Nursing has long been crucial to the delivery of health care to the American public, as well as a core middle-class profession, especially for women and women of color. The COVID-19 pandemic has exacerbated a nationwide shortage of registered nurses, which threatens to further destabilize America’s healthcare system and undermine people’s health. Policy makers need to understand the causes and effects of the shortage and how investments in higher education and coordination strategies can alleviate pressures on the nursing workforce and health care systems.
A new report from the Center for American Progress examines the factors driving the current nursing shortage, particularly issues that prevent a more cohesive response to nursing shortages and limit higher education’s ability to train more of nurses. It also explains why nursing is a crucial profession for improving health, economic security and racial equity in this country.
The shortage of nurses
COVID-19 has put a strain on the healthcare system. Employment levels for registered nurses fell 3% between 2020 and 2021, the biggest drop in at least 20 years.1 Chief nurses have consistently reported that staffing has been their biggest challenge throughout the pandemic, with vacancy rates reaching 30%.2 The rise of itinerant nursing, low morale and traumatic experiences, and the disproportionate amount of adversity faced by nurses of color are unacceptable features of the current nursing shortage and require direct intervention by policy makers.3
Other challenges predate COVID-19, including an aging general population that needs more care, an aging nursing workforce whose retirements will further fuel shortages, and limited facility capacity. higher education to train new nurses. The United States also lacks a coordinated strategy between policy, education, employers and other partners to deal with peaks in nursing demand.
At the same time, nursing offers solid salaries and is relatively diverse, making it an attractive profession for workers. By investing in a more complete and diverse nursing workforce, the United States can provide high-quality jobs for millions of workers while providing better health care, especially to medically and economically underserved communities. .
Constraints to higher education
The evidence points to three main constraints that prevent colleges from educating more nurses:
- A shortage of nurse educators, including college professors, clinical instructors and preceptors
- A shortage of clinical placements for student nurses, where students gain hands-on experience that is necessary for graduation and licensing
- Inadequate campus facilities and equipment, such as nursing labs and simulation technology
Without additional funding, nursing programs cannot enroll and graduate the number of future nurses needed. For example, colleges need more nursing faculty, but nurses with advanced degrees are deterred from pursuing teaching careers due to factors such as relatively low salaries.4 Raising faculty salaries is one part of a broader proposal to build capacity for nursing programs in higher education institutions.
Federal policymakers must design long-term solutions to the current nursing shortage and ensure that the education and health care systems are better prepared to alleviate future shortages. The recommendations of the CAP report are designed to achieve the goals of increasing the number and diversity of nurses entering the profession and creating a permanent structure to deal with changes in supply and demand. nursing workforce.
Congress should increase the ability of educational institutions to enroll and graduate more nursing students and improve access and outcomes for nursing students of color by:
- Future Advancement of Academic Nursing Act passed
- Passage of the Momnibus Black Maternal Health Act of 2021
- Increase funding for programs related to registered nursing education under Title VIII of the Public Health Services Act
- Helping higher education institutions pay for capital projects, such as buildings, labs, and equipment
Federal and state actors should introduce new proposals to expand clinical placement capacity and help nurses with associate degrees earn a bachelor’s degree in:
- Fund clinical placements for nursing students from historically disadvantaged backgrounds and for those attending underfunded colleges, with the Graduate Nurse Education Pilot as a model5
- Invest in pathways for nurses with an associate degree to earn a bachelor’s degree, such as increasing the availability of a Bachelor of Science in Nursing degree at community colleges
Congress should create permanent bodies to document and advise on matters of recruitment, training and retention by:
- Funding from the National Health Care Workforce Commission, originally authorized by the Affordable Care Act in 2010
- Fund and supplement state-level nursing workforce organizations to address state-specific nursing shortages
Major federal funding investments and sustained coordination are needed to mitigate the impact of nursing shortages and improve the country’s response capacity. If policymakers at all levels think more ambitiously about solving the nursing shortage and improving racial equity, more workers will have equitable access to a high-quality, well-paying profession, more more patients will have equitable access to high quality nursing services and a healthier population will have better school and life outcomes and build stronger communities.