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Addressing the Nurse Staffing Crisis in Light of COVID-19

Jordan O. McCoy

School of Nursing, James Madison University

NSG 462: Issues in Contemporary Nursing Practice

Dr. Jill Delawder

November 6, 2022
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Addressing the Nurse Staffing Crisis in Light of COVID-19

It is no secret that hospitals in the United States and across the world are struggling with

nursing staff shortages. Several factors have contributed to this shortage, such as the retirement

of many baby boomer nurses coupled with the inability to backfill these positions with

experienced nurses in specialty care units. In addition to these factors, more and more nurses are

choosing to become advanced practice providers, such as nurse practitioners (Buerhaus, 2021).

The COVID-19 pandemic has only exacerbated these shortages, as inpatient censuses increased

at the same time as absences increased due to illness and/or quarantine requirements (Jones et al.,

2022). In response to these shortages, both long—and short-term changes must be made to

protect patient safety and job satisfaction among nurses.

In September 2021, the President of the ANA sent a letter to the Department of Health

and Human Services outlining the specific actions that the current administration should take to

address the nursing shortage in the United States. These include using a whole of government

approach in declaring a national nursing staffing crisis, implementing a system that allows

organizations to bill for nursing services, and addressing the mental and physical wellbeing of

nurses (Grant, 2021).

Particularly intriguing to me is the notion of billing separately for nursing services

because this seems like an obvious solution to compensating nurses fairly for their time and skill.

This would be consistent with other members of the healthcare team’s ability to bill for their

time, such as doctors and dietitians. Fair compensation would presumably lead to greater job

satisfaction and better retention, which benefits everyone. Nurses assume an enormous amount

of responsibility each day as part of their role, and their compensation is often not commensurate

with the importance of the duties they are performing as what many consider the backbone of the
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healthcare team. Couple this with the lifestyle of working nights, weekends, and holidays, it is

not surprising that many of these open positions are remaining unfilled. Working holidays and

weekends is the nature of working in a hospital, but if we could address the compensation then

more students may want to enter the field, meaning more coverage for weekends and holidays so

that each individual nurse can work fewer of them.

A different solution to this problem could be the implementation of a team-based nursing

approach. In this approach, a team of nurses cares for the same patient, allowing more

experienced ICU nurses to handle the more specialized ICU-related tasks, while delegating

general care tasks to another RN. In order for this approach to be successful, it is critical that

nurses receive delegation education to ensure effective communication, role clarity, and

adherence to the appropriate scope of practice (Beckett et al., 2021).

Many of the provisions in the American Nurses Association Code of Ethics are

applicable to nursing shortages, particularly those related to the COVID-19 pandemic. One of the

most relevant provisions is provision 5, stating that the nurse values and promotes care for

herself in the same way she promotes the health and safety of her patients (Windland-Brown et

al., 2015). Vaccine refusal amongst nurses has been a major issue, with an estimated 20.7% of

nurses refusing the vaccine worldwide (Khubchundani et al., 2022). One can assume that this

might have contributed to a mistrust of the vaccine by some in the general population. Fewer

vaccinated individuals means more infections, or at least a higher incidence of severe infections,

leading to higher censuses which could further contribute to nursing shortages. While many of

the problems that lead to staffing crises are out of nurses’ control, vaccine promotion and

providing accurate information to patients regarding the vaccines are ways they can adhere by

this provision of the Code of Ethics.

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While increasing available staffing would be ideal, hospitals can work on improving their

work environments by identifying weaknesses on the unit and working as a group to address

them with the staff that are currently on hand. This has been shown to result in less missed or

delayed care, which in turn leads to better patient outcomes (Lake et al., 2020). Individual units,

or organizations as a whole, should form workgroups to put this into practice using input from

the nurses working on the front lines. This idea reflects provision 6 of the Code of Ethics by

collaboratively improving the moral work environment and conditions of employment in the

interest of quality patient care (Windland-Brown et al., 2015).

Despite the uphill battle that organizations and nurses face in addressing the staffing

shortage in the United States, it is not hopeless. There are tangible steps we could take now to

address the shortage, and the obligation to do so is embedded throughout the ANA Code of

Ethics. The future of the profession depends on us working together with our organizations and

the government to create an environment where nurses can provide safe, high quality care to

patients. Never has this mission been as important as it is now in a global pandemic. Throughout

the pandemic, nurses have proven how critical they are to our entire healthcare system and it is

time to reward them with better pay, better nurse to patient ratios, sufficiently staffed units, and

the recognition they deserve.

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References

Beckett, C. D., Zadvinskis, I. M., Dean, J., Iseler, J., Powell, J. M., & Buck‐Maxwell, B. (2021).

An integrative review of Team Nursing and delegation: Implications for nurse staffing

during Covid‐19. Worldviews on Evidence-Based Nursing, 18(4), 251–260.

https://doi.org/10.1111/wvn.12523

Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences:

Time to Change Our Present Course. Nursing Economic$, 39(5), 247–250.

Grant, E. (2021, September 1). ANA Letter to HHS. Nurses Weekly. Retrieved November 3,

2022, from https://njsna.org/ana-letter-to-hhs-about-staffing-concerns/.

Jones, K. L., Johnson, M. R., Lehnertz, A. Y., Kramer, R. R., Drilling, K. E., Bungum, L. D., &

Bell, S. J. (2022). Rapid deployment of team nursing during a pandemic: Implementation

strategies and lessons learned. Critical Care Nurse, 42(3), 27–36.

https://doi.org/10.4037/ccn2022399

Khubchandani, J., Bustos, E., Chowdhury, S., Biswas, N., & Keller, T. (2022). Covid-19 vaccine

refusal among nurses worldwide: Review of trends and predictors. Vaccines, 10(2), 230.

https://doi.org/10.3390/vaccines10020230

Lake, E. T., Riman, K. A., & Sloane, D. M. (2020). Improved work environments and staffing

lead to less missed nursing care: A panel study. Journal of Nursing Management, 28(8),

2157–2165. https://doi.org/10.1111/jonm.12970
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Winland-Brown, J., Lachman, V.D., & O’Connor Swanson, E. (2015). The new code of ethics

for nurses with interpretive statements. (2015): Practical clinical application, Part II. Med-

Surg Nursing, 24(5), 363-368.