research question for nursing shortage

NCSBN Research Projects Significant Nursing Workforce Shortages and Crisis

CHICAGO – Today, NCSBN unveiled its research, titled “Examining the Impact of the COVID-19 Pandemic on Burnout & Stress Among U.S. Nurses,” in a panel titled “Nursing at the Crossroads: A Call to Action” in Washington, D.C. at the National Press Club at 9:30 am EST.

For the first time, the research findings reveal how the nursing workforce was impacted by the pandemic and how many left the workforce in this period, and forecast how many nurses in the U.S. have an intent to leave the workforce. The research also examined the personal and professional characteristics of nurses experiencing heightened workplace burnout and stress due to the COVID-19 pandemic.

The study is considered to be the most comprehensive and only research in existence, uncovering the alarming data points which have far reaching implications for the health care system at large and for patient populations. The research was gathered as part of a biennial nursing workforce study conducted by NCSBN and the National Forum of State Nursing Workforce Centers.

Key findings include:

• Approximately 100,000 registered nurses (RNs) left the workforce during the COVID-19 pandemic in the past two years due to stress, burnout and retirements.
• Another 610,388 RNs reported an “intent to leave” the workforce by 2027 due to stress, burnout and retirement.
• 188,962 additional RNs younger than 40 years old reported similar intentions.
• Altogether, about one-fifth of RNs nationally are projected to leave the health care workforce.
• 62% of the sample reported an increase in their workload during the pandemic.
• A quarter to half of nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) “a few times a week” or “every day.”
• These issues were most pronounced with nurses with 10 or fewer years of experience, driving an overall 3.3% decline in the U.S. nursing workforce in the past two years.
• Licensed practical/vocational nurses, who generally work in long-term care settings caring for the most vulnerable populations, have seen their ranks decline by 33,811 since the beginning of the pandemic. This trend continues.

Research also suggested that nurses’ workloads and unprecedented levels of burnout during the COVID-19 pandemic played key roles in accelerating these workforce trends and threatening the future of the U.S. nursing workforce, particularly for younger, less experienced RNs. Further, high levels of turnover were seen with the potential for even further declines in a post-pandemic nursing workplace as disruptions in prelicensure nursing programs have also raised concerns about the supply and clinical preparedness of new nurse graduates. Early career data for new entrants into the profession suggest decreased practice and assessment proficiency. Coupled with large declines among nursing support staff, NCSBN calls for significant action to foster a more resilient and safe U.S. nursing workforce moving forward.

“The data is clear: the future of nursing and of the U.S. health care ecosystem is at an urgent crossroads,” said Maryann Alexander, PhD, RN, FAAN, NCSBN Chief Officer of Nursing Regulation. “The pandemic has stressed nurses to leave the workforce and has expedited an intent to leave in the near future, which will become a greater crisis and threaten patient populations if solutions are not enacted immediately. There is an urgent opportunity today for health care systems, policymakers, regulators and academic leaders to coalesce and enact solutions that will spur positive systemic evolution to address these challenges and maximize patient protection in care into the future.”

The research findings and proposed solutions were presented in a panel discussion today at the National Press Club in Washington, D.C.

Panelists included:

• Antonia Villarruel, Dean of Nursing at University of Pennsylvania
• Gay Landstrom, Senior Vice President and Chief Nursing Officer at Trinity Health System
• Congresswoman Lisa Blunt Rochester, U.S. Representative of Delaware
• Robyn Begley, CEO of the American Organization for Nursing Leadership and CNO/Sr. VP for the American Hospital Association
• Rayna M. Letourneau, Board of Directors, National Forum for State Workforce Centers

A recording of the panel discussion is available on ncsbn.org .

To request interviews with NCSBN or view the entire research, please contact [email protected] or visit ncsbn.org .

Research Methodology: The study examines a subset of the 2022 National Nursing Workforce Study for analysis. Reported trends represent population-based estimates. There were 29,472 registered nurses (including advanced registered nurses [APRN]) and 24,061 licensed practical nurses/vocational nurses across 45 states included.

About NCSBN Empowering and supporting nursing regulators across the world in their mandate to protect the public, NCSBN is an independent, not-for-profit organization. As a global leader in regulatory excellence, NCSBN champions regulatory solutions to borderless health care delivery, agile regulatory systems and nurses practicing to the full scope of their education, experience and expertise. A world leader in test development and administration, NCSBN’s NCLEX® Exams are internationally recognized as the preeminent nursing examinations.

NCSBN’s membership is comprised of the nursing regulatory bodies (NRBs) in the 50 states, the District of Columbia and four U.S. territories. There are five exam user members and 25 associate members that are either NRBs or empowered regulatory authorities from other countries or territories.

The statements and opinions expressed are those of NCSBN and not individual members.

Nursing in 2023: How hospitals are confronting shortages

When we tabulated the results of our first nationwide nursing survey almost two years ago , we were surprised to see such a high reported likelihood of nurses planning to leave their jobs—and we did not expect this trend to persist for such an extended period of time.

About the authors

This article is a collaborative effort by Gretchen Berlin , Faith Burns, Connor Essick, Meredith Lapointe, and Mhoire Murphy , representing views from McKinsey’s Healthcare Practice.

But that is what has happened in the wake of the COVID-19 pandemic. In fact, we have seen some of this reported anticipated turnover actually occur, as well as a decrease in the overall active nursing workforce. And there is still cause for concern: today, 31 percent of nurses still say they may leave their current direct patient care jobs in the next year, according to our most recent survey. That said, we are cautiously optimistic that some of the practices implemented by healthcare organizations to improve the experience of nurses are bearing fruit.

In this article, we share the latest data from our September 2022 frontline nursing survey of 368 frontline nurses providing direct patient care in the United States (see sidebar, “About the research”). We offer these insights as resources for organizations as they continue their journeys of attracting, supporting, and retaining a vibrant workforce, as well as promoting longer-term workforce stability.

What’s been happening in the nursing workforce

About the research.

Nursing turnover continues to be a substantial challenge for healthcare organizations as the number of individuals with the intent to leave their jobs remains high. In our most recent nursing survey, 31 percent of respondents indicated they were likely to leave their current role in direct patient care, a figure that has stabilized over the past six to 12 months yet is still higher than the 22 percent rate observed in our first survey in February 2021 (Exhibit 1). 1 Gretchen Berlin, Meredith Lapointe, and Mhoire Murphy, “ Surveyed nurses consider leaving direct patient care at elevated rates ,” McKinsey, February 17, 2022; Gretchen Berlin, Meredith Lapointe, Mhoire Murphy, and Molly Viscardi, “ Nursing in 2021: Retaining the healthcare workforce when we need it most ,” McKinsey, May 11, 2021. Our research further shows that the intent to leave varies across settings. For example, inpatient registered nurses (RNs) have consistently reported a higher intent to leave than the average of all surveyed RNs. In our most recent pulse survey of inpatient RNs, we saw intent to leave rise again, from 35 percent in fall 2022 to over 40 percent in March 2023.

Recent analysis of studies comparing intent to leave to actual turnover show that both jumped meaningfully over the course of 2021. A study from Nursing Solutions Inc. (NSI) showed that actual reported hospital and staff RN turnover increased from 18 percent in fiscal year 2020 to 27 percent in fiscal year 2021; the same March 2022 study reported that the workforce lost about 2.5 percent of RNs in 2021. 2 2022 NSI national health care retention & RN staffing report , NSI Nursing Solutions, March 2022. In the latest NSI report (March 2023), turnover reduced to 23 percent in fiscal year 2022 but still remains elevated compared with prepandemic levels. 3 2023 NSI national health care retention & RN staffing report , March 2023. A Health Affairs study published in April 2022 found that the RN workforce fell by about 100,000 by the end of 2021, which is a “far greater drop than ever observed over the past four decades.” This decline was particularly pronounced among midtenure nurses (aged 35 to 49). 4 David Auerbach, Peter Buerhaus, Karen Donelan, and Douglas Staiger, “A worrisome drop in the number of young nurses,” Health Affairs Forefront, April 13, 2022. In terms of where they are going, nurses are both leaving the profession entirely as well as simply changing employers or roles. About 35 percent of respondents to our most recent survey who indicated they were likely to leave said they would remain in direct patient care (that is, at a different employer or role). The remainder said they intended to leave the bedside for nondirect patient care roles to pursue different career paths or education or to exit the workforce entirely.

