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Clinical workforce shortages can pose enormous risks to a healthcare industry crippled by low employment growth rates, leading to significant margin losses and, in some cases, hospital closures. The shortage of nurses is nearing a crisis point as a result of retention challenges, issues around pay differentials and overall costs for contract workers, and an aging workforce. More nurses left the nursing profession in 2021 than in any previous year and there will be an estimated 200,000 openings for registered nurses annually between now and 2030. Healthcare systems are taking steps to be more proactive in developing the nursing workforce pipeline.
In 2020, more than 66,000 academically qualified students were turned away from four-year bachelor of science in nursing (BSN) programs due to a scarcity of seats, caused in part by a shortage of qualified faculty and clinical training sites. Academic institutions have made efforts to increase the size of nursing classes, but there remains a need for a coordinated strategy across the educators and employers of the nursing workforce.
Many academic institutions are getting creative by exploring faster pathways to graduation, including 12- and 16- month BSN programs for students who qualify through a prior degree or transferable credits. Programs are also using satellite campuses and summer programs to help address the shortage of clinical sites and clinical faculty. Meanwhile, some health systems are developing innovative strategies to bring nurse training into the clinical care environment, including initiatives modeled after physician residency programs.
Providers can join forces with academic institutions to play a role in educating and training nurses, thereby creating the clinical workforce of the future. They can:
- Accommodate a learning environment for nurses-in-training by opening up clinical placement slots, thus allowing academic students to enroll more nursing students.
- Design staffing and employment models for the existing nursing workforce to teach nursing students, helping to alleviate the faculty shortage. Providers can also offer creative incentives to encourage nurses to return to academia, and academic institutions can focus on employing enough nursing faculty to support higher volumes of students.
- Explore recruitment and retention opportunities for new nurses through educational incentives.
- Build recruiting pipelines and streamlined processes via clinical placements in limited undergraduate education areas, including peri-op, ICUs, ORs, EDs, pediatrics and home care/ambulatory clinics.
- Partner with academic institutions to develop collaborative models allowing for increased nursing student enrollment and clinical training opportunities at the hospital system.
- Some hospitals partner with universities to offer an accelerated BSN work-study diploma program for registered nurses to earn their degree while being fully employed.
- Some medical centers offer their own staff, resources and facilities to assist with training students in exchange for a return on service from students.
Health system leadership can focus on reestablishing trust with the healthcare staff through robust communication and greater care team investments, including technology upgrades, expanded benefits and flexible staffing to help teams quickly adapt to fluctuating patient volume. Many different nurse “personas” exist among the nursing workforce. Taking a long-term approach by catering to individual needs – which are evolving with the arrival of new generations to the workforce – and tailoring retention initiatives to specific personas could forestall debilitating shortages the next time there’s a major health crisis. Consequently, providers can:
- Attract and keep top talent through streamlined recruiting processes and by building a reputation for sufficient staffing, minimal administrative burdens and a supportive work culture focused on the well-being of team members.
- Focus on supporting the nursing workforce by prioritizing patient-centric organizational values and culture, continuing education and recognition for high-performing bedside care.
- Develop career pathways that support leading practice clinical care, quality and leadership development.
- Revisit the organization’s total rewards package with a focus on the employee value proposition.
- Go beyond conducting market analysis to compare salaries in the region. Reexamine work-satisfaction surveys and act quickly on the feedback.
The nursing shortage owes in large part to burnout: Daily stresses faced by nurses and other clinical providers have resulted in moral injury and emotional exhaustion. Care teams, which blend interdisciplinary skills to help align team member insights, goals and provide comprehensive care delivery, focusing on the patient, can be redefined:
- Evaluate existing workflows and handoffs across the patient care team to help create different approaches to performing daily tasks.
- Expand the care model to be interdisciplinary, thus reducing the burden on RNs. For example, paramedics can be leveraged to accelerate care in order to lessen the burden on care teams and improve patient experience.
- Reimagine the traditional model for ICUs and med-surg units by redefining roles within the team, delineating caregivers’ responsibilities and considering new ways of working to support top-of-scope activities for caregivers.
- Deploy surveys to help identify unnecessary administrative burdens and create strategies to help manage work more effectively.
- Leverage innovative models — pools, travel agencies, patient care support and virtual care — across hospitals, providing staff with opportunities for flexibility.
- Consider new approaches to staffing design including non-clinical rotations, expanded preceptor opportunities and administrative roles requiring clinical acumen to help break up the daily routine.
While healthcare has lagged behind some other sectors in adopting technology-enabled strategies, many organizations are building connected health ecosystems, requiring them to embrace cloud and digital, help build consumer trust and invest in intelligent technology for the workforce. These initiatives are most effective when they’re informed and guided by clinical technologists so that solutions and capabilities can be designed and used in ways that enhance nursing practice.
An effective workforce strategy complemented by the right technology investments begins with optimizing the use of the current portfolio, upskilling the digital literacy of stakeholders, and taking full advantage of advanced technologies like artificial intelligence (AI) to better inform operational decision making.
Disconnected manual tools can hinder the efficiency and productivity of healthcare workers, further adding to the administrative burden nurses often bear and ultimately impacting the quality of patient care. Decisions about using technology to address nursing burden and quality issues are often driven by the affordability of the systems and tools. Healthcare systems should involve clinicians in the vendor selection process and even partner directly with vendors to help drive technology adoption that better supports improved employee experience.
- Automation, A1 and machine learning solutions help decrease the administrative burden of redundant tasks, streamline task lists, and provide decision support at the point of care. Deployment of applications helps accelerate recruiting processes to better match candidates to job requirements and optimizes the hiring and onboarding process.
- Enhanced communication based on analytics facilitates better communication among nurses, between nurses and patients, and between the nursing team and the larger healthcare organization. Staffing assignments can be informed by analytics related to the volume and frequency of interventions each patient requires rather than strictly based on the number of patients assigned to each nurse.
- Clinical decision-support tools can be used for real-time insights to help assist nurses in making evidence-based decisions on care, including early sepsis warnings, readmission risks, and automated fall detection. These enhanced tools can also reduce alert fatigue, caused when the volume of electronic beeps signaling patient needs and pop-up reminders about other obligations becomes so overwhelming that caregivers are no longer able to help identify and respond to the most urgent alerts.
Predictive analytics informed by multiple data sources for precise predictions — for example, the numbers of patients projected to be admitted to the ER — can help identify risks or staffing issues and address them before they interfere with patient care.
The Future of Healthcare
The future of healthcare will likely demand a more agile workforce and new approaches to delivering care, requiring nurses to be more agile than ever before. Healthcare systems and educational institutions can help close the staffing gap by using short-term and long-term strategies to bolster the education and training of nurses and to increase retention. If healthcare leaders dedicate the time and resources to improving the everyday working experience for nurses, the current crisis could trigger positive, sustained change for nurses and other healthcare workers.
By striving for measurable improvements, the sector may emerge stronger for patients as well as the healthcare workforce.
By striving for measurable improvements, the sector may emerge stronger for patients as well as the healthcare workforce.
Conclusion
Health systems need to build the nursing workforce of the future by creating an active learning environment and reimagining the employee experience to retain the workforce and help them thrive. The current environment presents an opportunity for health systems to make constructive, long-term improvements to educate, employ, and retain nurses, thereby creating a virtuous cycle for clinical workforce development. Explore this and other topics in the future of healthcare at https://www.pwc.com/us/en/industries/health-services.html.
Insights
Healthcare organizations building their nursing workforce can gain the greatest benefits from existing and emerging technologies.
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