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Staffing Shortage: An Issue in Contemporary Nursing Practice

Alena Lawrence

James Madison University

NSG 462: Issues in Contemporary Nursing Practice

Professor Andrews

November 15, 2020

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Abstract

The purpose of this paper is to discuss a growing issue in contemporary nursing practice, staffing

shortage. Through research it is seen that the national nursing shortage is expected to continue to be a

growing problem through 2030. This along with the current coronavirus pandemic is causing increased

burnout and further adding to the staffing shortage. Patient and staff safety are priority concerns with

this problem. Through increased educational opportunities we can work to combat this increasing

challenge.
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Staffing Shortage: An Issue in Contemporary Nursing Practice

When looking into current issues in the nursing world, the one that sticks out the most to me is

staffing shortage as I have felt its effects personally. Staffing shortage is nothing new to the nursing

community but in the years to come it is expected to get much worse. It has been predicted that with

the baby boomers ageing and older nurses retiring, the demand for nurses will continue to grow in the

years to come. 2020 has done nothing but add to this issue. This year has proven to be a difficult one

with the coronavirus pandemic and increased need for nursing care. These struggles have caused more

cases of burnout and led to higher staffing shortages. In order to combat this growing problem more

nurses need to be trained and quick.

Background

For many years, the American Association of College of Nursing (AACN), the Bureau of Labor,

and many other groups have been studying the trends in nursing employment and increased demand.

Years ago, the prediction was that staffing shortages would spread across the United States from 2016

to 2030. According to the AACN (2016), “The U.S is projected to experience a shortage of Registered

Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows.

Compounding the problem is the fact that nursing schools across the country are struggling to expand

capacity to meet the rising demand for care given the national move toward healthcare reform” (para

1).

An ageing population

Starting in high school or even before I remember being taught about the increase in birth rates

following World War 2. This group is known as the baby boomers and were born between mid-1940’s

and mid-1960’s. That would put their current ages from around 60 to 80 years old. Being the largest

generation, their aging has a huge impact on society, especially the nursing world. There are two major
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ways that aging baby boomers effect nursing. First is the increase in the age of the general population.

“In 2017, the U.S. Census Bureau reported that by 2030, the number of US residents age 65 and over is

projected to be 82 million” (American Association of Colleges of Nursing, 2016). With this increase

comes a higher need for medical care. Second, is the increase in retirement of baby boomers in the

nursing field. One study conducted by David Auerbach found that approximately 40% of registered

nurses are above the age of 50. Along with that the amount of nurses retiring or simply leaving the

nursing field has doubled, from 40,000 to 80,000 since 2010 (American Association of Colleges of

Nursing, 2016). I have noticed this in the ICU I work on, about 20% of our staff has or will be retiring

within the next year. The aging population is not the only concern when it comes to nursing shortages.

Covid-19 collides with an already struggling field causing increased burnout

The year 2020 started off as normal as any with the added excitement in the nursing field, as

this was our year, the year of the nurses. What a cruel joke that turned out to be. In January and even

February the coronavirus (covid-19) was not much of a concern around the U.S. but by March that had

changed. Hospitals that were already struggling were becoming overrun with critically ill patients and

not enough resources to safely care for them. According to Lasater, et al (2020), “Mean staffing in

medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New

York City” (para. 3). This research comes just weeks before the first massive wave of covid-19 patients.

As we all saw on the news within the next couple months, New York City was one of the worst hit areas

for covid-19. There were pleas for help coming from all the hospitals throughout that area, travel nurses

were being offered over 100 dollars an hour for month long contracts. Even with this high salary, the

lack in resources along with safety equipment was enough to deter most people from rushing to help.

Prior to this surge in patients more than half of the staff in New York hospitals gave their facility a bad

grade in safety and were not recommending their hospital. Burnout was already at a high and the covid-
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19 surge only made it worse (Lasater et al., 2020). “The recent National Academy of Medicine (NAM)

report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being found

that 35% to 54% of U.S. nurses and physicians exhibit substantial burnout symptoms” (Vuong, 2020).

Covid-19 aside I can understand the high rate of burnout in this field of work. I have only been a nurse

for 6 months and I leave most days exhausted and sore. Without the deep love I have for nursing and

the patient population I work with I would not be able to see myself staying in this field for long.

Safety concerns

One of the biggest impacts this staffing shortage has is safety. This includes the safety of the

patients as well as the safety of the nurses. There have been numerous studies that have shown the

negative effects of high patient to nurse ratios within the US as well as other countries. One European

study showed that just adding just one patient to a nurse’s workload could increase the patient’s chance

of dying within 30 days of admission by 7%. Another study by Dr. Jack Needleman showed that the

mortality rate increases by 6% on understaffed unit’s vs those with adequate staffing (American

Association of Colleges of Nursing, 2016). From a nurse standpoint safety is a concern for us as well.

Juggling more patients without extra help can be physically dangerous. We may be forced to assist

patients on our own even in cases of total care or bedridden patients. For example, I have personally

injured myself while attempting to adjust a large patient in bed alone because there was no extra help. I

ended up on light duty for 2 weeks further increasing the staffing struggle. While physical safety is

always a concern for me, I worry more about my mental wellbeing. I take everything to heart when it

comes to the care of my patients. With increased patient to nurse ratios comes an increase in likelihood

to miss something. While this may not be a problem what if that miss is something that could change a

patient’s quality of life. An example I think of is a patient I took care of with a spinal drain following

aortic aneurysm surgery. The drain was removed early in my shift and by about 1600 the patient was
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having decreased sensation in her left leg. Luckily, in this case, she was my only patient, and I was able

to get her to CT and MRI within the hour. I often think of that situation because if I had other patients

that were also sick and missed the change in sensation that patient could have been paralyzed or worse.

Increasing the amount of nurses

There are many ways to combat this staffing shortage but to me the biggest is to increase the

amount of people getting into nursing schools. “Nursing schools turned away 64,067 qualified applicants

from baccalaureate and graduate nursing programs in 2016 because of insufficient number of faculty,

clinical sites, classroom space, and clinical preceptors, as well as budget constraints” (Mehdaova, 2017,

p. 75). While this statistic was from 2016, I know this is still a huge struggle today. One of my close

friends has been applying to a community college program for the last two semesters and although she

is highly qualified, she has been denied both times. According to the school they had over 840 applicants

and were only able to accept 75 of them. If that is just one community college, I can only imagine how

many qualified applicants are being turned away throughout the United states.

Conclusion

Overall, I am deeply concerned about the future and safety of the nursing field. With the

predictions already showing increased nursing shortage and the added stress of the covid-19 pandemic,

it will only get worse. The burnout rate is at an all-time high throughout the US and nurses are leaving

the profession at an astonishing rate. While there are many federal and state legislations aimed at

helping the nurse shortage the best thing we can do is train more nurses. Therefore, we need to be

expanding our nursing schools and allowing more people into programs.
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References

American Association of Colleges of Nursing. (2016). Nursing Shortage. Aacnnursing.org.

https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Reneau, K., Alexander, M., &
McHugh, M. D. (2020). Chronic hospital nurse understaffing meets COVID-19: an observational study.
BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2020-011512

Mehdaova, Edward A., "Strategies to Overcome the Nursing Shortage" (2017). Walden

Dissertations and Doctoral Studies. 4653. https://scholarworks.waldenu.edu/dissertations/4653

Vuong, L. (2020). Staffing Ratios and Burnout. AJN, American Journal of Nursing, 120(5), 13.
https://doi.org/10.1097/01.naj.0000662724.83879.81