The U.S. is experiencing a severe Registered Nurses (RNs) shortage as the demand for healthcare increases and the Baby Boomer generation ages. With this huge shortage, it is unfortunate that patient care is sometimes getting compromised, and key care areas are understaffed.
With the increase in healthcare needs brought on by an aging population, it is estimated that 1.1 million new RNs are currently needed in the U.S. However, despite attempts to increase pay and other benefits and reduce hours, the nursing shortage is continuing to accelerate, with COVID-19 exposing serious gaps in our healthcare system and creating an increasing demand for well-trained nursing professionals.
"Nurses play a vital role in the healthcare system and the consequences of a nursing shortage can be severe, including decreased quality of care, increased patient mortality rates, longer wait times, and increased healthcare costs," observes Kanza Ahmad Khan, MHA, one of the founders at Global MedStaff, a newly formed staffing and resources platform for the healthcare ecosystem with high-quality and well-trained nurses and healthcare professionals.
Organizations like The American Association of Colleges of Nursing (AACN) are working with schools, policymakers, nursing organizations, and the media to bring attention to this issue. However, addressing the nursing shortage will require a multi-faceted approach. In this article, we will explore some of the factors contributing to the nursing shortage and the potential solutions that are being proposed to address this critical issue.
Facts and Figures
The American Journal of Medical Quality published a report card and shortage forecast for the U.S. registered nurse workforce in September/October 2019, which projected a widespread shortage of registered nurses until 2030. The authors of the report conducted a state-by-state analysis and predicted that at least 30 states would face a shortage of RNs, with the Western region experiencing the most severe shortage.
In April 2022, Dr. David Auerbach and colleagues published a nursing workforce analysis in Health Affairs, which found that the total supply of RNs decreased by more than 100,000 from 2020 to 2021 - the largest drop 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.
Contributing Factors Impacting the Nursing Shortage
The projected demand for RN and APRN services is not being met adequately, as nursing school enrollment is not growing at a fast enough rate
"There are unfortunately several reasons for the current nursing shortage including nurse burnout, especially following COVID, a lack of nursing instructors and students that have not had an adequate clinical training opportunity, but in my opinion, the most pressing issue is our aging population including the nurse population, which has caused both an increase in the number of patients and a decrease in the number of nurses," explains Michael Moorhead, CEO of Stonewall Memorial Hospital in Aspermont, Texas.
In 2021, there was a 3.3% increase in enrollment in entry-level baccalaureate nursing programs, but AACN reported declines of 0.7% and 3.8% in Ph.D. and master's nursing programs, respectively. These trends are causing concern about the ability of nursing schools to meet the expected demand for nursing services, which includes the need for more nurse faculty, researchers, and primary care providers.
A shortage of nursing school faculty is restricting nursing program enrollment
AACN's report on 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing revealed that U.S. nursing schools had to reject 91,938 qualified applications (not applicants) for baccalaureate and graduate nursing programs in 2021 due to various reasons, including a lack of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.
A considerable portion of the nursing workforce is approaching the age of retirement
The National Council of State Boards of Nursing conducted a survey on the nursing workforce in 2020, which revealed that the average age of a registered nurse is 52 years old. This could indicate a significant influx of retirements in the next 15 years.
The nursing workforce, much like the communities they serve, is aging. With over a million registered nurses aged 50 and above, approximately one-third of the workforce could retire in the next decade or so. This situation is further compounded by the fact that nurse faculty, who are included in this count, are also approaching retirement age, creating a unique challenge of training more nurses with limited resources. The shortage of nursing faculty leads to enrollment limitations in nursing schools, thus limiting the number of new nurses being generated. Consequently, this lack of faculty can result in fewer students and a decline in the overall quality of nursing programs and classes.
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 a higher number of people over the age of 65 than those under the age of 18, which underscores the need for more nurses to care for the aging population. According to the Bureau of Labor Statistics, the demand for registered nurses is expected to grow 7% from 2019 to 2029, faster than the average for all occupations.
The COVID-19 pandemic has further exacerbated the nursing shortage.
