5 ways to think about addressing the nursing shortage

By Lauren Rewers

Dr. Buerhaus and team's study is a much-needed infusion of information about the clinical workforce—at a time when health care leaders have never been more concerned about staffing. Broadly speaking, the team's findings are consistent with what my fellow experts are hearing from C-suites across the country and care continuum: the health care labor market is on shaky ground, and stabilizing the workforce will be one of the industry's major focuses for years to come.

But how should leaders make sense of this information? See our five takeaways below.

Five takeaways for health care leaders

1. Addressing the growing experience-complexity gap should be every hospital's strategic imperative. In addition to exacerbating RN shortages, the exodus of younger nurses from the (inpatient) workforce rapidly accelerates a problem that existed well before the pandemic: the experience-complexity gap. In other words, a workforce that is increasingly made up of new graduate nurses, who are delivering more complex care. We wholeheartedly agree with Buerhaus and team that organizations must work to retain and re-recruit their young nurses—starting with creating a practice environment that equips new graduate RNs with the space and education they need to move from "novice" to "competent."

    

2. The true barrier to expanding the nursing pipeline isn't decreasing applications, but a fewer number of clinical and educational experts. Buerhaus rightly raises the alarm on a declining number of nursing school applicants in 2020. What this trend belies is that fact that our nursing education system can't handle more students, even they did receive more applications. Schools have long struggled with a shortage of nursing faculty. And staffing shortages within clinical sites make it difficult to safety increase clinical rotation opportunities. While addressing these structural problems may not be the industry focus right now, leaders will have to turn their attention here in the not-so-distant future to make up for the exodus of younger staff.

    

3. Widening compensation differentials by site-of-care are setting up a cross-continuum war for clinical talent. Compensation differentials between care sites are not new, particularly between hospitals and skilled nursing facilities. But the widening compensation gap Buerhaus identifies between these sites of care places makes already tenuous nursing home staffing an existential threat, as inpatient staffing shortages create a negative vacuum pressure drawing post-acute clinicians to comparatively lucrative bedside roles. This competition for staff is likely inevitable. But hospitals may have to support their post-acute partners to train or recruit staff regardless, lest they experience debilitating discharge delays due to SNF bed closures.

    

4. Rising labor costs are here to stay. To be clear, it's great to see wages rise—particularly among LPNs and nursing assistants who averaged hourly rates of just $23.32 and $14.77 respectively in May of 2019. These wage gains are critically important to financially stabilize the clinicians not only underpin care delivery broadly speaking, but who are often the primary caretakers of our most vulnerable: seniors. Given that we expect for these staffing shortages to persist, health care providers should think of these rising wages not as temporary, pandemic-triggered investments, but as permanent changes to their workforce strategy—and readjust their cost structure accordingly.

    

5. Equity must underpin future workforce strategy. Buerhaus notes that though the labor market is becoming more candidate-centric, these advantages have not been equitably distributed. Specifically, clinicians of colors experienced persistently higher unemployment rates than their white peers. In other words: workforce leaders still have much room to grow to create inclusive work environments reflective of their patient population. Doing so must be a central component of the next phase of workforce strategy, particularly as nurses of color make up a larger proportion of the overall workforce.

The bottom line: The data we are observing continues to reflect clinical shortages will be an ongoing challenge. Leaders are likely entering a future in which they will need not only to re-shape their organization's employee value proposition, but fundamentally change the way they deliver care so our systems can do so safely and effectively with a fewer number of clinicians.