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Critical Mass: The U.S. nursing shortage is close to blowing up in our faces

American hospitals are facing a near-crisis in nursing and other medical personnel. It is only going to get worse, and soon.

Estimates are that, with current trends, most institutions will have to do a full replacement of their medical staffs within the next five years.

There are unscrupulous efforts on the Fascist Left to pile on more fearmongering about the CCP virus, claiming sick nurses and those who are suffering burnout from an 18-month-long battle against the disease is driving the shortages.

The issue, though, if far more complex than that, and the virus plays a small and insignificant role in it.

The nationwide nursing shortage is not a new topic. The American Association of Colleges of Nursing (AACN), the Institute of Medicine, as well as the ANA, have all reported the importance of addressing the nursing shortage since 2010, before the CCP virus existed.

As the current nursing shortage deepens, the pressure will intensify for nursing programs to increase the enrollment capacity to fill these vacancies. But there is also a shortage of nursing educators. Nationwide nursing faculty shortages limit nursing program student capacity, making it impossible to keep up with the demands of the nursing shortage. The problem has been discussed in a language such as “in the next 20 years.”

Given the lack of educators and the five-year, 100 percent turnover rate, this is also a significant concern to the U.S. healthcare system. The year 2026 is the next five-year mark of concern.

The healthcare industry worldwide is undergoing radical transformation based on recommendations from the Institute of Medicine and Quality and Safety Education for Nurses (QSEN) initiatives. The nursing profession is at the forefront of this transformation, but the nursing shortage must be addressed. 

There are four main contributors to the nursing shortage.

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Retiring nurses, and those choosing to leave the profession, are a couple aspects driving the shortages. One of the reasons is the Baby Boomer nurses are retiring at record rates as they reach retirement age. A 2017 survey showed that 73% of Baby-Boomer nurses who are planning to retire say they will do so in three years or less. That time period ended last year.

At the other end of the generational scale are the Millennials and GenZers who are leaving nursing less than five years after graduation. Fully one-third to one-half of them do not like the fact they cannot get flexible hours, make critical clinical decisions, or get breaks when they want them as opposed to being guided by patient need. Their answer to those issues to is to quit.

Generational statistics of the patients also are major factors in the nursing shortage.

Again, it is the Boomer generation, though in the case of patients, it is their large numbers that have aged past retirement and are now suffering ill health. All of the factors that figure into a nursing shortage are also making it increasingly difficult meet the needs of the aging population.

More patients are in need of acute and chronic care management than ever before, and there are fewer experienced nurses to do the job. Due to advances in modern medicine and care management, many of these individuals are expected to live longer with multiple chronic comorbidities.

In the next 10 years, the percentage of Medicare beneficiaries living with three or more chronic conditions will reach 40 percent. The increased complexity of care associated with chronic care management means that not only will this large population begin requiring more geriatric services, but it will also likely require care for a longer period of time. This will demand an increase in health care providers, which will only further exacerbate the current nursing shortage.

To put it bluntly, the U.S. healthcare system is extremely worried about being able to provide the bedside personnel to meet those needs. By 2030, twenty percent of Americans will be of retirement age, marking the first time that older people will outnumber children. But will health care be prepared for this giant demographic shift?

shortage of geriatricians means that care of older patients will likely fall to other medical care professionals, especially nurses, who work closely with patients across health care settings. But according to a 2016 discussion paper in the National Academy of Medicine, fewer than one percent of registered nurses and three percent of advanced practice registered nurses are certified in geriatrics.

That is going to require further education, and perhaps nurses specializing in other areas of healthcare, such as emergency medicine or NICU, to consider changing their emphasis of practice.

Who is going to educate them, if there is a shortage of nursing educators? How serious is that problem, really? While the fact of aging faculty and the pending wave of retirements of masters- and PhD.-level nursing educators is a concern, the root of the problem is a classic chicken-or-the-egg conundrum.

Nurses desiring to attend graduate schools for a master’s program or doctorate program are turned away by the thousands each year because there are not enough nursing professors to educate future educators. Compounding the problem is the fact that nursing educators in academic positions earn significantly less ($77,000/year) than clinical or private-sector nurses ($97,000/year) with the same education.

The AACN notes that the U.S. must make multi-pronged attempts to address faculty shortage. For example, by expanding NursingCAS, the nation’s centralized application service for RN programs, all vacant master’s and doctorate positions are identified and filled. Additionally, states such as Wisconsin are funding fellowships and loan forgiveness programs for nurses who choose faculty pathway careers to incentivize nurses to academia.

None of that, however, overcomes the dreaded burnout. A problem in all levels of healthcare, both on the healthcare and mental health side, the shortages we see nationwide are actually increasing the speed at which our veteran nurses hit the wall and want out.

