Stress, burnout and retirement are depleting nursing’s ranks, including the instructors needed to train their replacements

 The constant search for qualified nurses is nothing new, having been an issue before the pandemic and accelerating in the past year. But one aspect that hasn’t gotten as much attention involves another workforce conundrum—finding more teachers who can train nursing students, several observers said. 

“Just like there is a shortage of registered nurses at the bedside —whether it be acute care or in long-term care or wherever—this increase in students seeking out a career in nursing has put the spotlight on the need for more nurse educators,” said Dr. Cheryl Grab, dean of nursing for Pennsylvania College of Health Sciences in Lancaster.   

By 2030, the number of registered nurses that will be needed in the United States is estimated to increase from 2.8 million to 3.6 million, according to Grab, who cited statistics from The National Center for Health Workforce Analysis. And that means a lot of students will need qualified educators to prepare them for a demanding career, Grab and others said. 

In 2019, The Hospital and Healthsystem Association of Pennsylvania created a taskforce to examine the various challenges facing the health care industry and a lot of the concerns focused on nursing, said Robert G. Shipp III, HAP’s vice president for population health and clinical affairs. Like other industries, baby boomers are expected to retire in record numbers in coming years, adding to the pressures for finding both nurses and nurse educators, said Shipp, who is a registered nurse and holds a PhD. 

“Not only is it the ones at the bedside, it is also the registered nurses in the instructional programs,” Shipp said. “Those two challenges were already there. We knew going into the pandemic that filling those nursing positions was a challenge.”  

One trend he has noticed is that some nursing programs are consolidating. While that can be fine and lead to operational efficiencies, he said, he wants to monitor those moves to make sure that the number of programs aren’t reduced. 

“We have to make sure there is no reduction in the number of nursing programs,” Shipp said. “Or, maybe there is an opportunity to enhance and increase the programs.” 

The nursing programs at Pennsylvania College of Health Sciences grow every year, and college officials work to accept everyone who applies. The graduation rate is 67 to 70 percent, which Grab said is on par or better than other nursing programs. And the popularity of the programs means constantly recruiting qualified teachers to ensure that the clinical training ratio of 1 instructor per 8 students stays intact, Grab said.  

But to be a faculty member at her school, someone needs at least a master’s in nursing or a doctoral degree. The college has seen the need for a few years, having established a master’s in education program in 2015, Grab said.  

“We feel like we are trying to find a solution for that on our own in promoting that program,” she said. “We can’t meet the need of educating more individuals to be in the profession of nursing if we don’t have nurse educators. It’s sort of a chicken-before-the egg situation.” 

The college might add a certificate program that would allow nurses who have a master’s degree—but not in nursing education—to become qualified teachers. They could take an additional 15 credits focused on education and instruction to receive a certificate. “That is another way we are trying to meet that need,” she said. 

Even with such initiatives, the struggle will continue, with one study showing that one third of RNs are now over 50. “That is pretty significant,” Grab said. Likewise, nurse educators are poised to retire at similar levels. “So, it is crucial that we get new nurses into those positions, both for the health care industry, as well as education.”

Registered nursing is listed among the top occupations in terms of job growth through 2029, Grab said, citing federal Bureau of Labor statistics. The bureau projects 175,900 openings for RNs each year through 2029, when nurse retirements and workforce exits are factored into the number of nurses needed in the U.S, she added.

The average annual income for an RN in Pennsylvania is about $62,000, which can vary depending upon the education of a nurse, shift differentials and other factors, Grab also said. The pay and benefits offer incentives for younger workers looking to start a career or for people mid-career looking for job security. Positions are increasingly in demand at long-term care facilities, schools, pediatric practices, mental health facilities, community and public health nursing programs, and acute-care facilities, such as hospitals, she said, adding that those are just a few of the opportunities available for trained nurses. 