With this persistently high turnover and the corresponding gathering storm in US healthcare , it is more important than ever for healthcare organizations to design and deploy initiatives that respond to and address workforce needs. Most healthcare organizations have learned that attracting and retaining nursing talent in the postpandemic era will require a more nuanced understanding of what nurses are looking for in a profession and an employer.

Our four frontline nursing surveys over the past two years have enabled us to glean insights into factors contributing to both attrition and retention. Frontline nursing respondents have consistently ranked elements of flexibility, meaning, and balance as the most important factors affecting their decision to stay in direct patient care (Exhibit 2). Recognition, open lines of communication, and embedding breaks into the operating model (for example, during shifts, between shifts, and formal paid time off) have consistently been rated as the top initiatives to support well-being.

The nursing workforce has evolved over the course of the pandemic, and the strategies aimed at attracting and retaining tomorrow’s workforce have evolved as well. To start, structural solutions  that help to ensure a manageable workload—for example, consistent support staff, a safe environment, reduced documentation and administrative requirements, predictability of schedule, and ability to take paid time off—continue to be critical. Surveyed nurses who left a direct patient care role in the past 18 months indicated that not being valued, unmanageable workloads, and inadequate compensation were the top factors in their decision to exit (Exhibit 3). There are no one-size-fits-all solutions, but many healthcare organizations have adapted their approaches and carried out interventions that appear to be yielding results.

What stakeholders can do in the short term

Our most recent survey found that 75 percent of nurses who left a job in the past 18 months reported that not being valued by their organization was a factor in their decision. In addition, 56 percent of total respondents reported that appropriately recognizing nurses for their contributions was the most effective initiative to support well-being. Surveyed nurses suggested various ways to respond to the recognition gap, including simple acknowledgement, appreciation of excellence, and reinforcement through broader workplace culture and support in the field.

Many healthcare systems have found ways to implement the nurses’ suggestions. While more research is needed to understand the full impact of these efforts, they may be helpful short-term starting points in the attempt to show support for the workforce.

At the Orlando VA Medical Center, “Employee Well-Being Centers” were set up to address the burnout and stress caused by the pandemic. Setting up a dedicated quiet space with amenities like virtual-reality headsets, aroma therapy, and sound machines, as well as snacks and beverages, resulted in a measurable positive impact on Employee Whole Health engagement scores and decreased feelings of burnout, higher retention, and increased overall well-being. As a result of these improvements, the program has expanded to more than ten medical centers across the Veterans Health Administration network. 5 “Employee well-being centers and carts,” VA Diffusion Marketplace, accessed April 2023.

Some health systems have employed digital tools to ensure that tailored recognition can be delivered in a timely and meaningful way. For example, nurse managers at the Orange Coast Medical Center in Fountain Valley, California, were using sticky notes, mining emails, spreadsheets, and other manual processes to remind them which nurses did what to deserve recognition or to schedule meetings to help other nurses improve their work. While meaningful, these recognition processes were time-consuming for nurse managers. 6 “Frontline nurses are burning out. This digital health start-up is trying to change that," Laudio, May 13, 2022.

To sustain both this type of in-the-moment recognition and to reward bigger milestones, Orange Coast implemented the Laudio technology platform, which enables frontline leaders to monitor and manage team activity and performance. Use of this system has shown that one meaningful, or high quality, interaction per team member per month can reduce turnover by 36 percent. 7 “Frontline nurses are burning out. This digital health start-up is trying to change that," Laudio, May 13, 2022. In addition to keeping track of events and alerting managers about matters to engage in with specific nurses, Laudio can send digital cards and notes to nurses to acknowledge high performance.

Safety is also increasingly top of mind for nurses, as troubling incidents involving visitors and patients have risen. 8 Christine Porath and Adrienne Boissy, “Frustrated patients are making health care workers’ jobs even harder,” Harvard Business Review , May 14, 2021. In our most recent survey, 42 percent of nurses indicated that not having a safe working environment was an extremely or very important factor affecting their decision to leave direct patient care, up from 24 percent in March 2022.

To address safety concerns and incivility, UMass Memorial Medical Center in Worcester, Massachusetts, developed a patient and visitor code of conduct. At the entrances to facilities, visitors are asked to sign an agreement to adhere to a code of conduct that formalizes parameters and expectations of behavior. In addition, UMass created talking points for employees to use to respond to and de-escalate contentious situations. In just over a month of piloting the program, the hospital collected 56,000 signed agreements and only asked four visitors to leave the premises. 9 Christine Porath, “Frontline work when everyone is angry,” Harvard Business Review , November 9, 2022.

In addition to deploying more effective strategies to support and retain employees, healthcare executives can look at ways to better attract talent in the near term. To recruit staff, health systems should ensure that their value proposition is aligned to the workplace elements that nurses consider most important—especially when differentiating on compensation is less feasible. Aya Healthcare, a healthcare-talent software and staffing company, found that hospitals seen as a great place to work paid less to secure talent throughout the pandemic. In fact, hospitals seen as great places to work had labor compensation rates 11 percent lower than those without this advantage. 10 April Hansen, “The value of a good reputation (or the cost of a bad one…),” The Staffing Stream, April 8, 2021.

What stakeholders can do in the medium term

In the medium term, finding ways to incorporate flexibility into work schedules is an initiative that 63 percent of surveyed nurses ranked as the most effective for their well-being. We saw similar responses regarding nurses’ decision to stay in their current position: 86 percent cited a flexible work schedule as the reason, which ranked second after “doing meaningful work.” The nature of nurses’ work—typically specialized and always in demand—may make providing schedule flexibility seem daunting. But health systems have pursued several creative ways to address the issue.

The nature of nurses’ work—typically specialized and always in demand—may make providing schedule flexibility seem daunting.

For example, the Mercy health system launched Mercy Works on Demand, a systemwide on-demand platform that allows its full- and part-time nurses as well as other experienced nurses to select when they work. Through the platform, Mercy has hired about 1,100 individuals they are calling gig nurses and have improved overall fill rates by two percentage points. 11 Kelly Gooch, “How Mercy embraced a gig mindset for nursing,” Becker’s Hospital Review, December 5, 2022. But flexibility means different things to different people, which has increased complexity for employers. Charting a path forward will require a nuanced understanding of the employee value proposition as well as what options resonate with the workforce.

Job flexibility is at the center of many health systems’ strategies to not only attract new talent but also to welcome back nurses who left during the pandemic. Henry Ford Health has been able to bring back 25 percent of the nurses who left by offering flexible opportunities. Nursing leaders worked closely with Henry Ford Health’s human resources department to design flexible options such as the ability to work in different settings (for example, inpatient, outpatient, or virtual) or to work only on weekends. The health system also created fixed-term positions for nurses who didn’t want full-time permanent jobs, with the option to transition to permanent roles once their term was up. 12 Mackenzie Bean and Erica Carbajal, “How Henry Ford rehired 25% of nurses who left during the pandemic,” Becker’s Hospital Review, February 15, 2023.

As in other industries, the flexibility to work remotely has become increasingly important to some nurses. Trinity Health launched a virtual-care model, allowing more experienced nurses to continue providing patient care but away from the bedside. The new virtual model opens the door to nurses who may be physically tired from the demands of in-person care and to those who prefer to work from home. In addition, this program has enabled the virtual nurses to provide support to teams at the bedside and to improve patient experience by giving them more chances to interact with a nurse. The program is being rolled out across Trinity’s 88 hospitals nationwide. 13 Giles Bruce, “Trinity Health plans to institute virtual nurses across its 88 hospitals in 26 states,” Becker’s Hospital Review, January 13, 2023.

What stakeholders can do in the long term

As health systems look beyond retaining the current workforce and meeting the expected demand for nursing talent, they could have a role to play in building a longer-term pipeline through investing in new-graduate nurses and in the infrastructure required to ensure successful onboarding into the profession.

