How to Fix the Nursing Shortage


The US healthcare system needs more nurses. Nursing schools are not producing enough graduates, young workers are quitting and older workers are retiring early. Throughout the pandemic, widespread shortages reduced the quality of care and even claimed lives. To strengthen the workforce and better prepare for the next crisis, the US needs to invest in its domestic pipeline and remove barriers to qualified international talent.

Nursing shortages have been a problem for decades and will continue long after Covid-19 has abated. Not only is the US population aging, but nurses themselves are aging. Some researchers estimate that 1 million registered nurses will retire by 2030.

In the past, hospitals, nursing homes, clinics and other healthcare facilities have turned to staffing agencies when they have shortages. Traveling nurses, as they are known, travel all over the country and typically work for 13 weeks. At the height of the pandemic, they could easily triple or quadruple their pre-pandemic salaries and make $5,000 to $10,000 a week.

This arrangement sounds like a good deal: healthcare facilities get the staff they need and nurses get paid well. But the rise of traveling nursing had several unintended consequences.

First, nurses demanding higher wages defect. Contract nurses now make up 8% to 10% of the workforce in hospitals, down from around 4% before Covid. Employers operating on razor-thin profit margins are struggling to raise salaries at a time when federal Covid funding has dried up. Hospitals spent nearly 40% of their total nurse labor costs on travel nursing in January 2022, up from 5% in 2019, according to the American Hospital Association, which expects labor costs to increase by $86 billion this year the fear of turnover makes employers even more reluctant to lose their contract workers.

Traveling nurses have their own reasons for concern: while the pay is good right now, they don’t have the benefits of a salaried job if demand eventually changes. Reports of surprise pay cuts are already emerging. The patients, on the other hand, suffer most from the long-term higher fluctuation.

Some lawmakers want to investigate whether the rise of contract nursing has unduly hurt the healthcare industry. A better question is why aren’t more nurses making it into the field in the first place.

One reason is lack of funding. In 2021, nursing schools rejected more than 90,000 qualified applications because they did not have enough educators or clinical internship positions. Low or no pay is a primary challenge. Congress should expand funding for tuition reimbursements for nurses who teach and for those who commit to work in shortage areas. Public-private partnerships, on the other hand, would better integrate schools and workplaces to facilitate clinical training.

Foreign-trained nurses are another under-utilized resource. The Migration Policy Institute estimates that about 118,000 immigrants with a bachelor’s degree in nursing work below their skill level, many as low-paid assistants, home attendants and domestic help. Streamlining their re-credentialing process would help increase staffing levels in times of immediate shortages. Priority placement in underserved facilities such as nursing homes would also make sense.

Finally, better oversight of the work program for foreign graduates from US universities is long overdue. The optional internship program grants a three-year work visa to certain STEM majors. It is inexplicable that drama therapy and journalism graduates qualify when nursing is excluded. Such a change could add tens of thousands of future nurses in one fell swoop.

Tapping into the large pool of aspiring and qualified nurses that already exists in the US would strengthen the healthcare system for the next pandemic, reduce reliance on contractors, and bring unbalanced labor market dynamics back to reality. A more sustainable caregiver will ultimately save money and lives.

More from the Bloomberg Opinion:

• A better flu shot? Hurry, Pfizer and Moderna: Lisa Jarvis

• Nurses shouldn’t have to be martyrs: Stephen Mihm

• An NYU professor was fired. Then everyone missed the point: Faye Flam

The editors are members of the Editorial Board of Bloomberg Opinion.

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