Survey: 87% of Acute Care Sites Short of Nurses
‘If we don’t address salaries, all these bonuses are just a Band-Aid’
Healthcare delivery is at a critical tipping point due to a nursing shortage crisis that is projected to get worse, and no clear consensus on new labor models to meet the crisis, according to a survey and report1 by two companies involved in medical education and labor solutions.
Even before the pandemic drove workers from the clinical bedside, experts projected 1 million more nurses would be needed by 2030.
“Since the pandemic, about 5% of our workforce has actually left the profession,” said Anne Woods, DNP, RN, CRNP, chief nurse of Wolters Kluwer Health Learning in Waltham, MA. “We knew our baby boomers were going to be retiring. It was figured that starting around 2018, about 50,000 to 60,000 per year [would retire], and that has definitely ramped up. We are expecting a little over 100,000 baby boomer [nurses] to retire each year.”
Woods spoke at a recent webinar2 on the national nursing shortage report, which was jointly created by Wolters Kluwer and the Ultimate Kronos Group (UKG), a labor solutions company based in Lowell, MA. From summer through fall 2021, the researchers conducted interviews and an online survey to better understand nurse leader perspectives on staffing and evolving care delivery workforce models.
The idea was to provide a current snapshot and then ask survey respondents for a projection over the next 18 months.
“We are beyond the point of no return,” the report authors wrote.1 “A scarcity of nurses and supportive personnel is having an impact on the entire system. Change is long overdue. … [Our] results point to a wide disconnect between the challenges healthcare facilities acknowledge they’re experiencing and the plans they already have in place — or that they plan to put in place in the future — to respond to workforce challenges.”
Eighty-seven percent of respondents in acute care settings said they were currently experiencing staff shortages. “The majority of those were full-time RNs,” Woods said. “They just simply didn’t have enough. [In addition,] 53% reported a deficiency in their unlicensed assistive personnel, so those are people like your certified nursing assistants. In the post-acute setting, very similar picture — 92% reported that they had current shortages, most of them [lacking enough] full-time unlicensed assistive personnel [UAPs] and RNs.”
The respondents were then asked to project their situation over the next 18 months in full-time equivalents.
“It was really eye-opening,” Woods said. “In acute care settings, 89% reported that they expected to be short of budgeted head count. Now, think about that. They actually have money to have full-time positions, but they lack the supply to fill those. In post-acute, it was even more dire: 94% reported that they were expecting to be short of budgeted head count.”
The report authors also recommended viewing recruitment and retention as two sides of the same coin. Acute care facilities signing off on hiring bonus checks need to realize the retention value of continuing professional development and continuing education as well as offering certification opportunities for staff.
“We need to invest equally in recruitment and retention and understand that if we don’t address salaries, all these bonuses are just going to be a Band-Aid,” Woods said. “It’s a short-term solution. We have to look at the salaries of nurses.”
As staffing is closely linked to patient safety — and as the shortages are now subject to public awareness — nurse-patient ratios could be regulated in some manner and disclosed as a quality measure that patients can assess, Nanne Finis, RN, MS, chief nurse executive at UKG, said at the webinar.
“This is kind of the view of the future,” Finis noted. “We’re going to continue to see states and other federal and national regulatory influences that continue to look at and monitor our nurse staffing, but also then provide public disclosure. We need to be obviously ready for that.”
Woods agreed, but countered there is much to be done in the present before legislative mandates attack the problem. “Healthcare organizations and academia need to initiate those changes now, and not be afraid to get out there and make innovative change,” she said. “The only way we’re going to be able to do that is to make sure that [clinical] practice talks to academia so that they can change their curriculum [and] can develop practice-ready nurses. But then practice needs to understand that nurse needs to continue learning [in the clinical setting]. We need to really look at revamping our orientation models, our transition to practice models, our nurse residency programs, so we can provide that support for them.”
Speaking of nurse residency programs, it was noted this option can greatly reduce nurse resignations in the first year. Only 5% of nurse residents resign, as opposed to the 24% flight rate for typical first-year nurses. (For more information on this topic, see the related story in the July issue of ED Management.) Citing a rather startling statistic, Woods said 33% of nurses leave in their second year. “Nurses are looking to leave. We need to stop that,” she said.
The report also warned strong reliance on agency and travel nurses is not a sustainable model based on the cost and the effect on hospital staff morale. “We need to obviously continue to use our agency and travel nurse companies, but they are meant to fill the holes,” Woods said. “They shouldn’t be the No. 1 way we staff our organization.”
While the current situation is well past the assurances of yoga and meditation on site, there are different kinds of resiliency tools to support staff. These include access to healthy food, work breaks, and helping healthcare workers with financial advice or taking care of their elderly parents, Woods said.
Other recommendations in the report include:
- Cross-training staff to enable the competency-based staffing needed to gain flexibility;
- Implementing flexible scheduling to ensure work-life balance and improve retention;
- Offering flexible shift options for nurses that are not regimented into 12-hour shifts.
Future projections from the report include:
- More nurses will be needed in post-acute care settings. Their skill levels may need to increase as they receive patients who would have previously stayed in a hospital.
- Acute care hospital nurses will be taking care of patients who, on average, will be more acutely ill.
- LPNs and UAPs will be used in higher proportions where possible to decrease the strain on RNs.
- Hospitals and smaller facilities will partner to offer more options for patients at varying levels of acuity.
- UKG, Wolters Kluwer. Nursing’s Wake-up Call: Change Is Now Non-Negotiable. 2022.
- Lippincott Nursing Center. Nursing’s wake-up call: Change is now non-negotiable. March 24, 2022.
Healthcare delivery is at a critical tipping point due to a nursing shortage crisis that is projected to get worse, and no clear consensus on new labor models to meet the crisis, according to a survey and report by two companies involved in medical education and labor solutions. Even before the pandemic drove workers from the clinical bedside, experts projected 1 million more nurses would be needed by 2030.
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