Healthcare workforce shortages in USA

17 April, 2024 By Edd Church

Source: Pexels

Burnout, pay and abuse from patients are among the reasons thousands of nurses in the US want to leave their jobs, a new report has suggested.

The findings come from the recently published State of Nursing 2024 report, which was compiled by Incredible Health, a US-based healthcare career website.

The report presented the results of a survey of 3,300 registered nurses across the country and data analysed from around one million nurses who sought jobs via the organisation.

“The nursing shortage is a major crisis plaguing hospitals across the country”

Molly Rindt

With concerns from nurses aired over staffing, pay, burnout, mental health, redeployment, artificial intelligence, and abuse towards staff – the concerns of nurses in the US mirror many of those in the UK.

The vast majority (88%) of the surveyed US nurses felt that nursing shortages were negatively impacting on patient care and almost half (48%) thought the problem was getting worse.

Molly Rindt, a former emergency nurse in the US and operations lead at Incredible Health, described the country’s nursing shortage as a “major crisis”.

Nearly two-thirds (63%) of nurses reported feeling they were “stretched thin” due to caring for too many patients at a time, and 23% said they had been asked to perform tasks outside of their job description.

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Ms Rindt said: “The nursing shortage is a major crisis plaguing hospitals across the country, with nearly a third of nurses considering leaving the profession after the pandemic exacerbated their feelings of overwhelm and fatigue.

She highlighted that, last June, Incredible Health’s 2023 Healthcare Executive Report had found that 94% of senior managers in the US healthcare system described the nurse shortage as “critical.”

“While Covid-19 exacerbated the nursing shortage in 2020, it existed before,” she said. “Demand for healthcare due to the pandemic has only increased and the supply of workers is not sufficient.”

She added: “Several barriers exist to growing the number of healthcare workers, such as the cost of education, limited training available, retiring workforce, increasing workplace stress, and burnout.”

This shortage, according to Ms Rindt, has hit all corners of the US, but that states in the South and West have been struggling more acutely than others.

California, a 2017 US Department of Health and Human Services Report found, still needed tens of thousands of new registered nurses to reach service goals by 2030.

The report asked nurses who left, or were considering leaving, the profession for their reasons. Burnout, pay, inadequate staffing, poor management and work environment were the top concerns raised.

Ms Brandt said that, while the profession has recovered somewhat since the Covid-19 pandemic, burnout remained a big driver for nurses leaving.

“One significant factor plaguing nurses is burnout,” she said. “Almost half the nurses surveyed reported this as the top reason they plan to quit their jobs.”

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She added, however, that mental health in general among the workforce appeared to be improving with a 6% increase in positive mental health according to the 2024 report, when compared to 2023.

“The pandemic brought record amounts of stress and burnout to working nurses, negatively affecting the state of their mental health and increasing burnout,” Ms Brandt said.

“Seeing less impacted numbers in both of these areas is likely due to the fact that we’re moving farther from the pandemic’s impact and toward a better future of caring for nurses’ wellbeing,” she said.

Like the UK, pay among US nurses was found to be a driver of attrition.

The survey found that 64% of nurses felt they were not fairly compensated for their work, with three-quarters feeling they could just about meet basic needs with “little to nothing” left over for extras.

Just short of half (43%) of the nurses who told the survey they planned to leave cited pay and benefits as one of their primary motivations.

Ms Rindt said that providers with better nurse retention rates were those that were improving pay and career advancements, as well fixing other problems like carer progression and flexible hours.

She said one factor driving nurses away was a rise in workplace violence, with the survey suggesting half of nurses had been verbally or physically assaulted by a patient or relative in the past year.

Of these, a quarter said an abuse incident was making them consider leaving.

Ms Rindt added: “Factors that led to this aggression include patients being in a confused or altered state, frustration due to long wait times for care, anger around hospital guidelines, or frustration about high patient-to-staff ratios.

“To combat this issue and create workplaces that are safer for nurses, health systems leaders can set initiatives such as establishing a zero-tolerance policy toward workplace violence, investing in technology that allows nurses to alert when they are in danger of violence, supporting legislation that establishes penalties for violence toward healthcare staff, and setting strong safety plans and procedures for staff if any violence occurs in the workplace.”

Her organisation said some findings of the report, such as the mental health figures, gave “glimpses of positivity”, but staffing shortages continue to pose a “critical risk” to patient care.