For example, Dignity Health has invested heavily in longer-term pipeline building through a joint venture between Dignity Health Global Education and Global University Systems. The partnership offers online academic degrees to further the education, training, and development of the healthcare workforce. The joint venture spans technical, professional, executive, and leadership training and provides a range of flexible, accessible, and affordable education opportunities for healthcare workers to advance their careers. It also has a scholarship fund to remove financial barriers for education and to increase equity in healthcare. Dignity Health Global Education now has one of the most comprehensive nursing residency programs, available in 21 states. 14 “Dignity Health and Global University Systems announce joint venture to expand global education for health professionals,” Global University Systems press release, January 30, 2019.

The commitment to building a longer-term talent pipeline has expanded beyond individual health systems. Many city and regional partnerships have developed across the United States, bringing together critical stakeholders across the healthcare ecosystem to train and upskill unemployed and underemployed job seekers into healthcare occupations. For example, the Birmingham Region Health Partnership, the result of close collaboration among government, healthcare employers, and other community partners, including Birmingham Business Alliance and Innovate Birmingham, won a $10.8 million grant from the Good Jobs Challenge to train and place over 1,000 jobseekers in the region. 15 “Birmingham receives $10.8 million ‘Good Jobs Challenge’ grant,” Birmingham City Council press release, August 3, 2022. Similar collaborative partnerships exist in Chicago, Baltimore, Philadelphia, among others, to build a pipeline of healthcare workers and to create meaningful career opportunities for historically excluded job seekers. 16 BACH Quarterly Newsletter , Baltimore Alliance for Careers in Healthcare, accessed April 2023; “Cutting the ribbon on new West Philadelphia Skills Initiative Headquarters,” University City District, March 29, 2023; CHWC Overview & Update - February 2021, Chicagoland Healthcare Workforce Collaborative, updated March 10, 2021.

Other stakeholders are taking action at a national level. In 2022, the US Department of Labor budgeted $80 million to encourage not-for-profit organizations, educational institutions, and tribal organizations to apply for grants of up to $6 million each to train current and former nurses to become nursing educators and frontline healthcare workers to train for nursing careers. 17 “DOL Nursing Expansion Grant Program: Total funding available: Up to $80 million,” US Department of Labor Employment and Training Administration, 2022. The program emphasizes increasing workforce diversity and building partnerships with community-based organizations and training institutions.

Retaining the current nursing workforce while looking ahead to the longer-term talent pipeline will be critical to meeting the projected shortfall in registered nurses. There isn’t one answer to the challenges confronting healthcare organizations, and indeed, they have begun taking steps to address nurses’ stated needs through short-, medium-, and longer-term strategies that attract, strengthen, and grow a vibrant nurse workforce. There is more to be done, especially in taking account of the voices of the front line and addressing the core drivers behind why nurses are planning to leave. We are optimistic that the issues facing the nursing profession can be addressed, but this will require consistent and dedicated attention from many parties.

Gretchen Berlin , RN, is a senior partner in McKinsey’s Washington, DC, office, where Faith Burns is a consultant; Meredith Lapointe is a partner in the Bay Area office, where Connor Essick is a consultant; and Mhoire Murphy is a partner in the Boston office.

The authors wish to thank the nurses, physicians, and staff on the front lines who are caring for patients and communities. They also wish to thank Beth Bravo, Stephanie Hammer, Thomas Pu, Brooke Tobin, and Catherine Wilkosz for their contributions to this article.

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Nurses and the Great Attrition

Nursing Shortage Fact Sheet

The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows. Compounding the problem is the fact that nursing schools across the country are struggling to expand capacity to meet the rising demand for care. The American Association of Colleges of Nursing (AACN) is working with schools, policy makers, nursing organizations, and the media to bring attention to this healthcare concern. AACN is leveraging its resources to shape legislation, identify strategies, and form collaborations to address the shortage.

Download Fact Sheet [PDF]

Current and Projected Shortage Indicators

• According to the Bureau of Labor Statistics’  Employment Projections 2021-2031 , the Registered Nursing (RN) workforce is expected to grow by 6% over the next decade. The RN workforce is expected to grow from 3.1 million in 2021 to 3.3 million in 2031, an increase of 195,400 nurses. The Bureau also projects 203,200 openings for RNs each year through 2031 when nurse retirements and workforce exits are factored into the number of nurses needed in the U.S.  
• The Advanced Practice Registered Nurse (APRN) workforce, including Nurse Practitioners, Nurse Anesthetists, and Nurse Midwives, is expected to grow much faster than average for all occupation, by 40% from 2021 through 2031, according to the  BLS’ Occupational Outlook Handbook . Approximately 30,200 new APRNs, which are prepared in master’s and doctoral programs, will be needed each year through 2031 to meet the rising demand for care.  
• According to the  United States Registered Nurse Workforce Report Card and Shortage Forecast  published in the September/October 2019 issue of the  American Journal of Medical Quality , a shortage of registered nurses is projected to spread across the country through 2030. In this state-by-state analysis, the authors forecast a significant RN shortage in 30 states with the most intense shortage in the Western region of the U.S.  
• In April 2022, Dr. David Auerbach and colleagues  published a nursing workforce analysis  in  Health Affairs , which found that total supply of RNs decreased by more than 100,000 from 2020 to 2021 – the largest drop than ever observed over the past four decades. A significant number of nurses leaving the workforce were under the age of 35, and most were employed in hospitals.  
• The Institute of Medicine in its landmark report on  The Future of Nursing  called for increasing the number of baccalaureate-prepared nurses in the workforce to at least 80% to enhance patient safety. The current nursing workforce falls short of this recommendations with only 65.2% of registered nurses prepared at the baccalaureate or graduate degree level according to the  latest workforce survey  conducted by the National Council of State Boards of Nursing.

Contributing Factors Impacting the Nursing Shortage

Nursing school enrollment is not growing fast enough to meet the projected demand for RN and APRN services.

Though enrollment in entry-level baccalaureate programs in nursing increased by 3.3% in 2021, AACN did report drops in both PhD and master’s nursing programs by 0.7% and 3.8%, respectively. These trends are raising concerns about the capacity of nursing schools to meet the projected demand for nursing services, including the need for more nurse faculty, researchers, and primary care providers.

A shortage of nursing school faculty is restricting nursing program enrollments.

• According to AACN’s report on  2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing , U.S. nursing schools turned away 91,938 qualified applications (not applicants) from baccalaureate and graduate nursing programs in 2021 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints. 

A significant segment of the nursing workforce is nearing retirement age.

• According to a  2020 National Nursing Workforce Survey  conducted by the National Council of State Boards of Nursing found that the average age for an RN is 52 years old, which may signal a large wave over the next 15 years.  
• In a  Health Affairs  blog  posted in May 2017, Dr. Peter Buerhaus and colleagues project than more than 1 million registered nurses will retire from the workforce by 2030.

Changing demographics signal a need for more nurses to care for our aging population.

• The  U.S. Census Bureau reported  that by 2034, there will be 77.0 million people age 65 years and older compared to 76.5 million under the age of 18. With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases and comorbidities.

Amplified by the pandemic, insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession.

• According to data published in Nurse.com’s  2022 Nurse Salary Research Report , 29% of nurses across all license types considering leaving in 2021, compared with 11% in 2020.Among nurses who are considering leaving the profession, higher pay was the most influential motivation to stay, followed by better support for work-life balance and more reasonable workload.  
• In March 2022, the American Nurses Foundation and the American Nurses Association released the results of its  COVID-19 Impact Assessment Survey , which found that 52% of nurses are considering leaving their current position due primarily to insufficient staffing, work negatively affecting health and well-being, and inability to deliver quality care. In addition, 60% of acute care nurses report feeling burnt out, and 75% report feeling stressed, frustrated, and exhausted.  
• In September 2021, the American Association of Critical-Care Nurses reported  survey findings  which show 66% of acute care nurses have considered leaving nursing after their experiences during the pandemic.

Impact of Nurse Staffing on Patient Care

Many scientific studies point to the connection between adequate levels of registered nurse staffing and safe patient care.

