Nursing Shortage and the Impact of COVID-19

Nurses have repeatedly demonstrated that they are the backbone of the healthcare system. Without nurses, the hospital will not be able to provide 24/7 care. The COVID 19 pandemic has created significant stress in many institutions throughout the world for nursing personnel. Nurses on the front lines manage these critically ill patients.  The nurses face a substantial risk to their health and safety.

Nevertheless, despite the dangers and risks, many nurses continue to serve those in need. The question becomes, as the COVID crisis continues, will the existing nursing workforce be able to continue to manage these acutely ill individuals? Burnout and stress, while well documented within nursing has been exacerbated with the COVID 19 patients. As the pandemic begins to subside in some parts of the world, will the nursing workforce simply regroup and prepare for the next onslaught of the pandemic? Alternatively, will many simply move to other types of nursing positions where they face less risk to their health?

In 2019, hospitals across the nation participated in the ANSI National Healthcare Retention and RN Staffing Survey. Respondents to the survey had indicated a turnover rate reduction goal of 3.3%. While there was a slight decrease in the turnover rate, it still stands at 17.8%. Now with the impact of COVID 19, it is anticipated the retention rate, particularly for new graduates, will markedly decrease. The certified nursing assistants who are critical to supporting patient care has a turnover rate of 26.5%. The rate will most likely also increase.

The World Health Organization estimates there is a need for at least six million nurses worldwide. The question becomes how this workforce can be educated and then deployed appropriately to provide the needed services to patients. The current COVID crisis has focused on nursing care primarily on managing and assisting these individuals. However, as patients with chronic health conditions develop acute exacerbations plus the need for surgical interventions and hospitalizations, grow nurses will also be needed to care for these individuals.

According to the Employment Projections 2016-2026  of the Bureau of Labor Statistics, Registered Nursing (RN) is ranked among the top occupations in terms of employment growth through 2026. It is expected that the RN workforce will grow from 2,9 million in 2016 to 34 million in 2026, an increase of 438,100, or 15%. The Bureau is also forecasting the need for an additional 203,700 new RNs to fill newly created vacancies and replace retired nurses each year through 2026. One might question if the forecasting is accurate.

Current models of forecasting nursing workforce needs are inconsistent, and given the nature of forecasting often is unreliable. COVID 19 was not anticipated when forecasting models were developed. The forecasting models did not anticipate that many nurses will retire because of their experience in working with patients infected with COVID 19. It is anticipated that baby boomers if they have not already retired, will do so. Generation X and millenniums most likely will stay in the workforce. However, it may depend on their experience managing COVID 19 patients. Given the high death rate from nurses infected by the patients because the lack of personal protective equipment may impact nurse’s willingness to practice in acute care settings.

Nursing schools, at least in the United States, are not able to expand clinical sites in part because of the educational model used. The educational model, with some modifications, is utilized worldwide. There are limitations to the acute care practice model used by educational institutions.  How are they going to be able to educate enough nurses to meet the need for six million more nurses using an outdated model? A model-based primarily on practicing in hospital settings.

New and innovative community-based curriculums combined, including the use of human simulation models, are urgently needed. Competency-based education that integrates a comprehensive educational experience designed to educate nurses for the 21^st century must be created and implemented. No longer can we rely on a predefined mandated clinical hours educational model. These curriculum standards rely heavily on state boards of nursing regulations regarding the number of clinical hours. Boards are prescriptive, often including the type of learning experiences students are expected to achieve. Most of these models are developed primarily from the job analysis of nurses working in an acute care environment. As the number of beds in hospitals decreases, patients hospitalized will be more acute. The nursing educational models need to be adjusted. Future nursing will be primarily community-based, caring for individuals in a wide variety of settings, and addressing many health disparity issues. Perhaps lessons learned from state boards of nursing, allowing other models of learning besides a defined number of clinical hours because of the COVID crisis will result in evidence-based changes. Given the foreseeable need for nurses, particularly in low- and middle-income countries, the need for change is urgent.