NURSING SHORTAGE, BURNOUT, MAGNET 1

The Nursing Shortage, Nurse Burnout, and Magnet Recognition Program

Elizabeth Sutliff, BSN, CCRN

Youngstown State University

Healthcare Issues and Trends/NURS6900

Dr. Susan Lisko, DNP, RN, CNE

June 16, 2021

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Abstract

The nursing shortage is a well-documented phenomenon that has been occurring in the

United States healthcare industry for many years. It is difficult to pinpoint when the it occurred

—but with advances in healthcare and an aging population, it has only created a demand for

more registered nurses. Nurses are leaving the profession at an alarming rate due to the retiring

of the baby-boomers and factors contributing to nurse burnout. One of the greatest defenses we

have in this crisis is keeping established nurses in the field. Magnet is a program that is aimed at

preventing nurse turnover, improving nurse satisfaction, and preventing burnout. The Center for

Medicare and Medicaid uses incentives for reimbursement of facilities related to patient

outcomes and patient satisfaction. The nursing shortage is a nursing problem and public health

crisis. Incentivizing hospitals to offset the cost of Magnet could benefit the public two-fold—as

research shows that Magnet facilities have better patient satisfaction and outcomes, but also

improves nurse satisfaction, increases retention, and combats nurse burnout.

Keywords: nurse burnout, Magnet, CMS reimbursement

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The Nursing Shortage, Nurse Burnout, and Magnet Recognition Program

The nursing shortage is a topic that is widely discussed and researched; factors that

contribute to the shortage include the retiring of the baby boomers, lack of nursing faculty, aging

of the population, and technical advances that increase the acuity of care. Registered nurses are

being utilized in ways they never have before. The government noticed a shortage and in the

1940s they passed legislation subsidizing nursing education; since then, little has been done by

state and federal leaders to combat this crisis. The biggest obstacle to overcome the nursing

shortage is the nursing shortage itself.

The high demands of the nursing profession including increasing workloads, inadequate

staffing, stressful work environments, lack of qualified assistive personnel, and high turnover

rates lead to nurse burnout. Burnout is described as emotional exhaustion, constant state of

feeling overwhelmed, an inability to connect with others and feelings of insignificance. Studies

have shown up to 70% of Registered Nurses have reported feeling burnout (Bakhamis et al.,

2019). Burnout is causing nurses to leave the field leaving vacancies—the increasing number of

vacancies contributes to an additional workload and burnout and the cycle continues. Something

must be done to combat the nursing shortage as it is quickly no longer becoming a nursing

problem but a public health crisis.

Historical Aspects

The nursing shortage in the United States has been driven by a demand for more nurses.

This is greatly due to an aging population, medical advances, and increased utilization of nurses.

It is hard to put a pinpoint historically speaking, when the nursing shortage started, but it is easy

to start in the 1940s after World War II. After World War II, there was a huge boom in the

population which led to the term “baby boomers”. This was a huge population influx due to
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massive reproduction and the start of new families post war. In addition to that, the United States

government passed legislation in the 1940s that created a demand for more nurses, the Hill-

Burton Act. This act provided funding for hospital construction and improvements increasing the

utilization of nurses substantially (Penn State University, 2021). Utilizing nurses to their

potential; largely in roles never utilized before created an even bigger demand for nurses.

One of the biggest measures the federal government has taken in nursing funding was

related to passing of another act, the Bolton Act. It was recognized that there was a huge demand

for a larger nursing population. This Act used federal dollars to subsidize nursing educations

across the country. Many nursing students received free educations and stipends for living

expenses while in nursing school. Sadly, the funding ran out after about five years (Spalding,

1943). Since then, minimal efforts have been made to combat this rising public health crisis.

Implications to Nursing

The baby boomers of the late 1940s-1950s are becoming older and with age comes

additional health problems. Technology and advancements in healthcare are keeping people alive

longer, but they are much sicker than ever before (Huston, 2020). The increasing population and

increased acuity of care is creating a huge demand for Registered Nurses, leaving vacancies

across the country. The massive vacancies are concerning to nursing because the population of

professional nurses is getting older. It has been estimated that around almost a quarter of

Registered Nurses plan to retire in the next few years (Huston, 2020).

Nursing faculty are also aging quite quickly and the number of adequately educated

professors are unlikely able to meet the demand of educating the new waves of students.

Recruiting nursing students has not been a challenge though, finding faculty able to teach is huge

barrier—vacancy rates for nursing faculty are reported around 7.9%. In 2017, the AACN
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reported that 64,067 capable nursing applicants were turned away citing insufficient faculty

(Huston, 2020).

Nursing schools report increasing enrollments (Huston, 2020) and that is great, but it is

not enough to meet the demand of replacing those that are leaving. Nursing students spend two

to four years earning an education to join the profession, but they are leaving at an alarming rate.

One report claimed that thirty three percent of new nurses were leaving the workforce within two

years, siting burnout as the main factor in their decision to leave (Bucceri Androus, 2021).

