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Introduction   

Over the past several years, the demand for nurses across the United States has continued to increase. This, combined with the COVID-19 pandemic, has left a gap in the nursing workforce of licensed practical/vocational nurses (LPN/LVNs), registered nurses (RNs), and advanced practice registered nurses (APRNs). This gap has significantly impacted patient care and the nursing profession. The purpose of this course is to discuss the nursing shortage and review statistics surrounding it. It also reviews the impact of nursing shortages on patient care and suggests strategies for mitigating them. 

Nursing Shortage Statistics and Contributing Factors 

There are many factors contributing to the nursing shortage, which are discussed in the sections below. 

Nursing Workforce Demand 

According to the U.S. Bureau of Labor Statistics (BLS), the occupational outlook for LVNs and LVNs is expected to increase by 5% from 2022-2032. Additionally, it’s projected that there will be around 54,400 job openings annually for these roles [9]. The projected 2022-2032 job outlook for RNs is 6%, with approximately 193,100 job openings each year [11]. Lastly, for APRNs, including nurse anesthetists, midwives, and practitioners, the BLS projects a 38% increase from 2022-2032 and over 29,200 job openings annually [10]. The growing job outlook for nurses displays the demand for nurses nationwide. 

Nurses Leaving the Bedside 

Although the demand for nurses remains high, many nurses are choosing to leave the bedside. In April 2022, Health Affairs published its findings regarding the RN workforce. It showed that the growth in the RN workforce lulled during the beginning months of COVID-19, although the demand for nurses exponentially increased. Furthermore, from 2020 to 2021, the workforce’s total number of RNs decreased by more than 100,000 in one year. Many RNs leaving the workforce were younger than 35 years old [3]. Lastly, the 2022 National Nursing Workforce Survey estimated that around 200,000 experienced RNs and 60,000 LPNs and LVNs left the nursing workforce during the 2020 to 2022 period [8]. 

Nursing School Faculty Shortage 

Many nursing schools are having to turn away students due to faculty shortages. According to the American Association of Colleges of Nursing (AACN), over 90,000 qualified nursing school applicants were turned away in 2021. Factors such as inadequate classroom space, budget constraints, and lack of clinical placement sites and preceptors contributed to having to turn away applicants. However, the most significant and top-reported factor was nursing faculty shortages. Furthermore, data released in October 2022 by the AACN reports that nurse faculty vacancy rates were 8.8% nationwide [2]. 

Nurses Nearing Retirement 

Many nurses are also nearing retirement age, so they will no longer be part of the nursing workforce, thus contributing to the nursing shortage. According to the 2022 National Nursing Workforce Survey, the median age of RNs was 46 years old and 47 years old for LPNs and LVNs, which is a six-year decline from the previous survey in 2020. The survey also revealed that 28% of its respondents plan to retire in the next five years [8]. 

Aging Population 

The aging population is also a contributing factor to the nursing shortage. According to the 2020 U.S. Census Bureau, 16.8% of the U.S. population is 65 years and older. This 10-year population growth was the fastest growth during any decade since the previous 10-year period of 1880 to 1890. Furthermore, baby boomers (people born between 1946 and 1964) continue contributing to the aging population [12]. Many of the aging population will require health services and nursing care. Thus, contributing to increasing nursing demand and adding to the nursing shortage. 

Nursing Shortage Impact on Patient Care 

The nursing shortage can have several significant impacts on patient care which are discussed in the sections below.  

Increased Morbidity and Mortality 

First, inadequate staffing increases nurse-to-patient ratios, causing several downstream patient safety concerns. Patient safety concerns may include increased risk of patient mortality, sentinel events, and medical or medication errors. Patients in facilities with higher nurse-to-patient ratios have higher patient mortality and morbidity rates than those with lower nurse-to-patient ratios [4].  

Medical errors are also more likely to occur due to nursing shortages. Contributing factors such as burnout and fatigue may contribute to this. However, with nursing staff shortages, many nurses are asked to work overtime or longer-than-usual shifts to support patient care and staffing needs. Working overtime and longer shifts can also lead to medication errors [6]. 

Healthcare Associated Infections 

In addition, inadequate staffing can lead to an increased risk of healthcare-associated infections (HAIs). A research study published in 2019 reviewed infection data from a large urban hospital from 2007 to 2012 and found that patients in understaffed units were more likely to develop HAIs [7].  

