By James X. Stobinski
The American nursing workforce continues to evolve following the COVID-19 pandemic. I have written previously on the numbers of nurses who left the profession during the pandemic. The premature loss of large numbers of experienced nurses near the end of their careers was a severe blow to the profession in terms of a knowledge and experience drain. That impact hit disproportionately in the OR when surgical volumes declined, and some perioperative staff were furloughed or lost employment. The American nursing workforce declined overall by 100,000 in 20211 and this included perioperative nurses who are now likely permanent losses.
While the loss of experienced nurses during the pandemic was a harsh reality there was still a reason for optimism. Shortages in the American nursing workforce do tend to run in cycles. Overall, we have experienced a steady rise in both the number or registered nurses and also the ratio of nurses to the overall population.2 Many of us remember the shortfalls of the 1990s and the rebound in number which resulted from very successful marketing campaigns.2 Since the early 2000s nursing school enrollments have seen a steady increase and the numbers of nurses holding baccalaureate and higher degrees have risen steadily. The bigger issue for some time was in having sufficient instructors and clinical sites to accommodate the student load.
The articles I am sharing this month tell of another worrisome trend regarding patterns of accession to the profession. That is, how many students are now entering nursing schools and the employment patterns of early career nurses. Much of the information in these articles comes from Peter Buerhaus and his colleagues. In a 2022 article we find out that the recent nursing workforce losses have come disproportionately from nurses under the age of 35.2 This could be predicted as the heavy workload, stress of the pandemic and the demand for family caregiving heavily impacted these nurses. There are, however, larger implications for American health care.
In plain terms, there was a need for an influx of early career nurses to replace the experienced nurses who left during the pandemic. Secondly, the overall workforce must expand to meet the needs of an ageing American population and the demographic bubble of the Baby Boomers. A net loss in the workforce coupled with decreases in younger, early career nurses carries long term implications. These demographic realities serve as a backdrop to another related issue. The number of students enrolling in pre-licensure BSN programs declined in 2022 after years of steady gains.3 It is too early to know if the 2022 data is the start of a larger trend or just a post-pandemic blip.
The concern which arises from these trends is a further worsening of the nursing workforce shortfalls which will become more difficult to correct in a spiraling effect. Long-term shortfalls may contribute to further dissatisfaction, burnout and cause more nurses – including younger, early career nurses – to leave the profession. In turn, if nursing is seen as a stressful and less attractive calling the number of sorely needed BSN students may continue to decline. Buerhaus and his colleagues offer suggestions in a 2023 article on how to build up and sustain the nursing workforce1 including a conceptual framework.
These scholars have identified issues which are worthy of further research. A sustained shortfall in the American nursing workforce will negatively impact American health care and may restrict access to care. These are salient topics worthy of our continued attention. There are ample action items for stakeholders to this issue and I will speak to those in future columns.
– James X. Stobinski, Ph.D., RN, CNOR, CNAMB(E), CSSM(E), is the director of education at the National Institute of First Assisting.
References
1. Buerhaus, P., Fraher, E., Frogner, B., Buntin, M., O’Reilly-Jacob, M., & Clarke, S. (2023). Toward a Stronger Post-Pandemic Nursing Workforce. The New England journal of medicine, 389(3), 200–202. https://doi.org/10.1056/NEJMp2303652
2. Auerbach, DI, Buerhaus, PI, Donelan, K & Staiger, DO. (April 23, 2022). A Worrisome Drop In The Number Of Young Nurses. Accessed January 26, 2024 at: https://www.healthaffairs.org/content/forefront/worrisome-drop-number-young-nurses
10.1377/forefront.20220412.311784
3. McElroy, A. (2023, September 7). New data show enrollment declines in schools of nursing, raising concerns about the nation’s nursing workforce. AACN. https://www.aacnnursing.org/news-data/all-news/article/new-data-show-enrollment-declines-in-schools-of-nursing-raising-concerns-about-the-nations-nursing-workforce
