Pennsylvania Illustrates America’s Nursing Shortage

By Kyle Sammin

These days, it seems like there are shortages of everything. While the media has largely focused on shortages of goods, the increasingly tight labor market is also having widespread effects. Nowhere is this truer than in the shortage of qualified nurses. It’s a serious problem with many causes, most of which relate to the COVID-19 pandemic. Unless something is done to correct the problem, many hospitals – especially those outside of major cities – will face ever-worsening staffing crises.

Part of the problem is demographic and has been predicted for years. The Baby Boom generation is now fully into retirement age, but many Boomers have chosen to work past 65 or even 70. And why not? If people are in good health and enjoy their jobs, there is no reason not to put in another year or two and save more for that eventual retirement. Still, as early as 2009, the Highmark Foundation and others anticipated a severe labor squeeze in the profession by 2025. More recently, numbers have begun to decline seriously in some states.

The pandemic significantly accelerated this timetable. In the face of a virus that overwhelmingly harms older people, it is not surprising that many who were eligible to retire would do so. Added to that was the sad reality that some nurses died of COVID, often early in the pandemic when vaccines and better treatment options were not yet available.

Struggling to replace these front-line losses has made for tough going in many hospitals – and Pennsylvania hospitals have been as hard-hit as any in the country. Speaking to the York Daily News this summer, nurse Bill Engle said, “we’re giving safe care, don’t get me wrong. But the margin for error is getting slimmer and slimmer, and nurses are getting more burnt out.”

The commonwealth made some efforts to alleviate that shortage by suspending some licensing requirements as an emergency measure last year. As Danielle Ohl reported for Spotlight PA, these measures “included allowing out-of-state practitioners to treat patients in Pennsylvania, permitting retired or lapsed professionals to return to medicine, and expanding who could give a vaccine.”

Healthcare providers in other states have responded similarly, leading to a spirited competition for labor. In some ways, rising labor prices – that is, higher pay – is a good outcome, since it means more benefit to nurses and their families. But with wages rising so much, hospitals in poorer areas cannot compete with richer ones. Staffing agencies help accelerate the trend by hiring nurses from across the U.S. to work with employers that can afford higher salaries and signing bonuses.

That’s a great story for the individual who gets a good paycheck. Paying off student loans or saving for a house is much easier when one’s skills are in high demand. But it leaves many struggling communities in the lurch.

The constant churn forces less-experienced nurses into leadership positions earlier than ever before. That contributes to overwork and burnout, leading some nurses to leave the profession. Peg Lawson, a nurse at Philadelphia’s Einstein Medical Center, told the Philadelphia Inquirer last month, “we are experiencing a turnover rate now that I’ve never seen in the 30 years I’ve been at Einstein. Every day, someone leaves. Nurses used to be here for three or four years before moving on; now, it’s three or four months.”

Vaccine mandates at hospitals will have an impact, too. While most medical professionals were vaccinated months ago, some have resisted. With deadlines fast approaching in Philadelphia and more to follow elsewhere, the most stubborn holdouts may look to the abundance of job openings across the country – some in states or hospitals without such mandates – and choose to relocate.

With so many causes contributing to the nursing shortage, no one claims to have a perfect fix. Part of the solution will inevitably include paying more in wages and benefits to keep qualified nurses from leaving – a heavy lift for an already-strained medical system. What else might help ease the labor crunch? Patricia Duddy, a nurse manager at Einstein Medical Center, says that better use of nurses at or near retirement age could be part of the answer. “They have the knowledge and experience, so we can use them as a resource to supervise four new nurses on a unit to provide better safety for the patients,” she told me. This way, “they can stay around longer and not retire, but avoid doing the physical care that is pushing them to retire because of bad backs, knees, or hips.”

Smarter use of existing staff would surely help, but even as COVID fades from the scene, getting more people into the nursing profession – and keeping them there – is a must. Finding the way to do that will be a serious challenge for the nursing industry over the next decade.