Demanding that the hospital industry invests in safe staffing and that President Biden fulfills his campaign promise to protect nurses and prioritize public health, National Nurses United (NNU), the largest RN union in the United States, is calling for nurses to take part in actions across the country on January 13. Among the activities planned for this Thursday, the NNU will conduct a national virtual press conference at 1.00 PM EST and hold a candlelight vigil in Washington, D.C. for nurses who lost their lives to Covid-19.
“This is a vicious cycle where weakening protections just drives more nurses away from their jobs.”
—Zenei Triunfo-Cortez, RN, President, NNU
A perfect storm is brewing, according to NNU nurses. The Biden administration has “ripped away critical protections“ from health care workers and the public, the Centers for Disease Control (CDC) has weakened Covid isolation guidelines, and the Occupational Safety and Health Administration (OSHA) plans to withdraw critical Covid protections for health care workers—right when the Omicron variant is exploding across the country and hospitalizations are skyrocketing. The NNU states that leaving nurses unprotected by the government and by profit-driven hospital employers which have failed to invest in safe staffing and critical health and safety protections, has created unsafe working conditions that are driving nurses out of the profession.
Nurse retention will rise when hospitals set safe staffing levels
NNU President Zenei Triunfo-Cortez, RN suggests that the nurse staffing crisis—while it may have been exacerbated by the pandemic—is primarily a consequence of hospitals prioritizing dollars above human lives. In a statement, Triunfo-Cortez said, “As we enter year three of the deadliest pandemic in our lifetimes, nurses are enraged to see that, for our government and our employers, it’s all about what’s good for business, not what’s good for public health. Our employers claim there is a ‘nursing shortage,’ and that’s why they must flout optimal isolation times, but we know there are plenty of registered nurses in this country. There is only a shortage of nurses willing to work in the unsafe conditions created by hospital employers and this government’s refusal to impose lifesaving standards. So this is a vicious cycle where weakening protections just drives more nurses away from their jobs.”
NNU conducted a survey of thousands of registered nurses across the country from October to December 2021. Of the nurses who responded, 83 percent said at least half of their shifts were unsafely staffed, and 68 percent said they have considered leaving their position. RNs say nurses would stop leaving the profession if hospitals immediately improved working conditions by increasing staffing levels and followed nurses’ advice to grow the pool of available nurses. According to nurses, hospitals must actively hire permanent staff nurses and consider a wider range of educational qualifications; stop canceling nurses; properly cross-train current staff nurses so that they are competent to work in other departments, especially critical care, and institute optimal occupational health and safety protocols to protect nurses, other health care workers, and patients.
Schedule for Thursday, Jan 13
What: Virtual press conference, featuring national nurse stories
When:Thursday, Jan. 13, 1 p.m. ET/ 10 a.m. PT
Who: Registered nurses from across the United States
Nurses also call on the CDC to strengthen isolation guidelines for health care workers and the public, and on OSHA to institute a permanent Covid health care standard without delay. On Jan. 5, NNU joined leading labor organizations and unions representing the country’s nurses and health care workers to petition the United States Court of Appeals for the District of Columbia Circuit to order OSHA to issue a permanent standard and to retain the emergency temporary standard until the permanent standard goes into effect. Without the protections of a permanent standard, RNs emphasize that the health and well-being of nurses, other health care workers, patients, and the general public is in grave danger.
“Everyone will need medical care at some point in their lives, and when our loved ones are in the hospital, we want nurses to be able to deliver the focused care that all patients deserve,” said Bonnie Castillo, RN, NNU executive director. “But the working conditions that our employers and the federal government are telling nurses and health care workers to endure are both grossly unfair and unsustainable, and we are standing up on Jan. 13 to say, ‘Enough!’ We need permanent protections based on science, and we need them now because when nurses and health care workers aren’t safe, we cannot keep our patients safe.”
She lost two relatives of her own to the pandemic and worked on the frontlines when Covid cut short the lives of so many New Yorkers that hospitals needed morgue trucks to house the dead. So, Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC, the director of patient care services in critical care at Long Island Jewish Medical Center, knew what was at stake when she was asked to bare her arm for the first official Covid jab in the US on December 14, 2020.
This Nurse of Many Weeks has played her role as nursing icon with a very un-celebrity-like grace and lack of pretension. On top of her usual job duties, she has spent most of the year urging people to trust the evidence that the Covid vaccines work, appearing at Zoom town halls and other events in a tireless campaign to combat junk science and medical mistrust.
