International Nursing Group Sounds Alarm Over Interrupted Nursing Pipeline
Retirements and burnout are increasing
By Melinda Young
The coronavirus pandemic has increased stress, burnout, and mental health issues among case managers and other healthcare workers, according to emerging research.
- The American Nurses Foundation surveyed nurses in early 2021, finding that more than half felt exhausted within the previous two weeks.
- Adding to nursing stress were furloughs during the pandemic and workforce disruptions.
- It was difficult for nursing colleges to find clinical positions for nursing students, as hospitals were overwhelmed and had less time to work with student nurses.
Emerging data and reports suggest long-term stress and burnout among nurses has escalated since the COVID-19 pandemic began — which might contribute to increasing numbers of nurses leaving the workforce.1-3
The pandemic also affected nurse training in 2020 as nursing students experienced delays in graduation and training opportunities.4
The International Council of Nurses issued a policy brief in April 2021, stating most of its associations believe student nursing education was disrupted by the pandemic. These disruptions could affect the development of the nursing workforce.4 These findings suggest potential workforce shortages in coming years.
The American Nurses Foundation conducted a survey between Jan. 19 and Feb. 16, asking nurses about their overall mental health and well-being. More than half of responding nurses reported feelings of exhaustion within the previous 14 days. The survey also revealed 28% of nurses said they want to quit their jobs, and 18% intended to leave their position within the next six months. More than 50% of nurses who said they would leave the nursing profession in 2021 are retiring, and 47% said the work was negatively affecting their health and well-being. Forty-one percent cited insufficient staffing.1
The authors of a different study found that even before the pandemic, more than 50% of clinicians experienced some level of burnout, which was defined as long-term exposure to stress and high emotional exhaustion, high depersonalization, and a low sense of accomplishment.2
The pandemic had a big effect on nurses’ stress and burnout, says Ellen Fink-Samnick, LCSW, CCM, CRP, DBH-C, principal of EFS Supervision Strategies, LLC, in Burke, VA.
“When you look at the numbers of people who died in the pandemic, nurses and physicians took the biggest brunt,” she says. “Think about what that did to the workforce when over 3,600 members of the healthcare workforce died.”
Hundreds of health systems furloughed nurses and other workers during the early months of the pandemic, which added to stress and to many nurses’ desire to leave the profession, Fink-Samnick says.
Anecdotal evidence suggests some nurses who left bedside nursing jobs in hospitals decided to switch to case management. “You had all of these new folks ending up in the case management world,” she says.
Reports of this career switch partially come from a Facebook group for case managers. “You’ve got all of these people who joined the group, saying, ‘I am a nurse, and I am done with nursing,’” she adds. “Case management recruiting firms are very big, very busy right now, recruiting people who were nurses to do case management.”
Nursing Supply in Peril
The influx of new case managers can create short-term challenges in training and onboarding. It is likely temporary, as long-term nursing shortfalls could negatively affect every field dominated by registered nurses.
The nursing supply problem is complex, and the pandemic has accelerated the retirement of highly seasoned nurses, says Rhonda Maneval, EdD, RN, senior associate dean of the College of Health Professions and the Lienhard School of Nursing at Pace University in New York City.
“We have a supply problem of not enough nurses, and we’re heading into another nursing shortage,” Maneval warns. “You add on top of it an already critical need for nurses, and then you have more retirement than you anticipated, so the need becomes greater.”
The shortage is not caused by a lack of young people interested in nursing. Nursing schools reported a large influx of applicants during the pandemic. The problem was schools did not have the faculty and clinical opportunities needed to enroll more nursing students.5
The American Association of Colleges of Nursing reported 80,521 qualified applications were not accepted at nursing schools in the United States because of a shortage of clinical sites, faculty, and resources.5
Educating new nurses at a time when nurses are in critical demand creates a vicious cycle, says Crissy Hunter, DNP, RN, CHSE, CNE, clinical nursing faculty and COURSE coordinator for the nursing education track at Southern New Hampshire University in Manchester.
Healthcare systems, particularly in rural areas, might be short on nurses and patient beds because of the nursing shortage, she says. Then, they have to limit the number of nursing students who can receive clinical hours and supervision because they do not employ enough faculty to handle all the nursing students who need the clinical training. With fewer student nurses receiving training in the local hospital, fewer will stay in the area to work, thus creating the vicious cycle that perpetuates the nursing shortage.
Not just any experienced nurse can become faculty at a nursing school or in the clinical setting. Clinical faculty need at least a master’s degree for the evaluation of the student.
“It’s tough because if you have a bachelor’s-prepared nurse as clinical faculty, they can’t evaluate,” Hunter explains. “The facility has to have the manpower of a master’s-level nurse to be present to evaluate the student.”
The two main reasons nursing schools are not admitting enough qualified candidates are because of the shortage of qualified faculty and lack of sites for clinical practice. “Most states have a cap on how many students can be safely at a clinical site that has one faculty member,” Hunter adds. This means even in cities and larger health systems, there is limited capacity to admit students.
Nurse case managers and other working RNs can help nursing schools admit more students by earning master’s degrees in nursing education, Hunter says. Nursing schools that educate and train pre-RN licensure staff have more challenging faculty staffing needs than do schools that train nurse educators.
“There’s a difference between nursing students who don’t have an RN license,” Hunter says. “The amount of structure and faculty [ratio] to students is a different requirement than for those with post-licensure.”
Hunter teaches nurses in a post-licensure online college program. “I have hands-on time with 100 students and can teach 25 at a time in a certain course,” she explains.
Prelicensure nursing education programs need a smaller faculty-student ratio. The clinical faculty might be limited to eight or 10 students per faculty member.
Experienced nurses who may consider becoming a college or clinical faculty instructor should consider earning a master’s degree from a nursing education program. Programs might accommodate students who also work in the field, and some are virtual and asynchronous, which means that students can complete course instruction and work at any time that works with their schedule.
“There is a federal grant that reimburses you if you go into a nursing education field at a place that has a deficit,” Hunter notes. “That’s highlighting the role of the nurse educator, and it’s such an amazing profession.”
If experienced nurses and case managers go back to college to become nurse educators, it could help address the nurse shortage and help in the long run, Hunter says.
- American Nurses Foundation. Pulse on the Nation’s Nurses COVID-19 survey series: Year one COVID-19 impact assessment. February 2021.
- Norful AA, Rosenfeld A, Schroeder K, et al. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021;69:20-26.
- Berlinger N, Wynia M, Powell T, et al. Ethical framework for health care institutions & guidelines for institutional ethics services responding to the coronavirus pandemic. The Hastings Center. March 16, 2020.
- International Council of Nurses Policy Brief. Nursing education and the emerging nursing workforce in COVID-19 pandemic. April 2021.
- American Association of Colleges of Nursing. Student enrollment surged in U.S. schools of nursing in 2020 despite challenges presented by the pandemic. April 1, 2021.
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