Numerous recruitment ideas are being tried. Shipp said HAP has suggested changes in federal visa rules for health care workers trained overseas. It also is working with veterans to ensure they get meaningful civilian jobs comparable to what they did in the military, coordinating with various workforce investment boards to capture talent, and networking with colleges and teaching programs. “All to make sure that the workforce of tomorrow is being prepared for,” Shipp said.

Focus on Retention

One downside to the career can be the stress and long hours that come with the job, a situation that was pronounced before the pandemic but became more of a concern in the past year, Shipp, Grab and others said.

“Physically, psychologically, it was too much,” Grab said, adding that a lot of nurses left the field in the past year. “Unfortunately, there are not enough nurses in the pipeline to fill those spots.”

HAP developed a tool kit to address the challenges. The idea was to answer a basic question, Shipp said: “What are ways to support the workforce?”

HAP’s “Resources for a Resilient Workforce” was published in September to assist health care providers dealing with the heightened emotional and physical demands put on workers during the pandemic. “All of this is an unfortunate perfect storm for increased stress and burnout, which can lead to anxiety, depression, substance abuse, and suicide in rare cases,” the 28-page guidebook noted. It offered various checklists and resources that identify the signs of stress and burnout and then strategies for combating the problems.

The Pennsylvania State Nurses Association, a trade group based in Harrisburg, has argued that too many nurses are leaving the profession because of the high stress, despite the decent pay and benefits.

“Most nurses would say that the pay is enough, but it is the work environment,” said Betsy M. Snook, CEO of PSNA. “Who wants to go to work and feel stressed all the time? In the state of Pennsylvania, we don’t necessarily have a nursing shortage —we don’t have the working conditions where nurses want to stay.” 

She agrees that the retirement trends are a serious issue, with some studies showing that a million nurses will retire over the next 10 years. Other studies also indicate that one in five nurses will leave because of the stress, Snook said.  

“How are we going to care for all these folks if nurses are leaving because of all this stress? And COVID makes it worse,” she added. “It’s not going to get any better if we don’t reverse it somehow. They are tired, and they are burned out. They have cared for these patients day in and day out and their mental health has suffered.” 

For years, PSNA has supported legislation that would require nursing levels to be set at ratios that would lower stress and, therefore, reduce turnover, Snook said. This year, PSNA has joined with other nursing groups to introduce bills in the state House and Senate. The bills, known as the Patient Safety Act, would set patient-to-nurse ratios specific to a unit. For example, an intensive care unit might have ratios as close as one-to-one, while ratios for other disciplines would be higher.  

One goal of House Bill 106 and Senate Bill 240 would be to entice nurses who left because of burnout to come back into the industry. Some nurses, who left Pennsylvania for other states where the pressures are not as bad, might return, Snook said.  

“There are enough workers in our state,” Snook said. “What we have to worry about is them leaving the state. We don’t have the work environment to encourage them to stay.” 

The hospital association, HAP, wouldn’t speak to the details of the proposed legislation but offered a general statement about the proposals. 

“As for the Patient Safety Act, generally speaking, HAP opposes legislation mandating nurse staffing ratios and nurse staffing reports,” said Rachel A. Moore, a spokesperson for HAP. “Especially in light of the COVID-19 crisis, hospitals need to maintain flexibility in how they determine the most appropriate staffing complement for their current patient volumes.” 

Snook said she recognizes that there is disagreement but that PSNA strongly believes that legislation is warranted. 

“We have a difference of opinion with some of the hospitals and health systems,” Snook said. “We believe there’s a problem to be solved with legislation.” 

Lower patient-to-nurse ratios have proven to reduce patient mortality and lead to better care, generally, Snook said, adding that lower ratios can save money over time. She said it costs 1.5 times the salary of a nurse to fill an open position. “Wouldn’t it be better to retain the nurse?”  

She added that nursing is one of the most trusted professions in the country for a reason. 

“We have to really start thinking about how we can care for the nurses who care for the patients,” Snook said. “It is now time to really examine this and do something about it.”