Nursing shortage requires hospitals to improve work environment, experts say

Hiyam Nadel, right, director of the Center for Innovations in Care Delivery at Massachusetts General Hospital, unfurls a list of responsibilities for nurses. Mike Golebiowski, corporate vice president of B. Braun Medical Inc., helps hold the list.

Health systems and hospitals need to make changes to stop the wave of nurses who are leaving the bedside.

The number of registered nurses dropped by 100,000 in 2021, the biggest drop in 40 years, according to a report in Health Affairs. Nurses say they have been pushed to the limit throughout the COVID-19 pandemic. Some nurses have left hospitals and health systems due to frustrations with staffing, and some nurses have said they don’t feel hospitals are sufficiently concerned with their health and well-being.

A panel of nursing leaders at the HLTH Conference talked about the challenge of retaining nurses.

“This is an exodus from a profession that no one is talking about,” said Rebecca Love, chief clinical officer at IntelyCare, a company which uses a technology platform to enable nurses to find openings.

• Read more: Should hospital nurses be working 12-hour shifts?

Nurses are shouldering an unreasonably heavy workload, the panelists agreed. Hiyam Nadel, director of the Center for Innovations in Care Delivery at Massachusetts General Hospital, illustrated the point of the rising demands on nurses, including documentation. She held up a page to show the list of duties she had earlier in her career.

And then, she unfurled a list of current responsibilities, which measured several feet.

“This is just impossible and not sustainable,” Nadel said.

Mike Golebiowski, corporate vice president of B. Braun Medical Inc., cited the onerous demands of nurses in filling out information in electronic medical records. Too often, nurses are being given additional tasks, he said.

“You just can’t ask nurses to do one more thing,” Golebiowski said. And he added that nurses “don’t have good work-life balance in the profession.”

With nursing staffing levels so low, some nurses are so overworked they aren’t getting lunches and struggle to even find time for bathroom breaks, and that’s pushing people out of the profession, Golebiowski said. “No one wants to work for a bad boss, a bad environment,” he said.

Panelists discuss the nursing crisis at the HLTH Conference in Las Vegas, Nov. 13. From left, moderator Bonnie Clipper; Rebecca Love, chief clinical officer at IntelyCare; Will Patterson, founder & CEO of CareRev; Mike Golebiowski, corporate vice president of B. Braun Medical Inc.; and Hiyam Nadel, director of the Center for Innovations in Care Delivery at Massachusetts General Hospital.

Will Patterson, founder & CEO of CareRev, a technology staffing platform for healthcare workers, said there’s clearly a shortage of nurses working in bedside positions at hospitals. It’s critical to get more nurses working in hospitals, but he said the working environments are going to have to become more attractive for nurses.

“It’s about changing how we actually think,” he said.

There’s also a troubling drop in the level of experience in hospital nurses on 12-hours shifts, the panelists said. The average tenure for nurses on 12-hour shifts dropped to 2.8 years in March 2022, down from 3.6 years in January 2021, according to a study by Epic Research. The Epic study found turnover in nursing is rising and underscored “the need for organizations to invest in retention and onboarding programs for nurses.”

While there are many new graduating nurses, many lack basic knowledge of duties such as starting IVs, and hospitals are left to do a great deal of training new nurses, Golebiowski said. Too often, young nurses are left to sink or swim on their own. “They don’t have that foundation,” he said.

Plus, with more nurses leaving, younger nurses don’t have as many experienced colleagues to help guide them as they gain experience, the panelists said.

The understaffing of nurses is being noticed by patients, Nadel said. She asked the audience at the panel session to think about their last interaction with a health system. “Probably most of you would say it wasn’t great,” Nadel said.

“Patients are angry, they don’t understand,” she added.

Government reimbursement models for hospitals are going to have to be adjusted to help health systems recruit and retain nurses, panelists agreed. It’s going to become more critical as health systems develop more options to provide care at home and outside of the hospital, they said.

The shortage of nurses demands more attention, and more creative solutions, from the healthcare industry, panelists said.

“They’re already short on nurses right now,” Golebiowski said. “It’s scary what’s coming around the corner.”

Some nursing leaders have said health systems need to allow nurses to focus on their nursing duties and find ways to remove other tasks off their plate.

The American Association of Critical-Care Nurses issued a report in August that said less than half (47%) of nurses feel their organization values their health and safety. Two out of three nurses are considering leaving their position in three years, the group said, and among those thinking about leaving, 36% of nurses said they’d leave in a year.

After the fatal shooting of a nurse and social worker at Methodist Dallas Medical Center last month, nurses have urged health systems and lawmakers to provide more protection for healthcare workers.