Statistics show the nursing shortage is still a crisis, but 2023 could be a turning point.
Front-line nurses don’t need numbers to know that the nursing shortage is wreaking havoc on their workplaces. Nevertheless, the data do make a convincing case that it’s past time to get serious about making changes. And in 2023, recruiting and retaining good nurses could be the most critical area of focus in determining a hospital’s success.
Numbers tell a dire story
The financial cost of the nursing shortage couldn’t be clearer. The 2022 Nurse Salary Research Report by Nurse.com found that of 2,516 nurses surveyed, 29% were considering leaving the profession altogether.
If you’re considering a change in work settings, you have plenty of company. For the 28% of nurses who did so, dissatisfaction with pay and management were top reasons. The percentage of nurses considering changing employers was 17% (up from 11% from 2020). The average number of years of experience was 22.5 (down from 26 years in 2020).
With vacancy rates at all-time highs, hospitals have strong incentives to decrease turnover. For every bedside nurse who is lost, hospitals incur $46,100 in cost. For every 1% decrease in turnover, the average hospital saves $262,300 annually, according to the 2022 NSI National Health Care Retention & RN Staffing Report. Most (61.2%) hospitals had nurse vacancy rates over 15%.
New approaches needed
What do all these numbers mean to you? The nurses you’re working with are more mobile, less happy with their jobs, and less experienced. There are also fewer of them.
“The reality is that hospitals have chronically operated on the thinnest margins of nurse staffing. This erodes the safety of patient care and the trust that nurses have toward their employer,” warned Jane Muir, PhD, FNP-BC, a postdoctoral research fellow at University of Pennsylvania School of Nursing.
Regular merit increases, the ability to use full scope of nursing practice, and managers were top factors in job satisfaction in the Nurse.com report. To learn more about what’s needed in 2023, Nurse.com talked with prominent nursing leaders.
Burnout prevention is key
About half of nurses are reporting burnout, and turnover rates are at 20% to 30%, found a recent study.
Nurses at hospitals with burnout reduction programs stayed in their jobs for 20% longer. What’s more, those hospitals spent 36% less on recruitment than hospitals without such programs. What factors contributed to burnout most? Long hours, lack of support, frequency of assaults, and high-stress settings are among the most reported.
On the positive side, hospitals with less burnout and less turnover (due to better work environments) saw impressive cost savings. “The findings provide timely and targeted evidence on per-nurse costs, both yearly and over 10 years, to hospital leaders and policymakers for financial investment in nursing resources,” reported study author Muir.
Staffing is everything
In real estate, the most common trope is location, location, location. To combat the nursing shortage, it’s staffing, staffing, staffing. “Staffing matters, full stop. If hospitals can’t staff safely, they should close beds designated for elective procedures,” said Diana J. Mason, RN, PHD, FAAN, senior policy service professor at the George Washington University’s Center for Health Policy and Media Engagement.
Shortsighted hospitals view nursing as a line item for budget cuts. “Nursing care is often perceived as a labor cost from a hospital financing perspective — despite evidence demonstrating the value that nurses bring to hospitals through improved patient outcomes,” said Muir.
“Indeed, a major reason that nurses are striking in hospitals across the country — most recently in Minnesota–is that nurses say they do not have safe working conditions for themselves, and for their patients,” said Muir.
Nurses’ well-being is priority
Hospitals can’t — and shouldn’t — decide on strategies without input from front line nurses. Many nurses report that mandatory overtime is causing problems. “Nurses are forced to choose between their families and their jobs,” said Mason.
Robyn Begley, CEO of the American Organization of Nursing Leadership (AONL), is seeing burnt-out nurses leaving organizations because they want better work-life balance. “This exacerbates the staffing shortages that are the primary driver of burnout,” said Begley. Emotional health and well-being of staff and staff retention are the top challenges facing nurse leaders, according to the AONL October 2022 Longitudinal Nursing Leadership Insight Study.
Begley offered these winning strategies: Safe work environments, competitive compensation, healthy work-life synergy, flexible scheduling, professional development, and shared decision-making.
Hospitals are using onboarding, surveys, town halls, rounding, and team huddles to ask employees about their core needs to combat the nursing shortage. “Not feeling listened to or supported at work ranks right up there with insufficient staffing and insufficient pay among the reasons nurses list for leaving,” reported Begley.
