During the early phases of the pandemic, nurses were quitting their jobs in droves, prompting major concerns about the future of the workforce as well as the healthcare industry’s reliance on agency labor.
But things are different now — new data from Mercer shows that there will be a national surplus of about 30,000 nurses by 2028.
Things are better now than they were a couple years ago, but this doesn’t mean that provider organizations can relax or be complacent with their nurse recruitment and retention strategies, noted Dan Lezotte, a partner at Mercer’s workforce strategy and analytics division.
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Though an overall nurse surplus is projected nationally, there will still be significant shortages of nursing labor in a handful of states, including New York, Georgia, Tennessee, New Jersey and Massachusetts, Lezotte noted. Shortages also persist in most of the country’s rural areas, he added.
To begin solving this workforce problem, Lezotte and three other experts interviewed this month agree that providers need to recruit from wider labor pools, prioritize creating a more supportive work environment and minimize nurses’ nonclinical tasks.
The labor supply differs vastly across the nation
From 2020 to 2022, about 100,000 nurses across the country left the workforce due to stress, burnout and retirement, Mercer’s report pointed out.
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Now, fewer nurses are fleeing the industry — but it’s important to note that the nursing labor outlook can differ widely from state-to-state.
The report predicted that some states would have large surpluses of nursing labor — for instance, Texas and California are projected to have surpluses of 8,000 and 6,000 nurses by 2028, respectively. On the other hand, New York is projected to have an estimated shortage of 12,000 nurses, and New Jersey and Tennessee are both projected to have a shortage of 3,000 nurses.
“It can be a matter of where healthcare demand is growing, but it’s also just a matter of movement — the migration of people from some states to other states. It’s often due to where [nursing] programs are and things of that nature,” Lezotte explained.
States with projected shortages may want to start thinking about recruiting nurses from nearby states with predicted surpluses, he said.
Along with expanded recruitment efforts, Lezotte added that providers may also want to consider developing their own nursing talent internally through training and certification programs.
Rural America’s nursing shortage
Not only does the nursing labor situation vary greatly from state to state, but it can also differ significantly among the regions within a state, Lezotte remarked.
Take Michigan and Colorado for example. There is a healthy level of nursing labor in the major metro areas of Detroit and Denver, but there are shortages in these states’ rural areas, he noted.
Another expert — Jennifer Mensik Kennedy, president of the American Nurses Association — declared that nursing shortages are “twice as worse” in rural areas.
The healthcare industry still has work to do to figure out how to best recruit nurses into rural communities so that patients in these areas don’t have to seek care elsewhere, she said. She also noted that rural providers need to spend more time figuring out how to educate and retain their nurses.
“We might really need to start looking into some types of high school transition programs or prep programs that go into those rural communities and educate people — getting them ready to be nurses and stay in the community,” Mensik Kennedy explained.
Additionally, the industry needs to get better data showing the maldistribution of nursing labor across the country, she said.
Current data shows that there are nursing surpluses in some areas and shortages in others — but we need more specific data to help healthcare leaders pinpoint how this nursing labor might be able to be redistributed more evenly across the country, Mensik Kennedy remarked.
What role is tech playing?
Technology is often heralded as a solution that can address healthcare labor shortages — but the jury is still out as to whether new technologies have proven to be effective solutions for nursing shortages.
Some technologies have been proven to improve nurse burnout and therefore lead to better retention levels. For instance, several health systems — including Novant Health, UNC Health and Nebraska Medicine — have released case studies detailing their successful deployments of a platform that assists frontline nurse managers by integrating their core workflows into a single platform and automating their repetitive work. That platform is made by Laudio.
Novant Health released a case study this week showing that its nurse turnover rate has dropped by 15% since adopting Laudio’s platform.
These types of automation tools have the potential to improve nurse retention by reducing staff members’ burnout, Mensik Kennedy noted. However, sometimes these useful tools get introduced and then abruptly taken away, she said.
“If the hospital’s having a harder time with budget and finance, the first thing that they look to cut is the nursing bucket — because it’s the largest bucket from a budget perspective. That’s the wrong decision when you’re having a budget issue. We create these problems by saying, ‘Here are great solutions — and yes, they worked, but now that we’re in a budget crisis, we’re going to get rid of these wonderful things we put into practice,’” Mensik Kennedy declared.
