In the midst of a nationwide healthcare crisis, where nurses are striking due to staffing shortages, a paradoxical problem persists – nursing schools are turning away thousands of qualified applicants. The American Association of Colleges of Nursing reported a staggering 78,200 qualified applications were rejected last year, an alarming number that showcases the urgency to train more nurses in the United States. As the demand for healthcare professionals rises and nurses face burnout, the staffing industry could bridge this gap and ensure that the healthcare system thrives.
The Nursing Shortage Problem Isn’t New, It’s Just Growing
In November 2021, we posted an article entitled “Nursing Schools Lack Teachers. Perhaps We Should Be Training Veteran Nurses for Those Roles.” Nearly two years later, an eerily similar headline has emerged in mainstream media.
For context, nursing schools in 2018 were forced to reject 75,000 qualified applications because of inadequate staffing, teaching facilities, clinical sites, and funding. Without access to the proper education and credentialing, fewer nurses will be trained and ready to join the labor force.
NPR’s Yuki Noguchi wrote at that time, “Across the country, hospitals desperate for nurses — especially in acute care —are trying to address intense burnout among health care workers and accelerated nurse retirements by hiring new graduates. They're offering jobs to students even before they graduate, and in many cases offering bonuses and loan repayment as financial incentives.”
Here we are in the final stretch of 2023, and the number of qualified applicants rejected for the same reasons has climbed to nearly 79,000. Of those applications, 66,300 were for entry-level bachelor’s degree programs — in other words, roughly 84% of those rejections represented a fairly robust pool of potential new nurses to fill critical shortages, rather than the remaining percentage, which covered established nurses looking to advance their education, probably in anticipation of moving up to positions beyond the bedside.
Back in 2021, data released by the American Association of Colleges of Nursing (AACN) indicated that student enrollment in baccalaureate, master’s, and doctoral nursing programs had increased despite concerns of diminishing interest in nursing careers. “In programs designed to prepare new registered nurses (RNs) at the baccalaureate level, enrollment increased by 5.6% with 251,145 students now studying in these programs nationwide,” AACN’s annual survey found. Unfortunately, schools had fallen victim to long-standing bottlenecks in the system.
Today, little has changed. “Staffing shortages are the main reason why nursing schools are not able to accept more students who want to become registered nurses,” Tami Luhby explained in her article for CNN. “The programs are contending with a lack of faculty, clinical placements for students and preceptors who supervise the students during their rotations at health care providers. Preceptors also have strict limits on how many students they can oversee, with the ratios often set by state nursing boards.”
“The staffing crisis, as well as the strenuous working conditions in the early years of the Covid-19 pandemic, has left many registered nurses — and other health care workers — feeling burned out and thinking of leaving the profession,” Luhby added. “ It’s a main reason why nurses around the country have gone on strike or threatened to recently.”
The demand for nurses will only grow as Americans age and enjoy greater longevity than generations past. But many challenges exist in accommodating that demand.
Money Is the Root of the Staffing Shortage Problem in Nursing Schools
Nursing schools, the incubators of future healthcare professionals, are grappling with severe faculty shortages, limited clinical placements, and preceptor constraints. The shortage of qualified educators, exacerbated by low salaries, inhibits the expansion of nursing programs. Clinical placements, vital for hands-on training, are hampered by hospitals’ own staffing challenges, leaving aspiring nurses with limited opportunities for practical learning.
Judith Jarosinski, professor emerita at Salisbury University’s School of Nursing in Maryland, told Luhby and CNN that salary remains one of the biggest obstacles — the “elephant in the room” where recruitment and retention are involved.
“The national median salary for nursing school professors with master’s degrees is just under $89,000, according to the nursing college association,” Luhby wrote. “But the median salary for advanced practice registered nurses, who hold graduate degrees, is $120,000, according to the 2022 Nurse Salary Research Report issued by Nurse.com, which the association cites as a comparison in a fact sheet. The figures can vary by region of the country.”
The salary debate, certainly, has been a large topic lately, particularly with large-scale strikes ramping up, such as with Kaiser Permanente. Health system CEOs have publicly lamented the “crisis pay” surges the pandemic accorded skilled nurses and travelers. Once the worst of the COVID-19 outbreak subsided, these executives rushed to reduce pay back to pre-pandemic levels. But it’s also opened them up to a lot of scrutiny in the press.
Pay Disparities Between Clinicians and Administrators
The pay disparity between hospitals’ administrative staff and clinical staff is exploding, according to research out of North Carolina State Health Plan. Many CEOs covered in the study saw their salaries increase by more than 700% over the past handful of years, while doctors and nurses received a fraction of that bump — in the neighborhood of 15% to 20%, across an entire decade.
“The disconnect between the soaring pay of hospital leaders and the plight of nurses and patients is a symptom of a dysfunctional health system that too often prioritizes moneymaking — even for systems technically classified as nonprofits — over patient care,” wrote Dylan Scott in Vox. “That’s especially true since many hospitals use aggressive tactics to extract payments from low-income patients and fail to deliver the community benefit that justifies their nonprofit status.”
“Existing evidence suggests that hospital CEO pay is not meaningfully tied to quality of care or patient safety,” the authors of this new study, commissioned by North Carolina State Treasurer Dale Folwell and peer-reviewed by academics at Rice University and Johns Hopkins, wrote. “Instead, experts have warned that too many hospital CEOs and top tier executives are financially incentivized to cut costs and boost revenue in ways that threaten patient safety and hurt affordability.”
Accusing Staffing Agencies of Price Gouging (Most Didn't)
During the height of the pandemic, the staffing industry played an instrumental role in helping healthcare providers find travel nurses, bolster float pools, and otherwise ramp up the numbers in systems where resignations and dwindling applications have severely impacted the remaining staff.