“It’s the everyday, ordinary people seeing me on the street or in different locations and recognizing me, even with my mask on … and coming up to me and saying, ‘Thank you….'”
—Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC
Just last month, nurse Lindsay readily agreed to the request of 9-year-old Desiree Mohammadi, daughter of a Queens pediatrician, and held her small hand as a pediatric nurse administered a Covid jab. Afterward, Desiree sent her idol a grateful thank-you letter. The photos and video of the nurse who was the first person in the US to be vaccinated for Covid-19 will be in textbooks soon, but she is already inspiring children to seek a better understanding of both science and nursing.
“I encourage people to speak to experts who can answer their questions, to access trusted science. I let them know that it’s OK to ask questions.”
The nursing profession may be too diverse for any one nurse to be seen as its “face,” but Dr. Sandra Lindsay is nonetheless a superb representative. The 53-year-old critical care nurse displays the qualities that inspire our trust in nurses. She communicates clearly and honestly, in a no-nonsense manner; her practice follows science and evidence, not opinions. With those who prefer to heed opinions, her approach is nonjudgemental*, and seeks to persuade without condescension.
“It’s the only job I know of where they pay you to learn.”
—Joan Blondell, as “Maloney” in Night Nurse (1932)
As for the “nursing public,” any nurse can take pride in Lindsay’s ongoing pursuit of education. If you’re a nurse, your last name doesn’t have to be followed by an ever-expanding alphabet of degrees and credentials, but those proliferating letters do speak to the long-overdue increase in respect for nurses. (Of course, if the general public was aware of the mathematical calculations an RN performs every day or knew how quickly the “average” nurse masters complex new procedures, technology, and treatments, they might be intimidated). Lindsay is also a fine example of nurse leadership. She cites evidence as the basis for her words and actions and bears her responsibilities with a quiet, natural authority.
And for aspiring nurses, whether immigrant or native-born, Lindsay is an exemplar of the classic American dream: if you are smart, determined, self-disciplined, and willing to work very hard, you don’t need wealth or family clout to make a difference in the world.
But perhaps the most significant reason that Dr. Lindsay is our Nurse of the Year is this: as Elvis did with the polio vaccine, she set an example that is saving lives. When NPR spoke with her last week, she shared the following anecdote:
Lindsay was at the Jamaican Embassy one day (she was born there and immigrated to the US when she was 18) when a woman came over and began to thank her profusely. She told Lindsay that she and her family had not intended to be vaccinated—until she saw Lindsay getting that first jab on TV. After seeing the nurse’s confident mien, she said, “We all went and made an appointment. So I want to thank you so much for inspiring us.”
For that alone, may Dr. Lindsay have the best possible 2022, and many more great years after that.
School nurses have been on the front lines since the start of the COVID-19 pandemic, administering COVID-19 testing, tracking the results and performing contact tracing, among other duties.
Underpaid, overworked and overextended, school nurses have been placed in an unsustainable position as “de facto” public health officials for the children under their care—and like actual, appointed public health officials, are frequently on the “frontlines” of community battles being waged over mask requirements, quarantining of infected children, and of course vaccination. However, if they start to feel overwhelmed and frustrated, they have a place to vent, share anecdotes, and support one another, thanks to the efforts of The Relentless School Nurse… aka Robin Cogan, MEd, RN, NCSN, FAAN, the clinical coordinator of the Rutgers University–Camden school nurse program.
Cogan, a vocal advocate for school nurses, hosts a virtual support group for these nurses throughout the United States, which focuses on keeping students safe, as well as a variety of critical issues related to COVID-19.
“Being responsible for the health and safety of students and staff has weighed heavily on school nurses,” says Cogan. “It is not in our nature to receive. We are usually the ones giving. That is not a healthy stance; we must also be able to receive…” Describing the group to the New York Times in November, she explained, “It’s a safe space for school nurses to share their experiences and to kind of download and say: ‘This is hard. I’ve written my resignation letter 10 times. I’m about to turn it in — can somebody help talk me out of it, help me get through another day?’”
Since October 2020, Cogan has held weekly peer-to-peer sessions on Zoom, where participants offer solutions and empathize with each other about the demands of handling their standard and expanded duties.
In the hour-long sessions, school nurses around the country talk freely about stress, an untenable workload, and trying to keep up with the latest COVID-19 protocols and testing.
