By Don Sadler
With the COVID-19 pandemic now in the rear-view mirror, the nursing profession continues to face shortages, including in the perioperative area. Some of them are severe in certain pockets of the country, especially rural areas.
The Bureau of Labor Statistics projects that the U.S. will require nearly 195,000 new nurses annually through the end of the decade. Meanwhile, a study conducted by the American Association of Colleges of Nursing (AACN) reports that one million nurses will retire by 2030.
Chief nursing officers nationwide have consistently reported staffing as their greatest challenge, with vacancy rates as high as 30 percent.
Nursing Shortage Isn’t New
“For as long as there have been nurses, there has been a nursing shortage,” says David Taylor, MSN, RN, CNOR, the president of Resolute Advisory Group LLC. “However, things are different today. The alarm has been sounding for more than three decades, but never louder than now.”
Taylor says that the pandemic worsened what was already a national shortage of registered nurses.
“This is making it increasingly urgent that policymakers invest in higher education, coordinate strategies to alleviate the pressures on the nursing workforce and make the entire health care system more equitable and stable,” he says.
“Nurses have always worked hard, but post-COVID they are working harder than ever,” adds Taylor. “Unfortunately, there don’t seem to be any quick fixes to reduce their workloads any time soon.”
Taylor also points to unfavorable nursing demographics. For example, the median age for RNs in 2020 was 52 and 19% of working RNs were 65 years of age or older.
“A wave of retirements is expected and there is little hope there will be enough younger replacements,” he says.
Beverly Kirchner, MSN, RN, CNOR, CNAMB, has done a considerable amount of research on the nursing shortage.
“It is real,” she says. “I believe that it will take years to fill the shoes of the baby boomer nurses who are retiring, especially with the low number of graduates nursing schools are turning out annually.
“I recently read that this is about 82,000 graduates a year,” says Kirchner. “If this is true, we will never catch up.”
Causes Beyond the Pandemic
Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative services with AnMed Health, says that today’s nursing shortage was predicted 10 years ago.
“It is due to a number of different factors including retiring baby boomers, the stress of the work environment and a lack of sufficient nursing school professors,” she says.
Dennis cites a recent study in which nearly two-thirds of hospital nurses said they have experienced burnout, while another study revealed that more than one-third of all nurses are not emotionally healthy. In yet another study, three-quarters of nurse managers said that the emotional health and well-being of nurses was their top challenge while 25 percent said that they themselves were not emotionally healthy.
“Even before the pandemic, many clinicians already faced burnout along with stress, anxiety, depression, substance abuse and even suicidality,” says Dennis. “Now this crisis is presenting clinicians with even greater workplace hardships and moral dilemmas that are very likely to exacerbate existing levels of burnout and related mental health problems.”
Dennis does see a light at the end of the tunnel.
“We are now transitioning out, but cautiously,” she says. “There are still challenges with staffing and resources, but all this has taught us to be creative while assessing new opportunities and new models of care.”
Dennis believes that low pay is another cause of the nursing shortage. “Nurses are the lowest paid among health care professionals,” she says. “And compared with other occupations, their earnings increase less over their careers.”
According to Dennis, there are currently five generations of nurses in the workforce. “They all have different expectations of leadership,” she says. “Our leaders need to embrace change management and how to significantly meet the increased demands for care in an increasingly complex health system.”
Meanwhile, Kirchner cites the regulated capacity of nursing schools as a main cause of the RN shortage.
“Fortunately, some states have started addressing this issue,” she says. “For example, Texas is providing nursing prerequisites in some specialized high schools so that when students who have taken the nursing track in high school graduate, they can immediately apply for nursing school. I think this is a great move.”
A Gradual Increase in Nurses
Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the CEO and executive director of the Association of periOperative Registered Nurses (AORN), is seeing a gradual increase in the number of perioperative nurses since the pandemic.
“This is due to several factors,” says Groah. “For starters, the public’s increased awareness of the importance of health care workers has led to a greater interest among individuals considering a career in nursing.”
In response to this growing demand, educational institutions and nursing programs have expanded their capacity and offerings. “For example, they are increasing the number of perioperative nursing programs and providing additional resources for aspiring nurses to acquire the necessary skills and knowledge,” says Groah.
Health care organizations are also establishing collaborative partnerships with educational institutions to “bridge the gap between academic training and real-world practice,” adds Groah. “These partnerships often include clinical rotations, internships and mentorship programs that allow nursing students to gain valuable hands-on experience in the perioperative setting.”
AORN Collaborates with Chamberlain University
In early 2022, AORN began a collaboration with Chamberlain University, an Adtalem Global Education institution, to combat the lack of specialty exposure at nursing schools by incorporating Introduction to Perioperative Nursing into its curriculum on select campuses. As a result of this, Chamberlain developed the “Practice Ready. Specialty Focused. Nurse Education Model.”
