The Nursing Shortage Causes Stress on American Health Care

By Skylar Staples

The COVID-19 pandemic illustrated the importance of nurses to the framework of America’s
healthcare system as a lack of nurses struggled to support the country through a desperate time.
Millions relied on nurses who are both overworked and trapped in a cyclical employment
shortage with many nurses leaving the hospital setting after the pandemic.

“Yes, there are shortages of nurses, but more accurately there is a shortage of nurses who want to
work in hospitals right now. Much of that stress is caused by the pandemic, it is not gone but
lower than it was 12-18 months ago,” said Katherine Kenny, an Associate Dean of Academic
Affairs at Arizona State University- Edson College of Nursing and Health Innovation.

Nursing has been stuck in an endless period of employment issues. There have been ongoing job
problems within the healthcare world.

“So I will tell you in 1975, when I graduated, there was a surplus of nurses. We all got jobs but
there were some people that had to wait six months or eight months. Then in about 1981 or 1982
there was a huge shortage of nurses. We are having to close units and hospitals and operations
because we don’t have enough nurses,” said Kenny.

Medicare put into place the DRG system, otherwise known as the diagnostic related groups
system, which forced hospitals to analyze the cost of care per person and forget prior methods of
staffing. Before 1984, hospitals were staffed by estimations and past knowledge. If there were
usually four nurses on a certain floor, they would only staff four nurses on that floor regardless of
the number of patients.

Cassandra Pettis, a former acute care nurse and current school nurse said, “Retention of nurses in
the hospital setting is almost nonexistent. Nurses are worked to the ground with long hours and
large patient-to-nurse ratios. I always tell others that I still would be a cardiac nurse in the
hospital if I was guaranteed to only have three-four patients at a time. On the night shift, I had
seven patients many nights. Each patient had medical needs and it wasn’t physically possible to
make sure I provided them with the best care they deserved. It was unsafe most nights. I felt like
my license, that I worked so hard to achieve, was on the line.”

Illness and population statistics also play a factor into the shortage as many areas have a greater
need for nurses.

“It is also cyclical by region, by that I mean Arizona is identified by HRSA as a shortage area. It
is not because we don't have enough nurses right now but with the population prediction and the
aging population, more nurses are needed to care for people that are 70, 80, 90 years old that are
independent now and they don’t need care. So as the population ages, more nurses are going to
be needed,” said Kenny.

The pandemic affected the healthcare community as many nurses left the profession and caused
others to reconsider their place in nursing.

“I completely changed routes in nursing because of Covid. I initially was working in an acute
care setting in a large hospital. I would care for patients before and after surgery/procedures.
Covid significantly decreased the amount of elective procedures scheduled which led to less
work. Therefore, we were deployed to the covid ICU or the emergency room to serve as safety
monitors. At the time, I had a 12 week old baby at home and was just as fearful of Covid as
everyone else in the world. I decided to take a leap of faith into the school nurse role and I
couldn’t be more thankful that I did,” said Pettis.

Current nurses changed job settings which increased a shortage in hospitals. The nurses still
working in hospitals are grossly overworked and underpaid for their time in the field. Nursing
students are also fearful about the future of nursing in an acute care setting.

“Would I work through another pandemic? No. I realize that there is a major shortage of nurses
out there mainly because of the issues/obstacles that they are facing like understaffing, which
increases their workload; putting so much extra pressure and stress on them which is not ideal for
them or the patients that they work on,” said Jordyn Keiser, a nursing student at SIUE.

The economy also affects the shortage as hospitals have less funds for salaries.

“I will also say in 2008 there was a very big surplus of nurses because the economy tanked and
nurses who were going to retire could not and they worked around five years longer. New nurses
coming out of schools had no jobs available. The economy plays a big part too,” said Kenny.

The economy is entering a recession as of right now, the aging population is growing and more
people are getting sick. Nurses are leaving the hospital for their own safety and professional
pride as many are being the victims of understaffing.

Nursing schools and hospitals are adding to the shortage issue as many have a “cap” on
admissions. The cap, or limit on admitted students, only allows a select number of spaces within
each class size. The regulated number ensures all students get hands-on experience with clinical
partners.
Clinicals are a standard practice within most nursing students. It allows for students to get
hand-on experience within a professional setting, like a hospital. The pandemic caused many
schools to stop all clinicals and in-person learning. Many smaller schools during this time
stopped all admissions.

The government is attempting to aid the nursing shortage by funding hospitals for in-person
teaching. Proposals being drawn up for nurses which would incentivise having a nursing student
in a clinical setting, allowing for more students to get acute care training.

Nursing students are also being scared away by the cap and rigorous coursework of the
schooling. Many potential candidates ultimately choose a different major based on the fear of not
succeeding.

“Nurses start clinicals their junior year of college. That is intense plus they have the course load
on top of that. It’s just a stressful time overall. It’s not like other majors where you can slack off
and don’t have to submit assignments or worry about assignments that much, and nursing your
every point counts, and if you miss something you’re screwed. There’s barely any extra credit
and there’s hardly any time to do anything non-school related because of the amount of time that
it takes to study, prepare and be successful in those classes,” said Keiser.

The need for nurses within the acute setting is exacerbated through many factors that are deeply
rooted in the health care system. As the population grows and illnesses spread, the nursing
shortage is more noticeable in acute care settings. Many patients might not receive quality care
due to the various systemic factors.

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Contact information:
Katherine Kenny: Katherine.Kenny@asu.edu
Cassandra Pettis: (217) 836-0336
Jordyn Keiser: +1 (217) 361-5704