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Op-ed

Nursing shortage is a national health issue | GUEST COMMENTARY

At the height of the pandemic nurses made headlines as heroes. Nearly two years into the pandemic, nurses make headlines walking out of their jobs and leaving bedside care. Some nurses resign from burnout and fatigue. Others are choosing to become travel nurses, retire early or to simply leave the profession entirely.

The nursing shortage is leading hospitals to close units or scale back services, which affects not only high acuity units like the Intensive Care Unit and Emergency Department, but long-term care, labor and delivery, and the operating room.Desperate to keep their units staffed, hospitals are offering upwards of $40,000 sign-on bonuses and paying upwards of $140 an hour out of desperation.

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To say these lucrative incentives aren’t tempting would be a lie. After leaving my years of bedside nursing behind to work in global health, even I considered a return to bedside care. Undoubtedly, I am not the only one. As hospital administrators race to conjure up competitive recruitment strategies, many employees are left wondering where the retention bonuses are for those who stay, and if staying is even worth it.

The fact is that nursing is facing considerable issues. The field continues to struggle with unsafe staffing ratios, moral distress and burnout, lack of support from management and low morale. A close friend was an ICU nurse in a city in the South for five years and worked in her hospital’s COVID-19 unit at the peak of the pandemic. When she approached management to inquire about crisis pay, she was advised that this is what she signed up for and that it would be the new normal. Upset and disillusioned, she said, “If this is the new normal, then why not at least get paid really well for it?” A few weeks later she resigned and signed-on as a travel nurse. Now, she is making close to $6,000 a week. In fact, hospitals are now relying on travel nurses more than ever—an expensive, and unsustainable fix, as the U.S. faces its “great resignation.”

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But where does this leave smaller community hospitals in rural settings that cannot afford to pay these hefty sign-on bonuses and hefty wages? What effect does staffing units filled with travel nurses have on the continuity of patient care, safety and quality outcomes? To be clear, nursing shortages and high turnovers are not new. While a shortage had already been predicted in the pre-pandemic world, it has only worsened since, and will continue to do so. So, what is exacerbating the nursing workforce squeeze? And what has brought us to the brink of a new health care crisis?

The great “financialization” of the health care industry has finally trickled down. Capitalism and the unfettered and unfiltered drive for the dollar has degraded the nursing profession in many regards. The historic exploitation of nurses to increase productivity and reduce costs, worsened by the pandemic, has led to a historic nursing shortage being faced today.

Hospital leadership must stop seeing nurses as a line item of a budget. Nurses are not an expenditure; they are the cost-savings measure and the lifeline of the health care system. A 2020 study found that improving nurse staffing decreased length of inpatient stay and decreased patient mortality; it also saved $720 million among Medicare patients.

Similar to the nursing shortage faced in the 1980s, we need to reframe the nursing shortage and target the root of the problem. First, legislators need to redesign models of care that will recalibrate the nursing role with care delivery standards. Such measures need to be introduced and implemented at a national level. Second, we must institute professional governance from policy development through the institutional level. Third, state and federal leaders need to create and invest in a National Nursing Corps that can serve as a reserve workforce. This reserve can be deployed like the national guard in times of public health crisis and natural disasters and help control nursing workforce migration.

The current nursing shortage is a national health issue. If policymakers and hospital administrators do not work together to prioritize the well-being and retention of the nursing workforce, then patients will pay the price.

Angela Chang (achangc1@jhmi.edu) is manager of the Center for Global Initiatives at Johns Hopkins School of Nursing and a Doctor of Nursing Practice student at Duke University School of Nursing.


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