• In November  2021, new research in Nursing Outlook examined  Variations in Nursing Baccalaureate Education and 30-day Inpatient Surgical Mortality . Researchers found that having a higher proportion of baccalaureate-prepared nurses (BSN) in hospital settings, regardless of educational pathway, is associated with lower rates of 30-day inpatient surgical mortality. The findings support promoting multiple BSN educational pathways.  
• In the July 2017 issue of  BMJ Quality & Safety , the international journal of healthcare improvement, Dr. Linda Aiken and her colleagues released  findings from a study of acute care hospitals  in Belgium, England, Finland, Ireland, Spain, and Switzerland, which found that a greater proportion of professional nurses at the bedside is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding assistive personnel without professional nurse qualifications may contribute to preventable deaths, erode care quality, and contribute to nurse shortages.  
• In a study published in the journal  BMJ Quality & Safety  in May 2013, researcher Heather L. Tubbs-Cooley and colleagues observed that higher patient loads were associated with higher hospital readmission rates. The study found that when more than four patients were assigned to an RN in pediatric hospitals, the likelihood of hospital readmissions increased significantly.  
• In the August 2012 issue of the  American Journal of Infection Control , Dr. Jeannie Cimiotti and colleagues identified a significant association between high patient-to-nurse ratios and nurse burnout with increased urinary tract and surgical site infections. In this study of Pennsylvania hospitals, the researchers found that increasing a nurse’s patient load by just one patient was associated with higher rates of infection. The authors conclude that reducing nurse burnout can improve both the well-being of nurses and the quality of patient care.  
• In a study publishing in the April 2011 issue of  Medical Care , Dr. Mary Blegen and her colleagues from the University of California, San Francisco found that higher nurse staffing levels were associated with fewer deaths, lower failure-to-rescue incidents, lower rates of infection, and shorter hospital stays.  
• In March 2011, Dr. Jack Needleman and colleagues published findings in the  New England Journal of Medicine , which indicate that insufficient nurse staffing was related to higher patient mortality rates. These researchers analyzed the records of nearly 198,000 admitted patients and 177,000 eight-hour nursing shifts across 43 patient-care units at large academic health centers. The data show that the mortality risk for patients was about 6% higher on units that were understaffed as compared with fully staffed units. In the study titled “Nurse Staffing and Inpatient Hospital Mortality,” the researchers also found that when a nurse’s workload increases because of high patient turnover, mortality risk also increases.  
• A growing body of research clearly links baccalaureate-prepared nurses to lower mortality and failure-to-rescue rates. The latest studies published in the journals  Health Services Research  in August 2008 and the  Journal of Nursing Administration  in May 2008 confirm the findings of several previous studies which link education level and patient outcomes. Efforts to address the nursing shortage must focus on preparing more baccalaureate-prepared nurses in order to ensure access to safe patient care.  
• In March 2007, a comprehensive report initiated by the Agency for Healthcare Research and Quality was released on  Nursing Staffing and Quality of Patient Care . Through this meta-analysis, the authors found that the shortage of registered nurses, in combination with an increased workload, poses a potential threat to quality. Increases in registered nurse staffing was associated with reductions in hospital-related mortality and failure to rescue as well as reduced length of stays.  
• A shortage of nurses prepared at the baccalaureate level is affecting health care quality and patient outcomes. In a study published September 24, 2003, in the  Journal of the American Medical Association (JAMA),  Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a “substantial survival advantage” if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10% increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5%.

Efforts to Address the Nursing Shortage

• AACN is committed to working with the education and healthcare community to create a highly educated nurses in sufficient numbers to meet the needs of the nation’s diverse patient population. To address the nursing shortage, AACN is advocating for federal legislation and increased funding for nursing education (Title VIII, FAAN Act); promoting a post-baccalaureate nurse residency program to aid in nurse retention; encouraging innovation in nursing programs, including the development of fast-track programs (second-degree BSN and MSN programs; baccalaureate to doctoral); and working with partner organizations to highlight careers in nursing, including those requiring graduate level preparation.  
• Since 2010, AACN has operated  NursingCAS , the nation’s centralized application service for nursing education programs that prepare nurses for entry-level and advanced roles. One of the primary reasons for launching NursingCAS was to ensure that all vacant seats in schools of nursing are filled to better meet the nation’s need for RNs, APRNs, and nurse faculty.  
• In June 2022, the National Council of State Legislatures issued a  brief  profiling different legislative approaches states are using to address the nursing shortage, including adapting scope of practice laws and offering financial incentives for preceptors,  
• In a report on  How To Ease the Nursing Shortage in America  released in May 2022, the Center for American Progress calls for bold policies toward solving the nursing shortage to ensure that more patients with access to safe, high-quality nursing services. The report highlights how federal and state policymakers can address the shortage through coordinated planning, action, and investment.  
• Many statewide initiatives are underway to address both the shortage of RNs and nurse educators. For example, in October 2022, the University of Minnesota and Minnesota State joined forces to create  Coalition for Nursing Equity and Excellence , which will work with every school of nursing in the state, healthcare providers, and others stakeholders to increase enrollment in nurse education programs, expand equity in the nursing workforce, and increase student success. Additional initiatives are also underway in  Florida  and  Louisiana  among other states.  
• Nursing schools are forming strategic partnerships and seeking private support to help expand student capacity.

Recent Articles on the Nursing Shortage

• Buerhaus, P.I., Staiger, D.O., Auerbach, D.I., Yates, C., & Donelan, K. (2022, January).  Nurse employment during the first fifteen months of the COVID-19 pandemic.   Health Affairs , 41(1).
• Buerhaus, P.I. (2021, September/October).  Current nursing shortages could have long-lasting consequences: Time to change our present course.   Nursing Economics , 39(5), 247-250.
• Firth, S. (2022, May 16).  More Support Needed to Shore Up Nurse Pipeline, Experts Say .  MedPage Today .

Updated: October 2022

Robert Rosseter [email protected]

The Nursing Shortage Explained

What is the nursing shortage, why is there a nursing shortage.

• Is the Nursing Shortage Getting Worse?

How Do We Solve the Nursing Shortage?

The nursing shortage is a growing problem in the United States, with the   U.S. Bureau of Labor Statistics (BLS) projecting that a 6% growth rate in the demand for registered nurses will result in a need for 3.3 million nurses by 2031. But, how much of that will need will actually be met?

Unfortunately, the Covid-19 pandemic has only exacerbated this issue as front-line nurses feel the strain of increased workloads and decreased staffing levels. This has led to higher rates of nurse burnout due to long hours and high-stress levels.

The nursing shortage is impacting the care that nurses are able to provide for patients and stretching their ability to cope with having to do more work with less help. 

But why is there a nursing shortage? And can anything be done about it? Keep reading to learn about the causes and possible solutions of the nursing shortage based on findings from our own 2023 State of Nursing report and other findings from the AACN. 

>> Download the 2023 State of Nursing Report

According to the American Association of Colleges of Nursing (AACN) , the nursing shortage is a chronic and escalating problem created by several interrelated factors:

• Nursing school enrollment not keeping up with the demand for nurses
• Shortage of nurse faculty restricting nursing school enrollments
• A large number of nurses are retiring or approaching retirement
• Increase in the aging population and therefore nursing services
• Insufficient staffing causes nurses to leave the profession

Interestingly, many of the top reasons nurses cited as causes of the nursing shortage are not included in the AACN’s list.  When asked “What do you think are the primary causes of the nursing shortage?” these were the most popular responses from the 2023 State of Nursing survey:

• Nurses are burned out - 74%
• Poor working conditions - 58%
• Inadequate pay for nurses - 57%
• Lack of appreciation for nurses - 34%

The greater number of patients due to an aging population, changes to the medicare/healthcare system, and lack of nursing school educators/faculty got the least amount of responses from nurses. Indicating that, while these systemic factors may be contributing to the overall nursing shortage, that’s not what nurses are feeling on a day-to-day basis, and not what’s ultimately prompting many nurses to think about leaving the bedside, or even the profession altogether.

Is the Nursing Shortage Getting Worse? 

While a nursing shortage has existed for decades, 91% of nurses believe the nursing shortage is getting worse. Other reports support this as well.

