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.
