The impact of the nursing shortage: Where are all the nurses?

“We’re working short-staffed today.” Perhaps the most hated phrase in nursing— a sentiment shared by both bedside nurses and management alike.

Although working short used to be a situational occurrence, anyone working in nursing today can attest to the everyday commonality of this situation now. And while it may be tempting to wholly blame it on poor working conditions (not altogether untrue), the actual reasons behind our depleted workforce are a bit more nuanced.

Nursing shortages were cyclical—until they weren't The first nursing shortage happened in the early part of the 20th Century. On the heels of the Great Depression leading into WWII, the over-supply of nurses for nursing roles suddenly experienced an about-face.

Determining the cause to be a bottleneck in educating a refreshed nursing workforce, nurse leaders at the time employed a three-prong approach to fill the gap; first, recruiting more nursing students, second, dividing fewer clinical traditional nurse roles using ancillary nursing assistants, and third, reducing the time nurses spent being educated. This approach was a success— by the 70s, the perceived nursing shortage was ameliorated.

Unfortunately, we didn’t learn from our past mistakes. One of the most interesting aspects of our nation’s first nursing shortage was its parallels to today’s. In an effort to determine the reasons why nurses were leaving the field prematurely or choosing alternative careers instead, studies conducted in the 1920s (not surprisingly) determined that nurses—to put it bluntly—worked in crap conditions for crap pay.

However, when faced with this helpful information about why nurse retention and recruitment were not going so well, hospitals declined to increase wages or improve working environments for existing nurses.

In their estimation, it was far more lucrative to recruit nursing students and rely on nursing assistants than to prioritize the value of the experienced nurses already on staff. This trend was allowed to play out unchecked until a decade past war-time upheaval.

In 1964, the government eventually stepped in with the Nurse Training Act, a massive funding effort for nurse education. This, coupled with significant and long-overdue wage increases eventually eased the strain of the decades-long nursing shortage. Now, for the past 10 years or so, talk of a critical shortage in the nursing workforce has again resurfaced.

An aging population utilizing more health-care resources, coupled with an aging nursing workforce— and again, working in crap conditions for crap pay—have all contributed to a current shortage that is only going to worsen. To be more precise, this current shortage was predicted to peak by 2030—and that prediction was made before COVID-19 arrived in 2020, with all its nursing career-killing vibes.

The current nursing shortage like any complex problem, the current nursing shortage is multi-factorial. The obvious ones—that half of the current clinical RN workforce is 50+, the COVID-19 shake-up with its rollercoaster vacillation between furloughs and critical staff shortages prompted many younger nurses to seek out traveler contracts, and sparsely employed nursing programs already turn away more than 80,000 qualified hopefuls per year—seem to provide, if not easy, at least straight-forward solutions.

And yet.

Nurses working today do so under the constant feeling of having infinite things added to their plate, and nothing is taken away. Continuing to work long after the onset of burnout has become a disturbing trend that fewer and fewer nurses are willing to endure.

To revisit our succinct phrase—nurses are no longer willing to work in crap conditions for crap pay. And therein lies the heart of the current nursing shortage problem, as it stands unchanged for more than a century. With so many career options available to nurses today, many nurses are simply electing not to work in clinical or acute bedside roles in lieu of non-traditional nursing roles.

This is not just for our mental self-preservation (although that’s a perfectly valid reason to step away from the bedside), but also in response to a disturbing trend seen in the criminalization of nursing errors. Vanderbilt RN, Radonda Vaught, nursing home LPN, Christian Gainey, and corrections RN, Michelle Heughins, are just three examples from the past year of nurses who have fallen on the sword of prosecution for patient deaths, while the institutions they worked for and in were left largely unscathed.

For many nurses, yesterday’s worst-case scenario of losing one’s license due to a traumatic-for everyone error has now been replaced with today’s fear of criminal prosecutions. Who wants to be here for that? Nursing isn't what it used to be — is there still time to make it better? “Nursing isn't what it used to be.” If you work with any seasoned nurse, we know you’ve heard this phrase uttered more than once.

Or perhaps, you yourself are a nurse who’s been around the clinical block a time or two, and you’ve experienced the cultural shift yourself. No matter the decade one joins the profession, nurses get into nursing to be caretakers.

Whether that means assuming the role of direct hands-on patient care, or leading a nursing innovation round-table, nurses inherently have the innate drive to work proudly in this sacred profession. What we ask for in return really isn’t that much.

Fair pay, working conditions that support our professionalism, and most of all—and what may be one of the biggest “misses” in our working lives—a genuine and sincere sense from our employers that we are valued members of the interdisciplinary teams that we work within. For Nurses’ Week 2022, here’s something we can all reflect on… Organizations that truly value nurses will retain them.

Some of those same nurses will inevitably go on to teach other, newer nurses entering the field. Access to affordable education and broadened acceptance of applicants will again produce new crops of eager nurses, just as it did in 1964.

Let’s all hope that the critical difference in this century will be that these new nurses arrive empowered with a sense of their worth—both to themselves and the institutions they pour themselves into.

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