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    Chris Harrop
    Chris Harrop

    Across an industry inundated with big claims about AI and machine learning, the healthcare world has another standout when it comes to eye-catching headlines: Nursing shortages. 

    Depending on which study you’re reading, there is a troubling to apocalyptic share of nurses prepared to call it quits on their clinical careers after the COVID-19 pandemic and rising burnout: 

    • Nearly 800,000 registered nurses (RNs) plan to leave the field by 2027 after almost 100,000 left during the COVID-19 pandemic, according to an April 2023 analysis by the National Council of State Boards of Nursing (NCSBN). 
    • A report from staffing company AMN Healthcare (PDF) suggested about 3 in 10 RNs were likely to leave their career due to the pandemic, while 18% said it’s likely they would retire from nursing due to the pandemic. This report was additionally worrisome for healthcare leaders, as it found that younger nurses reported lower satisfaction, mental health and well-being compared to older nurses. 
    • Staffing agency ConnectRN says the share of nurses who are thinking of leaving the profession is closer to half, per a November 2022 report

    To better understand these shocking estimates, a May 23, 2023, MGMA Stat poll asked medical group leaders how their nurse recruiting and hiring efforts have changed in the past year. The bad news is that it largely confirms the gloomy reports referenced earlier: The majority (46%) reported their efforts worsened this past year, while only 17% said they saw their efforts improve and another 37% reported it stayed the same. The poll had 360 applicable responses. 

    Successes and challenges 

    Medical groups, health systems and hospitals all have shifted gears in their recruitment and retention strategies for an array of healthcare positions amid the pandemic and subsequent staffing shortages. An Aug. 16, 2022, MGMA Stat poll found that most medical groups had planned 3% to 5% merit or cost-of-living increases in support staff wages for 2023 to remain competitive, with a similar amount seen in a December 2021 poll

    Beyond higher salaries, efforts throughout The Great Resignation to recruit and retain nurses have included taking burdens off staff through more patient self-service tools, updating job descriptions to better reflect the work to be done and adding or expanding employee benefits

    What’s working 

    According to this week’s poll respondents: 

    • Improvements in recruiting efforts have been aided by the decline in travel nurse compensation as COVID-19 caseloads ebbed, nurses opting to leave the hospital setting for private practice models and broader labor market shifts. “Systems are starting to say ‘no’ to exorbitant traveler mark-up,” one practice leader told MGMA, which has allowed for some market stabilization. 
    • Multiple groups reported examining and redesigning their care teams to change the mix of RNs and licensed practical nurses (LPNs) and reassess how the knowledge and skills of their nursing staff are used. 
    • Embracing flexibility to allow part-time job sharing for nurse staff who want it, which makes scheduling more flexible and, in some instances, results in some full-time benefit costs decreasing.  
    • Taking a fresh look at compensation, benefits and bonuses led to recruiting new hires, in addition to increased efforts around student recruitment. 
    • More creative incentives reported by poll respondents included expanded employee appreciation events outside the office, such as picnics, food truck events and trips to amusement and water parks. 

    As medical practice leaders told MGMA in the past year, medical assistants (MAs) were often the most-difficult role to recruit in the pandemic era. However, organizations that invested in developing their own internal MA training and development programs to supplement staffing needs are now seeing return on those investments. Developing career paths and building tiers for nursing staff also showed results for some groups. 

    Where challenges remain 

    Among practice leaders who said the success of their efforts remained the same this past year, most cited a continued lack of worker availability and intense competition from hospitals and larger systems in terms of signing and starting bonuses. “Hospitals and specialists can pay more than private practice primary care,” one respondent told us. [MGMA members can read an in-depth overview of the bidding war for nurses from retired MGMA senior fellow David N. Gans, MSHA, FACMPE, in his April 2023 Data Mine article.] 

    While keeping pace with hospitals on incentives has proven a tough task, one practice leader told MGMA that basing sign-on bonuses to longer commitments (two years, for example) has produced positive results. 

    For the majority of practice leaders reporting worsening outcomes since last year, increasing compensation expectations were a frequent challenge, as well as just getting candidates in for an interview. “I have had no response and candidates have ghosted us and not shown up for interviews that have been set up,” one practice leader told MGMA. “Absolutely the most frustrated I have ever been in my career!” Candidate interest in flexible scheduling and aversion to non-day shift work also were common responses from practice leaders. 

    Tracking nurse job growth 

    • RNs: The Bureau of Labor Statistics (BLS) Occupational Outlook Handbook estimated there were about 3.13 million employed RNs nationwide in 2021, and that the position would grow at a rate of 6% through 2031, or roughly 195,400 new RN roles. 
    • LPNs and licensed vocational nurses (LVNs): LPN and LVN job growth is estimated at 6% through 2031 per the BLS Occupational Outlook Handbook, resulting in about 41,300 new jobs in that period. 
    • Nurse anesthetists, nurse midwives and nurse practitioners (NPs): The BLS expects faster-than-normal growth (40%) in nurse anesthetist, nurse midwife and NP jobs through 2031, with an estimated 118,600 new jobs to be added in that period. jobs through 2031, with an estimated 118,600 new jobs to be added in that period. 

    There’s a bottleneck, though 

    While the demand for more nurses is obvious, it takes nursing schools to bring those new professionals into the field, and the past few years have not been kind to those looking to hire a new generation of nurses. 

    The American Association of Colleges of Nursing (AACN) 2021-2022 report on nursing program enrollment and graduations found that “U.S. nursing schools turned away 91,938 qualified applications from baccalaureate and graduate nursing programs in 2021 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints,” with faculty shortages often ranked as the top reason for qualified applicants not making it into a program. 

    The same report pointed to many faculty in nursing schools approaching retirement age, with about one third of existing nursing faculty “expected to retire by 2025.” Faculty shortages are also exacerbated by increasing compensation  to pull teachers back into clinical settings, as well as declining enrollment in master’s and doctoral programs in nursing that produce the nurse educator workforce. 

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    Chris Harrop

    Written By

    Chris Harrop

    A veteran journalist, Chris Harrop serves as managing editor of MGMA Connection magazine, MGMA Insights newsletter, MGMA Stat and several other publications across MGMA. Email him.

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