But recruiting and retaining travel nurses is a difficult task. Retention strategies today must include commensurate increases in wages, hazard pay, and safer nurse-to-patient ratios. But as we pointed out in our March 2022 coverage of the situation, staffing agencies came under fire for alleged price gouging amid the pandemic. And some lawmakers took action, with nearly 200 congresspeople writing to the White House to compel an investigation into price gouging by staffing agencies.
Some states saw red flags when travel nursing salaries increased by up to 40% and staffing agency revenues “soared” to an increase of nearly 60%. However, the condemnation didn’t really make sense—nor did presuming that these spikes resulted in pure profits for the agencies.
Toby Malara, vice president at the American Staffing Association, offered much clarity in this matter when he spoke with KFF Health News: “Typically about 75% of the price charged by a staffing agency to a healthcare facility goes to costs such as salary, payroll taxes, workers’ compensation programs, unemployment insurance, recruiting, training, certification, and credential verification.”
He added, “hospital executives have, ‘without understanding how a staffing firm works,’ wrongly assumed price gouging has been occurring. In fact, he said many of his trade group’s members reported decreased profits during the pandemic because of the high compensation nurses were able to command,” KFF Health News reported.
Staffing Providers Have a Pivotal Role to Play
In the face of these challenges, staffing agencies play a pivotal role. By connecting experienced healthcare professionals with academic institutions, these agencies can help alleviate the burden on nursing schools and hospitals alike. Here’s how staffing agencies could make a significant impact.
Facilitating Clinical Placements
Staffing agencies can collaborate with hospitals to create specialized programs for nursing students. By providing well-trained, temporary staff, these agencies enable hospitals to open their doors to students without compromising patient care.
Filling Educational Gaps
Qualified nurses, especially retirees or those looking for flexible schedules, can step into part-time teaching roles. Staffing agencies can match these seasoned professionals with institutions in need, ensuring students receive high-quality education.
Supporting Nursing Education
Staffing agencies can financially support nursing education programs. By offering scholarships or grants, these agencies empower aspiring nurses, addressing the financial barriers that prevent many from pursuing their dreams.
In the 1950s, universities were churning out nuclear scientists and engineers in droves. But that field waned steadily over time as computer science and technology rose in prominence. Between 1997 and 2004, nuclear power plant staffing witnessed a year-over-year decrease of 20%. Retirement of senior engineering staff at nuclear generating facilities created a massive and complex set of challenges for the operators. However, some clever alternatives cropped up. Leveraging the power of skilled alumni as mentors was a critical component. Retired engineers and scientists were contracted to help develop protege candidates by serving as technical and career mentors. At a practical, on-the-job type level, these teachers were able to fill in the gaps left behind by exiting staff and even schools. Why can’t we do the same with nurses?
Using staffing alumni programs, nurses seeking to retire over stress—but who want to continue working—have the chance to utilize their expertise by working in teaching facilities to bolster faculty and expedite the training process for nursing students.
Investment in Training and Development
Hospitals, health systems, and other entities that can focus on training probably should. An experienced nurse has all the relevant knowledge for the role. Preparing that person to qualify as an instructor would require an investment in certification and education-specific training. However, that time would be well spent. And as we wrote previously, online learning is making that progress faster and easier.
Yet there remain other essential healthcare positions that organizations are filling with talent outside of the field. “Hospitals and systems are also struggling to fill more senior or specialized positions across a range of job functions, from hospital administration to highly specialized roles needed in specialty areas (e.g., infectious disease, intensive care, operating rooms, emergency rooms), or in fields like quality control and reporting, health IT, and data analytics,” explained Rebecca Love and Daniel Pianko in Fortune. “Those positions typically require no small amount of experience in health care, making it increasingly challenging to find candidates with the right skill sets and background to fill these positions.”
Veteran nurses bring most, if not all, of the experience, qualifications, and skills necessary for those roles. But as Love and Pianko note, health systems are instead hiring people from business, finance, and technical sectors. The article’s authors also offer a straightforward solution:
“Hospitals and health systems should create frictionless career pathways for nurses to enter senior leadership positions. It’s an approach that far too few hospitals take today, but there are a few compelling examples. At Sunrise Hospital in Las Vegas, for instance, the StaRN program recruits newly graduated RNs both to meet immediate demand for nurses and to provide training in a structured environment. When the program launched in 2015, the year-over-year nurse retention rate at Sunrise was around 50%. This year, it reached a new high of 93%—demonstrating that investing in nurses, even just within their first years of nursing, can help health systems attract and keep talent.”
Government Initiatives and Partnerships
The recent injection of $26.5 million into the Nurse Faculty Loan Program by the US Department of Health and Human Services is a step in the right direction. However, the government and educational institutions may gain more ground by collaborating with staffing agencies to create comprehensive solutions. Through this combination of resources, expertise, and financial aid, a sustainable model can be established.
Several institutions have already embraced partnerships with staffing agencies to overcome their challenges. Initiatives like the Faculty Academy and Mentorship Program in Maryland and the collaboration between Jefferson College of Nursing and Jefferson Health showcase the potential of such partnerships. These success stories underscore the importance of teamwork and innovation in overcoming the hurdles faced by nursing schools.
Looking Ahead: A United Front
As America's aging population continues to increase the demand for nurses, addressing the bottlenecks in nursing education is paramount. By fostering collaborations between staffing agencies, educational institutions, and the government, a united front can be formed. Together, we can ensure that every qualified nursing applicant has the opportunity to contribute to the healthcare system, creating a healthier, more robust future for all.
In the face of adversity, unity and innovation prevail. Let us join forces to build a future where no aspiring nurse is turned away, and where our healthcare system thrives under the care of skilled, compassionate professionals.