurses the ability to work only at the facilities they choose helps to maximize their working conditions, while giving health care facilities more incentive to improve working environments.
This isn’t enough, but we also aren’t done: we work every day to find less obvious but equally important ways to make nurses’ lives and careers better. Solving this problem completely will take more than just Clipboard Health; our society as a whole might need to take a long look at the causes of the shortage and be willing to do what’s necessary to solve the problem. But for now, we are proud to be contributing in any way we can; the nurses we serve deserve it.