"If we want to think about policy solutions that are going to stop the loss of healthcare professionals ... we need to make sure that we understand the major drivers" of nurses leaving the profession, said Patricia "Polly" Pittman, PhD, of the Milken Institute School of Public Health at George Washington University in Washington, D.C.
Approximately 185,000 registered nurses graduate from nursing programs every year, Pittman said, which is not too far from the 195,000 nurses that the Bureau of Labor Statistics projects are needed. But a shortage of faculty, preceptors, and clinical sites has prevented many of those interested in nursing from entering the field, she explained.
In 2021, over 90,000 qualified nurse applicants were turned away from nursing schools due to a lack of space, citing the American Association of Colleges of Nursing.
As Linda McCauley, RN, PhD, dean of Emory University's Nell Hodgson Woodruff School of Nursing in Atlanta, pointed out, the number of PhD-prepared nurses has "completely flat-lined" -- a trend she characterized as "alarming," given the need for highly educated nurses to help lead health systems in the future.
In Pittman's work as a grantee for the Human Resources & Services Administration (HRSA), interviewing nurses about working conditions, she discovered that an important precursor to burnout in the field has been "moral injury" -- a term derived from soldiers returning from war with "a form of post-traumatic stress disorder."
"What nurses say is that they are feeling betrayed," not only by employers but also by colleagues and by society, she explained. And, as a result, they feel unable to do their jobs because "something is in direct conflict with their professional code of ethics."
Nurses are torn between speaking up and keeping quiet, and if they say nothing they often experience "a sense of guilt, shame, and helplessness," she added.
"There are other drivers of burnout too, but this may be the superhighway," Pittman said, noting that it's important to bear in mind when trying to identify solutions to the workforce problem.
Solutions to the Nurse Shortage
One classic approach to addressing workforce shortages at the federal level is loan repayment programs, Pittman said. For example, HRSA's Nurses Corps pays 85% of unpaid education debt if the nurse pledges to work in critical shortage facilities or at certain nursing schools. Programs that focus on transitioning to practice for both RNs and nurse practitioners have also been shown to be effective, she added.
Zangardi noted that her health system offers a nurse "externship" program that incentivizes students to stay with the School program and may receive tuition reimbursement and loan repayment. It also has invested in a "post-hire survey," which requests periodic feedback from nurses about their experiences on the job.
McCauley said that a number of Graduate Nurse Education Demonstration Projects have proven very effective at the federal level, such as CMS-funded nurse practitioner training programs and initiatives incentivizing hospitals to provide preceptors, though "getting the federal government to adopt [these programs] is very difficult."
"I believe deeply that nursing is a public good, and the production of a sufficient number of nurses to care for our population is a public good," McCauley said. "I think for the production of nurses right now to really get our country where it needs to be, there needs to be investment at the national and state level," she added, noting that differences in licensure and scope-of-practice laws "do nothing but hurt us in today's world."
If we continue to have policies that are outdated in practice it harms the opportunity for individuals who are qualified nurse applicants. Educational rights for students entering the healthcare setting should be educated on the limitations of nursing education.
APA
Firth, S. (2022, May 16). More support needed to shore up nurse pipeline, experts say. MedPage Today. https://www.medpagetoday.com/nursing/nursing/98663
Netscribes_Admin. (2023, June 8). Healthcare market entry: Major barriers and how to overcome them. Netscribes. https://www.netscribes.com/healthcare-market-entry/
The shortage of faculty and preceptors at clinical sites has significantly hindered young nurses from entering the field. Linda McCauley's observation referring to the number of PhD-prepared nurses has “completely flat-lined” is indeed alarming, especially considering the crucial role highly educated nurses play in leading health systems. Additionally, the concept of “moral injury” resonates with nurses, who often feel torn between their professional code of ethics and the challenges they face in the healthcare system. This delicate balance can lead to burnout and a sense of guilt among nurses