For example, a 2022 report by  McKinsey consulting and advisory firm warns that the “nursing shortage will become dire by 2025” due to a projected shortage of 200,000 to 450,000 nurses—roughly 10% to 20% of the nurses required to provide all patient care.

Already some nurses describe having to “ration care” due to inadequate nurse-patient ratios so they can focus on keeping patients “alive”, often at the expense of meeting patients’ other basic needs such as helping them with a much-needed bath.

When asked “What do you think would make the biggest impact on the nursing shortage” 71% of nurses replied that improved staffing ratios would have the biggest impact, followed by better pay (64%) and better working conditions (41%).  

But ultimately, addressing the nursing shortage will require a multi-faceted approach that includes both short-term solutions to improve nurses' daily lives and long-term strategies to address the underlying issues. 

1. Increasing Funding to Improve Nurse-Patient Ratios and Retain Nurses 

Hospitals and healthcare facilities need to start listening to nurses if they want to retain them and improving staffing ratios was the number one factor that nurses thought could positively impact the nursing shortage. 

New York state nurses described “abysmal working conditions” as they went on strike in January 2023 but were told “There’s no money in the budget” to improve working conditions and ensure safe nursing staff levels. Hospital administrators and those that control the purse strings of healthcare facility budgets need to reevaluate their budget priorities if they want to retain and attract nurses and protect patients.

2. Paying Higher Salaries to All Nurses, Particularly to Recruit and Retain Nursing Faculty

As we saw above, 64% of nurses believe that better pay would help lessen the nursing shortage. When we asked nurses how they felt about their current pay, 75% of nurses said they felt underpaid. 

In addition, a major reason for the shortage of nursing faculty is low salaries. While the average salary of an advanced nurse practitioner with a master’s degree is $120,680 , master’s prepared nursing faculty were paid just $87,325/year in 2022. 

With the average nursing faculty salary being $33,372/year less than what nurses earn in clinical and private-sectors positions, it’s hard to attract and retain faculty. Therefore, nursing faculty salaries need to be increased substantially if nursing schools want to attract and retain faculty.

3. Better Working Conditions

Being able to do things like take breaks and feeling that they’re able to turn down extra shifts may seem like basics that all nurses should be getting, but our survey shows that they are not. 72% of nurses don’t have adequate backup, 53% of nurses are unable to take sick days, and 36% feel that they can’t turn down extra shifts at work. 

4. Providing Funding for More Master’s and Doctoral Nursing Student Enrollments 

According to the AACN, “Master’s and doctoral programs in nursing are not producing a large enough pool of potential nurse educators to meet the demand.” 

For example, although enrollment in entry-level baccalaureate nursing programs increased by 3.3% in 2021, enrollment in master’s and PhD nursing programs dropped by 7% and 3.8%, respectively. 

Therefore, more funding and recruitment need to be directed at graduate-level nursing programs to help prepare more nursing faculty and create more advanced practice nurses.

5. Designing Nursing Positions That Offer Better Work-Life Balance

And finally, nurse leaders need to start creating nursing positions that allow nurses to have a better work-life balance if they want to attract and retain nurses in these positions. 

The high levels of nurse burnout and chronic stress in nursing are simply unacceptable and cannot continue if the nursing shortage is to be significantly reduced.  81% of nurses said they’ve felt burnt out in the past year, according to our survey. 

Nurses will continue to leave the profession and their jobs in search of a more manageable lifestyle and less stressful work.

By making a commitment to listen to nurses and implement these changes, policymakers, facility administrators, and nurse leaders can reverse this nursing shortage and ensure that our healthcare system has enough nurses to meet the needs of patients now and into the future.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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Post-Pandemic Nursing Shortage Affecting Aspiring Nurses

Nurses are a critical part of the healthcare system. During the COVID-19 pandemic , many saw how much nurses contribute to the care and protection of patients.

What has also become evident is a growing nursing shortage. COVID-19 has highlighted the gaps in healthcare and created an increasing demand for bedside nurses. In the United States, it is projected that 1.1 million nurses are needed to replace retiring nurses by 2022. Globally, the need is closer to 13 million.

The shortage has pros and cons for nursing students. One pro is being able to find a job quickly after graduation. A key disadvantage, though, is that nursing programs have fewer openings. For students, this means acceptance into a program may be more challenging.

The nursing shortage has many consequences. First, let’s address a few frequently asked questions before diving into what it may mean for prospective nurses.

Frequently Asked Questions on the Nursing Shortage

It’s important to correct some misconceptions about what has caused the shortage and how it might affect healthcare. Identifying the challenges the nursing workforce faces may help with potential post-pandemic nursing solutions.

What Is Causing the Nursing Shortage?

To ensure hospitals are fully staffed, we must identify why there is a nursing shortage . Professional nursing organizations and published studies have identified the following factors:

• Aging population: An aging population has strained the workforce. Older adults typically have more than one chronic disease . Many illnesses that were once terminal are now considered chronic.
• Aging workforce: Nurses are also reaching retirement age. At the start of the pandemic, some nurses retired, and others were given an early retirement package , increasing the shortage.
• Nurse burnout: The consequences of nurse burnout on patient care may be severe. Data show that high workload, low staffing, and long shifts are triggers.
• Family obligations: The majority of nurses are women. According to the U.S. Bureau of Labor Statistics (BLS), 12.6% of working nurses are men. Villanova University reports 20% of its incoming nursing students in 2021 are men. With the lack of family care benefits, a high number of women nurses who are also working parents may cut back or leave the profession to raise their families.
• Nursing educators: There’s a major bottleneck in nurse teaching . A shortage of nursing faculty limits the students a program can accept. Retirement, moving into the private sector, and a lack of incentives to become nurse educators affect the faculty shortage.

What Is the Current Status of the Nursing Shortage?

According to the American Nurses Association (ANA), more jobs will be available in nursing in 2022 than in any other profession. This shortage will have a significant impact on patient care. The BLS projects a 9% job growth rate for registered nurses (RNs) from 2020-2030, slightly higher than average.

The Department of Health and Human Services estimates at least seven U.S. states have the most severe nursing shortages. These include:

• South Carolina

Even before 2020, there were statewide initiatives to address the shortage of bedside nurses and nurse educators .

What Does the Nursing Shortage Mean for Healthcare?

Several key factors affect staffing needs . These include the level of patient illness, patient number, and staff skills and expertise (seasoned nurses versus new graduates). Patient outcomes are affected by staffing shortages. High nurse-to-patient ratios can lead to medication errors and higher morbidity and mortality rates.

Data also show that a patient’s risk of infection increased by 15% when the unit was understaffed. Higher nurse-to-patient ratios can also increase readmission rates in the pediatric population.

Staffing shortages, paired with a global pandemic, can increase nurse burnout and patient dissatisfaction. A staffing shortage also impacts the hospital’s level of reimbursement . Though the pandemic created a massive need for more nurses, it also reduced funding for hospitals, resulting in staff layoffs .

At the pandemic’s start, hospitals canceled elective surgeries to prioritize COVID-19 patients. Many non-COVID patients avoided hospitals. This led to decreased hospital funding and administrations furloughing nursing staff, further contributing to staffing shortages.

The Nursing Shortage on a Global Scale

Nursing shortages are not limited to the U.S. The International Council of Nurses (ICN) Policy Brief published in 2020 shows that 27.9 million nurses were working worldwide. However, the ICN estimates there was a shortfall of 5.9 million nurses.

Unfortunately, 89% of the shortages were in low- and lower-middle-income countries. Additionally, 17% of nurses expect to retire by 2030. The report shows that 4.7 million nurses are needed to maintain the current workforce. To address the global nursing shortage, 10.6 million more nurses must replace retiring nurses. (This 10.6 million estimate doesn’t take into account the loss from COVID-19.)

Retirement is only one of the challenges. Each factor contributing to the nursing shortage must be addressed to help fill the gap.

Global Impacts of COVID-19 on the Nursing Shortage

COVID-19 has not only highlighted disparities in healthcare but further contributed to the nursing shortage. In 2020, healthcare professionals used technology to provide care for people at home such as telehealth nursing . While this helped expand the reach of healthcare, it cannot replace the care of a bedside nurse.

