Kyle Feinstein, Stanford University
At the height of the COVID-19 pandemic, America fell ill to a critical shortage of nurses. At its core, the shortage was an economic disease, and it was spreading. Within months, the global shortage of nurses, estimated at 5.9 million nurses, climbed to a staggering 13 million. The scarcity caused nurses to be deployed out of their specialty. Hospitals were pushed to invest copious funds into contract nurses to alleviate the workload. High turnover rates spawned discontinuity issues, giving rise to safety concerns. This cascade of challenges forced hospitals to limit services and jeopardized the most central responsibility of healthcare providers: patient outcomes.
However, COVID-19 did not mark the beginning nor end of the American nursing shortage. Instead, the pandemic exacerbated deep structural vulnerabilities within the healthcare economy. When health systems were pushed to their breaking point, the whole nation witnessed a broader narrative unfold as years of work environment challenges, healthcare demand shifts, and educational barriers reached a precipice. By studying the causes, effects, and history of the ongoing nursing shortage, healthcare economists can better understand the human elements of labor systems and map the way back to a full recovery.
Significant nursing shortages have been a recurring phenomenon in the US since the invention of commercialized healthcare. In the 1930s, amid the Great Depression, America experienced its first modern nursing shortage due to hospital budget cuts, increased demand for care, and limited nursing career advancement opportunities. In the next decade, the crisis was further amplified by America’s entrance into World War II, resulting in 77,000 nurses (25% of the total nursing population) joining the military service. Fortunately, the civilian nursing economy eventually rebounded after collaborative initiatives to subsidize nursing education and open accessible nursing aid positions.
Due to COVID-19, America is again facing a nursing shortage caused by economic strife, workload challenges, and external pressures bloating general demand for care. When asked in a November 2022 survey what factor most impacts the shortage, nurses’ top responses were improved staff ratios (71%), better pay (64%), and better working conditions (41%).
According to a survey published by the National Council of State Boards of Nursing, approximately 100,000 registered nurses resigned from the workforce because of the stresses of COVID-19. Exacerbating the situation, many nurses were forced to leave their jobs because they refused to comply with vaccine mandates. Strict COVID policies, increased inpatient volumes, and the demands of a high-stakes, high-pressure environment coalesced to lead nurses out of the profession.
Nurses considering retirement took this moment as their chance to exit. This constituted a nontrivial portion of the population. In 2020, the median age of a resident nurse was 52 years old, with more than 20% of nurses indicating an intent to retire from nursing in 5 years. Others freshly joining the workforce looked for alternative positions in the industry when their current employers failed to raise compensation to a competitive level given the higher workload. Many escaped to traveling nurse roles with higher wages. This perpetuated the fiscal problem for hospitals. By failing to raise pay for nurses, hospitals were forced to turn to costly and temporary contract laborers. Fewer nurses led to higher workloads, which resulted in greater turnover and reliance on more costly alternatives, in turn leaving fewer nurses in the labor force. Hence, many healthcare economists across the nation are looking for ways to break the loop and find a cure for the nursing shortage once and for all.
One potential long-term remedy can be found by looking back on historical nursing shortages. During the nursing crisis of the 1930s, many hospitals started recruiting licensed practical nurses to bridge their staff ratio gap. Licensed practical nurses were hospital staff who underwent short educational training programs to provide primary care under the supervision of a registered nurse. This lowered the barrier to entry for hospital positions and created a safe way to alleviate menial yet tiring tasks for nurses.
Analogously, the health economy of today possesses an abundance of technological tools that can improve workload management. For instance, providing routine remote telemetry opportunities for nurses could dissipate stress and improve working conditions. Moreover, hospitals could evolve to adopt more artificial intelligence and machine learning tools to streamline data-driven nursing tasks.
Another potential treatment for this issue may involve strengthening the education pipeline. In the 1930s, the Bolton Act expedited the healthcare industry’s recovery by creating the Cadet Nurse Corps program, providing $160 million in funding for nurse education and financial support for nursing students. Legislators and medical institutions alike could learn from this strategy and move to invest more heavily in new and existing nursing schools to reach a lasting solution.
The battle to maintain a safe nursing staff level may only be at its beginning. 91% of nurses believe the nursing shortage is getting worse. However, while the nursing shortage continues to plague the healthcare industry, America can use the lessons it has learned from the past to treat this sickness.