By Nat'e Guyton, RN, MSN 

While we currently have over 3 million registered nurses in the U.S., demand for these professionals will continue to grow by at least 5% over the next 5 years. But according to research, with more than 900,000 nurses expected to permanently leave the profession during that same period due to retirement, burnout, or career change, over half of U.S. states (29) will not be able to fill the demand for nursing talent.

Simply stated, our ability to educate and prepare enough nursing professionals to sustain today's healthcare system is falling far short for the pipeline we need. Knowing that nurses spend more time with patients than other disciplines in healthcare, system leaders need both short-term and long-term strategies to avoid the significant ramifications to healthcare delivery and hospital operations this growing problem may cause.

Without rapid course correction to solve this challenge at scale, all stakeholders in healthcare, including patients, will feel the impact. There are three key areas where healthcare leaders need to reconsider current strategies in order to effectively address this growing workforce problem.

New Models of Nursing Care Delivery

The current Individual Patient Allocation and Nurse-to-Patient Ratio models of nursing care delivery are not suitable or effective given current industry challenges. With a shortage of nurses, the individual patient allocation model is inherently broken. The idea of nurse-to-patient ratios is good in theory, but fails in practice because hospitals are not able to turn away patients or discharge them early to open capacity for patients who need care.

Further, the hospital cannot hire more nurses, thus exasperating frustrations. These two staffing models are clearly unsustainable without a dependable and renewable nurse workforce. That means we must review, test, and scale the most appropriate alternative workforce models.

Team-based nursing, for example, isn't a new concept, but it should be considered as a tool to combat the emotional and physical burnout felt across the healthcare ecosystem. The team-based nursing model was developed in the '50s to address a staffing shortage. By distributing the breadth of skills needed for holistic care across multiple clinicians with complementary skill sets, team-based nursing reduces the pressure of needing to be an expert in every area of care. With widespread adoption, systems could bring in more specialists to join a care team, adding bandwidth and building a bench for the future.

On top of the new staffing models, healthcare leaders must create career paths that encourage specialists to build additional skills sets with commensurate compensation, resulting in a sustainable and long-term staffing solution.

Balance and Mental Health Benefits

Work and life are changing for everyone, and for nurses the challenges at work are often extreme. In the pandemic, the decisions nurses made were life or death, and policies were constantly changing. We are in the process of paving a new future of work where professional and personal lives are blended. Employers must support the overall health and security of their employees to create a long-term, symbiotic relationship. We're already seeing great progress in other industries, and the nursing industry has a lot of catching up to do.

Scheduling practices are part of the solution. For over four decades, 12-hour shifts have been utilized by healthcare systems to address staffing shortages. Unfortunately, it created an even larger challenge, negatively impacting nurses' health and contributing to insomnia, anxiety, and stress. Research found that the odds of emotional exhaustion for nurses working 12 or more hours in a shift is 26% greater than for those working shifts 8 hours or less.

According to a 2021 survey of nearly 20,000 RNs in the U.S., 39% reported flexibility and work-life balance as factors influencing job retention. Healthcare leaders must explore new approaches to nurse scheduling and implement staffing models that protect the health and wellness of nursing professionals, as well as promote job satisfaction to attract new talent. Empowering nurses to select 4-, 8-, or 12-hour shifts that fit their family commitments and their capacity for short-term stress will result in long-term satisfaction.

Changing scheduling practices alone won't solve burnout -- health systems must also implement on-site wellness coaches, mandatory meetings with employee assistance counselors, and higher salaries. Staffing adjustments to support team members as whole individuals, not just employees, will inherently lead to greater gratification and better retention.

Technology-Based Care

With fewer nurses to deliver care, technology must be considered a standard part of healthcare delivery models. As digital transformation continues to expand, nurses need to be included in the discussion, design, and integration of new and innovative technology.

When used appropriately, technology can benefit nurses and help to reduce burnout without completely changing the way nurses work. A great example of this is Moxi, the robot, or "cobot," currently being deployed in the ChristianaCare health system. Moxi is designed to handle administrative tasks like retrieving equipment and supplies for nurses, allowing nurses to spend more time with patients. As leaders, we need to seek out alternatives like grants for innovation, and implement technology that actually benefits staff members.

It's important to keep in mind that technology is only as effective as the people operating it. This plays into at least two of the "seven deadly barriers" for telemedicine, adoption and evidence, which are key to the success of telehealth and healthcare technology more broadly -- and also require nurse buy-in. To make sure these tools are being used to their full potential, leaders must invest in their workforce by demonstrating the value of new technology and training nurses on how to use it.

Moving Forward

We cannot continue to operate in healthcare the way we have in decades past. The nursing industry is certainly due for modernization -- including updates to technology, policies, and benefits. Now is the time to be innovative, consider alternate approaches to care delivery, and invest in our nursing colleagues in new ways. This begins with looking more closely at workflows, scheduling practices, and how technology is shaping care delivery. We must invest in our workforce to keep improving and eventually create a more sustainable healthcare system for nurses, physicians, health systems, and patients alike.