A survey conducted in 2019 revealed that around one-third of nurses reported an emotional exhaustion score (a calculation used to measure psychological fatigue) of 27 or more, recognized by medical professionals as “high burnout.” In a separate study, 49 percent of registered nurses under the age of 30 experienced significant levels of exhaustion.

Various organizational factors influence nurse burnout, including the length of time spent at work. In one study, registered nurses in Michigan who worked 12-hour days reported higher stress levels than registered nurses who worked eight-hour shifts.

The number one cause of stress among U.S. nurses is teamwork —working together as a group and hampered by such things as poor communication, conflict, and tension. This was followed by stressors linked to job circumstances, like employer demands and work satisfaction. Moreover, nurse shortages are becoming an epidemic, predicted to only worsen by 2025

In addition to these common stressors, nurses may encounter burnout due to their innate desire to put others before themselves. Many nurses feel it’s their calling to care for others first, paralleling the profession with selflessness.

Unfortunately, when nurses are primarily motivated by their desire to help others, as opposed to the enjoyment of the work itself, it is easier for them to suffer burn out. Researchers found that nurses who were driven by the lifestyle the profession affords and the opportunity to interact with patients are more satisfied with their employer and less likely to leave their job.

Regardless of the cause, nurse burnout has far-reaching consequences. Evidence from the American Nurses Association suggests that stress from long hours working, rotating shifts and infrequent breaks slows down reaction times, reduces motivation, and increases errors — all of which can affect patient care.

Nurse burnout could even increase rates of infection in patients. For example, in one Pennsylvania hospital, researchers showed an association between nurse fatigue from increased workloads and increased numbers of urinary tract and surgical site problems in patients.

Nurse burnout also affects patient satisfaction levels. A recent study found a positive correlation between patient happiness and nurses who experienced adequate administrative support and had good relations with doctors and other staff. Also, these nurses were less likely to report burnout.

Self-care is the most vital regimen nurses can practice. They should work toward “me time,” a ridiculously overused phrase but necessary to their physical and mental health. The three-day, 12-hour shift work schedule may be more stressful than the five-day, eight-hour shift work week, but it affords more down time as well. Not all of those four days have to be spent “doing.” Some of it needs to involve relaxing, enjoyable activities that destress and prepare the nurse for the next shift.

What can be done about the increasingly emergent nursing shortage?

One thing we know is it will not be easy to meet the demand. A recent study done by Mercer, a global healthcare staffing consultant, found that as America’s population continues to age, 2.3 million new healthcare workers will be needed by 2025 to satisfy the demand. That is just slightly more than three years from now.

The scarcest healthcare position? Home health aides and nurses. Also by 2025, Mercer foresees a deficit of 446,300 home health aides and a combined shortage of 125,000 nursing assistants and nurse practitioners.

There’s a lot of work to be done if the U.S. is to effectively mitigate the nursing shortage. Policy, both at the federal and institutional level, stands to play a large role in the change. In some cases, attitude or expectation shifts may be necessary.

Primarily, the US needs to increase the number of potential nurses in educational programs, as this will directly impact the number of nurses available to enter the workforce.

Educational opportunities will only grow with the addition of funding and faculty, though the first does impact the second. Universities need to reassess their programs and see where they can afford to increase salaries in order to attract faculty. Non-monetary incentives, such as access to campus resources or publishing connections, will also be necessary to retain top teaching staff.

Before entering the field, nurses need experience making stressful decisions in real-time. Many teaching hospitals and healthcare educational programs are turning to technology for answers. Using simulation mannequins, computer programs, or virtual reality situations allows educators to put nurses in controlled situations to test their knowledge under pressure.

Hospitals may also be encouraged to use clinical residencies for nurses as they do for doctors. This is highly effective in Argentina, which has been assigning nursing residences for a dozen years. Both of these strategies could help with the retention of Millennials and GenZers, with their tendency to become easily frustrated with rigid work environments. These will ease them into their careers.

While many articles remind nurses of how to cope with stress and fatigue using healthy strategies, advice like “get adequate sleep” and “take breaks while at work” can be frustrating if schedules don’t allow for it. Rather than asking nurses to do what feels impossible within their circumstances, employers need to accommodate their nurses’ basic needs and listen to their feedback.

Several programs across the country provide examples of doing just that. Funded by grant money, nursing programs are turning inward to invest in their nurses and find out what needs to happen to reduce turnover and keep happier staff. In one instance, a program retained 95 percent of the charge nurses who participated in a program to help develop their own resources.

Whatever tactic healthcare organizations and educational institutions choose, they must move quickly. Finding 2.3 million new nurses in the next three and half years is a monumental task we are already way behind in being able to accomplish.

Mike Nichols is a conservative, a patriot, U.S. Army veteran, behavioral therapist, political enthusiast, sports fan and writer living with his beautiful wife Liz in the Heartland. He is a regular contributor at  has a regular blog at the GenZConservative news website and a Facebook presence at Americas Conservative Voice-Facebook