How is this Nursing Crisis Different?

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

In a recent article, executive coach Larry Robinson highlighted an essential question that leaders need to ask to gain insight into the challenges they confront. The question is, how is this different? He reminds us that when strategic planning, most organizations do some form of this yet fail to ask: How is this — this time, this coming year, this business environment — different? Without asking this question, we make plans using old assumptions. Many leaders and organizations expected a high degree of status quo in much of their work. If it was ever true, that time is passed. Today’s world is deeply abnormal for even the most carefully led health systems.

In thinking about the current crisis in nursing, and it is nothing short of an emergency at this point, here is what I believe is different:

Unlike other nursing shortages, the numbers of nurses needed and available don’t add up. The gap could be as high as one million in a few short years. Enticing people to return to work or work more will not be enough.
Nursing schools will never be able to backfill the number of professionals required in the timeframes needed.
A younger generation of nurses is far less willing to sacrifice their own needs and well-being for those of organizations.
Pay has eclipsed the benefits package as a critical differentiator for competitive recruitment.
Valuing individual rights over collective needs is a widely accepted cultural norm in the US today.
Patients and families are ruder and more violent toward staff, making patient care more challenging and less satisfying for professionals.
Organizational loyalty is viewed differently by younger staff who don’t intend to work in any given area for a large part of their career.
The US population is aging and less healthy than in 2019, leading to higher acuity levels among those seeking care.
Social determinants of work health such as the cost of housing, childcare availability, and household debt are driving employment decisions.
Care across the continuum has been seriously, perhaps even permanently disrupted with nursing homes, assisted living, and rehab centers closing beds due to staffing shortages.
Working in acute care environments is seen as less desirable by the current nursing workforce, and many more options than in the past are available.
Support staff is less available to shore up teams or participate in care redesign efforts.
Direct care in most acute settings, including specialty areas, is often given by the least experienced nurses.
The American public has become far less trusting of healthcare but has high demands about the service they should receive.

Albert Einstein wisely reminded us, “You cannot solve a problem with the same thinking that created the problem.” But in many ways, that is what we are trying to do in healthcare today. We are not paying close enough attention to what is different this time.

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