“This model provides an end-of-program cocurricular badge and precepted clinical experience in select nursing specialties for pre-licensure students,” says Karen Cox, Ph.D., RN, FACHE, FAAN, the president of Chamberlain University. “It is designed to decrease first-year turnover rates and ongoing workforce shortage among nurses, especially in acute-care setting, by helping students understand the realities of the practice area they are interested in and show up more practice ready.”
The model is comprised of a co-curricular learning activity consisting of a 16-module, self-paced online didactic course.
“Any student in good standing on one of Chamberlain’s 22 campuses and BSN-online program is eligible to participate,” says Cox. “Those who complete the course receive a digital badge and an opportunity for a clinical experience in a specialty prior to graduation.”
Following successful completion of the specialty course, students begin an intentional clinical experience that occurs over an eight-week period. This provides 96 clinical hours that are required as part of Chamberlain’s academic requirements for NR446, Collaborative Nursing. Students also receive a complimentary one-year AORN membership upon completion.
After graduating from the program, students better understand what the specialty of perioperative nursing entails and are ready to enter Periop 101: A Core Curriculum. This is AORN’s six-month program to train novice nurses in perioperative nursing.
“Periop 101 is the premier perioperative nurse education program for RNs entering the perioperative specialty,” says Groah. “Hospitals and ASCs that use Periop 101 report quality improvement, reduced training time for staff and educators, and stronger staff recruitment and retention.”
Cox believes that perioperative nursing was an ideal specialty to use as a pilot for the nurse education model because less than three percent of pre-licensure nursing school graduates seek employment in this setting. “This is largely because students have limited or no exposure to perioperative services in nursing school,” she says.
Groah is encouraged by students’ response to the program. “More than 80 percent of the students who have completed the program have entered into the perioperative specialty or are considering it,” she says.
Throwing Out the Old Playbook
At AnMed, Dennis says they have thrown out the old playbook when it comes to attracting and retaining perioperative nurses. “It’s important to understand the dynamics of the generations who are practicing today,” she says. “Hospitals can’t compete with the salaries of travelers, but what we can do is create a culture where nurses want to work.”
To this end, AnMed now holds town hall meetings each quarter with all departments so staff can voice their concerns. “We’ve also eliminated call for both the OR and PACU by hiring call teams to cover with a higher rate carrying the beeper with still time-and-a-half when called back,” she says.
In addition, AnMed permits self-scheduling for nurses and offers 8-, 10- and 12-hour shifts.
“All nurse managers are required to perform 1:1 rounding with staff,” says Dennis. “We’re also offering nurses retention bonuses and incentive pay, and we’re creating a full-time position with six months on and six months off with an annualized salary, similar to teachers.”
AnMed has also converted travelers to full-time positions. “We treat travelers like family so there is consistency with care and a more permanent staff,” says Dennis.
Kirchner says that working in an ASC limits some of what her organization can do to help with the nursing shortage. “But we have discussed using our center as a clinical site for nursing students,” she says. “They can learn to take and assess vital signs, start IVs, learn sterile technique and how to perform a nursing assessment, and teach patients how to care for themselves post-surgery.”
Taylor suggests partnering with local universities and incentivizing staff with the right credentials to become adjunct faculty.
“This will help augment the universities’ need for faculty and allow more students per class,” he says. “Also offer your facility as a clinical site since clinical rotations are critical for learning.”
Nurses Seek Work-Life Balance
Groah stresses the importance of offering workplace flexibility.
“This is so important to nurses today,” she says. “Work-life balance is crucial and nurses need flexibility to support their mental health.
“Additionally, institutions must continue to provide greater flexibility for nurses to explore their numerous career possibilities while fostering the introduction of new technologies that can simplify and lighten a nurse’s workload,” adds Groah.
Taylor also suggests naming spokespeople who can engage with your community.
“Nurses are the best advocates for the profession,” he says. “During Nurse’s Week and other community functions, set up a booth to offer health screenings and have your recruiters and nursing leaders available to interview potential perioperative nursing candidates.”
In addition, Taylor recommends visiting elementary and middle school career fairs to talk about the nursing profession and plant seeds early that can be fertilized over time.
“Our young people need to know why we entered the profession and why it can be an opportunity for them,” he says.
According to Kirchner, Texas has started providing nursing prerequisites in some specialized high schools so when students who have taken the nursing track in high school graduate, they can immediately apply for nursing school.
“This is a great move,” says Kirchner. “However, Texas has turned away over 10,000 qualified applicants a year for many years due to insufficient professors or clinical sites.”
Dennis believes it’s important to understand the culture in your facility if you want to understand what is impacting the nursing shortage.
“Encourage professional development among nurses and allow them to practice to the full extent of their education and training,” she says. “Nurses should be full partners with physicians and other professionals in the health care setting.”
Desperately Seeking Solutions
Kirchner says that nursing leaders in national organizations are desperately seeking solutions to the nursing shortage.
“I believe leaders have looked at the history of the nursing shortage and decided that what was tried in the past did not work and will not work now,” she says. “As working nurses, we need to support our leaders and nursing schools to help them solve this critical problem.”
