“A crisis in nursing is upon us,” exclaimed AMN Chief Clinical Officer Dr. Cole Edmonson in a CNN article from 2023. One might assume that time would ease this clinical catastrophe but the problem continues into 2025. Nurses are vital to the medical field and there is incredible variety in what they do from day to day. They ensure that patients’ needs are being met efficiently and thoroughly, administer medicinal treatments, record patient history and developments, collaborate with physicians and the patients’ families to create the best treatment plans, and so much more. For every kind of doctor there is every kind of nurse, whether that be scrubbing into an operating room or working in the cardiac care unit, which is why a nursing shortage is so impactful on a single hospital and the nation as a whole.
The need for nurses continues to increase due to this shortage. At the start of the 20th century, there were slightly more than three million people above the age of 65 in the United States. In 2000, this number climbed to 35 million, and it went up to 52 million in 2018. These are people who, if not living or moving to retirement homes, will likely spend increased time in medical facilities due to age-related conditions. There is also the possibility of a growing need for hospice services, at home care meant to improve the comfort of someone approaching the end of their life. Registered nurses (RNs) have multifaceted roles in retirement homes, as they interact with patients, record important details, and supervise other staff such as Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs). Hospice nurses often range from RNs to LPNs to Certified Hospice Palliative Care Nurses (CHPNs). There is a continually growing need for people trained in these positions, but the number of those available is egregiously far from where it needs to be. The shortage is concentrated in certain areas across the nation, specifically in rural zones and states like Utah and Texas The shortage is also detrimental for the nurses who remain, with the possibility of an increased workload, lower patient satisfaction, and higher rates of burnout. For example, Aiken et al. (2002) have linked higher nurse to patient ratios with better patient care in their study “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction.”
Nurse burnout also plays a significant role in the shortage, with the COVID-19 pandemic overwhelming nurses and healthcare workers with longer hours, impractical conditions, and patient concentrations. According to a 2021 survey by the American Nurses Foundation, 62% of nurses reported burnout during the pandemic. While the current environment differs from the 2020, nurses still work long shifts without much opportunity for sleep, face the general emotional strain from caring for the unwell, and must manage high patient to nurse ratios. These stresses increase the likelihood of nurses leaving their professions and decrease the overall standard of care. Although the nursing field is projected to grow by 6% from 2023 to 2033, these high levels of burnout not only threaten recruitment rates but retention levels as well.
Laws that protect nurse mental health and workplace safety have proven effective and been linked to lower rates of burnout. This was first visible in California, which enacted the first mandatory nurse to patient ratios depending on the unit in 2004. For example, in the intensive care unit (ICU), it is required that there is one nurse for every two patients. They are also entitled to breaks for rest, meals, and given protected time off– which are just some of the measures taken to ensure nurses are happy and healthy in their workplace. As a result, California displays incredibly low rates of nurse burnout in comparison to many other states, as per the study “The Effects of Nurse Staffing on Patient Outcomes and Nurse Burnout in California” which was published by the Journal of American Medicine Association.
Many RNs are also nearing the age of retirement, with around one-third being 50 years of age or older. These nurses are in a range of professions, from private physician offices to public dialysis centers, so the loss from their retirement would be varied and hard-hitting. Not only does the retirement of experienced nurses leave positions empty in the overall field, but especially in nursing schools. It’s currently incredibly difficult to get accepted into nursing school, and not due to higher standards or the general applicant population lacking certain qualifications. According to the AACN, over 80,000 well-qualified applicants were rejected from nursing schools because of a lack of faculty and resources– and that’s just in 2020 alone. Marie Ann Marino, dean of the Thomas Jefferson University College of Nursing, explained that, “Many hospitals are experiencing their own staffing shortages and are relying on short-term contract nurses or travel nurses. This reduces their capacity to train students.” This means there is little ability for nursing students to get clinical experience even if they are accepted, as many hospitals do not have the time to train students.
Although nursing is a critical profession, every step involved in becoming a nurse has severe challenges. Getting accepted into nursing school is difficult because of the lack of faculty and clinical observation opportunities. Getting hired after graduating is difficult because many hospitals prefer more experienced nurses. Nurse to patient ratio disparities and high rates of burnout are large hurdles even after employment.. Physician and essayist Lewis Thomas once said that hospitals are “held together, glued together, enabled to function…by the nurses,” so how will American healthcare adapt to this growing nursing shortage?
