Post-Pandemic Nursing Shortage Affecting Aspiring Nurses
The aftermath of the 2020 pandemic has significantly affected the nursing profession, contributing to a global shortage of nurses. 
This shortage has far-reaching implications for healthcare systems, particularly in terms of nursing practice. Nurses play a crucial role in patient care and protection, as exemplified during the COVID-19 pandemic. However, alongside the acknowledgment of their importance, a concerning trend of a growing shortage of nurses has emerged. In the United States alone, projections indicate a need for 1.1 million new nurses to replace those retiring by 2022, while globally, the demand is estimated to be as high as 13 million. For nursing students, this shortage presents both opportunities and challenges. On the positive side, graduates may find employment quickly, given the high demand. However, the downside is that nursing programs are experiencing reduced capacity, making acceptance into these programs more competitive.
Examining the Causes and Consequences of the Nursing Shortage
To comprehend the implications of the nursing shortage, it’s essential to address some commonly asked questions and dispel misconceptions surrounding its origins and impact on healthcare. Identifying the challenges faced by the nursing workforce is crucial for devising potential solutions in the post-pandemic era.
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Causes of the Nursing Shortage:
Professional nursing organizations and published studies have identified the following factors:
1. Aging Population: The strain on the workforce is exacerbated by an aging population, which tends to have multiple chronic diseases.
2. Aging Workforce: The retirement of older nurses, both voluntary and incentivized, has contributed to the shortage.
3. Nurse Burnout: High workload, low staffing, and extended shifts have led to nurse burnout, affecting patient care.
4. Family Obligations: Most nurses are women, constituting the majority of the workforce. According to the U.S. Bureau of Labor Statistics (BLS), only 12.6% of working nurses are men. Notably, Villanova University reported that 20% of its incoming nursing students in 2021 are men, indicating a growing but still underrepresented male presence in the field.
The absence of family care benefits poses a significant challenge, particularly for women nurses who are also working parents. This circumstance may lead many to consider reducing their work commitments or even leaving the profession altogether to prioritize the care of their families. The lack of supportive policies in this regard may contribute to a potential loss of skilled and experienced women nurses from the workforce.
5. Nursing Educators: Shortages in nursing faculty limit the number of students a program can admit, with retirements and a lack of incentives contributing to the faculty shortage.
Current Status of the Nursing Shortage:
The American Nurses Association predicts that nursing will see more job opportunities in 2022 than any other profession. The Bureau of Labor Statistics anticipates a 9% job growth rate for registered nurses from 2020 to 2030, slightly above the average. Certain U.S. states, such as California, New Jersey, South Carolina, Alaska, and Texas, are facing severe nursing shortages.
What Does the Nursing Shortage Mean for Healthcare?
Various factors play a pivotal role in determining staffing requirements within healthcare settings. These factors encompass the severity of patient illnesses, the volume of patients, and the proficiency of the staff, considering the experience levels of seasoned nurses as opposed to recent graduates. The repercussions of staffing shortages reverberate through patient outcomes, with elevated nurse-to-patient ratios correlating with an increased likelihood of medication errors and heightened morbidity and mortality rates.
Data further indicates a 15% surge in a patient’s risk of infection when a unit is inadequately staffed. Moreover, escalated nurse-to-patient ratios are linked to higher readmission rates, particularly in the pediatric demographic. The intersection of staffing deficiencies and a global pandemic exacerbates challenges by fostering nurse burnout and diminishing patient satisfaction. The repercussions extend to the financial realm as staffing shortages impact a hospital’s reimbursement levels. While the pandemic intensified the demand for additional nursing personnel, it concurrently decreased funding for hospitals, leading to staff layoffs.
In the initial phases of the pandemic, hospitals redirected resources towards COVID-19 patients, necessitating the cancellation of elective surgeries. Simultaneously, a significant portion of non-COVID patients opted to avoid hospitals altogether. This confluence of events resulted in reduced hospital funding and subsequent administrative decisions to furlough nursing staff, thereby contributing to the persisting staffing shortages.
The Global Landscape of Nursing Shortages
Nursing shortages transcend geographical boundaries and extend beyond the confines of the United States. The International Council of Nurses (ICN) Policy Brief, released in 2020, underscores the global scope of the issue. Despite having 27.9 million nurses worldwide, the ICN estimates a shortfall of 5.9 million nurses.
Alarmingly, 89% of these shortages are concentrated in low- and lower-middle-income countries, perpetuating healthcare disparities. Additionally, 17% of nurses anticipate retiring by 2030, adding another layer of complexity to the shortage. The report emphasizes the need for 4.7 million nurses to sustain the existing workforce, while an additional 10.6 million nurses are required to fill the void left by retiring professionals, not factoring in losses due to the impact of COVID-19.
