A new study shows that the labor market for the nursing workforce tightened throughout the first 15 months of the COVID-19 pandemic, in a period marked by falling employment and rising wages across the health care industry.
The paper, “Nurse Employment During the First 15 Months of the COVID-19 Pandemic,” funded by The Johnson & Johnson Foundation, The John A. Hartford Foundation, UnitedHealth Group, and The Robert Wood Johnson Foundation, is in the January issue of the journal Health Affairs. Using data from the Bureau of Labor Statistics and the Current Population Survey, the study identified and described the immediate economic impact of the pandemic on registered nurses, licensed practical nurses, and nursing assistants across the U.S. from April 2020 through June 2021.
Dr. Peter Buerhaus, MSU Mark and Robyn Jones College of Nursing.
The authors found that the pandemic has had dramatic impacts on health care delivery organizations and the nurse workforce they employ.
Although the research team focused on the nursing workforce, the results also shed light on overall employment in major sectors of health care delivery. Overall employment throughout health care delivery systems – including hospitals, outpatient facilities, home health care agencies, physician offices, and nursing homes – experienced an “unprecedented” decline after the COVID-19 virus was identified and began spreading throughout the country.
But as employment gradually resumed in most settings, the health care labor market shifted. Overall employment in hospitals, home health, and physician offices had nearly bounced back to pre-pandemic levels by June 2021 with two exceptions: employment in outpatient facilities not only bounced back but exceeded pre-pandemic levels by October 2020, and nursing home employment continued a steady decline over the study period.
Nurses and the “Covid-19 Effect” on unemployment
For nurses specifically, the researchers found that in the early months of the pandemic, unemployment shot up in hospitals, physician offices, home health care, and outpatient clinics as patients canceled appointments and these organizations greatly reduced their operations. Between the first and third quarters of 2020, unemployment rates peaked. At their highest, approximately an additional 100,000 registered nurses, 25,000 licensed practical nurses and 90,000 nursing assistants were unemployed compared to pre-pandemic numbers.
The authors noted that unemployment has rarely been a problem for nurses in health care. For example, over the past several decades, the unemployment rate for RNs has rarely exceeded 1%.
“These findings are especially striking regarding the total supply of registered nurses,” Auerbach said. “We have gotten used to the workforce growing year after year – yet these data suggest we may be experiencing a plateau right now. That would have huge implications for the delivery of health care.”
Auerbach noted that nursing unemployment during the first 15 months of the pandemic varied by settings, with increases in unemployment higher in non-hospital settings.
Furthermore, unemployment spikes in the second quarter of 2020 were higher among registered nurses and nursing assistants of color than among white, non-Hispanic registered nurses and nursing assistants.
Real wage growth for the first time in a decade
In addition, the researchers found that the pandemic seems to have positively affected nurses’ earnings. After a decade of virtually no real wage growth, wage increases during the first five quarters of the pandemic were 9.5% for licensed practical nurses, 5.7% for nursing assistants, and 2% for registered nurses. Wage increases were highest in hospital settings and also higher among the lowest-paid registered nurses, licensed practical nurses, and nursing assistants.
“These data confirm anecdotal reports of rising wages among nurses and nurse aides in response to staffing challenges in both hospitals and long-term care facilities. It’s important to note regional and state variation in these effects as the pandemic flares locally and regionally in this time period,” Donelan said.
More disruption ahead?
Looking ahead, the researchers plan to continue analyzing monthly data on the nurse workforce through 2021. The team also plans to make new projections of the supply of the registered nursing workforce through 2030, taking into account two factors that could greatly impact the registered nursing workforce in coming years: interest in nursing as a career and retirement plans of older nurses.
“Regarding entry into the nursing workforce, it is unclear whether the pandemic will lead to increased or decreased interest,” Buerhaus said. “With regard to exit from the workforce, an estimated 660,000 baby boom nurses are still working during the pandemic, the vast majority of whom are expected to retire by 2030. If substantial numbers of these older registered nurses exit the workforce earlier than they had planned, the size of the nursing workforce could decrease more quickly and disrupt nursing labor markets throughout the country.”
The exit and entry questions bear careful watching, Buerhaus added. Buerhaus’s co-authors include Douglas Staiger at Dartmouth College; David Auerbach, external adjunct faculty at MSU; Max Yates, a recent MSU graduate; and Karen Donelan of Brandeis University.
