Solving the nursing crisis: 3 lessons learned from the COVID-19 experience

Accounts of the nursing shortage may vary in emphasis, but the contours of the crisis are plain: The United States does not have enough nurses to deliver the high quality of patient care that all healthcare organizations are mandated to provide. This challenge is driving healthcare facilities to rethink how they staff themselves in the immediate and longer term.

The ability of hospital and health system leaders to meet this challenge depends first on understanding the three key factors behind the current healthcare workforce shortage:

• The first is demographic. The aging of the Baby Boomers means both a greater demand for care and the loss of experienced nurses to retirement.
• The second is a lack of faculty available to teach nursing students, limiting the enrollment and training of potential nurses.
• The third stems from the first two: Nearly a third of employed RNs say they are contemplating leaving their jobs, due in large part to unmanageable workloads and not enough control over their schedules — byproducts of the same workforce shortage that their departures would exacerbate.

With these concerns in mind, healthcare leaders need to act deliberately to adopt strategic solutions that will ameliorate these factors. And they can best start by building on what worked during the COVID-19 pandemic.

COVID drove many healthcare organizations to experiment with technology and navigate reduced regulatory requirements to get nurses to where they were needed most. The pandemic also impressed on hospital leaders the profound need to take nurse burnout seriously and find ways to make the work manageable again. The following are the three primary takeaways from the COVID experience regarding how to counter the aforementioned concerns and improve the workplace experience and satisfaction of nurses and other clinical staff.

1. Be aware of and embrace new HR staffing technology

A platform staffing model was introduced prior to the pandemic, but its adoption accelerated dramatically during COVID. It is now widely available nationwide in the healthcare marketplace. This model uses technology, including AI solutions, to connect qualified nurses to facilities in need, somewhat akin to how Uber connects available drivers to passengers looking for a ride.

This approach leverages technology to optimize all of the critical actions that legacy staffing companies perform manually, including using algorithms to ensure there is a good clinical match between the nurse’s qualifications and the acuity needs of the facility. These platforms also provide a means to digitize and validate nurse credentials. For the fintech-savvy, they can also deliver same-day pay to the nurse directly after the shift.

The platforms function as two-sided marketplaces. On one side, healthcare workers can log in and submit their profiles and credentials; on the other, facilities sign up, screen for talent that matches their filters and request the clinicians they need. In the middle is a cloud-enabled team of experts who validate the credentials and clinical match.

For example, an acute care center’s need for an ICU nurse may also require Level 1 trauma experience and an NIHSS certification. Once an algorithm receives these details, it can quickly confirm a clinical match with no manual work — something that can take hours or even days for a legacy staffing agency.

Without this capability, in the worst-case scenario, a clinician might be grossly misplaced, posing a potential patient safety risk to the facility. A key consideration for healthcare finance leaders, therefore, is to assess the extent of the platform’s validation capabilities, including how effectively it can validate a nurse’s skillset and acuity match to the healthcare organization and address broader workforce performance issues for the organization (e.g., timeliness, documentation efficacy and call-out history).

Healthcare frequently lags behind other industries by 10 or even 15 years when it comes to adoption of technology.^a In the arena of recruiting, as well as workforce optimization in general, this lag is particularly pronounced. The pandemic piqued the appetite for adoption, and the industry is primed for changes that can begin to resolve the nursing crisis.^b

2. Keep informed of and advocate for changes in regulatory requirements

During the pandemic, changes to state-based licensure requirements removed obstacles to nurses working across state lines. As states issued executive orders to enable any state license to cross their borders, the reduced regulatory burden expedited clinical mobility and onboarding. Meanwhile, fears about the threat to patient safety proved unfounded.

Permanently replacing the patchwork of state-based requirements with a single, federal licensing standard would address the imbalance experienced from one state to another — and would accelerate overall employment in healthcare at this critical inflection point. A shift to a single federal standard could also reduce the costs of travel nursing.

These costs soared during the pandemic. Part of the premium for travel nurses is the cost of maintaining multiple state licenses (compact plus single state licenses) as well as the ever-changing and inconsistent credentialing requirements that vary from state to state and facility to facility. Simplifying this aspect of nursing employment would both broaden the pool of available, qualified nurses and reduce labor costs.

The pandemic showed us that standardizing credentialing had no impact on patient safety. Inadequate staffing, on the other hand, is already wreaking havoc on access to care: A recent Wall Street Journal article revealed that, post-pandemic, some hospitals are reducing services because they can’t afford the staff. The looming impacts to healthcare access and quality care may not be as visible as those from a novel, infectious disease, but they nonetheless demand an equally vigorous, creative response.

3. Remain mindful of the factors contributing to nurse burnout

Many if not most nurses are still suffering post-pandemic burnout. Healthcare facilities recognize this reality and are stepping in to provide counseling, meditation, and mandated work breaks and mental health days. Will that be enough to reverse, or even slow down, the number of nurses who say they will leave the profession? In a word: no.

While such interventions are meaningful, the scope of the crisis demands something far more comprehensive. We need a holistic workforce management solution that harnesses the capabilities of modern technology platforms and predictive analytics — and that applies those insights to the humane, responsive management of our limited and stressed workforce.

Innovation is the only option

A pre-pandemic study by the U.S. Department of Health and Human Services (HHS) projected that, by 2030, the demand for registered nurses in the United States will reach 3.6 million, yet HHS also projected that the sum of employed nurses by that year will fall about 100,000 short of that number.^a Long-term recruitment and training of future nurses is the only way out of this crisis. But there are technological, regulatory and workforce retention measures that can and should be taken to immediately reduce the impact of the crisis and protect access to healthcare.

Editor’s note: In the version of this commentary published in the November 2023 print edition of hfm, the projected nurse shortage number cited in the concluding paragraph was erroneously stated as 3.6 million.

Footnotes

a. See, for example, Landi, H., “Study: Healthcare Lags Other Industries in Digital Transformation, Customer Engagement Tech,” Healthcare Innovation, March 18, 2018.
b. See, for example. ACCN, ANA, AONL, HFMA and IHI, Nurse staffing think tank: priority topics and recommendations, 2022, which describes the work of a national task force – of which HFMA was a participant – to identify practical solutions to the nursing crisis.
c. Haines, J. “The State of the Nation’s Nursing Shortage,” U.S. News & World Report, Nov. 1, 2022. The