The COVID-19 pandemic has put unprecedented pressure on the healthcare system, and nurses have been on the frontlines of the response. The pandemic has worsened the existing nursing shortage, with nurses facing burnout, stress, and a high risk of contracting the virus. This has led to some nurses leaving the profession entirely, exacerbating the shortage further.
Addressing the Nursing Shortage
Addressing the nursing shortage will require a comprehensive strategy that employs various methods and approaches, involving both short-term and long-term strategies. Some of the strategies that can be implemented include:
Increasing Enrollment in Nursing Education and Technology
We need more nurses and we must look at bringing more people in the nursing space, This can be achieved through funding for new nursing programs, expansion of existing programs, and increasing the number of faculty and clinical preceptors. In addition, there is an opportunity to leverage technology. This can be achieved through the use of telehealth, mobile apps, and other technology to improve efficiency and effectiveness in delivering care.
Recruiting and retaining nurses/Advancement Opportunities
This can be achieved through competitive salaries, benefits, and incentives, such as student loan forgiveness programs, tuition reimbursement, and sign-on bonuses. There is also an opportunity to build out career paths for nurses. This can be achieved through mentorship programs, leadership training, and opportunities for professional development and career advancement.
Increasing diversity in the nursing workforce
This can be achieved through targeted recruitment efforts, scholarships and grants for underrepresented groups, and cultural competency training for nursing faculty and students
Utilizing foreign skilled nursing talent
There are currently 4.2 million registered nurses in the US, with approximately 336,000 of them being foreign-born and trained. The Philippines, India, and Jamaica are the top three countries with the highest number of foreign-born RNs, with the Philippines having 175,000 registered nurses.
To address the nursing shortage, Global MedStaff is introducing a new initiative. This approach involves bringing in foreign skilled nursing talent from the Philippines to help relieve the nursing shortage in the US.
International nurses often take nursing positions that traditional U.S. nurses do not desire, such as psychiatric nursing, critical care nursing, and emergency care nursing. To qualify for work in the US, Philippine nurses undergo a certification process, which includes a 4-year course in nursing, passing the board exam for nursing with the Professional Regulatory Commission (PRC), and taking the NCLEX National Council Licensure Examination for Registered Nurses (RN) USA. Additionally, they must take the IELTS English Proficiency Test and a medical test to ensure they are in excellent health before they leave the country.
The Global MedStaff platform is collaborating with Philippine healthcare institutions to find nursing talent and vets their applications, conducts background checks, conducts interviews, and communicates acceptances. Global MedStaff will then connect nurses to U.S. healthcare institutions, matches them based on preferences, and allows nurses to accept or decline placement.
The platform also fills any skills gaps for nurses and fulfills all the required certifications for working in the U.S. After deployment to the United States, the Medicare International alumni program mentors new nurses and refers other nurses to apply.
The initiative by Global MedStaff to bring in skilled nursing talent from the Philippines is crucial in addressing the nursing shortage in the United States and "will help better manage rising staffing costs, reduce healthcare fatigue and decrease health related errors," notes Eden Florencio, a member of the founding team at Global MedStaff. The platform's commitment to supporting nurses from application to placement and beyond highlights the importance of investing in the healthcare workforce.
"With a rigorous certification process and a focus on filling skill gaps, this approach is an effective way to address the shortage and provide high-quality care to patients in need," explains Bhavdeep Singh, Managing Partner at Whitehawk Associates, and founder of Global MedStaff. Prior to Whitehawk Associates and Global MedStaff, Bhavdeep Singh was the Founder and Chairman of HealthQuarters, a new and high paced healthcare platform in New York City. Prior to that, he was CEO of Fortis Healthcare, one of the largest providers of healthcare in Asia. Singh has been integral in supporting a transformative approach to healthcare globally and an ardent supporter of the nurse staffing initiative.
The nursing shortage in the U.S. is a complex problem that is expected to intensify over the next decade. "Addressing the issue will require a collaborative approach, involving strategies such as increasing nursing school capacity, recruiting and retaining nurses, increasing diversity in the nursing workforce, encouraging nurse leadership and advancement, investing in technology and innovation, and utilizing foreign skilled nursing talent," says Singh. "It is crucial to address this critical issue to ensure that we can meet the growing demand for healthcare in this country for years to come."