Cogan has noted repeatedly how the challenges that school nurses are facing this fall are compounded by the rising political battle over masks and vaccination requirements in schools.
It is Cogan who says school nurses are acting as the de facto health department. Like public health officials, school nurses have also been under siege since the pandemic arrived on US soil. Cogan recognized the need for a support group early in the 2020 school year, and created the virtual sessions with the Mental Health Association in New Jersey and the state Department of Human Services Division of Mental Health and Addiction Services, along with a Federal Emergency Management Agency (FEMA) grant to offer nurses an opportunity to care for their mental health.
While Cogan is a facilitator of the group, she is also benefitting from the sessions. “We are sharing a collective traumatic experience,” says Cogan. “It’s encouraging to have this group to review the week and determine next steps or ways to cope that do not take me down a negative rabbit hole. I have learned from them to set strong guardrails and ask for help.”
“Front-line workers during the pandemic are heroes who need support. I applaud Robin Cogan for her work in caring for the mental well-being of school nurses,” says Rutgers‒Camden Chancellor Antonio D. Tillis.
A school nurse for 21 years, Cogan is a leading voice for school nurses and an advocate for children. Her blog, “The Relentless School Nurse,” shares school nurses’ stories from across the country.
Cogan was recently selected as a fellow of the American Academy of Nursing (FAAN), one of the highest honors that can be bestowed in the field.
Cogan is among 225 fellows of the class of 2021, joining a small group of school nurse leaders inducted into the academy. FAAN selection criteria include contributions to nursing and health care, reducing health disparities and inequalities and influencing health policies and health care delivery.
Nurses and health care workers across the country are finding strength in numbers and with labor actions not seen in years.
In California, which has a strong union tradition, Kaiser Permanente management misjudged workplace tensions during the covid-19 crisis and risked a walkout of thousands when union nurses balked at signing a four-year contract that would have slashed pay for new hires. In Colorado, Pennsylvania, North Carolina and Massachusetts, nurses have been embroiled in union battles over staffing and work conditions.
As deadly coronavirus cases spiked this year, daily pressures intensified on hospital floors. Some nurses retired; some became travel nurses, hired by agencies that advertised more than double, even triple, the day rates for intensive care unit, telemetry and emergency room nurses. Others gave up their jobs to avoid possibly carrying the covid virus home to their families.
“Things had gotten particularly stark for nurses,” said Rebecca Kolins Givan, an associate professor of labor studies at Rutgers University.
“They Can Make More at McDonald’s’”
It was so grim in Pittsburgh that registered nurses at West Penn Hospital, part of the Allegheny Health Network, voted this year to authorize a strike — less than a year after they unionized with SEIU Healthcare Pennsylvania. Chief among their complaints: The hospital system had balked at improving staff ratios even as it offered bonuses, up to $15,000 for some, to hire registered nurses to fill vacancies.
Kathleen Jae, a member of the bargaining team that reached a pact without a work stoppage, said nurses wanted management to work harder to retain veteran staff members: “We had to face the fact that nurses are retiring, nurses are leaving the bedside out of frustration, and, in certain instances this year, nurses had more patients than they felt comfortable taking care of.”
Allegheny Health Network said the first-ever pact with RNs at West Penn provides “competitive wages and benefits” to help it “recruit and retain talented, experienced nurses.”
Liz Soriano-Clark, a teacher-turned-nurse on the bargaining team, said the pandemic had made workers across the health sector more careful and choosier about what jobs they’ll take.
“There’s a nursing shortage and a shortage of nursing instructors, nationwide. They’ve seen aides leave. They’ve seen cleaners leave,” Soriano-Clark said. “Why is that? Because they can make more at McDonald’s and not have to clean up vomit.”
In September, the American Nurses Association alerted the Biden administration to an “unsustainable nurse staffing shortage facing our country” in a letter to the Department of Health and Human Services. The ANA said a “crisis-level human resource shortage” was evident: Mississippi had 2,000 fewer nurses than it did at the beginning of 2021. Tennessee called on its National Guard to reinforce hospital staffs. Texas was recruiting 2,500 nurses from outside the state.
Union membership among U.S. nurses has inched up over the past 15 years and held steady, at about 17%, for five years, according to unionstats.com, an academic website. But 2021, a year of union organizing and holdouts in such disparate workplaces as Starbucks cafes and John Deere tractor plants, might well be a turning point for essential workers in health care.
