By: Anupa Fabian, Chief Evaluation and Learning Officer
At the Mother Cabrini Health Foundation, we understand that a thriving nursing workforce is the foundation for high quality patient care. Unfortunately, hospitals across the nation and New York State are finding it difficult to recruit and retain nurses, impeding their ability to provide the high-quality care their patients need. While the situation has improved since the pandemic, difficulties persist. According to a recent survey of hospitals across the US by NSI Solutions, the average RN vacancy rate was close to 10% at the start of 2024; nearly half of hospitals (48%) report a vacancy rate greater than 10%. In 2023, the national average RN turnover rate was about 18%, an improvement from the previous year (23%) though higher than what it was pre-pandemic in 2019 (16%). In New York State, according to SUNY’s Center for Health Workforce Studies’ 2024 report on the healthcare workforce, about 90% of hospitals found it difficult to recruit Registered Nurses (RNs), and nearly all hospitals (98%) found it difficult to retain RNs.
So, we set out to study the problem – what’s driving it and how we can solve it. We reviewed a range of studies and surveys on the topic. We spoke to stakeholders in the field including academics, nurse leaders, and industry experts. And, most importantly, we commissioned SUNY Albany’s Center for Health Workforce Studies (CHWS) to conduct a study with hospitals across New York State on the drivers of the problem and promising solutions. The CHWS study Understanding and Responding to Registered Nursing Shortages in Acute Care Hospitals in New York included interviews with chief nursing officers and executives, nurse recruiters, and human resources staff representing more than 50 hospitals, about a quarter of the 200+ hospitals across New York State.
Here‘s what we learned.
Major drivers of the problem are:
- Workplace culture and well-being: Nurses experience high levels of burnout, stress, violence, bullying, and incivility. Younger RNs report higher levels of burnout than older RNs. Workplace violence, while affecting hospitals generally, is of particular concern to urban hospitals. Burnout is both a cause and a consequence of the nursing shortage, creating a vicious cycle.
- Issues related to the younger generations: Some hospital HR and nurse leaders perceive younger nurses to be less mission-driven and more concerned about work-life balance. They are less clinically prepared, partly because they had less patient care contact in their training due to the pandemic. They tend to experience higher levels of burnout and higher rates of turnover.
- Experience gap: COVID accelerated the retirement of older nurses leaving a gap in mentoring and precepting for new nurses. Caregiving responsibilities also contribute to experienced nurses leaving the workforce.
- Localized shortages of talent to recruit from: Rural hospitals – large and small – find it difficult to recruit due to a general lack of supply. Hospitals without linkages to academic programs report more difficulties with recruitment than those with linkages. Many hospitals in rural areas and upstate hospitals report having less access to baccalaureate-prepared nurses due to fewer Bachelor of Science in Nursing (BSN) programs.
- Competitive hiring dynamics within the healthcare sector and outside the healthcare sector: Hospitals compete with other hospitals and with long term care to recruit and retain talent. Education programs find it hard to recruit faculty since teaching is not as well paid as clinical practice. The healthcare sector is also competing with non-healthcare sectors for recruitment.
CHWS identified a range of promising solutions in their study:
- Educational Assistance: Expanding tuition assistance for advanced RN education or providing educational assistance to other staff to obtain nursing degrees through tuition assistance, student loan repayment assistance, and scholarships.
- Nurse Residency Programs: One-year programs, either accredited or homegrown, to assist newly trained RNs in the transition to practice.
- Pursuing Magnet or Pathway to Excellence Designation: Pursuing Magnet or Pathway to Excellence designation or using concepts associated with these programs to empower and engage staff, particularly RNs, by soliciting RN input into addressing workplace issues and engaging them in implementing solutions and evaluating outcomes.
- Workforce Development: Workforce development encompasses a variety of strategies to improve the preparedness of newly trained RNs and skill development for the existing RN workforce, including additional education for new RN hires, leadership development, skill enhancement, and training for preceptors and mentors.
- Reducing Burnout: The implementation of various programs to alleviate stress and reduce burnout, including employee assistance programs, wellness teams (often staffed with trained behavioral health professionals), and tranquility rooms to address the needs of employees.
- Violence Prevention: Developing strategies to address workplace violence to protect staff, including de-escalation training, establishing a team to address workplace violence, advertising and enforcing zero-tolerance policies, and implementing a secure infrastructure (such as weapons detection).
- Virtual Nursing: Implementing virtual nursing to assist with patient monitoring (such as virtual sitting), patient education, and managing admissions and discharges.
Importantly, one size does not fit all. While there are common challenges, what hospitals need depends on their particular characteristics, contexts, and capabilities. For example, through the CHWS study we learned:
- Rural hospitals were more likely to report difficulty in recruiting RNs.
- Hospitals with linkages to nursing programs reported less difficulty attracting newly trained RNs than hospitals without those linkages.
- Downstate hospitals, particularly urban hospitals and hospitals serving a high percentage of Medicaid patients, were more likely to report burnout and workplace violence.
- Small hospitals said that RNs were more likely to leave their jobs sooner for better opportunities.
In sum, the CHWS study paints a comprehensive, nuanced picture of what’s driving the nursing shortage in hospitals in New York State and what we – as leaders in healthcare, education, philanthropy, and government – can do about it. I invite you to take a deep dive into their report.