Creating healthier work environments
In addition to not making cost cuts on nursing technology, Mensik Kennedy also believes that providers need to meet the demands of the new generation that is entering the nursing workforce.
Younger nurses often want flexible scheduling and guaranteed breaks, which is something their employers should be offering, she stated.
“Too often, what I hear is, ‘Well, the newer nurses don’t want to work,’” Mensik Kennedy remarked. “The newer nurses aren’t going to put up with the bull that some of us put up with. I remember 25 years ago, I was working 12-hour shifts and not going to the bathroom or drinking water all shift. We knew that wasn’t right, but we didn’t know our options. Now we have younger nurses who know that’s not okay and not going to put up with it — and that’s good.”
In her view, a work environment where you can’t find the time to eat or drink for 12 hours is a hostile one. Nurses want a work environment that allows them to provide quality care and feel supported, she said.
Oftentimes when a nurse is assigned too many patients, they will go home and remember the tasks they forgot to do during their frenzied shift, such as check up on a certain patient or give a patient their second round of main medication, Mensik Kennedy pointed out. This feeling is a horrible one for nurses, she noted.
“With all these solutions, let’s create a healthy work environment. That can decrease the turnover and lessen the impact of the shortage, and then we will have more people wanting to come into the profession,” Mensik Kennedy declared.
Technology can play a role in creating a better workplace, she noted. For instance, hospitals can adopt self-scheduling technology so that nurses can choose the shifts that best align with their family life. Providers can also adopt virtual sitting tools or platforms that collect vital signs remotely so that nurses don’t feel overwhelmed with tasks during their shift.
National Nurses United, the country’s largest nurses union, also holds the view that providers must take immediate steps to emsure nurses have healthier work environments.
“There is no ‘shortage’ of professionals in their field. Simply put, there is a failure by hospital industry executives to put nurses and the patients they care for above corporate profits,” the union said in a statement from earlier this year.
In the statement, National Nurses United pointed out that there were more than one million nurses with active licenses who were not employed in the profession. Many of these nurses left the field because they felt unsupported at their workplace, so providers must make changes in order to attract these workers back to the profession and prevent further turnover, the union argued.
New models for care teams
Another expert at a consulting firm — Elizabeth Southerlan, partner in West Monroe’s healthcare and life science practice — pointed out that providers may need to rethink what the role of a nurse looks like with their care teams.
“We know that 30-50% of bedside tasks aren’t actually clinical — those numbers suggest that we are still continuing to ask more from nurses than the tasks they’re greatly specialized in, which is where they should be spending their time. We’re not thinking about how we can give them the support they need from maybe less licensed people, like nursing assistants,” Southerlan explained.
Many hospitals falsely assume that “nurses should be doing every task at the bedside,” she added.
At the same time, employers often prefer to hire nurses with Master’s degrees or specialized certifications, Southerland pointed out.
“They’re spending four to six years studying clinical pathways and how they can best care for patients in a clinical way — and then we’re asking them to clean rooms because we’ve decided to downsize our environmental services staff to hit a 10% savings on the operations side of the house,” she said.
Hospitals need to make sure they focus their retention efforts on minimizing nurses’ nonclinical tasks, enabling these workers to have more time with patients, Southerlan declared.
In her view, hospitals should start thinking about the pipeline of labor they need for those “less licensed tasks.” Hospitals can create this pipeline by partnering with staffing agencies that supply non-clinical workers, establishing a program for high schoolers in need of community service hours, or even creating a volunteer-to-paid technician program, she suggested.
Additionally, hospitals need to realize that when it comes to hiring people to perform these nonclinical tasks, they shouldn’t be recruiting people who are interested in a medical career. Rather, they should be looking to attract workers from the same labor pools as Costco and Uber, Southerlan said.
“[Hospitals] should not be looking not to hire someone who is ready to commit to a medical career to be performing the tasks that you don’t need a clinical license to do, like taking patients to their car when they’re leaving. Hospitals that are getting past the labor shortage are the ones that are valuing talent that does not have a goal to spend their entire life in a clinical career,” she remarked.
Nursing shortages may be less acute today, but the issue is ultimately about job satisfaction — things won’t continue to get better unless nurses are free to perform the tasks they went to school for, Southerlan noted.
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