“If you ask nurses what they want,” said Givan, who interviewed dozens of nurses for a 2016 book on health care workers, “they want working conditions where they can provide a high level of care. They don’t want appreciation that is lip service. They don’t want marketing campaigns. They don’t want shiny new buildings.”
Still, Givan noted, the health care sector has spent handsomely to fight unions.
After years of staff retention issues at Longmont United Hospital in Colorado, nurses are awaiting the results of a vote on whether to join National Nurses United, the largest union of registered nurses in the U.S.
Stephanie Chrisley, a registered nurse in the hospital’s ICU, said nurses are regularly caring for double the number of patients considered appropriate — often three to four “ventilated, sedated, critically ill patients.”
She and others protested outside the hospital in early December. They said the company that runs the hospital, Centura Health, this year had employed aggressive union-busting tactics, including disputing a handful of votes, which dragged out the union election for about five months. In another instance, her colleague Kris Kloster said, Centura, founded by Catholic nuns, issued company-wide emails announcing raises and retention bonuses for everyone except nurses at her hospital.
“Where there should have been newly hired nurses, there were anti-union consultants roaming around the hospital,” Chrisley said. Since July, she added, the hospital has lost nearly 80 RNs, “nearly a third of our nursing staff.” Longmont United Hospital Interim CEO Kristi Olson said in a statement that the hospital “will remain open and fully operational” and that “we are committed to making sure that all voices were heard” in the union election.
Organizing can take a long time, Givan said, pointing to tense labor negotiations in Massachusetts, North Carolina and Pennsylvania. “But when there is a crisis — what we call a hot shop — you can get workers to organize quite quickly.” Nurses represented by the Massachusetts Nurses Association walked off the job March 8 in Worcester. A chance to break the bitter impasse collapsed when management, Tenet Healthcare, refused to allow some nurses to return to their original jobs. In North Carolina, registered nurses at Mission Hospital in Asheville ratified a contract with the HCA management that locked in 17% raises over three years and set up a committee to review patient care conditions.
A recent poll by Gallup, the global analytics firm, found that the share of Americans who say they approved of unions was at 68%, its highest point since 1965.
Sal Rosselli, president of the National Union of Healthcare Workers, said that in the past year “there has just been an explosion of leads,” queries from health workers exploring how to unionize.
Rosselli, whose organization represents about 15,000 health workers, said the pandemic exposed practices that had long antagonized employees. Too many hospitals scrambled for masks, gloves and gowns, he said, and front-line workers were on round-the-clock schedules and facing ghastly daily deaths. “They weren’t keeping their employees and their patients safe,” Rosselli said, “and all because these systems were focused on profit over anything else. That has been coming on for a long, long time.”
Registered nursing is among the U.S. occupations expected to experience the greatest levels of job growth in the next decade, according to the Bureau of Labor Statistics’ Employment Projections 2020-2030. Also among the fastest-growing occupations are nurse practitioners, home health care aides and assistants. Shortages of RNs and other health care workers are expected to be the most intense in the South and West.
Some of the most powerful nursing unions in the nation operate out of California, representing employees in Western states. “The nurses in California have the hours they have, the care they have, the protections they have because of the union,” said Soriano-Clark, who has worked at hospitals in California and Pennsylvania.
Ready to Picket in a Pandemic
Douglas Wong, a physician assistant, never imagined hoisting a “strike” sign outside Riverside Medical Center. But that nearly happened after a sobering breakdown in talks between Kaiser Permanente and a top nurses union at the facility, part of the KP system. Nurses, pharmacists and operations staffers are among the insurers’ 160,000-plus unionized employees, according to KP spokesperson Marc Brown.
The California-based health system giant tried to force a two-tier pay schedule that would have cut wages for new nurses by 26%. Wong and thousands of allies — many who dryly noted they had been heralded as “heroes” in the covid crisis — prepared to picket in the middle of a pandemic. Kaiser Permanente’s demands crumbled when dozens of affiliated unions threatened one-day sympathy strikes.
The tiered-pay demand and an attempt to lower wages in some markets were dropped. Staffing ratios were adjusted to ease safety concerns. Wong said that, despite the pact, the bruising negotiations “felt like a betrayal.”
“Make no mistake: This was an enormous win for labor, especially pushing back on the two-tier. At the end of the day, they pulled back. And we made huge strides toward improvement in our staffing,” said Wong, a six-year KP employee and an official with the United Nurses Associations of California/Union of Health Care Professionals.