What’s the single best strategy to retain nurses? Lusine Poghosyan, PhD, MPH, RN, FAAN, and professor of nursing at Columbia University School of Nursing said it’s creating work environments that support well-being. Lack of support from administrative leadership increases job dissatisfaction and turnover. “This is extremely costly for hospitals,” said Poghosyan.
It’s a vicious cycle: All of the turnover leaves hospitals understaffed and further exacerbates the burnout of the remaining staff.
In 2023, hospitals will be more mindful of the importance of keeping a capable nursing workforce, predicted Poghosyan: “Leaders are searching for solutions to promote the well-being of nurses.”
Support new nurses
Hospitals are scrambling to recruit nurses. The problem is that the applicant pool is smaller than in the past. “In 2023, we will need to find new and better ways to onboard new-to-practice emergency nurses,” said Emergency Nurses Association (ENA) President Jennifer Schmitz, MSN, EMT-P, CEN, CPEN, CNML, FNP-C, NE-BC.
New nurses want meaningful relationships with peers and support from leadership. The ENA Emergency Nurse Residency Program centers on critical-thinking, problem-solving, and communication skills that nurses need to practice independently. “2023 will still be a struggle. But I believe we’ll make progress,” predicted Schmitz.
Retention is key
Recruitment is challenging, but retention can be even more so. “When nurses can have the same terrible conditions but get paid exponentially more a few miles down the road, why wouldn’t they?” asked Lisa A. Wolf, PhD, RN, CEN, FAEN, FAAN, Director of Emergency Nursing Research for the ENA.
Wolf said these are winning approaches to retain nurses:
- Strong orientation and residency programs
- Evidence-based leadership training
- Time off for continuing education
- Decreased mandatory overtime
- A decrease in “incentive” pay
This last point may seem counterintuitive to some, but when nurses are offered extra money to work more when they’re already exhausted, burnout occurs. “We only offer incentive pay when the unit is dangerously short-staffed,” explained Wolf.
Nursing shortage insights
To really move the needle, hospitals really must start taking a longer-term approach. “Hospitals need to stop throwing band-aids on bullet holes,” said Wolf.
The nursing shortage is complex in many ways. Yet at its core, the solution is surprisingly simple. “If you create an environment where nurses feel valued and supported, they will stay,” said Wolf.
For additional insights download and review our 2022 Nurse Salary Research Report.
I am speaking in response to this article. I have been a nurse for 28 years. I believe now what is contributing to the burnout and staffing shortage is the physical labor of staff nursing, and ungrateful, impatient patients and families. I have seen more demands and tasks put on nurses by their employer. I have worked with CNAs and fellow nurses who are not held accountable. Most patients now (at least 60%) are total care, which is physically demanding on staff. The acuity is high — multiple pressure wounds, dialysis, diabetes, blood transfusions, etc. To add to the shortage, nobody wants to do bedside care long term, which leads to most nurses going back to school or leaving the bedside practice. We really need to realize nursing now is a stressful high-demand profession.
This is EXACTLY what I would have said.
Med-surg RNs now are required to perform many tasks ICU RNs perform, and like you said, families and patients are extremely demanding. On top of it we have to deal with insane nurse/patient ratios.
And of course, working that hard for the money they are paying makes you feel totally unvalued. Pay is a big issue; the difference between a PA or an MD income and a nurse is huge! Huge! This discrepancy, along with the discrepancy between what top management income is and an RN income makes this profession extremely unworthy.
When every nurse understands that we are just taken advantage of maybe things will change.
What nurses would really like is a change to visitation policy. Imagine if you had to do your job with someone always in your space….at your job. Imagine pilots or surgeons trying to do their job with people being able to just come and go at will while they have the lives of others in their hands. Imagine just trying to check out at the supermarket if the cashier is distracted and his or her energy is directed somewhere else. It would slow the whole process down. Same for nursing. So many nurses have remarked on how much more job satisfaction they had before patient satisfaction scores held the power over them to get them actually written up and fired. Let’s take a look at that.
Anything else that is done is just a temporary band-aid.
We need nurse mentorship on the floors and RNs to help prepare new nurses for the NCLEX! Colleges are not enough. We need hospitals to partner with schools to make sure nurses meet all requirements. Clinicals must be done through partnerships!
