The current shortage of healthcare workers is unprecedented, and some hospital administrators fear the worst challenges are yet to come. Nurses are leaving in droves—some for higher-paying travel nurse positions, others choosing early retirement—while replacing them becomes increasingly difficult. Meanwhile, many nurses are abandoning the profession due to the physical and mental toll of two years on the front lines of the pandemic, making it nearly an "impossible task" for many healthcare systems to fill vacancies.

The U.S. Bureau of Labor Statistics projects that by 2030, U.S. healthcare facilities will need to fill nearly200,000 nursing positions annually, a significant portion of which stems from the need to replace nurses who have changed careers or retired.

"This is the largest workforce shortage we have ever faced," said Gay Landstrom, senior vice president and chief nursing officer at Trinity Health, a national nonprofit healthcare system that operates 88 hospitals across the country.

Although some systems anticipate that nurses who have left will eventually return, hospital officials point out that the workforce shortage predicted for the coming decade, even before the pandemic, is likely to persist due to the aging nursing population. In 2020, the average age of registered nurses in the U.S. was51 years old(according to a survey by the National Council of State Boards of Nursing), and a large number of senior nurses will enter retirement over the next two decades.

Although public interest in healthcare careers such as nursing has not waned, shortages of nursing educators and clinical placement sites pose an imminent challenge to the pipeline of new nurses.

Some healthcare systems are striving to retain nurses in the short to medium term by improving benefits and establishing internal staffing agencies; others are seeking to strengthen partnerships with academic institutions to bolster their future talent pipeline.

"The role of the nurse must be attractive," Landstrom said. "We need to provide appealing work that doesn't lead to burnout."

Nurses face violence and high pressure

During the pandemic, multiple surveys have consistently found widespread stress and burnout among the healthcare workforce. Some nurses report declining job satisfaction, and ongoing staffing shortages make it difficult to ensure quality of care, which has become unbearable for some.

A recent survey by staffing company Incredible Health found that more than a third of nurses plan toleave their current positionsby the end of the year, primarily due to burnout and high-stress work environments; the survey also found that higher pay is the top motivator for job changes.

Nurses surveyed also noted a rise in verbal and physical violence, half attributed to COVID-19 prevention regulations and the other half to issues such as longer wait times caused by staffing shortages.

Landstrom said shortages of support staff such as nursing assistants and patient care assistants exacerbate the situation, preventing nurses from practicing to the full extent of their abilities. "We must work harder to develop nursing assistants and ensure a steady flow of talent into both the nursing assistant and registered nurse pipelines."

Shortage of nursing faculty and seats

Despite the pandemic's heavy toll on the nursing profession, the number of students pursuing nursing degrees did not decline in 2020 (the most recent year for which data is available). According to a survey by the American Association of Colleges of Nursing, in 2020, enrollment in entry-level baccalaureate, master's, and Doctor of Nursing Practice programsgrew by 5.6%, 4.1%, and 8.9%, respectively, and has been rising steadily over the past 15 years.

However, that same year, approximately 80,000 qualified applicants were turned away from nursing programs due to resource constraints, primarily shortages of clinical placement sites and faculty.

"I don't think there will be a shortage of people willing to become nurses, but the challenge lies in getting them through nursing school," said Rita Wise, director of nursing programs at Pennsylvania College of Health Sciences. She noted that the faculty shortage stems mainly from the requirement that nursing educators hold a master's degree, and nurses with master's degrees often choose higher-paying positions in hospitals or clinical settings rather than teaching.

Additionally, nursing students need to gain experience in real clinical settings. Early in the pandemic, hospitals significantly reduced internship opportunities due to shortages of protective equipment, and although these have gradually recovered, nursing schools in a survey at the end of 2020 still citedlimited clinical placement sitesas the primary reason for turning away qualified applicants.

Wise noted that hospitals and other practice settings lack incentives to take on students because precepting requires additional time and resources, which is even more challenging amid current staffing shortages. Medicare currently helps reimburse some facilities for precepting costs, but not all programs qualify. Organizations such as the American Hospital Association havecalled on Congressto expand related programs to address the ongoing workforce shortages caused by the pandemic.

Academic partnerships and pipeline building

Two years after the outbreak of the pandemic, healthcare systems are still seeking partnerships with nursing schools and other academic institutions to alleviate concerns about the future talent pipeline. "We need to go beyond what we've done before and truly partner with academic institutions," said Landstrom of Trinity. She added that the transition from nursing programs to actual practice should be smoother, especially at a time of increased turnover.

Craig Laser, clinical associate professor at Arizona State University's Edson College of Nursing and Health Innovation, said hospitals and nursing schools used to collaborate more closely than they do now, and the pandemic is driving them to strengthen cooperation. Today, hospitals and nursing schools are "discussing supply and demand issues more than ever."

Wise of Pennsylvania College of Health Sciences knows the value of such partnerships well. She graduated from nursing school in the early 1990s, worked as a paid intern at a local hospital during her student years, and then worked at that hospital for 19 years after graduation. "That hospital truly got a return on its investment," she said.