The Nursing Shortage and Patient Safety

Nursing shortage statistics continue to show that the healthcare industry still has an urgent need for nurses. According to the American Association of Colleges of Nursing (AACN), the current shortage of RNs in the U.S. is expected to continue trending upward. The U.S. Bureau of Labor Statistics projects 194,500 average annual openings for registered nurses, and nurse employment will grow 9% through 2030. At the same time, more nurses will retire, with more than one-fifth of the nation’s nursing workforce considering retirement within the next five years. Because of these ongoing trends, healthcare organizations and the nursing community must work collaboratively to find ways to examine the link between the nursing shortage and patient safety.

Patient safety is a fundamental goal of all health care. It is the goal of every healthcare organization, provider, and clinician and the indicator to patients that they can place their trust in your health system, hospital, or practice. Unfortunately, even if every practicing healthcare professional is performing at a high level, nursing shortages can compromise even the highest levels of care.

Insights into the nursing shortage

Compensating for the current nursing shortage while preparing for an increased future demand for nurses is a complex challenge. With the combined effects of many different factors, only a multifaceted approach will succeed. Here are some of the main causes:

More nurses retiring

The youngest Baby Boomers will reach the age of 65 in 2029, bringing the percentage of Americans of retirement age to around 20%, compared to only 14% in 2012. This category includes veteran nurses who will leave the healthcare industry and begin retirement. Healthcare organizations will need to replace them with less experienced nurses.

Increased demand for health care

With the constant improvement and innovation in medicine, average life expectancy for individuals has also increased, creating a greater need for nurses to care for older patient populations and their more complex medical needs.

Lack of faculty in nursing schools

Nursing schools are not exempt from the nursing shortage. Nursing school faculty vacancies, currently at about 8.8%, are creating an additional obstacle for the nursing supply. With decreases in nursing faculty, classroom space, and training resources, nursing schools turned away over 90,000 prospective nursing students in 2021. These prospective students were unable to get the education they need to enter the profession, disrupting the pipeline for future nurses.

High nurse turnover rates

With the national registered nurse (RN) turnover averaging at about 23% in 2022, healthcare leaders are struggling to keep vacancies low. As an added concern, new graduate nurse retention statistics suggest that as many as one-third of new graduate nurses leave during their first two years of practice. Unfortunately, low retention rates can undermine a robust new nurse pipeline.

The clear link between the nursing shortage and patient safety

Given that nurses spend more one-on-one time with patients than other healthcare professionals, their ability to perform at a high level is essential for providing safe patient care. Research has shown that less time and resources for each nurse due to low staffing can negatively impact patient safety. Even with efforts to minimize the effects of short staffing in nursing on patient care, we have seen the following connections between the nursing shortage and patient safety:

Increased nurse-to-patient ratios

Recommended nurse-to-patient ratios vary by care setting. The Agency for Healthcare Research and Quality reports that five patients per RN may be appropriate in acute medical-surgical units, but only one to two may be appropriate for intensive care units. In some states, four patients per nurse is the maximum for emergency care. Besides safeguarding quality of care, maintaining recommended nurse-to-patient ratios prevents patient overcrowding and can decrease the length of patient hospital stays.

Nurse fatigue and burnout

Predictably, nurse fatigue rises with an increase in responsibilities beyond recommended levels. Since the pandemic, nurses have commonly exceeded their recommended professional capacities, leading to mental fatigue, physical exhaustion, and burnout. Burnout may not occur immediately but is often the result of prolonged stressful events such as the COVID-19 pandemic. Characterized by compassion fatigue, burnout occurs when nurses can no longer carry out their responsibilities with the same level of attentiveness they previously had, potentially endangering patients.

Increased errors

Additional linkage between the nursing shortage and patient safety is increased errors. Mistakes can range from minor oversights to serious lapses such as medication errors, adverse events, and higher patient mortality. The risk of making errors while providing routine care increases when staffing issues exist. Constant disruptions, too much multitasking, excessive overtime shifts, and routine double shifts can lead to errors. In one widely reported incident involving a fatal medication error, the nurse noted that her fatigue from working a double shift the previous day played a major role in the negative patient safety outcome that occurred.

Lower patient satisfaction scores

Not only can inadequate nurse staffing lead to lower patient satisfaction ratings, a 2021 study found that  quality of nursing correlated directly with overall hospital rating. In this study, hospitals that had low patient experience scores in nursing generally had lower overall scores, underscoring how important good nursing is for patient experience.

Strategies to address the nursing shortage and patient safety

Healthcare organizations are maximizing their efforts to recruit more nurses through opportunities such as the Talent Marketplace on Nurse.com. But recruiting is not the only way to help mitigate staffing shortfalls. Consider the following additional strategies:

• Review patient safety practice protocols — Ensure your internal review processes are helping you to meet and exceed industry recommendations. Follow new research that may offer methods and insights into how other organizations are successfully mitigating current staffing realities. Promote a culture of safety throughout your internal messaging and initiatives.
• Emphasize communication and teamwork — Employees are less likely to leave a workplace where they have good working relationships with their teams and managers. Increase the likelihood that your nurses will stay by focusing on communication and collaboration.
• Enhance your nurse retention programs — Each year, our Nurse Salary Research Report documents exactly what nurses say they want in their workplace of choice. Review the list of benefits and perks nurses are seeking and weigh the feasibility of providing them.
• Invest in technology and innovation — Nurses who have their pick of hospital systems will seek out top-rated organizations so they can use state-of-the-art technology and provide cutting-edge care. Nurses want to work for an organization that is advancing the field of medicine.
• Promote diversity, equity, inclusion, and belonging — Is your organization unappealing to diverse nurse candidates? You might appear uncompetitive to certain groups because you are not inclusive in your recruiting approaches, materials, and workplace culture. A DEIB review could help.
• Advocate for patient rights and quality care — Most nurses choose a career in health care because they want to make a difference. An organization that actively works to support important patient causes will attract nurses who share your mission and have the passion and dedication required for longevity in the nursing profession.
• Provide more opportunities for nurse education — Nurses want to continue to grow in the profession, and education is a primary means of doing so. Ensure that you are providing high-quality, best-in-class healthcare education for your nurses.

Interested in learning more nurse retention strategies?

During a nursing shortage, retaining your existing nurses is of critical importance, both from the perspective of the organization and for patient safety. Providing your new nurses with a supportive environment helps them onboard successfully, but retaining them requires more than that. Placing nurses in the right specialty at the start of their nursing practice leverages their unique skills, critical thinking, and personality attributes, increases their job satisfaction, and decreases turnover rates. Relias offers assessment and learning solutions to assist in improving nurse retention, streamline onboarding, evaluate competency, and develop the next generation of nurse leaders.

Relias Assessments is the national leader in holistic healthcare assessments. Using data-driven assessments to make informed placement decisions results in long-term nurse success, satisfaction, and retention. Covering 40+ nursing specialties, Relias Assessments matches nurses to the roles that best fit their strengths.

Designed by nurses and validated by clinical researchers, our assessments predict a new nurse’s likelihood of success in a specific role by evaluating three areas:

• Clinical competencies — Gain insights into specialty-specific job knowledge and key skills needed for safe, independent practice.
• Situational competencies — Measure critical thinking and assess how a nurse would respond in specific clinical scenarios.
• Behavioral characteristics — Assess individual personality attributes to match a nurse to a unit or preceptor.

Relias Assessments provides reports on individual nurses to customize onboarding, enhance life-long learning, and create leadership succession plans.