Solutions to shortage are complex, but require nurses lead the efforts
According to the American Nurses Association, there will be more jobs for registered nurses through 2022 than for any other profession in the United States.
Domestically, the U.S. Bureau of Labor Statistics predicts more than 275,000 additional nurses are going to be needed from 2020 to 2030 – a growth rate of approximately 9%.
Globally, the International Council of Nurses estimates up to 13 million nurses will be needed to fill the international nursing shortage gap in the future.
The United States and the world are facing the worst nursing shortage in the last century.
Causes of the nursing shortage
Before the COVID-19 pandemic, there was already a widely recognized nursing shortage. Causes of the shortage are multifactorial and include the following:
- A shortage of nursing school faculty is limiting nursing program enrollment numbers. According to a report released by the American Association of Colleges of Nursing, nursing schools in the United States turned away 80,407 qualified applicants to baccalaureate and graduate nursing programs in the 2019 to 2020 academic year due to lack of faculty, clinical sites, classroom space, preceptors and budget constraints;
- Retirements due to an aging workforce were a concern before the pandemic and have accelerated since the onset of the pandemic, dramatically reducing the number of employed nurses; and
- COVID-19 and the consequences of working during the pandemic have impacted the nursing workforce.
Initially, the difficult working conditions and exposure to the morbidity and mortality associated with COVID-19 impacted nurses. Yet, nurses persevered under these difficult physical and mental conditions. As the pandemic ensued, high patient-to-nurse ratios, unsupportive work environments, unsafe working conditions and violence in health care settings resulted in mounting stress and fatigue, declining job satisfaction, worsening mental and physical health, suicides and staff turnover, with many nurses leaving the profession of nursing altogether with no plans to return.
Nephrology nursing practice settings have not been spared from the staff shortages plaguing health care due to the pandemic. Nephrology nurses have experienced long hours with extensive overtime, increased stress, fatigue due to workload and sleep issues, and denied professional development and paid time off. The American Nephrology Nurses Association (ANNA) conducted a mental health and health-related cross-sectional study from July through August 2020. In total, 393 nephrology nurses participated.
Findings indicated nephrology nurses were facing health and wellness challenges due to significant work-related stressors. Participants reported feeling burned out from work (62%), symptoms of anxiety (47%) and major depressive episodes (16%). In the 2 weeks prior to study participation, respondents reported working 35.5 plus or minus 13.2 hours a week. Twenty-seven percent of respondents reported missing a change in the patient’s condition due to high workloads, and 42% voiced workload concerns to their immediate supervisor.
In addition, 26% reported workloads were leading them to look for a new position.
It must be recognized that these data were collected before the height of the delta and omicron surges, which had a compounding impact on already burned out and fatigued nephrology nurses. If this study were to be conducted today, data would be even less favorable.
Before the pandemic
As noted earlier, a significant nursing shortage existed prior to the onset of the pandemic, and that was also seen in nephrology. ANNA has long recognized this shortage and responded with task forces that have investigated the issue and developed targeted programs. These programs, directed at undergraduate and graduate nurses, highlight the opportunities and career mobility in the specialty. To create exposure and engagement, ANNA offers scholarships for students in registered nurse and advanced practice registered nurse programs to attend the national conferences at no cost and provide mentorship opportunities.
Complementary virtual memberships are provided to students in undergraduate programs. These virtual memberships provide all the benefits of full membership to the association and access to special live webinars for new practicing nurses and students. ANNA managed the production of a suite of materials that explores the many career paths in nephrology nursing. These materials are used at the ANNA exhibit booth at nephrology and student nursing conferences with accompanying print materials.
ANNA is also working across the nursing and kidney communities to educate health care colleagues on the many opportunities and career benefits offered by the specialty.
Additionally, ANNA has been correcting the misuse of the term “dialysis nurse,” which is often used to describe a nephrology nurse. The knowledge and skills of a nephrology nurse extend beyond being able to provide a dialysis treatment and the practice settings are vaster than employment in a dialysis facility. Nephrology nurses possess skills of assessment, critical thinking and judgment, decision-making, interprofessional collaboration, evaluation of care provided and honed abilities to provide education to patients and families.
Interventions and solutions
There is a reason for great hope and opportunity related to the nursing shortage, but it is going to require collaboration, nursing involvement and effort. There have been proposals across the health care community to create workarounds for the nursing shortage. Such workarounds have included placing unlicensed personnel in nursing roles and assigning health care professionals with non-nursing skills and education to perform uniquely nursing roles. These suggestions are not only dangerous, but also violate the nursing scope of practice standards.
There are some interventions and solutions that may help resolve the nephrology nursing shortage (see sidebar).
A better solution to the growing nephrology nursing shortage is to embrace solutions that empower nurses and allow them to contribute fully as a member of the health care team. Embracing these interventions is going to require members of the nephrology community to work with each other, instead of against each other in the name of advocacy and intending to provide the best patient outcomes.
Nephrology nursing is a unique profession that has long championed the importance of interprofessional collaboration. Nephrology nursing also provides the environments and role structures that make all the suggestions listed above possible. Responding to the growing nursing shortage is going to take ideas, insights and support from all health care providers, yet this work should be guided by nurses. Empowering and joining with nurses will allow the profession to expand the number of nurses entering and remaining in the workforce with the outcome of enhanced patient care and safety. When there is enhanced patient care and safety and all members of the team are playing their roles, everyone (and most importantly the patient) comes away victorious.
- For more information:
Tamara Kear, PhD, RN, CNN, FAAN,
in the executive director of ANNA and can be reached at firstname.lastname@example.org.
David Walz, MBA, BSN, RN, CNN, FACHE,
is the president of ANNA and can be reached at email@example.com.
- American Nurses Association. The 2021 American nursing shortage: A data study. www.usa.edu/blog/nursing-shortage/. Published May 2021. Accessed April 1, 2021.
- Bureau of Labor Statistics, U.S. Department of Labor (2021). Occupational Outlook Handbook, Registered Nurses. www.bls.gov/ooh/healthcare/registered-nurses.htm. Published Sept. 8, 2021. Accessed April 1, 2021.
- Carayon P, Gurses A. (2008). Chapter 30: Nursing workload and patient safety: A human factors engineering perspective. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. www.ncbi.nlm.nih.gov/books/NBK2657/. Published April 2008. Accessed April 1, 2021.
- International Council of Nurses (2021). The global nursing shortage and nurse retention. www.icn.ch/sites/default/files/inlinefiles/ICN%20Policy%20Brief_Nurse%20Shortage%20and%20Retention_0.pdf. Accessed April 1, 2021.
- Montoya V, et al. Neph Nurs Jrnl. 2021;doi:10.37526/1526-744X.2021.