The most distressing of all, able bodied nurses are leaving the field well before the age of

retirement, seeking out new opportunities outside of the field. One of the biggest factors

contributing to professional nurses leaving the field is general dissatisfaction. This dissatisfaction

can be described with the term burnout. Burnout is described as emotional exhaustion, constant

state of feeling overwhelmed, an inability to connect with others and feelings of insignificance.

Studies have shown up to 70% of Registered Nurses have reported feeling burnout (Bakhamis et

al., 2019). Nurses have been leaving by the masses and these numbers have been on a steady

incline each year; it has been estimated that around 80,000 experienced nurses left the profession

in 2020, with more to come in the following years (Sinclair, 2020). When surveyed, 43.4% of

nurses identified burnout as the reason contributing to their decision to leave their job; other

factors sited were 34.4% reporting stressful work environments, and 30.0% reporting inadequate

staffing (Shah et al., 2021). Other factors reported are related to lack of supportive staff and

ineffective management. With retirement on the horizon for many nurses, our best opportunity to

battle this crisis is preventing dissatisfaction and keeping our abled nurses in the field.

We are very quickly coming to a point where our supply will not meet the demand.

During the COVID-19 pandemic our nation witnessed this firsthand, as talk of “flattening the
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curve” was on the nightly news. It was obvious that flattening the curve was about preventing a

large amount of people from becoming ill, but also, it was apparent that the measures taken were

aimed at preventing hospitals from being overwhelmed and meeting maximum capacity. Many

hospitals were unable to meet the needs of their community before the pandemic. As the

pandemic pressed on, and hospital admissions reached frightening numbers, it was the nurses

that cared for the sick.

During the pandemic, there were reports of unsafe environments, unsafe staffing levels,

and mandatory overtime in urban and rural areas across the country. That is proof enough that

our nation was not ready to handle such a disaster. Reports of some Intensive Care Units (ICUs)

showed nurse-to-patient ratio as high as 1:4 in with the standard of being 1:1 or 1:2; similar

reports came from medical units with ratios as high as 1:9 with a standard of 1:5 (Lasater et al.,

2020). Those numbers are concerning as the nurses were required to care for almost twice as

many patients as normal. By keeping and utilizing nurses that are active and already established

in the profession will be imperative in combating this shortage—especially in the midst of a

pandemic.

Proposal

As nurse burnout and the already established shortage of Registered Nurses is

contributing to the additional shortage, retaining nurses is one of the most important things that

can be done to mitigate the shortage. One of the best researched programs is Magnet. Magnet

prides itself on lower nurse burnout, higher nurse job satisfaction, and lower rates of turnover.

Not only does it have positive outcomes for the nurse, but it also has positive patient outcomes

including decreased length of stay, lower mortality rates, lower nosocomial infection rates, lower

hospital acquired pressure ulcer rates, higher evidence-based practice implementation rates,
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higher patient experience ratings and much more (ANA, 2021). This program benefits hospitals

by decreasing nurse turnover and preventing vacancies, but it also improves patient outcomes

(Tevis et al., 2015).

The biggest obstacles for hospitals and nurses to obtain Magnet certification, is the cost.

The cost of the Magnet process varies from each facility but can range from 100,000-600,000

dollars per year (Jayawardhana et al., 2014). That is an astronomical cost for a hospital to

voluntarily elect to take on. By Centers for Medicare and Medicaid (CMS) using monetary

incentives to help offset the cost in obtaining Magnet status would benefit the public in two

ways, as the nursing shortage is not just a nurse problem, it is also a public problem. Incentives

like this is not new for CMS, currently, CMS uses several incentives such as patient satisfaction

and value-based purchasing programs that provides facilities with payments related to the quality

of care they deliver (CMS.gov, 2021). When nurses leave the profession due to burnout, that

leaves less nurses to care for an aging population. The government has used incentives directly

related to nursing in the past, and in the present, they use incentives for better patient outcomes.

Implementing an incentive for Magnet status can combat nurse burnout, prevent vacancies, and

improve patient outcomes.

Conclusion

Nurses are leaving the profession at an alarming rate due to retirement and burn out.

History has shown us that the nursing shortage did not occur over night nor will it end overnight.

In the past, the government used incentives to grow the profession. Currently the government

uses incentives for better patient outcomes. With the implementation of Magnet programs in

hospitals throughout the country, nurses have found ways to love their profession again. Magnet

facilities have increased nurse satisfaction, decreased vacancies, increased nurse recruitment and
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retention, and better patient outcomes. CMS incentivizes facilities and center repayment on

patient outcomes and patient satisfaction. Better patient outcomes and improved patient

satisfaction are connected to nursing satisfaction by improving staffing ratios, contributing to

safer patient care environments, and decreasing nurse burnout. Magnet status is a very timely and

costly endeavor, but by incentivizing facilities to obtain Magnet status benefits them two-fold. It

would mitigate the cost of certification, improve patient outcomes, and assist in the nursing

shortage.
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References

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