Do Sustainable Solutions to the Nursing Shortage Exist?
It’s no secret that health care is suffering from a nursing shortage. Workplaces are scrambling to recruit and retain nurses nationwide, and there are a vast array of mitigation strategies in place. A recent Doximity poll on the kinds of solutions being utilized shows that 40% of workplaces are expanding duties of nonclinical staff; 33% are offering recruiting and retention bonuses; 8% are recruiting educators and students; and 19% are utilizing other strategies.
With an underlying sense of frustration growing among nurses, the question becomes: Are any of these solutions effective and sustainable? Below, Doximity takes a hard look at each of the proposed strategies, and delves into each of their promises and limitations.
Expanding Duties of Nonclinical Staff
In some workplaces, nonclinical staff have been extending their working hours, taking on more tasks, and undergoing more training to help support patient care. Currently, a variety of creative ways to use unlicensed staff exist, such as having them coordinate with the care team, secure patient transportation, arrange Medicaid coverage, and more.
Employing the staff already on hand may free up more time for clinicians and could assist in staff retention, but it is unlikely to fully redress the turnover rates of nurses. Since 2016, the average hospital in the U.S. has turned over roughly 90% of its workforce and 83% of its RN staff. In addition to the large workforce to make up for, support staff may be feeling their limits already. According to a 2021 poll completed by Fierce Healthcare, nearly nine out of 10 health care staff members reported feeling moderate to extreme burnout.
Recruiting Educators and Students
Across the country, nursing students have been given approval to join the workforce prior to their graduation in order to support the struggling health care system. In Maryland, this early exit in the fall of 2021 came as a request from Gov. Larry Hogan and led to 172 nurses from University of Maryland School of Nursing (UMSON) joining the workforce. This is the fourth consecutive semester UMSON has participated in an early-exit program in order to reduce orientation time and usher nurses into positions faster. Gov. Hogan also relaxed guardrails around licensing for retired nurses or those who may have just moved to the state in hopes of utilizing all available resources.
However, a study conducted in Massachusetts noted that the issue may not be licensing, but rather the nature of the work itself, which has led to high rates of burnout across the industry. Results showed that there are more licensed nurses in 2022 than ever before in the state, with a 24% increase from July 2019. As to this discrepancy, Rachel Lipson, the founding Director of the Project on Workforce at Harvard, explained to WBUR, Boston’s NPR News Station, “It’s not just about the ratios on the floor but we do need some rethinking of the role, what the job looks like, and the whole person that fills these jobs.”
Offering Recruiting and Retention Bonuses
Some hospitals have gone the way of attracting RNs through hiring bonuses. In August 2021, the University of Arkansas offered a $25,000 signing bonus for nurses along with an $18,000 referral bonus for those who were already employed. Other employees are seeing additional cash hit their bank accounts for extra shifts or overtime, but the funds may not last long.
In Las Vegas, controversy has spiked since the University Medical Center there discontinued its crisis pay, and only two weeks later sent a memo to nurses regarding mandatory extra shifts/overtime. According to Becker’s Hospital Review, Chief Nursing Officer Debra Fox, MSN, RN, noted three reasons to discontinue crisis pay in the internal memo: “First, there was no longer a need to continue this expense when our dynamic staffing needs could have been managed using voluntary standby and extra shifts/overtime shifts. Second, every hospital in our community offering incentives has discontinued them. Third, it was apparent that the crisis incentive pay option was no longer being valued as a short-term way of recognizing those going above and beyond, but rather as an expectation of entitlement."
Travel nurses and the National Guard have temporarily stepped up to the plate across the country. State representation across the country is exploring the possibility of educating more nurses as a long-term solution; however, nursing schools are struggling to keep up with the number of applicants as is. Dean of Johns Hopkins School of Nursing, Sarah Szanton, explained to the Baltimore Sun, “We turn down thousands of qualified applicants a year. If nursing schools were able to take [these applicants], it would make a big dent in the shortage.”
Each year, U.S. hospitals lose $3.6 million to $6.5 million due to RN turnover. Why? Nurses are seeking career advancement, relocation, and, for the first time as a top three reason, retirement. One can blame an aging society, as well as the continuing COVID-19 pandemic for the current nursing shortage, but research shows that this has been a salient issue for decades now. With the projected need of 1.1 million new RNs to fill health care gaps, strategies equal to and greater than the ones above demand to be implemented. Fortunately, workplaces across the country are waking up to this reality — with varying success.
What solutions would you like to see your workplace implement to help mitigate the nursing shortage?
Illustration by Jennifer Bogartz