Having a patient say they want to do what YOU do, or receiving Facebook friend invitations from their family are among the happiest side effects of nursing excellence. The first-hand experience of making a real difference in peoples’ lives is one of the main reasons bedside nurses love their incredibly hard — and profoundly important job.
The nurses and other staff at University of California Davis Health Burn Institute Regional Burn Center will remember a recent patient and his loved ones long after the 92 thank-you cards are stored away (though as you can see, the cards are awesome too!). And when their former patient, Mexican truckdriver J. Guadalupe Romo Fonseca says he wishes he was a nurse—after spending some 8 months fighting through third-degree burns, a stroke, and the loss of his leg—it is evident that he had some truly inspiring caregivers.
“He pulled through so many times…”
During any other holiday season, truck driver J. Guadalupe Romo Fonseca would be traveling Northern California roadways, hauling heavy loads alongside FedEx, Amazon, and UPS drivers.
But this year, he’s off the road and thankful to be alive.
“For me, I was dead. I don’t remember nothing for six months,” Fonseca recalled.
That was his reality in November 2020 after a propane stove tank explosion tossed him outside his mobile home in Chico. The Guanajuato, Mexico native was making local hauls before his planned return to family in Mexico for Christmas.
Instead, he spent the holidays — and 235 days total — in the Firefighter’s Burn Institute Regional Burn Center at UC Davis Health. His wife, Berta, and their sons Silvestre and Jesus flew in and remained by his side. Alicia and Carlos, his daughter and other son, were not able to be there in person, but their minds and hearts were with their father.
“When my dad’s boss called and told us about dad’s serious burns on his body, we were just like, ‘Oh my God! Maybe it’s not that bad,’” said Silvestre Romo Llamas. “He is the strongest man I ever met. For me, seeing him like that was hard. It was heartbreaking.”
For the next six months, Fonseca drifted in and out of consciousness while recovering from third-degree burns over 60% of his body. He suffered a stroke, lost his right leg, experienced multiple bouts of sepsis, and underwent more than 10 surgeries.
“Twice I told the family to say their goodbyes. At times, it looked really bad. And then he pulled through. He pulled through so many times,” said Marianne MacLachlan, RN, one of Fonseca’s nurses.
“They were taking care of my dad, but also taking care of us.”
While Fonseca fought for his life, his family found support in MacLachlan and the team of nurses, therapists, and support staff in the Burn Center.
“It was so much love they were showing to my dad. They had great teamwork,” Llamas explained. “They were taking care of my dad but also taking care of us. They were angels for us.”
The Burn Center team consists of more than 25 experts: physicians, nurses, researchers, and administrative personnel who support patients and families in the largest burn treatment center in Northern California.
While it’s their job to care for those with serious burn injuries, doctors and nurses believe their role extends beyond the patient. Tina Palmieri, chief burn surgeon, says that “Patients and families spend many days in the hospital, with multiple operations, dressing changes, and physical therapy sessions. We work with them to envision what the patient can become and then help them get there. Our goal goes beyond survival: it is about helping the patient live a quality life.”
“It’s amazing what you can do for people when they trust you.
In 20 years, I’ll remember them. These are the people who stick with you.”
—Marianne MacLachlan, RN, UC Davis Health
“When you have a patient who’s very sick and not interactive with you, you do all you can to care for them, but you’re also caring for the family. They become the patient, too,” added MacLachlan.
MacLachlan added that of the many patients she has tended to over the years, this family was special.
“I’ve never seen such a beautiful connection with a family. Regardless of whether you speak the same language or not, compassion and love are the same,” she said.
It took a village—of 92 nurses, therapists, and physicians. And his son thanked each one of them with a personal card.
As the only nurse on the unit fluent in Spanish, Adrian Montano, RN bonded with the family and helped them navigate every challenge they faced.
“Everything that could have gone wrong did. But they stood by him and were there every day and very appreciative of staff,” Montano said. “You don’t see families like this very often, not to that extent. Every day they took the time to interact with everyone and get to know everyone.”
Once Fonseca was out of the woods and his discharge was imminent, his family surprised those who had cared for them with an unexpected thanks — handmade cards, created by Jesus Romo Llamas, for the 92 nurses, therapists, physicians and various other staff who tended to their needs.
