While COVID-19 has exacerbated the shortage of nurses in the US, the shortage precedes the pandemic by decades. Nurses across healthcare specialties have been in consistently high demand for many decades, and the current shortage, as the Baby Boomer generation continues to age (effectively converting them from nurses to patients themselves), has continued from around 2012. Some reports estimate that to fully cover our shortage by 2030, 1.2 million RNs will be needed. Yet, entry-level nursing programs are insufficient to meet the schooling demands for new nurses, especially as they continue losing experienced faculty.
Though the nursing profession was already experiencing changes prior to COVID-19, the pandemic accelerated some trends and initiated others. Many senior nurses retired early, and others became seriously ill or quarantined themselves. Short-staffed health systems that could afford to do so offered high pay for travel nurses to supplement their functions, directing nurses away from lower-paying systems. All this increased demand and reduced supply while making the nursing budget line item more costly. One hospital in Arkansas is offering a $25,000 signing bonus for nurses, while the largest health system in Florida is paying retention bonuses on top of overtime pay — and still needs to supplement with agency hires.
Shortages are especially critical in highly specialized settings like oncology, where patients are also immunocompromised and nurses who qualify to care for them can’t safely transfer back from COVID-exposed facilities. This creates a vicious cycle that burns out nurses and leads to even greater shortages. If this cycle continues unabated, nurse shortages will reach a critical level, likely impacting the quality of care and patient safety.
The Nursing Shortage “Cognitive Dissonance”
Despite all of this, many healthcare institutions operate in a state of denial. Patient scheduling templates continue to be built for the number of nurses “on the schedule,” though very few days are actually fully staffed. Department heads failing to meet operations targets explain that their issues will be resolved “as soon as we fill our remaining nursing vacancies,” while having no sustainable means to fill them. Nursing managers live in a constant state of relief when they have filled open vacancies – only to have more existing nurses resign before their new hires can actually start.
Said simply, healthcare is treating the nursing shortage like an acute problem; it’s time for the industry to start treating it as a chronic condition, which means looking for new solutions to this old problem.
A realistic approach for realistic solutions
What does it mean to treat the nursing shortage as a “chronic condition?” It means that, unless a system has unlimited resources to dominate the supply and demand game, it must assume that the nursing levels they currently have are likely to be the nursing levels they will have for the foreseeable future. This has serious implications when it comes to patient care and the ability of systems to handle even their current patient loads – even independent of COVID-19 related spikes.
When health system leaders and planners start from the assumption that more nurses aren’t coming, they can begin the sort of problem-solving that leads to lasting change. While simply reducing the number of patient appointments would resolve some issues, it would create a host of new, long-term problems, including both revenue and access. Instead, hospitals must treat nurses just as they treat other valuable assets, and figure out how to use them most efficiently.
In infusion centers, many have found ways to tackle this issue and see more patients with fewer nurses – without a reduction in nurse satisfaction. Nurses are able to take their lunches and breaks, as well as leave at their scheduled end time. It’s not magic, either- it’s just math.
The process starts by creating realistic nursing templates that reflect the number of nurses who are actually likely to be available on a given day. Then, using sophisticated data algorithms that incorporate a center’s historical patient volumes and mix, patient schedules are generated that level-load the day’s patients in novel ways, thus avoiding the common 11 am-2 pm patient traffic jam that results in no chairs available, overwhelming patient loads, and forfeiture of lunch and breaks.
This is just one example of how hospitals and other facilities that depend on nurses can start to adapt in a more permanent and comprehensive way to what is clearly a chronic problem.
Shooting the Nursing Sacred Cows
There’s not one single or simple solution to nurse shortage, but health systems have to start somewhere.
For example, what would happen if some of the considerable time, energy and money that currently goes (often fruitlessly) into filling nursing vacancies was redirected into programs that support the nurses who are already employed? What would change if every member of the hospital staff was allowed to work at the highest level of their licensure/certification? Would there be things that could be handled by non-RNs (or even non-LPNs, etc.) that are considered “nurse only” jobs today?
Or, what if healthcare systems began experimenting with the same flexible work arrangements that non-healthcare employers have already adopted? Would nursing shifts that run from 9 am to 3 pm attract back parents who previously left the profession when they couldn’t reconcile traditional nursing schedules with traditional childcare options? Could hospitals partner directly with local daycares to provide childcare options that offer the same hours as traditional nursing shifts, including having coverage for unexpected overtime?
There are so many more ways to approach the problem that has the potential to solve the problem better than the current Nursing Arms Race (i.e. who can pay the most) has. Many of these options will require hospitals to address outdated norms and assumptions and be willing to challenge them. This is something the healthcare industry often struggles to do well, l, but in this case, it’s not only worth it – it’s essential to healthcare’s future.
About Ashley Joseph
Ashley Joseph comes to LeanTaaS with over 20 years of service operations experience. She was integral to the early creation and building of the service operation practice at McKinsey & Company, where she served clients in the financial services, insurance, retail, energy, and healthcare industries. For over a decade, she owned and operated a chain of service-based franchises. Ashley has a bachelor’s degree from Georgia Tech and an MBA from Harvard Business School.