Some countries have encouraged retired nurses to return as a volunteer nurse or reinstate their licence to help relieve the nursing shortage. Some have even mandated inactive nurses back to the bedside.

An ICN survey found that nearly 90% of national nurses’ associations were concerned that heavy workloads, burnout, and stress were factors for the growing nursing shortages. Nurses were either retiring or moving into the private sector where stress was lower.

Infection rates and deaths are also contributing factors to the nursing shortage. Because of their close contact with patients severely ill with COVID-19, millions of nurses have also been infected. Nearly 3,000 deaths have been recorded in 60 countries. In the U.S., after 12 months, there were 3,561 deaths of healthcare workers ; 32%, or 1,136, were nurses.

The ICN estimates that as a result of all contributing factors up to 13 million nurses are needed to fill the gap.

COVID-19 Is Increasing Nurse Burnout

No job or career is stress free. Every decision a nurse makes may impact the lives of their patients.

COVID-19 has added to this stress. The ICN expects the added burden will increase burnout and post-traumatic stress disorder, which “could have potentially significant detrimental effects, especially on the nursing workforce.”

Nurse burnout is a mental, physical, and emotional state of exhaustion, often triggered by work-related stressors. Nurses who experience burnout initially feel detached and disengaged. As the condition progresses, they may begin to use food, drugs, or alcohol to cope. Some nurses have physical symptoms, such as headaches or stomach problems.

Nurse burnout can lead to health conditions like insomnia, heart disease, high blood pressure, and Type 2 diabetes. Burned-out nurses risk providing low-quality care, leading to mistakes and even death. One study from Marshall University found that when nurses took care of more than four patients in a shift, there was a higher correlation of burnout and a 7% increase in mortality for each additional patient.

An online survey found a key contributor to burnout during COVID-19 was a decreased feeling of well-being. The survey also evaluated staff resilience, or “the ability to cope with and adapt positively to adversity.” Several factors were associated with decreased well-being, including a low measure of resilience, feeling personal protective equipment was inadequate, and believing the workload had increased.

A study from India found that the higher a nurse’s resilience, the lower the risk of burnout. The ICN report expresses significant concern over the burden that COVID-19 had placed on the healthcare system, writing:

— “In January this year, ICN raised significant concerns about the mass trauma that is being experienced by nurses during COVID-19 pandemic, and the medium to long term effects that trauma will have on the nursing workforce. These issues and risks combined do not bode well for long-term nurse retention in an already overstretched and vulnerable workforce. The COVID-19 pandemic has the potential to increase the number of nurses reaching the point of burnout, and increase the number leaving the profession, which could have a damaging impact as early as in the second half of 2021.”

Hostile Working Conditions Fueled by COVID-19

During the COVID-19 pandemic, nurses faced spikes in workplace physical violence and verbal abuse as patients’ families felt helpless with sick loved ones in the hospital.

One study researched nurses’ experiences with workplace violence. The researchers used an online survey of RNs working in hospitals to calculate the frequency of physical violence and verbal abuse from February to June 2020. The purpose was to help describe the type of violence that nurses may be experiencing during the pandemic.

They found 44.4% nurses reported physical violence and 67.8% reported verbal abuse. The rate of violence was higher in nurses caring for COVID-19 patients than in nurses who did not care for COVID-19 patients. The researchers recommend that hospital administrators recognize nurses’ increased risk of workplace violence and the urgent need to carry out preventive strategies.

Another data sampling of nurses working in Iran found similar results. Researchers measured “incivility” in nurses working in seven training hospitals. Some nurses reported that patients’ families were uncooperative because of their lack of knowledge of healthcare practices. Once educated, their behavior seemed to change.

The interviews also revealed that emotional and physical abuse has increased during the pandemic, elevating an already stressful environment.

What the Shortage Means for Future Nurses

It might appear as if the shortage opens the field for nursing graduates to find a job right after school. However, there is good and bad news. Job opportunities will differ depending on the geographical area.

Many states with significant shortages have rural areas where it may be difficult to attract experienced, skilled nurses. Job opportunities may also depend on experience and skill level.

The Shortage Impacts Nurse Working Conditions

Nursing shortages have a high impact on working environments, patient outcomes, and the long-term health of nurses, leading to longer shifts and higher nurse-to-patient ratios. This shortage increases stress, fatigue, and the risk of injury to nurses. It can also reduce patient care.

Another effect of understaffing is nurses quitting because of heavy workloads and the stress of caring for dying patients. According to one estimate in 2018, the cost of turnover per nurse was $44,000.

The shortage of nurses also depends on the nursing specialty . Higher shortages are measured in labor and delivery, critical care nursing, geriatric nursing, and nurse educators.

Before the pandemic, the nursing shortage’s most significant factors were aging, burnout, wage disparities, and regional needs.

Some Regions Have Higher Demand for Nurses Than Others

The fastest growth potential are in the West and Mountain regions of the U.S. Some experts anticipate slower growth in the Northeast and Midwest regions. This aligns with the U.S. Health and Human Services’ list of states with the largest nursing shortage gap. As the population ages, there will also be growth potential in areas with high retirement populations . This includes Florida, California, and Texas.

Despite regional differences, the BLS estimates the overall growth rate for nurse practitioners to be an outstanding 52% from 2020-2030. This is much faster than the average job growth rate. While there continues to be a shortage of bedside nurses, the BLS estimates the growth rate for RNs to be 9% during the same decade, just above average. This may be a result of challenges faced in nursing education.

Interest in Nursing School Increases, but Applicants Are Turned Away

The pandemic seemed to inspire a career in nursing. According to a study from the American Association of Colleges of Nursing (AACN), student applications surged. Enrollment to bachelor of science in nursing (BSN), master of science in nursing (MSN), and doctoral nursing programs in fall 2020 increased.

While the interest was high, 80,521 qualified applicants could not be admitted. They included:

• 66,274 who applied to BSN programs
• 1,376 to RN-to-BSN programs
• 8,987 to MSN degree programs
• 3,884 to doctoral programs

Applicants were not accepted primarily because of a shortage of teaching faculty and clinical sites for nursing students.

According to AACN , nursing schools turned away 80,407 qualified applicants in 2019 for some of the same reasons like a shortage of clinical and classroom space. Another report identified a shortage of 1,637 educators in 892 nursing schools. Many of the empty faculty positions required or preferred a doctoral degree.

There Are Global Initiatives to Increase the Nursing Workforce

The ICN has encouraged national nurses’ associations and governments to address the nursing shortage. According to their estimates, 74% of associations have reported that their countries are committed to addressing the problem, and 54% are addressing the need to retain working nurses.

Nursing associations have recorded a 20% increase in the number of nurses who left the profession in 2020. This raises concerns about the emotional and physical trauma experienced by nurses during the pandemic and increases the expected nursing shortage gap.

Additionally, there will continue to be a 3-4 year gap in the nursing shortage before new graduates are ready to enter the field. During this period, national nursing associations worry that the added workload and stress will increase the number of experienced nurses who leave.

Changes Need to Be Made to Ensure On-the-Job Safety for Nurses

The stories of front-line nurses caring for COVID-19 patients have inspired many to apply to nursing programs and join a career that focuses on the care and protection of others. To close this shortage gap, the ICN has made several suggestions:

• Protect the safety and well-being of the current and future nursing staff
• Provide psychosocial support to bedside nursing staff
• Commit time and finances to long-term strategies that increase the number of nurses in the workplace
• Invest in the recruitment, retention, education, and training of nurses
• Improve wages and working conditions so local nurses do not leave for high-income countries
• Prioritize fair pay for all nurses

Nurses Can Advocate for Changes Too

Nurses need to advocate for changes at the local and federal levels. To that end, ANA has developed an activist toolkit with action plans nurses can use to support for their profession.

ANA offers one-click options of writing to legislators to encourage change or thank them for their efforts. Top federal priorities include the opioid epidemic, workplace violence, safe staffing, and health system transformation. Nurses can learn more about each effort through the site.

