The Impact of the Nursing Shortage on Patient Care


Update on the ongoing nursing shortage, from

Healthcare leaders are seeking solutions to the ongoing nursing shortage, as older nurses retire at a pace nursing schools can’t match.

By Debra Wood, RN, contributor

“We are not producing enough graduates to replace those of us who are retiring, and I think COVID has exacerbated that, with early retirement,” says Mary Carney, DNP, RN-BC, CCRN, CNE, a state director of nursing for WGU Indiana

The nursing shortage challenge

By 2029, the Bureau of Labor Statistics reports that 221,900 more nursing jobs will be created. At the same time, a growing number of nurses are retiring or leaving the bedside for other opportunities. 

Many nurses are pursuing additional education and becoming advanced practice nurses, added Summer Knight, MD, MBA, author of Humanizing Healthcare: Hardwire Humanity into the Future of Health? New grads often leave bedside nursing within one or two years. 

Regional differences in nursing shortages exist, with rural areas particularly hard hit, said Theresa Brown, RN, author of The Shift: One Nurse, Twelve Hours, Four Patients' Lives.

Travel nursing assignments have been one solution for these geographical challenges, getting nurses to the areas where they are needed most.

COVID-19’s effect on the nursing shortage

The COVID-19 pandemic has made this past year a long one for nurses. Brown said she believed the pandemic has worsened the nursing shortage.

“Nurses rise to the occasion and trained to desensitize themselves to life experience things,” Knight said. “We expect them to not be human, but need to recognize that they are human -- this is leading to burnout.”

Burnout contributes to nurses leaving the profession. 

“Nurses are seeing more and more death every day, which weighs heavily on this highly ‘humanizing’ role they play,” Knight said. “Nurses want to see they're making an impact, and many times with COVID, they're not able to see that impact.”

Anecdotal reports indicate that COVID-19 has increased burnout, stress and moral distress among nurses, but data about the effect it has had on the nursing shortage has not been released. Peter Buerhaus, PhD, RN, FAAN, professor in the Montana State University (MSU) College of Nursing and director of the MSU Center for Interdisciplinary Health Workforce Studies in Bozeman, is leading a study to determine COVID-19’s effect on the nursing workforce.

The information from the project is currently under review in a journal, waiting for publication, but Buerhaus expects the results can soon be released. 

Nursing shortage affects patient care

Nursing shortages lead to adverse outcomes. In some cases, nurses miss changes in patients’ conditions or are unable to answer a call light. 

“There are not eyes often enough on those patients,” Brown said. 

What happens is “there is undone care, and you hope the next shift picks up what you left undone,” Carney said. “You know patient care suffers.”

“Nurses will have to care for more patients at a time, so not enough time to do quality work [which leads to a] decline in patient care quality,” Knight added. 

Multiple studies, some dating back years, have demonstrated the risk the nursing shortage poses to patients:

  • A recent study in JAMA Network Open reported finding an increased risk of death when intensive care units were at capacity due to the COVID-19 pandemic. 
  • Linda Aiken, PhD, RN, FAAN, FRCN, at the University of Pennsylvania School of Nursing in Philadelphia, and colleagues reported in a 2014 Lancet article that increasing a nurse’s workload by one person raised the risk of dying by 7 percent. 
  • Heather Tubbs-Coolie, PhD, RN, FAAN, now at The Ohio State University in Columbus, led a 2013 study in BMJ Quality & Safety, which found patients cared for by nurses with heavier patient loads were more likely to be readmitted. 
  • Mary Blegen, RN, MA, PhD, FAAN, now at the University of Colorado at Denver, led a study reported 10 years ago in Medical Care, finding higher nurse staffing was associated with better patient outcomes. 

Nurse shortage solutions

Brown and Knight agreed that the nursing environment has to change, with mechanisms to ensure the shift is filled with another nurse if someone calls off, and making sure nurses have time for lunch and other breaks. 

If nurses must go into overstressed, under-resourced environment, they tend to leave and take advantage of other opportunities, Brown said. Those investments in educating these nurses are for naught if the person leaves the profession. 

“We need to increase the supply of nurses,” said Carney, reporting that she turns away “hundreds of qualified applicants every year because of the lack of clinical space.” 

COVID-19 has exacerbated that problem with many hospitals not accepting students, and those that do, require them to be fitted for a mask and purchase their own N-95 masks. 

Carney said the profession needs to work with boards of nursing to create innovative clinical experiences outside of the hospital, including more simulation, virtual reality, and more outpatient experiences. More care is moving outside the hospital. 

The good news is Carney indicated she has not seen a slowdown in applications to nursing school nor drop outs from the nursing program due to the pandemic. 

“We actually saw an increase of nursing applicants during COVID; however, there's a shortage in experience,” Knight said. 

Carney also recommended recruiting nursing school candidates with significant life experience and not simply high-school graduates. 

The nursing shortage is particularly acute in rural areas and nursing schools will need to focus on not only recruiting from rural areas but letting those students learn in their communities rather than training them in an urban center, where they are likely to stay, Carney said. 

Travel nurses help fill gaps from the nursing shortage

Opportunities for travel nurses exist across the country. AMN Healthcare, the nation’s largest healthcare staffing company, reported a record demand for nurses in the fourth quarter 2020, due to rising hospitalizations and a shortage of workers.. 

The nursing shortage affects everyone, including patients and nurses.

“How nurses do is how patients do,” Brown concluded. “If nurses are overworked and burned out, the patients are not going to get the care they need and deserve.”

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