How to Avert a Looming Nursing Shortage
By Taylor Maag and Erin Delaney
The COVID-19 crisis put America’s nurses in the national spotlight. Nurses were some of the most essential heroes of the pandemic — working long hours, putting their health at risk and bearing the emotional strains of more than 1 million deaths. Nurses across type and specialty demonstrated a commitment to public health and safety, reminding us of the importance of having a robust nursing workforce across U.S. communities — so that Americans are in good hands when the next public health crisis occurs.
However, that assurance may be far from reality. Currently, the U.S. has a shortage of 100,000 nurses. While this number is small compared to other industries, and the health care industry at large is seeing job growth in recent Bureau of Labor Statistics (BLS) projections, these numbers don’t represent the full picture.
A recent study by the National Council of State Boards of Nursing found that 610,388 nurses say they want to leave the field by 2027. This report found that high workloads and unprecedented levels of burnout from the pandemic have resulted in higher levels of turnover for young nurses and early retirements for those later in their careers. At the same time, the demand for health care services is increasing as the U.S. population ages. BLS projects that employment for registered nursing will grow 6% from 2022 to 2032, or roughly 193,100 jobs per year to meet this demand — equating to about 2 million more nurses. This growth is faster than the average for all other occupations.
While we are not in crisis mode yet, we will be soon if we don’t act now to stop the hemorrhaging of highly qualified nurses and attract more people to the profession.
This is why policymakers across all levels of government are giving the issue increased attention. Last month, the Biden administration announced $100 million through the Health Resources and Services Administration (HRSA) to grow the nursing workforce. The award focuses on helping licensed practical nurses (LPNS) become registered nurses (RNs); training nurses who deliver primary care, mental health care and maternal health care; and tackling bottlenecks in nurse training by supporting the expansion of nursing schools.
State and local leaders are also launching initiatives to build stronger pipelines. Last year, the National Governors’ Association (NGA) highlighted state policy efforts to expand education and training programs in nursing. Locally, Baltimore just launched a Public Health Pathways Program, which leverages federal American Rescue Plan (ARPA) funding to support a public-private partnership that connects residents from low-income backgrounds to pathways into nursing. The program covers education costs and removes barriers to learning by providing students with resources to supplement wages, address transportation or housing needs and pay for child care or other necessary services.
Developing policies and programs like this is key. We believe Washington can take additional steps to build on current efforts and reinforce state and local innovations.
First, federal policymakers should lift arbitrary restrictions on the health care services nurses provide. During the declared COVID-19 federal emergency, restrictions were waived that otherwise would have prevented advanced practice registered nurses (APRNs) from practicing the full scope of health care services they are educated and trained for. Now that the federal emergency has ended, those restrictions have been reinstated in both programs. APRNs have the knowledge and clinical competency to provide care beyond their registered nurse preparation. Studies have shown that not only are patients having comparable or better health outcomes when cared for by APRNs than physicians, but they are highly satisfied and voluntarily choose to receive their care.
By constraining the autonomy of nurses, especially those with advanced skill sets, such rules affect job satisfaction but also can put patients at risk. APRNs are the fastest-growing Medicare provider group, and over 40% of Medicare beneficiaries receive care from an APRN. Further, patients who live in rural and underserved communities are more likely to receive care from APRNs and physician assistants (PAs). Congress should pass the bipartisan, bicameral Improving Care and Access to Nurses (ICAN) Act that removes barriers to practice for APRNs, certified registered nurse anesthetist (CRNAs), and certified nurse-midwives under the Medicare and Medicaid programs. This legislation is expected to boost job satisfaction and retention in a key nursing profession and ensure patients wider access to potentially lifesaving care.
Policymakers should also focus on skill development — helping people in entry-level health care jobs or those changing careers to gain the skills needed to be a nurse. To support these efforts, state and local leaders should leverage federal funds, including the recently announced HRSA funding, ARPA’s CDC grants — which provide $2 billion to fund the public health workforce — and ARPA state and local recovery dollars (which must be obligated by next year), which can support an array of workforce development activities. As part of these efforts, policymakers must ensure the private sector is part of the solution. Employer partnerships ensure individuals learn the essential skills needed for immediate employment and allow for costs to be shared. For instance, the Department of Commerce’s Good Jobs Challenge is funding 32 grantees for training partnerships in high-demand sectors — requiring industry partners to co-design and inform training programs and commit to hiring agreements. Fifteen of the 32 sites are focusing on health care pathways.
Lastly, government leaders can take steps to expose young people to nursing careers. Policymakers must reinvent high school to ensure every young person gets a high-quality work-based learning experience through youth apprenticeship, internships career and technical education, or other initiatives. Programs focused on nursing can help expose students to these careers while also giving them on-the-job experiences at hospitals or other health care providers that prepare them for a good job after high school.
Washington must strategically act to prevent a nursing shortage and make America’s health care system more resilient against pandemics and other national emergencies. Policymakers should focus on creating more autonomy for nurses in the workplace, leveraging federal funds to build (with employers) career paths in nursing and growing youth career development opportunities. While these interventions will help grow our domestic nursing workforce, to truly address the looming crisis, we’ll also need to better utilize international talent — making it easier for individuals who come to the U.S. to access jobs they’re already prepared for. This action is critical to ensure our nurses can keep our people safe and our communities healthy.
Erin Delaney is the director of Health Care Policy at the Progressive Policy Institute. Taylor Maag is the director of Workforce Development Policy at the Progressive Policy Institute.
This story originally ran in The Messenger on October 8, 2023.