The Post-Pandemic Future Remains Uncertain

The future of the nursing shortage is uncertain. Higher than expected numbers of nurses are leaving the profession from:

• Rising stress that triggers burnout
• Physical and verbal abuse in the workplace

There is a massive increase in job growth for nurses and nurse practitioners, so nursing jobs are and will continue to be abundant. Although the pandemic has inspired many to apply to nursing programs, many schools do not have the clinical sites or faculty to accommodate applicants.

If you are experiencing the symptoms of burnout, don’t wait until the situation is so bad you must quit. Instead, take these self-care steps for nurses and avoid getting burned out.

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How the nursing shortage is affecting the Canadian health care system, patients and nurses themselves

by Lisa McKendrick Calder, Leanne Topola and Tanya Heuver, The Conversation

If you worry that there are not enough health care providers to meet health needs, you are not alone. Seventy percent of Canadians worry about access to care. One factor affecting health-care access is a global nursing shortage .

The increasing demand for nursing services in Canada far exceeds the current supply. Statistics Canada reported in 2021-22 nursing had higher job vacancies than any other occupation, and nurses worked over 26 million hours of overtime.

In honor of National Nursing Week 2024 (May 6–12), we ask all Canadians to consider asking a nurse they know about the realities of the nurses' working lives.

A short-staffed health system

Forecasting models predicted a shortage of 60,000 nurses nationwide by 2022, and further predicted that would almost double to more than 117,000 by 2030.

Responding to shortages has led to changes in staffing models , with fewer registered nurses, more licensed practical nurses and substantially more health-care aides. But even with these, there is a significant shortage, making it essential to retain existing nurses who have the required education and expertise.

In 2024 the Canadian Federation of Nursing Unions (CFNU), conducted a survey of 5,595 nurses. Thirty percent reported dissatisfaction with their career and 40 percent intend to leave nursing or retire.

Early career nurses were even more unhappy with 35 percent reporting dissatisfaction. This is due to occupational disappointment , which is a feeling of disheartenment with career choice.

Job dissatisfaction in nursing

The majority of CFNU survey respondents attributed this disappointment to high workload and insufficient staffing. One cause of increased workload is caring for more patients than the bed capacity is funded or staffed for. Seventy percent of nurses reported their workplace regularly operated over capacity.

Even when care areas are understaffed, patient needs do not change and fewer nurses must meet these needs. Nurses are also influenced by shortages in other health professions such as physiotherapy by picking up extra duties to meet patient needs.

Insufficient staffing increases nurse workload to above normal demands and can threaten patient safety. When there is insufficient staff, nurses from other areas may be displaced to cover. For example, a nurse scheduled on an orthopedic unit might be displaced to neurology.

Forty two percent of nurses in the CFNU survey were displaced within the last year and 40 percent of them felt inadequately trained for the care area they were sent to.

Insufficient staffing can also lead to missed care where patient needs are unmet. Common examples include delay or failure to answer patient call bells or assist with personal care. Recently neonatal intensive care units highlighted they were functioning at 102 percent capacity and babies were not able to be fed as frequently.

Nurses' concerns with substandard care impact job retention as they may experience moral distress . Moral distress is highly correlated with increased intent to leave a job , or the profession .

Safety and safeguards

When short staffed, nurses can be mandated to work beyond their eight- or 12-hour scheduled shifts. Under the Registered Nurse Code of Ethics, the nurse has a duty to provide care to assigned patients until they are transferred to another appropriate care provider. Failure to do so is considered abandonment.

While off duty, nurses can be called in for mandatory overtime. The CFNU policy statement advocates against the use of mandatory overtime except in exceptional circumstances such as disasters. Despite this, in 2023 Manitoba nurses worked over one million hours of mandatory overtime. This is shocking, especially considering Manitoba has legislation limiting mandatory overtime usage.

From a safety perspective however, restricting overtime is not a solution, as it could leave patients at risk and nurses even more overburdened.

Not all overtime is mandatory. Many nurses receive frequent calls to pick up extra hours , which leaves them unable to properly recover between shifts . Declining overtime can cause guilt or a sense of letting colleagues down. In the CNFU survey, 62 percent of respondents worked overtime in the last month out of obligation.

The impact of the nurse shortage

Work hour factors impact patient safety . The CFNU study "Safe hours saves lives" reported extended shifts led to deficits in patient care with nurses reporting decreased physical strength, focus, and ability to be compassionate. Fatigue contributes to medication errors.

Fatigue is correlated with drowsiness and difficulty staying awake both on shift and when driving home . This presents a danger to patients, nurses, and all Canadians on the roads.

Persistent fatigue has been found to impact nurses health. This influences work attendance which further worsens the shortage. Canadian nurses missed an average of 19 days of work for illness or leave in 2022, up from 14.7 days in 2021. This is more than double the sick time taken by government and private sector employees.

Many factors identified in this article contribute to nurse burnout. Canadian nurses have increasing rates of burnout. Ninety three percent of CFNU survey respondents reported symptoms of burnout . Burnout has been linked with depression, anxiety, and post-traumatic stress disorder.

Why a shortage of nurses matters

All Canadians ought to worry about the nursing shortage. Without addressing it, Canadian's ability to access safe, compassionate care will be compromised. When looking at the complex ways that the shortage impacts nurses and their work demands, it is no wonder why they experience occupational disappointment.

Work is underway by nurses alongside Canada's Chief Nursing Officer . The Nurse Retention Toolbox provides guidance. The work to address nursing retention cannot be done by nurses alone. All Canadians need to advocate for conditions that support the well-being of nurses and other health care providers. This is essential for a safe, sustainable health system for us all.

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Shortage at nursing homes have left an increasing number of patients in hospitals

JUANA SUMMERS, HOST:

Nursing homes take care of a range of patients. Some may only need a few weeks of rehab. Then there are patients who need longer-term care, and those patients are having a much harder time finding beds in skilled nursing facilities. Lesley McClurg from member station KQED reports.

LESLEY MCCLURG, BYLINE: David Alter (ph) always thought he'd grow old alongside his wife, Lisa (ph).

DAVID ALTER: We were very social, and she liked to be fun and wacky.

(SOUNDBITE OF JOAN JETT AND THE BLACKHEARTS SONG, "I LOVE ROCK 'N' ROLL")

MCCLURG: They loved to go to shows together.

ALTER: You know, there was a Joan Jett phase, you know?

(SOUNDBITE OF SONG, "I LOVE ROCK 'N' ROLL")

JOAN JETT AND THE BLACKHEARTS: (Singing) Singing, I love rock 'n' roll, so put another dime in the jukebox, baby.

MCCLURG: Lisa taught elementary school, and the couple had two children. But over the years, Lisa changed. She started to forget things. She became edgy and irritable.

ALTER: She was kind of struggling to hold the job.

MCCLURG: In 2011, a doctor diagnosed Lisa with Huntington's disease, a genetic brain disorder that causes nerve cells to break down over time. She was 45. Eventually, she couldn't walk, eat or talk on her own. Alter remembers hearing her one night.

ALTER: And then you got this panic. And then hearing her fall and - she hit the wall and, like, broke a hole in the wall. Now she's bleeding. It's 2 in the morning or something like that.

MCCLURG: He knew it was time for professional help. He says he called hundreds of nursing homes in California. He wrote personal letters.

ALTER: I want you to meet my wife, Lisa - see picture above - a vibrant woman, wife, teacher and mother of two beautiful children.

MCCLURG: But no one said yes. He asked for advice from the Huntington's Disease Society of America.

ALTER: I was told, you just don't have the power to do this.

MCCLURG: Their best advice was to leave his wife in the hospital after her next trip to the ER.

ALTER: The hospital can make negotiations that you're never going to be able to do.

MCCLURG: So even though it was excruciating, he didn't pick her up from the hospital the next time she fell.

MAURA GIBNEY: I don't know anybody that's gotten into a nursing home any other way.

MCCLURG: Maura Gibney is the executive director for California Advocates for Nursing Home Reform. She regularly advises families to leave their loved ones in the hospital.

GIBNEY: That's the only way.

MCCLURG: But 4 1/2 months later, Lisa was still there. Kaiser Permanente declined an interview, but in an email, they acknowledged that some discharges present challenges. That's also true for Scripps Mercy Hospital San Diego.

