By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
A manager who attended a recruitment and retention workshop recently shared the following observation: “As I listened to you discuss the current shortage and how pervasive it is, I realized that we had not done a great job of communicating this to our staff or leaders for that matter. I have a high level of frustration about staffing and am tired of being told to get creative. It is clear that we don’t have enough staff – we need to let the public know, change our delivery model and stop expanding services until we figure this out.”
This nurse manager makes some excellent points. Many of our nurses continue to believe that hospitals are greedy and not making an effort to either recruit staff or pay higher wages. While that may be true in some settings, it is not the norm. Frontline leaders spend up to 80% of their time on recruitment, staffing, and scheduling. Wise leaders recognize that it takes a village to staff hospitals today and are sharpening their processes to include staffing command centers, staffing huddles, and centralized staffing support.
And yet, the one constituency we are not effectively communicating with about the nursing shortage is staff nurses. The COVID pandemic accelerated workforce issues that were already in the making. In a comprehensive 2020 workforce study, the National Council of State Boards of Nursing sounded the alarm bells with the following statistics:
- The average age of a nurse in the US is 52.
- 19% of the current RN workforce is over the age of 65 and while licensed, many are not working.
- 54% of nurses work in hospital settings – a steady decline over the past 3 decades.
- 65.2% of nurses have BSNs – giving them more employment options.
- 20% of nurses surveyed planned 2020 to retire within five years.
- Only 64.9% of nurses worked full-time.
Depending on your data, shortage estimates range from 200,000 to up to one million by 2030. The Labor Department predicts the growth of nursing jobs to be at least 6% above the current supply by 2030. The reality is that our current nursing education system cannot possibly backfill against these numbers. The hardest hit will be direct care hospital settings which new graduates already indicate are not employers of choice.
So where does this leave us? Most health systems still use a primary nursing delivery system. The challenge is that delivering care this way has become unsustainable in most care settings, especially outside of OB, Critical Care, and the Operating Room. Over the last four decades, primary nurses have taken on many responsibilities that other team members could do. While we had the luxury of assigning nurses to non-nursing tasks at one time, the situation has changed, and we no longer can. Yet, the transition to a team or collaborative care model is challenging despite the need. Most young nurses today lack the leadership skills to delegate care and manage a team of care providers. Even when give PCTs to work with them, most nurses focus on nurse patient ratios versus offloading and delegating tasks to others.
Our current models of nursing care delivery are unstainable now and will be less sustainable in the future. Nurse leaders must discuss the workforce shortages with nurses to set the stage for inevitable changes in care delivery models. We will need to teach leadership to every nurse on the frontlines, as well as teamwork skills. We have no choice – what we are doing now is unworkable and will become less so moving forward.
© emergingrnleader.com 2022
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