Health Care Facilities Report Significant Nurse Shortages, Concern About Future Vacancies

A national survey conducted by Avant Healthcare Professionals on the state of nurse staffing in 2021 compared data from 2019 and 2020 to explore shifts in nursing trends in the United States.

In part due to older nurses retiring, current registered nurses (RNs) burning out, educational resources for new nurses decreasing, and turnover rates increasing, nursing shortages are expected to grow in the years to come. However, an aging US population, the opioid crisis, lack of frontline workers and COVID-19 have all contributed to the rising demand for health care professionals, researchers wrote.

To better understand this imbalance, a survey was sent to Chief Executive Officers (CEOs), Chief Nursing Officers (CNOs), and Human Resources (HR) executives at various health settings across the country between January and February 2021.

Over 100 responses from critical access hospitals, state facilities, and other settings were included in the analysis. Although executives reported they rely on new graduates (71%), internal recruitment (45%) and external advertising to fill nurse openings, an average of one in five nurses will leave their first job within 12 months of starting, amounting to $7 million in hospital losses annually.

Survey results show 36% of respondents anticipate more than 25 RN job openings in 2021 compared with 17% in 2020, while 21% of respondents said they had over 50 openings, and 11% reported over 100 vacancies in 2021. Eighty percent of those surveyed reported losing current RNs to other hospitals for travel assignments.

Compounding the issue, nursing school enrollment is not keeping pace with projected demand and many hospitals are turning to monetary incentives to fill RN openings. Nearly 30% of respondents plan to improve pay packages to meet the shortage and nearly 40% said they offer sign-on bonuses. Of those surveyed, 81% believe volume of nursing school graduates will decrease due to the COVID-19 pandemic.

Respondents indicated medical-surgical, emergency room (ER), intensive care unit (ICU), and operating room (OR) specialties need nurses the most while over 90% said they currently employ traveling RNs to assist with influxes of COVID-19 patients. Survey results show an increase in pediatric nurse demand from 8% in 2020 to 13% in 2021.

Demand for traveling nurses also led to increased rates, and “a majority of respondents said they were spending between $100-$150 an hour for travel RNs.” Because of this, some health care systems struggled to keep nurses who instead sought higher-paying travel assignments.

“Hospitals were not only paying double the rates for travel nurses but also increased RN staff pay and offered incentives to keep staff at their facility,” authors wrote, “58% of respondents said they offered staff a COVID-hazard pay increase while 56% offered bonuses.”

More cost-effective ways to combat increases in staffing costs could include tuition reimbursement, individuals seeking temporary to permanent work, and employing international nurses who are contracted for two to three years. In comparison, travel nurses typically are employed for 13-week commitments.

Suspension of routine operating room procedures to conserve capacity, supplies, and staff for COVID-19 patients also resulted in hospitals furloughing OR staff, while 20% of respondents reported they have not been able to bring back 100% of their OR RNs. Fifty-Five percent of respondents reported cross training these staff in different departments.

When it comes to the COVID-19 pandemic specifically, responses revealed:

• 70% of respondents reported that they lost anywhere between 5%-30% of their staff due to COVID-19 while 49% of respondents said they lost 5%-15% of their staff to higher-paying travel assignments.
• 70% of respondents said COVID-19 has impacted their onboarding capabilities, while 63% of respondents said COVID-19 increased new graduates’ orientation timeline.
• Some respondents said nurses were coming in with less clinical experience, they had orientation online rather than in person, they had to rush the orientation process and some even had to cancel their RN nurse residency program.
• 33% of respondents believe COVID-19 will have a long-term impact on the health and well-being of their staff over the coming months and there will be a great loss of bedside nurses to other careers in the years to come.

Although data projects two million new nurses will join the workforce in the future, another one million will be lost, researchers said. “There is now more than ever, a sense of urgency to fill the gaps of the amount of experienced, tenured nurses who will retire in the coming years,” they concluded.