Are Hospitals to Blame for the Nursing Shortage? Nurses and Hospitals Weigh In

COVID-19 has pushed many healthcare providers and facilities to the breaking point. The news has been inundated with headlines about how hospitals don’t have the staff to care for the influx of patients.

National Nurses United (NNU), the nation’s largest union of registered nurses, just released a statement blaming hospitals for the recent nursing shortage. The union accused the nation’s health networks of choosing profit over the safety of patients and staff. But hospital leaders say that’s not a fair assessment of what’s happening on the ground.

Harsh Criticism

NNU made headlines this week when it said there isn’t a shortage of nurses in the U.S. as a whole, citing a report from the Department of Health and Human Services that estimates there will be enough nurses to meet the country’s healthcare needs through 2030. Instead, the union says nurses are inequitably distributed across the country. NNU says hospitals are responsible for the current understaffing by driving away providers that aren’t “willing to risk their licenses or the safety of their patients by working under unsafe conditions in hospitals.”

The union says there are shortages of nurses in some areas, but these are the direct result of how hospitals treat frontline workers.

NNU alleges that even before the COVID-19 pandemic, most hospitals would regularly cut down on staff in every unit and ward to maximize profits. The union also states that hospitals have failed to maintain “a robust pool of nurses from which to draw when scheduling shifts.”

As the pandemic wore on, the union says, “hospitals rejected nurses’ advice…to prepare and plan for predictable staffing needs, including hiring and training more nurses, and cross-training current staff nurses to work in critical care departments. Instead, hospitals cut and laid off staff from units that had temporarily low patient census, and canceled RN traveler contracts.”

The statement ends by calling on hospitals “to immediately staff up every unit…and create a safe, sustainable work environment where nurses can feel confident about their ability to provide the best nursing care possible for their patients.”

Turning the Tables

Not everyone agrees with this, however. Hospital managers were quick to refute the union’s allegations.

Robyn Begley, DNP, RN, senior vice president and chief nursing officer of the American Hospital Association, pushed back with, “Shortages of critical healthcare workers were projected long before the pandemic began…hospital and health system leaders have used a variety of approaches to recruit, retain, and support their workforce.”

Nursing turnover has increased rapidly since the start of the pandemic.

According to a recent survey of large hospital systems from McKinsey, 84% of respondents said they face ongoing challenges with nursing coverage, and turnover of nurses has increased 4 -5 percentage points over the last 12 months.

When it comes to recruiting and retaining nurses, the respondents said they use a variety of strategies to staff up, including wage increases (31%), recruitment increases (30%), one-time bonuses (16%), and cross-skilling/upskilling nurses (10%).

These shortages appear most acute in the south. In Mississippi for example, around 1,000 hospital beds are currently understaffed. Studies show the state has lost 2,000 nurses since the start of the pandemic. Mississippi also has one of the lowest vaccination rates in the U.S., which has bolstered the recent surge. Some providers may be unwilling to work in areas with little immunity against the virus.

In Florida, around 70% of hospitals are currently understaffed. NPR reports that Miami’s Jackson Memorial Health System, Florida’s largest medical provider, “has been losing nurses to staffing agencies, other hospitals, and pandemic burnout.”

Gerard Brogan, RN, director of nursing practice for NNU, says Florida is a perfect example of what’s happening across the country. “HHS projected a glut of nurses in Florida of 55,000 from 2017 to 2030,” Brogan notes. “So why are we seeing this massive shortfall of nurses in Florida? It’s because Florida has a really poor reputation among nurses.”

He adds that he’s spoken to some nurses in the state that have been assigned to five patients in the ICU. “That’s dangerous and irresponsible. In California, where we have had mandated nurse to patient ratios since 1976, there’s a ceiling on how many patients a nurse can take care of in an ICU, and that’s two patients. There’s a scarcity of nurses in Florida who are willing to deal with those egregious working conditions. Some nurses close to retirement are leaving.”

The Delta variant continues to ravage unvaccinated hotspots in the west and south.

Peter Buerhaus, PhD, RN, a professor of nursing at Montana State University, says the local supply of nurses has already been exhausted in many of these areas. “There’s no way we have an available supply of these highly skilled nurses just sitting around, ready to jump into the ERs and ICUs. And those shortages are likely to continue. It takes several years to get those nurses up to speed and functioning in those areas,” he adds.

Many hospitals have tried to cross-train nurses to perform critical care, but not everyone is ready to make the transition to the ICU.

Buerhaus disagrees with the union’s assertion that hospitals are to blame for the shortage. He says many older providers have started to retire in greater numbers. Around 2010, he says the industry lost around 60,000 providers a year to retirement. In 2019, that number went up to 70,000.

He also says more nurses have pursued careers in advanced practice. “We estimate that the number of nurses in the labor market [will decrease] by 80,000 a year,” Buerhaus said. “So, you’ve got 80,000 nurses leaving patient care for that reason and 70,000 retiring, and some hospitals having periodic shortages. And when you have short staffing, you’ve got nurses working harder, and they’re unhappy.”

He admits that there are plenty of “bad actors” in hospital administration, but he doesn’t think it’s fair to put the blame on health systems.

“I don’t ever recall hearing a nurse saying directly or in a survey, ‘We have an adequate staff.’ Nurses always say we need more staff without consideration of other factors — the cost of that, or what you’re trading away by acquiring more staff. The profession takes that position reflexively, and some unions have exploited that.”

He says nurses are moving away from bedside care for a variety of reasons.

“I can’t over-emphasize how difficult the working conditions are for nurses across this country. And the pandemic has been the final straw. Nurses are trying to get away from the bedside. The nurse practitioner role offers more pay, more respect, and more autonomy. Or they say, ‘I’ll go work in a clinic because it might be less hectic, and I’m frightened silly of making a mistake because of the poor staffing [in the hospital].'”

“Between retirement and all the people going off to become NPs, the supply wasn’t going in the direction we needed it to be when COVID hit. And some of the bad actor hospitals got hit even harder, because they didn’t have enough staff to start with,” Buerhaus adds.

The healthcare industry is changing, and hospitals will have to do everything they can to hold onto the nurses they have.