Retirement poses just one facet of the multifaceted challenge. Addressing each contributing factor is imperative to mitigate the global nursing shortage and bridge the existing gaps in healthcare staffing.
Global Impacts of COVID-19 on the Nursing Shortage:
The COVID-19 pandemic has exacerbated existing disparities in healthcare and further contributed to the nursing shortage. Measures such as telehealth nursing, while expanding healthcare reach, cannot replace the essential care provided by bedside nurses. Countries have attempted to address the shortage by encouraging retired nurses to return or reinstating their licenses. However, factors such as heavy workloads, burnout, and stress continue to contribute to the growing nursing shortages globally.
Infection rates and deaths, particularly among nurses in close contact with severely ill COVID-19 patients, have further strained the workforce. The International Council of Nurses estimates that up to 13 million additional nurses are needed globally to fill the widening gap caused by various contributing factors.
COVID-19 Is Increasing Nurse Burnout
No profession or career path is devoid of stress. Each decision a nurse makes carries the potential to influence the well-being of their patients.
The advent of COVID-19 has exacerbated this stress. The International Council of Nurses (ICN) anticipates that this additional burden will escalate burnout and post-traumatic stress disorder among nurses, potentially causing significant harm, especially to the nursing workforce.
Nurse burnout, a state of mental, physical, and emotional exhaustion often triggered by work-related stressors, manifests initially as detachment and disengagement. As it progresses, nurses may resort to using food, drugs, or alcohol as coping mechanisms. Physical symptoms such as headaches or stomach problems may also surface.
The repercussions of nurse burnout extend to various health conditions, including insomnia, heart disease, high blood pressure, and Type 2 diabetes. Furthermore, burned-out nurses are at risk of providing substandard care, contributing to errors and, in some cases, fatalities. Research from Marshall University indicates a higher correlation of burnout and a 7% increase in mortality for each additional patient beyond four that nurses care for during a shift.
An online survey identified a significant contributor to burnout during the COVID-19 pandemic as a decreased sense of well-being. The survey also assessed staff resilience, defined as “the ability to cope with and adapt positively to adversity.” Factors associated with diminished well-being included low resilience, perceived inadequacy of personal protective equipment, and the perception of an increased workload.
A study from India found that nurses with higher resilience levels had a lower risk of burnout. The ICN report underscores substantial concern regarding the strain imposed by COVID-19 on the healthcare system, expressing worry about the mass trauma experienced by nurses and its potential long-term effects on the nursing workforce.
Hostile working conditions intensified by COVID-19
Nurses have faced a surge in workplace physical violence and verbal abuse during the COVID-19 pandemic, as families of patients felt helpless in the face of their loved ones’ illnesses.
A study examining nurses‘ experiences with workplace violence during the pandemic revealed alarming statistics. An online survey of registered nurses (RNs) working in hospitals from February to June 2020 found that 44.4% reported experiencing physical violence, and 67.8% reported verbal abuse. The incidence of violence was higher among nurses caring for COVID-19 patients compared to those who did not. The researchers recommend that hospital administrators acknowledge the heightened risk of workplace violence for nurses and urgently implement preventive measures.
Similar results were found in a study of nurses working in Iran, where increased incivility was reported. Nurses noted that patients’ families, initially uncooperative due to a lack of understanding of healthcare practices, showed improved behavior after education. The study also revealed a rise in emotional and physical abuse during the pandemic, exacerbating an already stressful environment.
What the Shortage Means for Future Nurses
While it may seem that the shortage creates opportunities for nursing graduates, the reality is nuanced. Job prospects vary depending on geographical location, with states experiencing significant shortages often having rural areas where attracting experienced nurses is challenging. Opportunities also hinge on experience and skill level.
Nursing shortages have profound effects on working conditions, patient outcomes, and the long-term health of nurses. They lead to extended shifts, higher nurse-to-patient ratios, increased stress, fatigue, and a higher risk of injury for nurses. Furthermore, understaffing can compromise patient care.
The Shortage Impacts Nurse Working Conditions
The shortage’s impact is not uniform across nursing specialties, with higher shortages observed in labor and delivery, critical care nursing, geriatric nursing, and nurse education.
Some regions exhibit higher demand for nurses than others, with the West and Mountain regions of the U.S. experiencing faster growth potential compared to the Northeast and Midwest. The U.S. Health and Human Services identifies states with the most significant nursing shortage gap, including those with high retirement populations like Florida, California, and Texas.
