The Future Faces of Nursing: How We Can Take Care of the Next Generation

We’ve been staring down a nursing shortage for a very long time. Even four decades ago, there were alarm bells sounding. In 1981, the Bureau of Labor Statistics estimated that the nursing workforce would need to increase by 85,000 per year every year through 1990 to meet demands during that era. Then, the 1990s brought about managed care with its capitated payment system and subsequent dramatic decrease in length of hospital stays. This created a domino effect with nurse layoffs, declining hires, and disincentives for would-be nurses to enter the profession in the first place.

Now, we’re facing significant gaps in nurse staffing, not only today, but for decades to come. According to the American Nurses Association, by 2022, there will be far more registered nurse jobs available than any other profession, at more than 100,000 per year. With more than 500,000 seasoned RNs anticipated to retire by 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees, and to avoid a nursing shortage. By 2030, the nursing shortage is expected to increase by 24.8%, meaning that 3.6 million nurses will be needed.

Compounding the problem, nursing schools are facing dire faculty and staffing challenges, some having to turn away qualified candidates because there is no one available to teach them. In fact, U.S. nursing schools turned away over 80,000 applicants in 2019 due to insufficient faculty, clinical sites, classroom space, and budget restraints, with two-thirds of nursing schools reporting faculty and clinical preceptor shortages as main drivers.

The COVID-19 pandemic has exacerbated the situation on all fronts. Frontline staff are exhausted. They’ve had to deal with staffing and resource shortages; they’ve become de-facto patient advocates and emotional support systems due to visitation restrictions; they’re donning and doffing PPE multiple times per day to maintain safety for all; they’re working overtime and taking on higher patient/nurse ratios to help cover their ill peers; and they are flexing their care delivery to account for ever-changing policies and guidelines.

The fallout has been astonishing: 14% of healthcare workers have probable major depression, 15% have generalized anxiety disorder, and 23% suffer from post-traumatic stress disorder, according to a Yale University study.

A bright spot exists, though, in the willingness of future nurses to jump into the fray. Nursing schools actually saw an increase in interest after the start of the pandemic, with upticks in applications as prospective students find inspiration in witnessing the courage of frontline providers battling the pandemic. However, these students have been thrown into a unique learning experience with limited clinical hours and rotations, completely virtual lab experiences, and having to undertake learning and communication with PPE. They’ll also soon be thrown into the same demanding environments that have pushed so many already in the profession to the brink of burnout.

Amid the pandemic, hospital leaders have recognized the importance of maintaining well-being among all staff, from those on the frontlines to those in the back office, often achieved through integrated staff check-in, engagement, and recognition programs. It’s incumbent upon hospital executives to take the same care with the “future frontline” of care.

Actively engage with students

Staff well-being and engagement programs should include nursing students and new graduates, particularly at certain junctions in their education. By proactively and systematically engaging with nursing students during their clinical rotations at your facility, hospital leaders can build relationships and give them a sense of care and belonging. It also just might be the tipping factor as to why they choose one facility over another. Leaders can show they care by asking questions that determine whether they have everything they need both in the hospital and outside. As nursing students and graduates will have evolving concerns, rounding should occur at specific stages of their education and cover certain strategic areas.

• Get the baseline: As soon as new graduates start with, leaders should understand where they are coming from, and where they are headed. Questions should include why they got into nursing, why they chose the specific facility, and why they are passionate about their specialty area. Understanding their concerns and feelings at the outset will not only help with longitudinal satisfaction monitoring, but also go a long way toward making them feel welcome in a new environment.
• Check in once they're settled: At the end of the initial residency/orientation period, just prior to them going “on-shift,” it’s imperative to touch base again. Leaders should ask how orientation went, what concerns they have going on shift, and whether or not their expectations are being met. This helps them start on the best possible footing and clear up any concerns as they’re going on shift.
• Past the honeymoon phase: Four to six weeks after going on shift is the next critical check-in point. By then, new nurses have found their groove and likely have new perspectives to share. This is the time to drill down on satisfaction: is the work what they expected? Do they have what they need from their manager, peers, and nurse educators?

At the end of the day, people do not go into the nursing profession to earn a huge salary or to be in the spotlight. Nursing is a calling. 2020 was a year that changed what it means to be a nurse, for good or ill. At a time when it has never been harder to be a nurse, when every day provides new challenges, healthcare leaders need to ensure that they are not only providing support to their current staff, but also making the profession a welcoming environment for the next generation of caregivers – the future of care depends on it.

Joy Avery, RN, MSN is VP of Clinical Services for CipherHealth.