Am I beating the proverbial dead horse if I bring up the nursing shortage again? Or is the horse dead because qualified healthcare professionals weren’t available to save it? Terrible riddle, I know. Forget I mentioned it. That’s not to say a paradox doesn’t exist in the national conversation. Yes, nurses are quitting or retiring in record numbers. However, universities and nursing schools are experiencing a surge in enrollment applications. The problem itself concerns matriculation. Colleges simply lack the slots and teaching faculty to accommodate the rising population of prospective students. Herein lies opportunity. Instead of succumbing to the burnout or taking that gold watch early, experienced nurses could secure a win-win-win by transferring their skills to education or other leadership roles. It’s time we reimagine and help reshape nursing career paths.

Healthcare’s Great Resignation Moment

As we pointed out in March, “The average national turnover rate for nurses is typically 17% annually, with some regions reaching as high as 40%. The pandemic has had a profoundly detrimental impact on those figures. We now confront the worst nursing staffing shortage in decades, with 60% of nurses and 20% of physicians preparing to exit their professions directly because of COVID-19. Analysts project these departures to cost individual hospitals an average of $5 million in turnover per year—about $137 billion overall.”

• The need for nurses will increase as the aging population grows, doubling in size by 2060.
• The U.S. Bureau of Labor Statistics (BLS) estimates that 62% of registered nurses age 54 and over are expected to retire within the next three years.
• In 2018, nursing schools were forced to reject 75,000 qualified applications because of inadequate staffing, teaching facilities, clinical sites, and funding. Without access to the proper education and credentialing, fewer nurses will be trained and ready to join the labor force.
  

NPR’s Yuki Noguchi wrote, “Across the country, hospitals desperate for nurses — especially in acute care —are trying to address intense burnout among health care workers and accelerated nurse retirements by hiring new graduates. They're offering jobs to students even before they graduate, and in many cases offering bonuses and loan repayment as financial incentives.”

A Problem of Infrastructure, Not Interest

At stake is not an issue of interest, though. It’s there. The American Association of Colleges of Nursing described an accelerating trend of student enrollment in U.S. nursing schools, despite challenges presented by the pandemic. For all the frontline nurses who decided to leave their careers over the dire conditions thrown in their path by the COVID-19 outbreak, many more people sought to take over the reins so they could help end it:

“According to new data released today by the American Association of Colleges of Nursing (AACN), student enrollment in baccalaureate, master’s, and doctoral nursing programs increased in 2020 despite concerns that the pandemic might diminish interest in nursing careers. In programs designed to prepare new registered nurses (RNs) at the baccalaureate level, enrollment increased by 5.6% with 251,145 students now studying in these programs nationwide. AACN’s annual survey findings are based on data reported from 956 of the 1,035 nursing schools in the U.S. (92.4% response rate) with baccalaureate and/or graduate programs.”

Unfortunately, the schools continue to be victimized by a long-standing bottleneck in the system. There’s a deficit in people who teach nursing. 

“That desperation is compounded by an aging demographic,” Noguchi explained in her article for NPR. “With so many in their late 50s and 60s, the country's nursing faculty is continuing to decline, to about two-thirds what it was in 2015. Taken together, those factors are severely limiting the number of students that schools can accept, and in some cases it disrupts classes themselves.”

Rethinking the Career Trajectory of Nurses

“For far too long, health care systems have simply seen nurses as a commodity, a never-ending resource—and as a result, those systems have done little to invest in the careers of nurses,” asserted Rebecca Love and Daniel Pianko in Fortune. “Investments into the profession historically seldom went beyond staffing numbers at the bedside, with little thought to career progression, leadership development, or educational opportunities that would enable nurses to have equal opportunities to rise to health care leadership positions.”

The existential dilemma of the pandemic-inspired nursing shortage has unwittingly pushed healthcare providers and hospitals to shift their focus almost exclusively on maintaining adequate staffing at the bedside. Unfortunately, the attention on “right now” detracts from a greater view of “what next?” The healthcare system, as a result, has overlooked the potential of bedside positions as milestones along a broader journey toward more specialized careers. Grooming nurses to lead in other areas could go far in solving the crisis. 

Alumni Programs

In August, I wrote an article on leadership “brain drain,” in which individuals with tremendous institutional knowledge depart a company and leave behind a void that’s overwhelmingly difficult to fill. In proposing solutions, I referenced an example from the nuclear power industry. In the 1950s, universities were churning out nuclear scientists and engineers in droves. But that field waned steadily over time as computer science and technology rose in prominence. Between 1997 and 2004, nuclear power plant staffing witnessed a year-over-year decrease of 20%. Retirement of senior engineering staff at nuclear generating facilities created a massive and complex set of challenges for the operators. However, some clever alternatives cropped up. Leveraging the power of skilled alumni as mentors was a critical component. 

Retired engineers and scientists were contracted to help develop protege candidates by serving as technical and career mentors. At a practical, on-the-job type level, these teachers were able to fill in the gaps left behind by exiting staff and even schools. Why can’t we do the same with nurses?

Using staffing alumni programs, nurses seeking to retire over stress—but who want to continue working—have the chance to utilize their expertise by working in teaching facilities to bolster faculty and expedite the training process for nursing students. 

Investment in Training and Development

Hospitals, health systems, and other entities that can focus on training probably should. An experienced nurse has all the relevant knowledge for the role. Preparing that person to qualify as an instructor would require an investment in certification and education-specific training. However, that time would be well spent. And as we wrote previously, online learning is making that progress faster and easier. 

Yet there remain other essential healthcare positions that organizations are filling with talent outside of the field. “Hospitals and systems are also struggling to fill more senior or specialized positions across a range of job functions, from hospital administration to highly specialized roles needed in specialty areas (e.g., infectious disease, intensive care, operating rooms, emergency rooms), or in fields like quality control and reporting, health IT, and data analytics,” wrote Love and Pianko in Fortune. “Those positions typically require no small amount of experience in health care, making it increasingly challenging to find candidates with the right skill sets and background to fill these positions.”

Veteran nurses bring most, if not all, of the experience, qualifications, and skills necessary for those roles. But as Love and Pianko note, health systems are instead hiring people from business, finance, and technical sectors. The article’s authors also offer a straightforward solution:

“Hospitals and health systems should create frictionless career pathways for nurses to enter senior leadership positions. It’s an approach that far too few hospitals take today, but there are a few compelling examples. At Sunrise Hospital in Las Vegas, for instance, the StaRN program recruits newly graduated RNs both to meet immediate demand for nurses and to provide training in a structured environment. When the program launched in 2015, the year-over-year nurse retention rate at Sunrise was around 50%. This year, it reached a new high of 93%—demonstrating that investing in nurses, even just within their first years of nursing, can help health systems attract and keep talent.”

Ensuring New Generations of Nurses

The nursing shortage won’t end anytime soon, unless bold new actions are taken. Senior nurses are retiring or quitting, largely due to the pressure placed on them during the pandemic. Students want to be nurses, but the programs are impacted and teachers are scarce. Vital leadership and administrative positions go unfilled or are staffed with talent outside the healthcare sphere. All of these issues converge into a simple nexus: provide veteran nurses with new career options that enhance their happiness, relieve them of frontline stresses, and empower them to mentor or develop a new generation of bedside nurses to preserve the health of the nation before they move up and foster yet another generation. 

It’s a simple yet profound cycle that ensures healthcare success and evolution. It’s also not simply a responsibility that health organizations must bear alone. Those in the workforce solutions industry can also expand their hiring horizons to offer nurses exciting new opportunities beyond the emergency room doors. 

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Photo courtesy of the National Archives