Nursing Shortage Solutions Are Happening — Because They Must

The 2022 National Nursing Workforce Study, released by the National Council on State Boards of Nursing (NCSBN) in April 2023, showed the impacts of COVID-19 on nursing in the U.S. — and the results are not surprising. The nursing workforce is still grappling with shortages that are causing serious challenges for healthcare organizations and the nurses who remain. Yet the need to care for patients never stops.

These difficult circumstances call for innovative approaches to safeguard care quality and protect nurses from overwork and burnout. Healthcare organizations need to take innovative and strategic approaches to overcome the challenges of the current healthcare landscape, and nursing shortage solutions are one of the first needs to address.

Nursing workforce survey findings

The NCSBN survey included a randomized national sample of over 300,000 licensed RNs and LPNs/LVNs from data collected throughout 2022. This biannual study serves as a resource to inform workforce planning and support safe, effective patient care. Findings from 2022 revealed the extent to which the pandemic worsened the national nursing shortage and the continued net loss of nurses, both of which have created an increasing urgency to find solutions.

Continued staff scarcity and impacts

The survey results included the following data points:

• Approximately 100,000 registered nurses and 34,000 licensed practical and vocational nurses left the workforce specifically due to the COVID-19 pandemic.
• 41% of RNs now have a mean age of 36 and less than 10 years of experience.
• 62% of nurses reported an increase in workload during the pandemic.
• Half of survey respondents reported feeling emotional fatigue or burnout multiple times per week, with over one-fourth reporting that they felt “at the end of their rope.”
• 800,000 RNs and 184,000 LPNs/LVNs indicated they are likely to leave nursing by 2027 — roughly 20% of total licensed nurses in the U.S.

The study authors suggested that the projected percentage of nurses who said they are likely to leave in the next three to four years could change if policymakers and leaders find solutions to foster resilience, sustainability, and safety in nursing.

How healthcare organizations can respond

When we look at organizations that have begun to recover from the pandemic and suffered lower staff loss, it is not coincidental that they tend to be organizations that had already focused on high reliability and resilience as core values. These organizations planned for disruption, creating a flexible infrastructure and building their ability to pivot quickly.

While leaders cannot predict the next crisis, they can create contingency plans and build a strong foundation to prepare for the unexpected. The Baldridge framework, for example, builds on core values and concepts relating to performance excellence. It uses a systems perspective, along with agility and innovation, to embed principles that can help carry organizations through difficult times with a common set of goals and values.

For those organizations that did not fare as well, now is the time to begin working on strategies that will improve their ability to respond to current challenges. They can begin by assessing their current state and developing models that will work with their culture. Many organizations are including new staffing models that are hybrids of older models. For example, some are continuing to support their existing workforce but also looking at new approaches, such as expanding internal resources and float pools.

Nursing workforce demographic shifts

The 2022 survey also revealed changes in nursing workforce demographics caused by the loss of over 200,000 total experienced RNs and over 600,000 LPNs/VPNs in the U.S. in the two years since the 2020 survey.

• The median age of RNs fell from 52 to just 46. The median age of LPNs/VPNs fell from 53 to 47.
• The number of RN respondents self-reporting as a member of a minority group was 20%, with the number of Hispanic/Latino RNs nearly doubling to 6.9%. LPNs/LVNs self-reported as 34% racial minority, with 11.5% Hispanic/Latinx.
• The number of male RNs increased nearly 2% to 11.2%, a continuing increase from 8% in 2015. Male LPNs/LVNs increased from 8.1% to 10.2%.
• Education levels shifted, with over 47% of RNs reporting that a BSN degree qualified them for their first U.S. nursing license, a jump of over 5% since 2020 — more than double the increase from the previous two-year survey period.
• Median self-reported pre-tax earnings for RNs increased from $70,000 to $80,000 since 2020 and from $44,000 to $50,000 for LPNs/LVNs.

How to leverage a changing nursing workforce

The demographic shifts we see in the nursing workforce along with the increasing need to bring more nurses into the profession require changes in how we currently develop our nursing talent pipeline. Establishing a strong community will be key to developing interest in the nursing profession among young people just beginning to consider their career choice.

To reach these potential nurses, healthcare recruiters should consider proactive approaches such as visiting high schools to offer shadowing and work programs where students can become part of an organization. Provide college opportunities and partner with local institutions to educate students about nursing career paths and build interest and participation among younger cohorts.

Medscape recently reported nursing school enrollment has dropped for the first time in 20 years. We can no longer expect to recruit from an existing pool of nurse graduates. We need to address potential nurses much earlier — before they have even considered nursing school.

Visible role models exhibit qualities that bring young people into the profession, sharing stories about helping others. As a teen, I worked as a “candy striper” and then participated in a high school program working evenings, shadowing nurses in the hospital setting. These experiences strengthened my decision to become a nurse and kept me in the profession.

Additional nursing shortage solutions

Healthcare is a wonderful world, despite its challenges. To be a great nurse, you must have true commitment and be fully engaged. We must work harder to find those potential nurses — young and old — who have what it takes to be great and inspire them. We all have a different story of what inspired us to join the profession, and we must get the message out to those whom we can in turn inspire.

Organizations should also consider strategies such as bringing retired nurses back as virtual preceptors, seeking more feedback and suggestions from current nurses, providing resources and emotional support, and using non-clinical resources to lighten administrative burdens. There is still so much we need to do to reenergize our nursing workforce.

The American Hospital Association’s (AHA) 2023 Workforce Scan discussed “recruiting innovatively, investing in retention, and building a robust pipeline” as one of three core challenges in the years ahead. Tactics they suggested included expanding training options in the community, helping to launch more nursing programs, recruiting globally, enhancing inclusiveness by creating psychologically safe and welcoming environments, recruiting for cultural fit, and setting up an in-house staffing agency.

For retention, the AHA suggested employing “smart onboarding” to ensure clinician well-being and engagement, providing flexible job options such as remote work and variable staffing models, investing in upskilling, advocating for increased federal funding for nursing programs, providing nontraditional support such as employee housing or loan forgiveness, and adding creative compensation benefits such as incentive pay.

We must choose a path forward

Maintaining the same strategies that worked in the past will no longer sustain healthcare organizations, and their future may be at risk if they do. Regardless of the nursing shortage solutions chosen, it is imperative to expand the scope of your efforts to address the most challenging workforce statistics we have seen in our lifetimes so that we can begin to see a more hopeful future for nursing.