2 Major Impacts of the Nursing Shortage

Addressing the nursing shortage requires a careful, multipronged strategy and a mindful approach.

The national nursing shortage is an ongoing pain point for CNOs and for healthcare organizations across the country.

It's critical for CNOs to understand why the nursing shortage is happening and the full extent of its impact, so they can develop robust strategies for combatting it.

According to Dr. Brad Goettl, chief nursing officer at the American Nurses Enterprise, the nursing shortage impacts a health system's financial situation and care delivery for patients. 

Economic impact

CNOs need to know that the nursing shortage has more of an impact on some areas than others, and there are still many people who are interested in becoming nurses, Goettl explained. However, there is a shortage in faculty and training capacity in educational settings.

"I like to point that out because it really is part of the solution to the workforce, making sure that we have enough training capacity at our universities to be able to get people that are interested and qualified through training programs so they can get out there and take care of our patients," Goettl said.

From an economic perspective, it's expensive to operate under workforce shortages. Labor costs are higher across the country in every aspect of healthcare, Goettl explained, but having to fill the gaps with agency nurses and overtime pay is also costly. Average turnover can cost a typical hospital anywhere between $4 million to $6 million a year.

"That can turn into this cyclical process where people are working too much, they get burnt out, and then they call out and then we're short," Goettl said. "We know that the average cost of turnover of a nurse can be upwards of $40,000 to $60,000, and it's only going up as labor costs are going up."

According to Goettl, there are significant financial returns from investing in turnover.

"Hospitals that invest in this, for each percent change that they decrease their turnover, they can save almost $300,000 a year," Goettl said, "so that investment in retaining your staff and keeping your staff and investing in your staff really comes full circle."

Patient care delivery

The impact on care delivery is largely straightforward: If there are not enough nurses to take care of patients, or if nurses are spread too thin, patient outcomes suffer.

"We have a healthcare capacity issue," Goettl said. "It's not just happening in the acute care hospital environment, but really all clinical environments, and patients are often being held all over the hospital while they're waiting for rooms, or there are delays in getting outpatient treatment [and] elective or semi-urgent procedures."

This causes barriers to healthcare access, and in turn that negatively impacts public health, Goettl explained.

"We know that there are poor outcomes to patients that are being treated at facilities that have nursing shortages or are understaffed," Goettl said. "That can translate to increases in pressure ulcers or outcomes, falls, increased mortality rates, and even nurse injury because you're not able to have your nurse colleagues help you with lifting, boosting, or needle safety."

Filling coverage gaps

For CNOs who are working towards addressing these shortages, Goettl recommends caution when developing staffing strategies.

"Don't spread your staff so thin and then make that the new normal," Goettl said. "[You] still have to invest in appropriate and safe nurse staffing, but the big investment is in professional development, providing opportunities for non-nurses like techs and LPNs to go back to school so they can stay in the health system."

Goettl emphasized the role of virtual nursing as well, as an opportunity to augment staffing. Virtual nursing can help with teaching, peer-to-peer mentorship, and retaining seasoned nurses who can work as preceptors or as clinical mentors.

"It doesn't replace a nurse, but it can definitely help in scenarios where you need to spend more time with patients," Goettl said.

Work-life balance is critical for nurse retention, Goettl said. Solutions such as self-scheduling and flexible scheduling can give some autonomy back to the nurse and simultaneously help fill up the schedule while empowering nurses to do what's best for them. Investment in transition to practice programs is also key.

“Investing in your nursing staff so that they have the tools [that prepare them] to do their job will help with retention all the way around," Goettl said.