Nursing shortages

A nursing shortage occurs when the medical community does not have enough nursing staff to operate effectively. Nurses perform many of the day-to-day tasks necessary for patient care. While some offer specialized care, most provide broad-spectrum patient care. Without an adequate number of nurses, most medical facilities cannot provide patients with quality care.

Nursing shortages have occurred throughout the twentieth and twenty-first centuries, at times attracting significant attention and concern. Shortages are often driven by large-scale demographic changes, including population aging. For example, the US began to experience a widespread nursing shortage in the early twenty-first century as the large Baby Boom generation reached retirement age, driving up demand for nursing services even as many older nurses left the workforce. Shortages can also be caused or exacerbated by many other factors. For example, the emergence of the COVID-19 pandemic in 2020 severely strained health-care systems throughout the world. This resulted in high levels of stress and burnout among nurses, causing many to quit their jobs.

Experts have recommended several remedies to increase the number of nurses and end nursing shortages. These include providing additional funding to nursing schools, which would enable more people to be trained for nursing. They also include placing stricter limits on nurses’ responsibilities and increasing schedule flexibility to reduce stress levels and burnout.

Background

Nurses play an essential role in the modern health-care system. Working with physicians and other medical staff, nurses are responsible for much of the day-to-day care that takes place in a hospital or medical environment. Nurses are responsible for tracking patients’ progress and administering medications, as well as patients’ holistic care.

Nurses are also responsible for patient advocacy, meaning that they support patients' best interests throughout the treatment process. They must maintain a patient’s dignity throughout care. In many cases, patients may not fully understand the care that doctors prescribe or may not be capable of expressing displeasure with a specific treatment. Nurses are responsible for making these choices on behalf of the patient.

Throughout much of a patient’s experience in the health-care system, nurses are directly involved in the decision-making process for care planning. They assess signs of problems that the patient may be facing and are able to recommend actions to hospital staff to rectify them. Additionally, because nurses spend so much time working with individual patients, they are often expected to notice any signs of distress or problematic symptoms that doctors may have missed.

Due to the wide variety of demands placed on nurses, nurses of different ranks and specialties may be found throughout the medical system. The registered nurse (RN) is one of the most common types of nurses. Registered nurses can be found anywhere where patients need care, including hospitals and long-term care facilities. RNs perform most tasks commonly associated with nursing, such as coordinating with doctors, providing patients with advice and support, and assisting with patient care.

Certified nursing assistants (CNAs) receive less training than registered nurses, so they are entrusted with more routine tasks of patient care. They might help patients walk, bathe patients, and monitor their vital signs. They do not work with doctors to decide the best course of action for a patient. CNAs are commonly employed in hospitals and long-term care facilities where patients need continuous assistance.

Some nurses specialize in surgical assistance. These nurses are responsible for directly assisting doctors during surgery by positioning patients, ensuring that the facility is properly equipped for the surgery, and helping the doctor quickly access needed tools. They are also responsible for providing presurgical and postsurgical patient care.

Other nurses work in emergency rooms. These nurses are expected to perform triage on patients who may be in critical condition when they arrive at the hospital. They must also determine the order in which patients must be treated, prioritizing those whose life depends on immediate treatment. They conduct examinations and monitor patient progress. To complete these tasks quickly and efficiently, emergency room nurses work closely with a staff of doctors.

Home care nurses work outside of hospitals, providing care directly to patients in their homes. They often work with patients who require full- or part-time care but can function well enough to exist outside a long-term care facility. These nurses are required to monitor patients, administer medications, change bandages, and note when patients are experiencing any unusual symptoms that might require more intensive care.

Certain registered nurses receive advanced training that allows them to carry out tasks typically designated to doctors. These nurses, commonly called nurse practitioners, are allowed to diagnose diseases, prescribe treatment plans, and order laboratory tests. Though they typically work alongside doctors, they are given the freedom to make diagnoses. Because nurse practitioners are responsible for making diagnoses and ordering tests, they may not be expected to provide patients with direct care.

As most medical facilities require a staff of nurses to properly function, there tends to be consistent and relatively high demand for nurses. In turn, a career in nursing is pursued by many people seeking a form of employment that offers job security and continued training opportunities. However, this also means that any shortage of nurses severely impacts the quality of patient care. For this reason, nursing shortages are often analyzed as not only a labor and economic issue, but also a fundamental public health concern.

Nursing Shortages in the United States

Despite the importance of nurses in the American health-care system, nursing shortages have occurred in the United States throughout history. In many cases, these shortages have been caused or exacerbated by significant events outside the medical system. For example, the outbreak of World War II caused a nursing shortage that lasted for decades. Many medical professionals who served as medics during the war or who fought in it chose not to continue their careers when they returned home. To alleviate this burden on the medical system, medical schools relaxed the standards for admission into nursing programs, enabling more people to become nurses and reducing the severity of the shortage.

Experts have argued that because each nursing shortage is unique, it must be addressed individually. Many nursing shortages have numerous causes and may not be addressed by a single change. For example, waves of retirement, trouble recruiting new nursing students, the high stress of the job, difficult working conditions, and external world circumstances can all contribute to both regional and widespread nursing shortages. The complex causes of each shortage must be addressed to bring nurses back into the workforce. Additionally, there has been increasing attention to the issue of diversity among health-care providers, and researchers have examined how this intersects with labor shortages. Many experts suggest that diversity must be considered in efforts to prevent and rectify nursing shortages.

In 2020, the COVID-19 pandemic swept across the world. This pandemic vastly increased the demands on health care facilities throughout the world. Many hospitals were quickly overloaded, lacking the space, staff, and other resources to treat all patients in need of care. Nurses and other frontline health-care professional also frequently faced direct exposure to the viral disease. Between heightened demand, absences due to illness, and increase in workplace stressors, many facilities struggled to find and retain enough nurses.

This nursing shortage was compounded by many factors. Between 2000 and 2018, the average age of employed registered nurses in the US rose to 47.9 years old. In the 2010s, a natural retirement wave occurred in the nursing community as many people in the large Baby Boom generation reached retirement age (this population aging also drove up demand for nursing and other health care services). More nurses opted to retire when faced with the COVID-19 pandemic. Others left the profession amid high levels of stress and burnout as the pandemic unfolded. With such pressures sharply affecting both supply and demand, the nursing shortage attracted much public attention in the early 2020s. There were many calls for more action at both state and federal government levels to address the issue.

Experts have advised the medical and educational communities to take various measures to address nursing shortages. Many experts have argued that more aspiring nurses must be admitted to training facilities, which would increase the size of the future workforce. For example, the American Association of Colleges of Nursing reported that in 2021 schools turned away almost ninety-two thousand aspiring nurses from undergraduate and graduate programs, due mainly to a lack of faculty. It has been contended that increasing the budgets allocated to nursing schools, allowing them to hire more faculty and improve their training facilities, would bring tens of thousands of nurses into the workforce over the following years.

Experts have also advised the medical community to find ways to alleviate the undue stress and burden placed on pandemic and post-pandemic nurses. If nurses are continually unhappy in their jobs, fewer will remain in the field. This in turn leads to an increased burden on the remaining nurses, creating a vicious cycle. Medical communities will have to continually find new ways to reduce worker burnout, improve nursing compensation, and reduce workplace tension. This may include placing clearer limits on nurses’ obligations, hiring additional support staff to reduce the labor required of nurses, and allowing for housing assistance, subsidized childcare, and flexible working schedules.

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