“The cards were just a little token of appreciation for all the intensive work I saw happening in the ICU.
Staff there gives everything they have so patients and family have another opportunity to be together. I wish I could give more than cards back.”
—Jesus Fonseca, son of J. Guadalupe
“Every so often we’ll get something from a family. But it’s very unusual for them to go out of their way to make something individual for everyone,” Montano said.
“It’s amazing what you can do for people when they trust you,” added MacLachlan. “In 20 years, I’ll remember them. These are the people who stick with you.”
“I’ve never liked hospitals to be honest, but now I’m thinking about being a nurse”
The compassion and care from UC Davis Health nurses not only paved the way for Fonseca’s recovery, they made an indelible impression on Silvestre Romo Llamas and his future.
“I’ve never liked hospitals to be honest, but now I’m thinking about being a nurse,” he said. “It’s incredible how you feel in this situation in such vulnerable moments. I want to help people.”
More than a year after that fateful day when an explosion rocked this family’s world, Silvestre Romo Llamas is taking a home health aide course and Fonseca is learning everything again.
“Since I got out of the hospital, everything was new for me again,” Fonseca said. “I’m doing a lot better. I got my prosthesis and I’m taking my first steps.”
Fonseca says his future, most likely, will not include driving a big rig. He hopes it includes a return home. But for now, gratitude: “This Christmas has special meaning, to be thankful of everything that’s happened through the year.”
Now they look forward to next year when they can return home to Mexico. And they stay in touch through Facebook with the team who healed them.
“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.
Becoming a nurse is no easy task, and for good reason. When you have a person’s health and well-being in your hands every day, you have to be highly trained, compassionate, and dedicated.
However, understanding the steps required to become a nurse can be a little bit confusing. There are several different nursing degrees to consider, plus licensure for the state. Nursing degrees and nursing licenses are not the same thing—and you need both to legally work as a nurse in the United States.
Nursing Degrees Vs. Licenses
Essentially, a nursing degree is a prerequisite for licensure. Before being allowed to take the licensure exams, a nurse must demonstrate that they have successfully completed an accredited nursing program and earned a degree.
Earning a degree means a nursing student has learned all of the skills needed to work as a nurse and pass their school exams. A high-quality education is essential for every nurse actively working in the healthcare industry.
Once a degree has been earned, however, there is one more hurdle: passing the all-important exams. These exams are challenging for a reason—they must evaluate whether or not a nursing student is ready to work with real patients. Licensure is necessary for getting a job and legally working as a nurse.
Types of Nursing Licenses and Types of Nursing Degrees
Degree programs for nurses can range from associate’s degrees to master’s degrees. Generally, the more education a nurse gets, the more the potential responsibility and pay increases.
There are also different types of nursing licenses, and each one defines the limitations of what tasks a nurse will be permitted to perform in a clinical setting. The most common license type is RN (Registered Nurse). Nurses with this licensure can perform many different patient care tasks and are indispensable in a hospital setting. Passing the NCLEX exam is required to become an RN.
Lower-level licensures include LPN (Licensed Practical Nurse) and CNA (Certified Nursing Assistant). These healthcare professionals must work under the supervision of an RN and are more limited in the tasks they can perform. However, the education requirements for taking these licensure exams are lower than for those seeking the RN licensure.
Autonomy and pay are two major considerations for those interested in getting a nursing degree. With an associate’s degree or bachelor’s degree, students can sit for the RN licensure exam. Advanced nursing degrees can lead to much more autonomy and greater pay. Some nurses go on to earn a master’s degree, become nurse practitioners, or even earn a Ph.D. in nursing.
Which Degree and License Type Is Right for You?
There are pros and cons to every degree and license type for nurses. Before you choose a nursing degree program, you need to think about what you envision for your career.
Are you hoping to finish your degree quickly and work part-time to earn supplemental income? If so, you may want to work toward an LPN or CNA license. If you want to work full-time as a nurse, however, an associate’s degree or bachelor’s degree in nursing is the standard path to becoming an RN.
If you want to take your career even further, you may want to consider an advanced degree. There is a need for nursing educators, nurse leaders, and nurse practitioners in the United States. Earning an advanced nursing degree could open up lots of doors and allow you to earn more money throughout your career.