Patient Satisfaction 

Nursing shortages also impact patient satisfaction. When nursing staff levels are low and patient ratios are high, patients are likelier to report negative or low patient satisfaction scores [5]. This may be because the nurses are unable to provide individualized, high-quality care due to their strained patient care loads. They are unable to provide highly effective patient and family communication and education or round on their patients every hour to assess their needs and requests. 

Delays in Care 

Many patients are unable to find or get care within a timely manner or experience delays in their care due to the overall healthcare workforce shortage. The Association of American Medical Colleges predicts that the United States will have a physician shortage of around 86,000 by 2036 [1]. The physician shortage and the aging population increase the demand for primary and other healthcare services. APRNs, especially nurse practitioners, can help close the physician shortage and patient care gap. However, there are still shortages in APRNs.  

 Strategies to Mitigate the Nursing Shortage 

Nurses, healthcare organizations, and others can take many actions to mitigate the nursing shortage. Below are several strategies to help close the gap.  

Strategic Partnerships 

Many nursing schools are having trouble finding preceptors and sites for clinical rotations. To help resolve these issues, nursing schools should consider forming strategic partnerships with local hospitals and healthcare facilities. Nursing schools can place students in certain healthcare facilities in hopes that they will provide them with future employment opportunities. The nursing school could also host nurse recruiting events where students and graduates can talk to representatives of healthcare facilities hiring within the area. 

Using Technology to Reach Patients 

Healthcare organizations should consider using technology whenever possible to reach patients. Many electronic health record (EHR) systems allow patients to communicate directly with their healthcare team. They can review patient discharge materials, ask questions, and view their lab results. Technology also provides better access to care. Patients can communicate with their healthcare provider directly through direct messaging, e-visits, or scheduled virtual appointments.  

Electronic Systems 

Technology and electronic systems can also help reduce time and errors. For example, some hospitals use robots to deliver medications to hospital units from the pharmacy or bloodwork to the hospital lab. This helps reduce the time nurses or other healthcare personnel have to walk to the pharmacy or lab. Also, EHRs reduce medication errors since they typically require nurses to scan patient identification bands and medication barcodes. Removing medications from a locked electronic medication cabinet is another way to prevent medication errors. 

Consider Patient Acuity 

If there is a nurse staffing shortage, management should consider patient acuity when organizing patient assignments. A patient with higher acuity needs more nursing care than a patient with lower acuity. For example, a medical surgical nurse may have a nurse-to-patient ratio of 1:6. In contrast, an intensive care unit (ICU) nurse may have a ratio of 1:2 simply due to the patient’s acuity. If a med-surg patient’s care needs are increasing and there are concerns that warrant a possible transfer to a higher acuity unit, the charge nurse should consider this while organizing patient assignments for the day.  

Conversely, suppose three patients are ready to be discharged or transferred out of the ICU. In that case, this may be an appropriate patient assignment for one nurse, so the nurse ratio increases to 1:3 instead of the standard 1:2. Nurses are more likely to feel less stressed when they have lower nurse-to-patient ratios and balanced assignments. 

Improve Nurses Salary 

The 2022 median pay for LPNs/LVNs was $26.26 per hour and $39.05 for RNs [9, 11]. During the COVID-19 pandemic, many nurses discovered they could leave their nursing jobs and pursue travel nursing assignments, which paid exponentially higher than their previous staff positions. Healthcare organizations should consider increasing nurses’ salaries to attract top talent and interest those looking to pursue a career in nursing. They should also consider offering retention bonuses for those who choose to stay with the organization. Another way is to provide incentives for high-quality patient care or nurses choosing to work extra time. 

Invest in Retention and Recruitment 

Healthcare organizations should also invest in the retention and recruitment of their nurses. They can recruit new nurses by offering sign-on bonuses or relocation reimbursement. Organizations can also provide new graduate residency programs where new nurses can shadow alongside experienced nurses for several months. Experienced nurses who choose to precept new hires should receive pay incentives. Investing in education and advancement opportunities is also necessary. Institutions should offer tuition and advanced certification cost reimbursement for nurses who wish to pursue higher education. Those who want to advance their careers in nursing leadership should be provided leadership classes, workshops, and employment opportunities. 

Provide Psychological Support to Nurses 

Nurse shortages can contribute to nurse fatigue and burnout [4]. Health organizations should consider investing in prevention and providing psychological support. Examples may include free self-care workshops, support groups, or mental health therapy. They should also provide training on recognizing burnout and when to seek help. Nurses may be more prone to work for employers that offer these services. 

Conclusion

Many factors contribute to the nursing shortage and can impact patient care. However, there are many strategies organizations can take to prevent shortages and support nurses. 

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