How can hospitals retain nurses, recruit new ones, and deal with extreme staff shortages?
From more positive images of nurses to more flexible roles, industry experts explored a range of solutions to address nursing shortages during a online round tablewhich was hosted by the Bipartisan Policy Center and sponsored by the American Hospital Federation.
“Precipitous drop” among full-time nurses
Reviewing the nursing workforce forecast from 2019 to present, Peter Buerhaus, PhD, RN, health economist and professor at Montana State University, said we are no longer on track for achieve objectives.
Just before COVID-19 hit, the nursing industry looked set to replace the 640,000 RNs who were due to retire over the decade, anticipating the arrival of a million more nurses in the field, a Buerhaus said.
In 2019, Buerhaus and his colleagues predicted that the RN workforce would grow from 3.5 million in 2020 to 4.5 million in 2030. But there was a caveat: the projections depended on whether the entry into nursing continues to grow at the same rate as in the past. 5 years. As Buerhaus noted, this is not the current reality.
In 2021, Buerhaus and his colleagues observed a “steep drop” of more than 100,000 in full-time RNs. Instead of the expected 4.4% growth in the RN workforce from 2019 to 2021, entry fell 1.8%, he said.
What worries Buerhaus the most is whether this drop is temporary or not.
Based on nursing data up to January this year – which is based on the findings of a Health Affairs study that Buerhaus and his co-authors published on workforce trends during the first 15 months of the pandemic – many indicators are returning to pre-pandemic levels.
Negative imagery, messaging
One solution to get its 2019 forecast back on track, Buerhaus said, is “to immediately control messaging about nurses and hospitals.”
“Too many current images…too many tweets, media coverage, social posts…are really quite appalling to nurses, often by nurses. And…these negative effects have the potential to reduce entry into the profession,” he noted.
He recalled a similar problem in the 1990s during a rise in managed care models that sought to control costs. Hospitals trying to win managed care contracts have cut high-paying nurses to limit their spending, leading to protests by nurses across the country.
Negative images of nurses in the media have led to diminished interest in the profession and lower enrollments and degrees, Buerhaus said.
In 1994, about 97,000 RNs graduated, but by 1999 that number had fallen to 67,000. This led to a national shortage of nurses in 2001, he explained.
It took strong messages such as the Johnson & Johnson Campaign for the Future of Nursing in 2002 to help correct the problem.
“We brought together hospital leaders, doctors and nurses for an evening, a celebration of the profession,” Buerhaus said, among other activities. “Almost immediately we started to see interest in nursing increase, degrees increase, and that trend line continues almost to today.”
He argued that this messaging problem is a “shared responsibility. It’s on me. It’s on you. It’s on our leaders. It’s on our professional associations, our educators and the union, and above all the media.”
Feel heard, feel valued
Maureen Chadwick, PhD, MSN, RN, Senior Vice President of Nursing and Clinical Operations for the Ascension Travel Program, and another webinar panelist agreed on the need for stronger communication and messaging, but stated that the focus should be on making nurses feel valued.
With each surge of the pandemic, more and more nurses have quit their jobs, in part because of the emotional toll. “They can’t ignore what they’ve seen during the pandemic,” she said.
To help address these mental health challenges, Ascension brought in chaplains and advanced practice nurses with mental health training to do the staff rounds. They identified struggling nurses and offered virtual support.
However, the nurses also left for other reasons, Chadwick noted. In an Ascension staff survey that included responses from 23,000 nurses, which was conducted during the Delta surge, Ascension uncovered the top four reasons hospital workers stay at their jobs.
Although people are leaving for higher-paying jobs, the main reason for staying was value, Chadwick said.
“Am I valued by my leadership? is the question that – if answered in the affirmative – kept the workers from leaving, she added. The other top three reasons staff gave for staying were to have leaders who inspired them, to feel part of a community, and to feel like the leaders helped break down barriers.
“We know that if we can’t control value, inspiring leadership, community and process, people will leave for money,” Chadwick noted.
Be flexible, welcome travelers back
Growing and sustaining the nursing workforce also requires greater flexibility in the design of nursing roles.
Chadwick said there are now opportunities for critical care nurses with many years of experience in the field to return to work in a virtual nursing role. These nurses can support graduate nurses during the night shift by answering questions in place of a doctor.
“Having someone kind of teleported in and able to provide that real-time support has been really, really powerful when you want to talk about supporting our new novice nurses,” she noted.
Another area where healthcare systems and nursing education need to be more flexible is in education requirements, said Deborah Trautman, PhD, RN, president and CEO of the American Association of Colleges of Nursing. “You don’t have to work ‘X’ years before you can practice in a certain setting,” she said.
Regarding traveling nurses, Chadwick said “we have to leave our egos at the door and be welcoming when people are tired of traveling. … And they’re starting to come back. That’s what we’re seeing. They want to come back.”