Ultimately, the choice is yours. You need to understand the commitment of time and money each option requires and choose based on your specific situation. While different options will give you different opportunities, the demand for nurses is strong and most people who earn their degree and licensure have no trouble finding a job.
Working toward a nursing license is a big commitment. But if you follow through, it can provide you with a fulfilling and interesting career path you can continue with successfully for many, many years.
Looking to build your career as a new Registered Nurse (RN), but not sure where to start? Discover a training program that will help bridge the gap between the classroom and real-world experience.
New nurses and recent nursing program graduates: VA’s RN Transition-To-Practice (RNTTP) Residency Program is structured for your success. This program gives new nurses the specific tools and guidance they need to grow and develop within the health care industry.
Transition from the classroom to practice
It’s no secret that nursing is a challenging career path. Although it is certainly a rewarding and honorable one as well, nursing can be mentally and physically demanding. The team-focused, support component of the RNTTP Residency Program cannot be overemphasized – it aids in your overall success as a nurse.
Throughout the 12-month developmental training program, experienced nurses will guide you through the role, duties, patient care activities and procedures RNs perform. Your assigned preceptor/preceptors will work closely with you during unit-based clinical orientation and throughout the program.
RNTTP Program Manager, Kim DeMasi, believes the program is built for success.
“Transitioning from student nurse to practicing RN can seem daunting; change is a challenge and an opportunity. The VHA RNTTP Residency Program is designed to provide the support you need to confidently and competently face this new challenge,” said DeMasi.
Learn more about the RNTTP Residency Program
If you have recently graduated from your nursing program or are a new graduate RN with less than a year of professional experience, you are eligible to enroll in the program.
In addition, VA medical centers are located nationwide – so your perfect job opportunity is waiting for you wherever you are. Above all, through developing your career at VA, you will be directly impacting the lives of our nation’s Veterans.
Discover exceptional career benefits
VA is the nation’s leading employer of nurses, with a team of more than 100,000 and growing. Nurses of all employment levels can take advantage of over 7,000 training programs in affiliation with over 1,800 educational institutions, from mandatory developmental programs to competitive opportunities. There are endless possibilities for growing your skills and advancing your career within the agency.
As the nation’s largest health care system, VA offers state-of-the-art tools, including speech-recognition capabilities, virtual technologies, mobile devices and renowned knowledge-based resources. VA is also the leader in telehealth, clinical innovation, and surgical quality.
Normally, Beaumont, Texas RN Vaughn Mugol sings to his bedside patients on the Christus St. Elizabeth’s oncology unit. On Monday, though, our Nurse of the Week wowed the likes of Ariana Grande, John Legend, and Kelly Clarkson during his audition for The Voice.
Using vocal chops that have cheered patients since 2017, Mugol performed a moving interpretation of Ed Sheeran’s “The A-Team.” All three judges turned their chairs in support of him, and Mugol chose Grande as his coach. All three judges were also surprised to hear that Mugol’s usual audience is his bedside patients. An admiring Legend remarked, “I feel that what you did required a lot of seasoning that one doesn’t expect from people who haven’t performed on big stages.”
The 27-year-old Mugol has always used his vocal talents on the oncology unit. In his Voice introductory video, he said, “At those vulnerable moments, usually I open up and sing to them when I know that they need it. To be able to help people with the healing process is very rewarding.”
However, John Legend may take some consolation in knowing that the Christus oncology unit has not been Mugol’s sole performance space. Prior to his network debut, Mugol often performed at local parties in Beaumont’s Filipino community – and previous auditors are not surprised that all three Voice judges wanted to be his selected coach. Melanie Lanuza, a family friend who has known Mugol since his childhood, says “We always sing karaoke at our Filipino parties, and I was surprised that he was so young and wanted to sing. None of the other kids were interested, but he wanted to sing. He blew me away even when he was so young.”
Paul Guidroz, chief nursing officer for Christus, proudly says that he spotted Mugol’s talent early. “In their orientation,” he remarked, “I spend time with all the new nurses as they begin their residency program. And in that session… I shared with him that, ‘Hey, I hear that you enjoy singing.’ I said, ‘Don’t lose that passion. You never know where it might take you.’”
Katy Kiser, communications director for Christus Health, cheered on their musical RN, saying of Mugol: “He’s an amazing nurse and he has full Christus support for his courage to go and sing on a national stage… We are all #VoteVaughn over here.”