Ask any nursing leader about their greatest challenge and they'll likely point to staffing. If hospitals weren't already feeling the effects of a severe nursing shortage, a nationwide rise in hospitalizations fueled by the highly contagious COVID-19 delta variant has made the effects of it unmistakable.
For many clinicians still coping from the initial waves of the pandemic, the current surge instills a deep brand of exhaustion. They've seen this before. Except this time, many of the critically ill patients they're treating are unvaccinated, provoking newfound emotions such as anger and frustration. As a result, it's become harder for hospitals to incentivize and recruit nurses.
The American Nurses Association estimates that more than 500,000 nurses plan to retire by 2022. To supplement retirees and expansion, more than 1.1 million new RNs will be needed, the U.S. Bureau of Labor Statistics projects.
But under current circumstances, it's difficult for nursing leaders to imagine how we'll get there.
Becker's spoke to four chief nursing officers about how their hospitals are coping with the unprecedented workforce shortage, and what should be done to help remedy the deficit.
A glimpse of the shortage
At the same time COVID-19 cases are surging, Midland (Texas) Memorial Hospital has a 30 percent vacancy rate for nursing positions.
"In good times, we'd see probably about 10 to 15 percent, so [the vacancy rate is] about double what we would normally experience at this time," said Kit Bredimus, DNP, RN, CNO at Midland Memorial.
Meanwhile, at UCSF Health in California, there are about 200 open nursing positions across the 1,000-bed system, CNO Pat Patton, DNP, RN, told Becker's.
"One of the changes we've had to make is to hire just a lot more travelers just to keep up and have staffing, and stay within state mandated ratios," Dr. Patton said.
The same is true back at Midland Memorial Hospital, where about 20 percent of the front-line nursing staff are travel or contract nurses, Dr. Bredimus said.
Turning to travel nurse agencies, however, is an unsustainable solution that still leaves hospitals competing for the same pool of nurses.
"The high demand for staff across the nation led to competition which made staffing both challenging with costly premiums at a time when hospitals were losing money," said Beth Oliver, DNP, RN, chief nurse executive and senior vice president of cardiac services at New York City-based Mount Sinai Health System. "Adding to the nursing staffing shortage is the fact that many nurses re-examined their priorities and transferred from inpatient to ambulatory settings within the organization, or relocated closer to their family to avoid lengthy commutes, while others made a geographic change."
At St. Louis Children's Hospital, vacancies are being filled, though slower than usual. At the same time, however, turnover is up, said Peggy Gordin, RN, CNO and vice president of patient care services at the hospital.
"We are seeing much higher turnout related to staff leaving to do travel nursing (for perceived experience and higher pay), as well as a lot of retirements," she said. "At the same time, pediatrics is experiencing unusually high volumes for summer, and are starting to see more children admitted with COVID-19 on top of that — a perfect storm."
How hospitals are responding
Dr. Bredimus said Midland Memorial has had to double down on local growth efforts, partnering with local colleges and high schools. The organization is developing a transition to practice program that can start in high school, nursing community colleges and/or paramedic programs.
"Wherever we can find folks, we're trying to get them on track for an ADN or BSN so we can get them into the workforce," Dr. Bredimus said. "And then of course, investing heavily into our practice transition program."
Increasing the pool of float nurses has enabled a bit more flexibility at St. Louis Children's Hospital, Ms. Gordin said. This was more beneficial during earlier phases of the pandemic when the hospital was able to float pediatric intensive care unit nurses to adult hospitals to support the system's adult COVID-19 patients. Under the current circumstances however, it's not much of an option.
"Unfortunately now with the delta variant wave, we are not able to receive similar help in return because all of us are extremely busy and there are no hospitals with lower volumes and staff to reassign," she told Becker's.
Mount Sinai has a robust nurse residency program and is actively partnering with its school of nursing along with other local academic centers, to develop and sustain a recruitment pipeline, Dr. Oliver said. The organization is also investing time and effort in fostering a work environment that provides nurses with access to self-care and supportive initiatives.
What nurses say could help
"It would be great to see national licensing or all states participating in the nursing licensure compact," said Ms. Gordin with St. Louis Children's Hospital. The hospital borders Illinois, a state that doesn't participate in a multistate nursing license compact, which limits the ability to move staff around the region, she said.
Fewer regulatory mandates that add to nursing documentation requirements would also be helpful, said Ms. Gordin, adding that, "another huge need is improved access to inpatient and residential facilities for children and youth with behavioral health needs to reduce burden on acute care facilities."
Counterintuitively, the root of the nursing shortage doesn't depend on the number of potential students — there are actually plenty of nurse applicants. Most nursing schools don't have sufficient faculty to teach more applicants, and not because there aren't enough qualified faculty to teach, but because there isn't enough money to pay them.
"We have a need for faculty, but they don't pay enough, so people aren't going into the positions," said Dr. Patton with UCSF.
According to the American Association of Colleges of Nursing, U.S. nursing schools turned away 80,407 qualified applicants from baccalaureate and graduate nursing programs in 2019 due to insufficient resources such as faculty numbers, clinical sites, classroom space and finances. Two-thirds of nursing schools responding to the AACN survey cited a shortage of faculty and/or clinical preceptors as the reason for not accepting qualified applicants.
To attract faculty to nursing schools, the AACN recommends several federal and state initiatives, including funding, fellowships and loan forgiveness programs for nurse faculty members. Hospitals should also focus on practice transition by partnering with nursing organizations and schools. All organizations should encourage nurses' use and education of healthcare technology, along with support of further career development. Lastly, a national licensing program, or having all states participate in a nurse licensure compact, would help rectify the current shortage of nurses and nurse faculty.