The negotiations were a marked shift for Kaiser Permanente, which for most of three decades has relied on a labor-management partnership with its unions, emphasizing cooperative decision-making and robust discussions. Talks were held with teams, set around circular tables, hashing out concerns. KP was known for much of the past decade as a market leader in wages and quality of care, and the labor-management partnership was received by academics and labor experts as an innovative, successful approach to managing a workforce.
The health system recently hired new top executives, and, to the surprise of the unions, Kaiser Permanente used negotiations this year to offer the two-tier pay regimen, a tactic used by auto- and steel-makers during economic downturns in the 1980s. The union negotiators noted this: The health care giant’s management wanted to scale back wages after notching $6.8 billion in net revenue from 2018 to 2020.
On Thursday, workers voted to ratify a four-year contract with KP. The company declined to comment for this article. In a news release, Christian Meisner, KP’s chief human resources officer, said: “This contract reflects our deep appreciation for the extraordinary commitment and dedication of our employees” during the pandemic. “We look forward to working together with our labor partners,” he said, to “further our mission of providing high-quality, affordable care.”
The Wall Street Journal recently reported that nurses’ pay was sweetened in 2021 by thousands of dollars in raises — handed out without union wrangling — as hospitals competed for workers. Premier, a health care consultancy hired by the Journal, analyzed 60,000 registered nurses’ salaries and found that average annual pay, not including overtime or bonuses, grew about 4% in the first nine months of the year, to more than $81,000. That compares with a 2.6% rise in 2019, according to federal data.
Raises don’t necessarily mean retention.
“There always seems to be a shortage of nurses,” said professor Paul Clark, who is a former director of Penn State University’s School of Labor and Employment Relations and has studied nursing and labor organizing. “But it’s important to realize there’s not a shortage of RNs. There’s a shortage of RNs willing to work under the conditions they’ve been asked to work.”
Aya Healthcare, a national travel nurse provider, has found that the pandemic aggravated historical understaffing at hospitals, spokesperson Lisa Park said in an email. “There were over 100,000 vacancies at the start of the pandemic. And now, that number has increased to over 195,000,” Park said. Travel nurses account for fewer than 2% of the nursing workforce, she added, but “with the increase in permanent vacancies due to burnout/resignations, the demand for temporary healthcare workers has increased.”
David Zonderman, a professor of labor history at North Carolina State University, noted that nurses unions have grown more political and more outspoken — in Washington, D.C., and their home states. Nurses on the hospital floor lived through a crisis — fearing for their lives amid shortages of protective equipment — much like the trials of American workers in the mining and manufacturing industries in decades past.
“This may sound weird,” Zonderman said, “but nurses are a little like coal miners. They tend to help each other. They are watching each other’s back. They have solidarity.”
“And,” he said, “if you treat people badly long enough, they finally say, ‘I’m done.’”
“Understaffing is not the result of the nursing shortage, but the cause of it,” Zenei Triunfo-Cortez, RN, president of National Nurses United (NNU), told Congressional leaders this week.
Triunfo-Cortez and frontline RNs from across the country explained the understaffing crisis at a Congressional briefing, which accompanied the launch of a new NNU report on the issue.
The RNs described first hand to members of Congress the many ways that the hospital industry, in pursuit of profits, has intentionally created the intolerable working conditions under which many nurses are unwilling to practice and has led to current crisis levels of unsafe staffing. The briefing was co-hosted by Rep. Jan Schakowsky, sponsor of H.R. 3165, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.
U.S. Rep Janice Schakowsky, from Illinois’s 9th congressional district.
“Right now, there are no federal mandates regulating the number of patients that a registered nurse can care for at one time in U.S. hospitals. This is dangerous – for nurses, for patients, for all Americans. This is why I introduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 3165), to require hospitals to develop annual safe staffing plans with the input of direct care nurses,” said Rep. Jan Schakowsky.
Schakowsky continued: “Even before the pandemic, registered nurses have consistently been required to care for more patients than is safe. Nurses have been pleading with hospitals to give them the staff that they need. Yet hospitals say they cannot find enough nurses and cannot afford to pay permanent nurses more in wages. This comprehensive report shows that is incorrect. There is no shortage of registered nurses. There IS a shortage of good, permanent nursing jobs where registered nurses are fully valued for their work. We celebrate nurses. We call them heroes. If we truly value their work and their sacrifices, we must give them the support that they are asking for.”