VALERIE NORTON: Some of the patients up here have been here for a really long time because we don't have anywhere safe to send them.

MCCLURG: Dr. Valerie Norton is an emergency medicine physician at Scripps.

NORTON: Behind this door is a patient that's been here for more than two years.

MCCLURG: The American Hospital Association reports that patients waiting to transfer to a nursing home spent 20% longer in the hospital in 2022 compared to 2019. Several factors are at play.

BRIAN MCGARRY: The number of nursing home beds have declined.

MCCLURG: Brian McGarry is a health services researcher at the University of Rochester. He estimates a 15% drop in capacity due to staffing shortages and closures during the pandemic.

MCGARRY: And so the nursing homes have become much more discerning and much more careful about who they're willing to accept.

MCCLURG: He says the hardest patients to place are...

MCGARRY: Patients who have complex medical needs, have intense personal care needs that are going to require a lot of staff time at the nursing home to really care for them, patients who are already on Medicaid.

MCCLURG: Medicaid is the state and federal insurance program for people with limited income or disability. It reimburses at the lowest market rates. But Craig Cornett, the CEO of the California Association of Health Facilities, denies that nursing homes are refusing entry based on insurance.

CRAIG CORNETT: The bigger issue has really been the workforce challenges. If facilities don't have an adequate number of staff, they have to reduce their census.

MCCLURG: Still, David's wife, Lisa, who is covered by the state insurance program, known as Medi-Cal in California, hasn't found a place in a nursing facility. They've been looking for three years. She's now 58 years old.

ALTER: You're just defeated.

MCCLURG: Eventually, Kaiser did find housing for her where she gets food and supervision but not specialized nurses or regular doctor visits. She needs a lot of help to eat because of her erratic movements.

ALTER: She doesn't have the care she needs. She's so tiny. She's so skin and bones.

MCCLURG: He says he's hired consultants, lawyers and written his legislators, all to no avail. For NPR News, I'm Lesley McClurg in Berkeley.

(SOUNDBITE OF ELHAE SONG, "KNOW") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

• Bureaus and Offices
• Contact HRSA
• Health Workforce Programs

Nursing Workforce Diversity (NWD)

We support projects that increase nursing education opportunities for individuals who are from disadvantaged backgrounds. This includes underrepresented racial and ethnic minorities among registered nurses.

Am I eligible?

You are eligible * , if you are

• An accredited school of nursing
• A nurse managed health clinic/center
• An academic health center
• A state or local government
• A private or public nonprofit entity that the HHS Secretary deems appropriate

How do I apply?

When funding is available, you apply via grants.gov. Read the most recent NWD funding notice .

Technical Assistance

FAQs : Nursing Workforce Diversity-Eldercare Enhancement (NWD-E2) Program

What's the impact of NWD grantees?

NWD Outcomes – Academic Years 2014-2019 (PDF - 124 KB)

How can I contact you?

Email Aja H. Williams

Call: 301-945-9658

* Note: Always read the notice of funding opportunity for full eligibility requirements.

The Federal Register

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• Southern Connecticut State University
• Undergraduate Nursing Programs

Accelerated BS in Nursing (ABSN) Program

The ABSN program is an accelerated BSN program for individuals already holding a BS/BA in any field from an accredited college or university who wish to enter the nursing profession. The intensive program allows qualified individuals to complete the nursing coursework in 12 consecutive months. Upon successful program completion, students are eligible to register for the NCLEX licensure examination.

According to the Bureau of Labor Statistics (BLS) Occupational Outlook Handbook (2018), employment of registered nurses is projected to grow 6% from 2022 to 2032 with an expected demand of more than 193,000 RNs nationally. With more than 500,000 seasoned RNs anticipated to retire by, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees, and to avoid a nursing shortage.  In Connecticut, nearly 46% of the full-time nursing workforce is over the age of 50, indicating a need for a significant number of new nurses to fill the anticipated retirements that will occur over the next decade. (Connecticut Center for Nursing Workforce, 2022).

The undergraduate nursing program(s) at SCSU are recognized as high quality program(s). Our NCLEX pass rates have been mostly between 90-100% over three decades, and employers readily hire and confirm the quality of our new graduates. Many curricular changes have been implemented during the last several years to improve the quality of our instruction and better prepare students for the realities of practice.

After reviewing the information below regarding how to apply, eligibility requirements, and prerequisites, you may email [email protected] if you still have questions.

• The nursing curriculum can be completed in just 12 months (excluding nursing prerequisites).
• The ABSN program is based on the same curriculum as SCSU's highly successful and nationally accredited traditional nursing program.
• There are opportunities to learn with other highly motivated, adult learners with rich life and work experiences.
• We offer small class size and affordable tuition.
• Our faculty are dedicated to working with this unique population.

The application for Winter 2024 is OPEN until July 15th, 2024. The application for Summer 2025 will open July 16th, 2024 with a deadline of December 15th, 2024. Please read the additional information below for detailed information about the requirements and application information.

• There are two entry terms for the Accelerated BSN program, Summer and Winter, each with their own application deadlines. Summer entry deadline is December 15th, Winter entry deadline is July 15th. 
• All prerequisites must be complete with a C+ or greater by the respective deadlines and all proper documentation and transcripts must be provided by the respective deadlines.  If applicable,  CLEP  examination(s) scores and AP scores must be received by the Transfer Admissions & Services Office by the application deadline.
• There is a required  Essay, Checklist ,and Prerequisite Form  that must be completed and submitted to the application portal. 
• Official transcripts from  ALL post-secondary schools  attended MUST be sent to the Transfer Admissions & Services Office by the respective application deadline.  Any international transcripts will need to be accompanied by syllabi for relevant nursing prerequisites in order to undergo proper evaluation. Courses on international transcripts without syllabi will not be considered for prerequisite equivalency.  High School transcripts and SAT/ACT scores are not required.  Resumes and recommendation/reference letters will not be accepted .
• Students  may not  apply to both the Accelerated BSN and Traditional BSN program at the same time.

To be considered for the Accelerated BSN Cohort, applicants must meet the following requirements:

• Conferred BA/BS degree from a fully accredited academic institution (by the application term deadline). 
• Minimum cumulative GPA of 3.0 (including all post-secondary GPA's from fully accredited schools attended).
• Completion of the required prerequisites, outlined below, with a C+ or greater (by the application term deadline.) Official transcripts must be submitted to the Transfer Services Office (by the application term deadline). Any outstanding or incomplete items after the intending application term deadline will result in an incomplete application. Incomplete applications will be pushed forward one application cycle. If applications remain incomplete after two consecutive application terms, applicants will need to reapply. 
• All prerequisites must be complete with a C+ or greater however applicants are not allowed to have more than 2 repeated prerequisite courses due to an initial grade below a C+.
• Completion and submission of the Accelerated BSN  Essay, Checklist, and Prerequisite Form  to your online application portal.
• Southern CT State University has an agreement with SCSU Senior students approaching graduation . The items outlined in this agreement are only applicable to matriculated SCSU students who are earning their undergraduate degree.

SCSU does not have a limit on the number of credits that you may transfer into the university. The university currently does not have an expiration date on any of the below required prerequisites. It is not a requirement to take the required prerequisite courses at a specific college or university as long as they are equivalent courses. Please use the provided tools to verify course equivalencies. 

Below is a list of the required prerequisite courses for the ABSN program, and their CT Community College equivalencies. All must be successfully completed, each with a grade of a C+ or higher. Non-science prerequisites are acceptable as online courses, but science prerequisites require an in-person lab (no online labs will be accepted). Official transcripts must be submitted to the Transfer Services Office. (Place an application during the designated application dates before you begin submitting documentation.)

If you attended and/or graduated from a regionally-accredited institution within CT, you may see how your courses will transfer to Southern before applying. Use the  TES Public View for Southern CT State University  tool to identify your college or university, and appropriate course equivalencies in the country. If your school is listed, you will be able to search the courses you have taken and see the transfer course equivalency.

If you are interested in both the traditional BSN and ABSN programs, you may be interested in comparing the two. For further information, please contact  [email protected] .