Journal of Healthcare Management

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May/June 2023 - Volume 68 - Issue 3

  • Eric Ford, PhD, MPH
  • 1096-9012
  • 1944-7396
  • 6 issues per year
  • 2.306

​​​​​​​From the May/June 2023 Issue...

My MBA class on strategic management at the University of Alabama at Birmingham had two traveling nurses among the students this past semester. One lives in Atlanta, Georgia, and commutes to Birmingham, Alabama, for work. The other lives in Birmingham and commutes to Atlanta. They literally pass one another on the freeway as they traverse their 2-hour commutes to and fro. Although I know the answer, the question nevertheless begs to be asked: Why travel so far when you can work full-time in the cities where you live? Their response channels the ghost of bank robber Willie Sutton: Because that's where the money is. Traveling nurses get paid nearly double their full-time counterparts.

The infamous rationale for robbing banks has become known as Sutton's Law and is primarily taught in medical schools. In the clinical setting, the law is intended to remind physicians to consider the most obvious diagnosis first and order the cheapest test to confirm (or rule out) an illness. As we like to practice what we preach, let's apply Sutton's Law to the nursing shortage and the rise in the use of traveling nurses. To do so, there are two questions to ask. First, what are the most likely and obvious causes of the nursing shortage? Second, what are the least expensive solutions to the problem?

With respect to the causes of the nursing shortage, the simplest answer is one of supply and demand. The U.S. educational system is not supplying enough nurses to meet the healthcare sector's needs. One might assume that there are not enough people interested in the nursing profession to meet the demand, but that is not the case. In fact, the American Association of Colleges of Nursing (2022) found that more than 90,000 qualified applications (not applicants) were turned away from nursing schools. The schools indicated that there were three main constraints to accepting more students: (1) the limited number of clinical rotation sites restricts class sizes; (2) a lack of faculty to teach larger cohorts; and (3) insufficient scholarships or financial aid for applicants. Each cause suggests at least one solution.

The biggest challenge to the nursing supply is the lack of clinical rotation slots in health systems. Although simulation tools can relieve some of the pressure, there is simply no substitute for working on the floor and at the bedside. By its very nature, this problem implies that it is the health systems and their leaders that need to make a concerted effort to increase clinical rotation availability. In our March/April interview, President and CEO John M. Haupert, FACHE, described how Grady Health System doubled the number of nursing rotation opportunities in partnership with local nursing schools. If more health systems made a similar effort, the nursing shortage would end much sooner.

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