The United States needs nurses now. Nationally, one in five nursing positions are vacant, yet nursing schools turned away more than 80,000 qualified applicants last year because they do not have the space or professors to educate them. The full ramifications of the pandemic on the nursing workforce are being analyzed, but the trends are concerning.
This shortage is a major barrier to patients getting the care they need, and it is driving burnout within the nursing community, which in turn leads to more exits from the profession. The implications are especially acute during a pandemic. The future presents more challenges as the vast majority of the estimated 660,000 nurses in the baby boomer generation are expected to retire in eight to 10 years.
The effect on nursing homes and the care of older adults is even greater. A new industry survey reports 89% of nursing homes have moderate or severe registered nurse, licensed practical nurse and nursing aide shortages — meaning an already overworked aide could have anywhere from 10 to 40 patients at a given time. This shortage of skilled nurses stands in the way of achieving age-friendly care, which is critical for the country’s aging population.
For care to be age-friendly, it must ask and act on what matters to older adults, ensure medications are safe, prioritize care for depression and dementia, and encourage physical activity and support to be as mobile as possible. Without enough nurses, one or more of these components of care could be overlooked, and older adults will suffer. To avoid an even bigger nursing emergency, we must act now, and we can act now.
We already have the solutions to address the national nursing shortage, they just need to be implemented and done so quickly. First, capacity of the nation’s nursing schools must be expanded by improving faculty pay and budgets, expanding academic and medical practice partnerships, providing full tuition and stipends for students, and offering full loan forgiveness for practicing nurses. Next, state governments can change regulations to increase autonomy for nurses in practice and scope so they can treat patients to the full extent of their training and expand nurse licensure compacts that allow nurses to practice across state lines.
Health systems can implement staff- and data-driven flexible staffing plans to ensure the right mix of clinicians are available at any given time, increase salaries and offer bonuses, create safer workplace practices, and ensure nurse leadership is supportive of their staff, providing a safe, affirming environment with shared goals. Finally, the time is now to create strong interdisciplinary care teams — including physicians, nurses, therapists and support staff — that respectfully work together for the safest and best care of patients while maintaining a positive workplace.
Major nursing organizations are already developing partnerships to help implement these various national, state and workplace solutions in a way that listens to nurses rather than just tells them what to do. Nurses need support from all corners of the healthcare system and from policymakers to make these solutions a reality, though, because no healthcare system can function without skilled nurses.
Groups representing nurses have brought this message to the White House and elsewhere across the federal government and to statehouses across the country. It is a message that must continue to be said and acknowledged as America addresses its nursing shortage crisis. A first step is declaring the shortage a national public health emergency, allowing the federal government with its full authority and the resources at its disposal to act boldly and decisively. This can and must be done immediately.
We are a nation of innovators, we value and expect justice in all situations, and we have pride in our health systems and in our clinicians. Together we can fix this. It is time to think big and bold. The public deserves and demands excellence in their healthcare immediately, and that requires a strong nursing workforce.
Terry Fulmer, PhD, RN, FAAN, is president of The John A. Hartford Foundation.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