Adopting policies of not supplying enough RN staff to safely care for patients
Cutting corners at work that endanger nurses’ health and safety, including refusal to provide necessary PPE to RNs during the pandemic until they were forced to do so
Disrespecting nurse judgment and autonomy by fragmenting, deskilling, and replacing aspects of their profession
Resisting hiring RNs from associate degree programs—an elitist practice that exacerbates the staffing crisis and undermines the nursing workforce’s racial and ethnic diversity
The report explains how these hospital industry practices played out during the Covid-19 pandemic and caused irreparable harm to registered nurses by creating unsafe workplaces that led to their mental health distress, moral injury, and hundreds of RN deaths.
“Although there is no general nursing shortage, the lack of racial, ethnic, cultural, linguistic, and socioeconomic diversity within the current nursing workforce reflects the need for increasing the numbers of and support for socioeconomically diverse registered nurses from BIPOC communities and other underserved communities. Racial and socioeconomic diversity within the nursing workforce is crucial for both improving our nation’s health and achieving health equity.”
Finally, the report proposes a number of immediate and long-term legislative and regulatory solutions that Congress and the executive branch could take to retain and grow the nursing workforce. Key recommendations include:
Pass federal safe staffing ratios legislation
Make the meeting of minimum safe staffing requirements a condition of getting Medicare reimbursements
Protect RNs’ health and safety at work
Strengthen union protections
Expand free, public community college nursing programs
Beef up financial assistance for nursing programs that improve workforce diversity
“These patients can go south in an instant; you need to watch them like hawks,” said June Browne, RN, who works in the multi-system intensive care unit at Osceola Regional Medical Center in Kissimmee, Fla. and explained that ICU nurses who should typically be assigned only one or a maximum of two patients at her hospital were routinely assigned three and up to four patients on one shift. “These patients cannot be left alone. But now I hear an alarm ringing in another room, letting me know something is wrong with another patient. What am I to do? Who do I help? I am being asked to make an impossible decision with someone’s life hanging in the balance.”
Zenei Trifuno Cortez, RN, President of National Nurses United.
The story is frighteningly similar around the country. Leah Rasch, RN, who works at Sparrow Hospital in Lansing, Mich., said her community is dealing with a massive surge of Covid patients but that management has provided “horrendous” staffing levels. “I simply cannot do my job well when I’m responsible for caring for eight Covid patients at one time,” said Rasch. “We are just trying to keep them breathing and keep them alive long enough to pass them off to the nurse on the next shift. One of the most heartbreaking things is that when a patient is passing away, I often don’t have time to even sit with them because I am trying to keep someone else alive. It is heartbreaking to know that anyone is dying alone. I can’t tell you how brutal that is and how brutal it feels.”
All the nurses encouraged lawmakers to help pass NNU-endorsed current pending federal safe staffing bills, S. 1567 and H.R. 3165, as well as support the many recommendations outlined in NNU’s report.
“Nurses need the backing of a union to be able to speak up safely at work, and patients, no matter where they get sick in the country, deserve safe, quality patient care that we believe, in the face of hospital industry greed, can only be achieved through RN-to-patient minimum staffing ratios,” said Triunfo-Cortez. “That’s why it’s so critical for Congress to pass the PRO Act, the safe staffing legislation we have proposed, and all the rest of the commonsense recommendations we lay out in this report.”
National Nurses United is the country’s largest and fastest-growing union and professional association of registered nurses, with more than 175,000 members nationwide.
While the last two years of the pandemic have shown how resilient and crucial nurses are to society, the growing nursing shortage continues to have a tremendous impact on the healthcare industry. Nurses are leaving the field at an alarming rate and the International Council of Nurses (ICN) has projected a potential shortfall of 13 million nurses worldwide by 2030. While many nurses are reaching the age for retirement, burnout and continued stress from the pandemic have become major factors in the decision to leave the profession.
In the U.S., recent studies show that more nursing jobs will become available in the next two years compared to any other profession, and the U.S. Bureau of Labor Statistics is projecting that 11 million new nurses will be needed to combat the shortage. Proactive measures must be taken to address this shortage. To do so, health systems, hospitals and educational institutions must come together and provide better support and resources to current and future nurses.
Below are four ways that I believe the healthcare industry and its leaders can reinvigorate the nursing industry while encouraging new nurses to enter practice.