Nursing can be a more rewarding experience if everyone respects each other, pay is matched to the quality of work provided, scholarships are offered by organizations to enhance growth of their staff, and even more so, each one teach one.
So sad to see what is happening in the nursing field. I was an ER nurse for 20 years, love my profession with all my heart, want to go back to do what I love, but now they close each door because of my age. I will do anything to go and help and do what I love, respect, and was so passionate about, the love for my patient, my fellow nurses, MDs. I hope in the future I can get the opportunity to work in the nursing field one last time.
So sorry about that. Your passion is almost palpable. Praying that your dream will be realized.
Maybe you could look into a nurse residency program. Not sure how long you’ve been away from the bedside.
Wishing you all the best.
Reduce the patient load and pay the nurses more. Case closed.
I would like to comment on the nursing shortage article. I believe it is foundational in the mindset of “nursing shortage complacency.” This has been a struggle with minimal solutions, and as written in this article, a Band-Aid fix has been the solution. Its not necessarily about more bodies or FTEs but a combination of solutions. Starting with prepared nurse leadership to grow and nurture nurses, competent/confident nurses, minimization of bureaucracy, and yes, improved salaries.
I’ve been doing bedside nursing since 2011. Every year it seems like the load on nurses gets worse and worse. We keep getting things taken away that was helpful (unit secretary, patient advocate, pharmacy filling our drawers in the morning), and then getting things added to our list of things to do (swallow evals, mobility evals, more skin prevention, decontamination protocols, increased charting, etc). To add insult to injury, our patient:nurse ratios went up during covid and never came back down. Now I don’t think they will ever go back to what they were because executives making decisions now think we can handle higher workloads. So, when I hear about nursing shortages, that’s only a small piece of the picture. Even if they filled in the open slots with people, the workload is still higher than ever and not lessening up. Nurses are forced to ration care throughout the day, then go home feeling like poop because they feel defeated. Let me also mention the tension between staff seems higher than ever–between night shift staff and day shift, between agency and full time, between techs and nurses. The stress is real.
I am curious to know if there is talk of expanding roles/nurse practice acts? I am an LPN with 30 years experience in various settings and have done the same jobs as RNs. I think they need to offer SEASONED LPNs with experience the ability to challenge the RN boards. I have friends who have been RNs for years getting calls to come train new grad RNs at the hospitals because they do not know what they are doing. I am not here to trash RNs, I have worked with several excellent nurses. Initials behind a name does not make someone qualified to do a job, why not let the LPNs who have the knowledge and experience be given the ability to obtain RN licensure. You look at job openings and see openings for RNs and MAs. Why have the LPNs been forgotten? Just curious.
I was a nurse for over 40 years. Nurses are on the budget line of room service. That means our service is on the same line as food service and janitorial service. I would like to see a janitor or a cook do my job. We already have over 20 years of documentation from California which has mandatory nurse patient ratios with measurable outcomes.
But hospitals don’t feel there is proof that more nurses means better outcome. Another problem I encountered was the CNAs refused to work together to take care of the patients. They would come to the nurse they were assigned to stop her from doing a job that required an RN and expect the nurse to help giving a bath or turning a patient and many other things that did not require a degree.
Most nurses worked an average of one to two hours of daily overtime because of underutilized accusative staff.
Overnight visitors are also a problem, in addition to allowing visitors to videotape nurses performing their tasks and also posting the nurse without their permission on Facebook. Also, I found a device inside a stuffed bear that was transmitting everything in the room to a nearby house.
The nursing supervisor and hospital allowed all of these things.
I became an RN in 1994. Patients are abusive, physically and verbally. My last job was on a cardiac floor. 8 patients assigned to me. Most with endocarditis that required every 3 hour antibiotics. I had 4 that needed those. Then 2 admissions. My head was spinning so bad I couldn’t run any faster at age 59. I left and never looked back. No one should be in fear for their life to do a job. I don’t think I will ever return. I also don’t think the public realizes just how unsafe these hospital have become. The nurses are ran so ragged criminal negligence is right around the corner. I never in 28 years had a true lunch break. The CEOs of these hospitals make billions yearly. Yet most nurses like in FL make 20 something an hour.