Nursing Shortage or Exodus? : AJN The American Journal of Nursing

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Nursing Shortage or Exodus?

AJN, American Journal of Nursing 122(3):p 12-13, March 2022. | DOI: 10.1097/01.NAJ.0000822928.16774.9a
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National Nurses United held a candlelight vigil in Washington, DC, in January to honor the nurses who lost their lives to COVID-19 and to demand the hospital industry invest in safe staffing. Photo by Rick Reinhard / Courtesy of National Nurses United.

Arecent report by National Nurses United (NNU) claims that methods used by the hospital industry to maximize revenue are driving nurses from the bedside.

Among examples cited by the report—Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry-Created Unsafe Staffing Crisis—is the pursuit by health care organizations of high customer satisfaction scores at the expense of authentic nurse–patient relationships. Few patients realize that nurses—often to their dismay—are told to improve these scores through repeated use of specific words such as “excellent” and “thank you” to condition patients to rate the hospital as “excellent” on surveys. In turn, the positive surveys are used by health systems to maximize incentive payments by the Centers for Medicare and Medicaid Services.

The NNU report also questions the oft-cited shortage of nurses in the United States, concluding that it may not be due to a dearth of nurses so much as a lack of good nursing jobs. As of November 2021, there were 4.4 million licensed RNs in the United States, but only 3.2 million employed as RNs and 1.8 million working in hospitals, according to the report, which faults poor working conditions such as understaffing for driving nurses away from acute care.

Also cited are systemic failures by health care organizations to invest in measures to protect nurses from health and safety hazards such as workplace violence, infection, and musculoskeletal injury. RNs have also reported experiencing moral distress, physical exhaustion, and such mental health issues as stress, anxiety, depression, and posttraumatic stress disorder, which the NNU report attributes to overwork and inadequate resources to support safe, high-quality nursing care.

The report recommends several federal remedies, including passage by Congress of the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, which would establish minimum RN-to-patient ratios, and the Workplace Violence Prevention for Health Care and Social Service Workers Act, which would mandate workplace safety protections. Both bills have been referred to Senate committees for study. In addition, the NNU report urges Congress to fund nursing programs at public community colleges so students from underserved minority communities can attend tuition-free, thereby augmenting and diversifying the nursing workforce.

Some states have already moved to implement the recommended measures. As early as 2004, California implemented specific nurse-to-patient ratios. Massachusetts did so in 2014, but only in ICUs. New York passed a law last year requiring hospitals to include nurses on staffing committees; it also launched a program that will cover tuition for 1,000 nursing students at state and city universities. And Kentucky governor Andy Beshear in December issued an executive order allowing nursing schools with sufficient resources to open new campuses and those at full capacity to refer qualified applicants to other schools with vacancies.

Also in December, the NNU participated in a virtual briefing of Congress to present its report and offer testimony from several nurses—among them Kelly Anaas, RN, from Minneapolis, who told the lawmakers that nurses were running out of stamina. “Does everyone remember when the pandemic arrived on our doorstep and we implemented all these mitigation efforts to make sure that we, as a society, did not get to the point where we are rationing care?” she asked. “Well, the truth is that we've been rationing care in this country for a long time. Short staffing leads to the rationing of care. Just because we are not pulling names out of a hat to see who gets a ventilator and who doesn't, doesn't mean we haven't been making awful decisions about the level and quality of care people receive.”

To read the NNU report, go to—Dalia Sofer

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