Despite regional variations, the Bureau of Labor Statistics (BLS) projects an outstanding 52% growth rate for nurse practitioners from 2020 to 2030, much faster than the average job growth rate. The growth rate for registered nurses (RNs) is estimated to be 9% during the same period, slightly above average. This may be influenced by challenges faced in nursing education.
Increased Interest in Nursing School, But Challenges Persist
The pandemic has sparked heightened interest in nursing careers, as evidenced by a surge in student applications. However, despite the increased interest, nursing schools faced challenges admitting qualified applicants. As the population ages, there will also be growth potential in areas with high retirement populations. In fall 2020, 80,521 qualified applicants were turned away due to a shortage of teaching faculty and clinical sites.
This situation mirrors previous years, with 80,407 qualified applicants turned away in 2019 for similar reasons. Nursing schools grapple with a shortage of educators, with 1,637 vacant positions in 892 nursing schools, many requiring or preferring candidates with doctoral degrees.
Increased Interest in Nursing Education, Yet Numerous Qualified Applicants Face Rejection
The inclination toward a nursing career saw a notable upswing amid the pandemic. As per a study by the American Association of Colleges of Nursing (AACN), applications from students surged, leading to heightened enrollment in bachelor of science in nursing (BSN), master of science in nursing (MSN), and doctoral nursing programs during the fall of 2020.
Despite the surge in interest, a staggering 80,521 well-qualified applicants found themselves unable to secure admission. This figure encompasses:
- 66,274 applicants for BSN programs
- 1,376 for RN-to-BSN programs
- 8,987 pursuing MSN degree programs
- 3,884 vying for doctoral programs
The primary reason for rejecting applicants stemmed from a shortage of teaching faculty and available clinical sites for nursing students.
The AACN reveals that in 2019, a comparable situation unfolded, with nursing schools turning away 80,407 qualified applicants, driven by similar challenges such as a scarcity of clinical and classroom space. Another report identified a shortage of 1,637 educators in 892 nursing schools, with many vacant faculty positions necessitating or preferring a doctoral degree.
Global Initiatives Aim to Boost the Nursing Workforce
In response to the nursing shortage, the International Council of Nurses (ICN) has urged national nurses’ associations and governments to take action. Their estimates indicate that 74% of associations have committed to addressing the issue at a national level, with 54% focusing on retaining the existing nursing workforce.
Nursing associations have observed a 20% increase in the number of nurses leaving the profession in 2020, raising concerns about the emotional and physical toll endured by nurses during the pandemic and exacerbating the expected nursing shortage.
Furthermore, there is a projected 3-4 year gap in the nursing shortage before new graduates enter the workforce. During this period, national nursing associations worry that the heightened workload and stress may lead to a further exodus of experienced nurses.
Necessary Changes for Ensuring On-the-Job Safety for Nurses
The experiences of frontline nurses caring for COVID-19 patients have motivated many individuals to pursue nursing careers, emphasizing care and protection. To bridge the shortage gap, the ICN has proposed several measures:
– Safeguard the safety and well-being of current and future nursing staff
– Provide psychosocial support to bedside nursing staff
– Allocate time and resources to long-term strategies for increasing the nursing workforce
– Invest in the recruitment, retention, education, and training of nurses
– Enhance wages and working conditions to prevent local nurses from seeking opportunities in higher-income countries
– Prioritize fair pay for all nurses
Nurses Can Advocate for Change
Nurses play a crucial role in advocating for changes at both local and federal levels. The American Nurses Association (ANA) has developed an activist toolkit, providing action plans for nurses to support their profession.
The ANA offers one-click options for nurses to communicate with legislators, either encouraging change or expressing gratitude for their efforts. Key federal priorities include addressing the opioid epidemic, combating workplace violence, ensuring safe staffing, and transforming the health system. Nurses can gain more insights into each initiative through the ANA site.
The Uncertain Post-Pandemic Future
The trajectory of the nursing shortage remains uncertain. Elevated numbers of nurses leaving the profession due to:
- escalating stress leading to burnout
- workplace abuse contribute to the uncertainty.
While there is substantial job growth for nurses and nurse practitioners, with a continuous abundance of nursing positions, the imbalance between the demand for nursing education and the capacity of schools to accommodate applicants persists. The pandemic has indeed inspired many to pursue nursing programs, but the challenge lies in the insufficient availability of clinical sites and faculty to accommodate the influx.
For those experiencing burnout symptoms, taking proactive self-care steps for nurses is advised to avoid reaching a point where quitting becomes the only recourse.
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