1. Improve Clinical Judgment Skills to Prepare Practice-Ready Nurses
Clinical judgment is a vital component of a nurse’s daily responsibilities, but research shows that many nurses entering the profession have not properly developed these necessary skills. As a result, nearly 40% of new nurses have reported making medication errors and 50% have reported missing signs of life-threatening conditions. The stress associated with these errors is leading to high turnover rates, with some hospitals experiencing new nurse turnover rates as high as 35% within the first year of employment.
To reinforce the development of these skills and ensure nurses are practice-ready, the National Council of State Boards of Nursing (NCSBN) is updating its National Council Licensure Exam (NCLEX). Starting in 2023, the exam will include sections to measure a student’s clinical judgment and decision-making ability. As students and educators prepare for these changes, a forthcoming study in the Journal of Professional Nursing demonstrated a path to NCLEX success. The research found that students who used HESI, an NCLEX review and assessment solution, and also scored a 900 or greater on the HESI Exit Exam had a pass rate of 97% on the NCLEX-RN.
To prepare students for the upcoming Next Generation NCLEX (NGN), nursing programs should integrate clinical judgment learning and assessment solutions across their program curricula. For example, EdTech solutions such as clinical experience simulations in combination with NGN assessments provide an innovative way to prepare students. The immersive learning experience provided by digital simulations allows students to practice clinical reasoning and clinical judgment skills while treating diverse sets of patients who they will eventually encounter in the real-world setting.
2. Provide Continued Professional Development Throughout the Career Journey
Education doesn’t end after nursing school graduation. Instead, the industry needs to approach education as a continuous life-long journey. Scaled continued education solutions can benefit nurses at every step of their career. Whether it is a student who is just entering nursing school, new nurses who are transitioning to practice or even the most seasoned nurses, ongoing training provides tools and guidance for professional development and career success.
As healthcare professionals continue to face information overload and more complex patient scenarios, these educational resources can provide nurses with the latest evidence-based information for improving patient safety and overall health outcomes. These solutions can also help create time-management efficiencies by reducing the time practitioners spend on research, assisting nurses in managing higher workloads and delivering high-quality patient care.
3. Invest in Nursing Education and Advanced Technology Solutions
Advancements in technology have transformed the delivery of nursing education. Academic institutions need to invest in new forms of technology that allow students to develop clinical reasoning skills while building confidence. As mentioned earlier, simulation-based education tools provide students with an immersive educational experience. Shadow Health is one example of how programs can provide digital clinical experiences at scale. This tool features real-life patient scenarios, providing nursing students with the opportunity to improve their decision-making capabilities and learn from mistakes in a controlled, safe environment.
These types of EdTech solutions offer multiple benefits to students and educators alike. As nursing schools continue to turn away qualified applicants due to lack of physical classroom space and clinical sites and an insufficient number of educators, these advanced tools provide more capacity to higher-education institutions and allow students to develop their skills by engaging in realistic patient scenarios. According to the American Association of Colleges and Nursing, more than 80,000 applicants were turned away at four-year institutions due to these limitations.
In fact, the National Council of State Boards of Nursing has found that digital simulations were just as effective as physical clinical experiences, supporting the utilization of simulations to replace up to 50% of traditional clinical hours without impact. By investing in innovative technologies, academic institutions are ensuring that nurses are getting practice-ready experience to prepare them for a multitude of patient situations.
4. Provide Access to Mental Health Resources and Support
It has been widely acknowledged that the ongoing COVID-19 pandemic has had a severe impact on the mental health of nurses and healthcare professionals. According to an ICN survey, nearly 80% of national nursing associations have received reports about mental health distress from nurses. Similarly, a February 2021 study by the American Association of Nurses (AAN) uncovered that a year into the pandemic, nurses continued to suffer from anxiety, depression, and other mental health disorders linked to occupational stress.
To help nurses maintain their mental wellbeing, hospitals and health systems have an obligation to provide nurses with support systems and resources. Hospital leaders need to listen to their nurses to truly understand what they’re going through and what they need in terms of wellness support. From there, these leaders should design and implement policies and programs that can best addresses the mental health needs of their staff. These types of programs can help reduce burnout caused by stress while improving workplace efficiencies to encourage higher levels of retention.
Nurses are the backbone of the healthcare industry, and it’s time we ensure they are set up for success throughout their career journey. These dedicated women and men have done so much for society, and now is our time to provide them with the continuous support and training they deserve.