Prior to the outbreak, most of the focus was on the impending retirement of the baby boomers, which will mean decades of nursing experience exiting the workforce. The number of boomer RNs peaked at 1.26 million in 2008 with 60,000 to 70,000 retiring annually since 2012, according to research published in the Journal of Nursing Regulation by Peter Buerhaus, professor in the College of Nursing and director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, and his colleagues.
That raises some concerns about the number of nurses in the workforce, though that facet of the problem may not be severe. The baby boom generation produced about a million nurses in the country who have been steadily shifting into retirement, with about seven to nine years to go before most are out of the workforce, Buerhaus said.
But Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, believes the current graduating nursing classes across America are offsetting the loss of the baby boomers as several nursing schools have high enrollment and long waitlists for their programs. “We have the most robust nurse supply that we’ve ever had in this country, and it continues to grow,” Aiken said. “We’ve added a million nurses to the workforce in the last decade.”
Buerhaus, however, said the influx of new nurses feeds fears of a quality shortage. “You have large numbers of nurses coming into the field, which is terrific, but they’re not necessarily replacing the retiring nurses in a one-to-one way,” Buerhaus said, noting that a young nurse joining the workforce isn’t really equal to one with two to three decades experience.
As hospitals see an influx of COVID-19 patients, experienced nurses are desperately needed to help lead their younger colleagues through the crisis. Problematically, that group’s older age puts them at particularly high risk for COVID-19, which would render them unable to care for patients or lead their younger staff, added Maggie Hansen, chief nurse executive and senior vice president at Hollywood, Fla.-based Memorial Healthcare System.
Still, as the outbreak exacerbates staffing shortages, hospitals need all available resources on the front lines. Some hospitals, Thomas said, have asked retired nurses to return to work, even though they too are at higher risk.
Despite these growing concerns, facilities have responded quickly with strategies to combat staffing issues by allocating nursing and other resources to departments and front lines where they’re needed.
Hansen said that her system has reduced elective surgeries, unnecessary outpatient procedures, imaging, outpatient testing and cardiovascular intervention procedures, among other things. The staff in those departments, both nursing and those not considered mission-critical to the COVID-19 pandemic, are redeployed daily to hospital departments where they are needed.
“Your labor pool and your ability to deploy has to be as nimble as the front line has to be in responding to the changes,” Hansen said.
Hansen also said her system set up a PPE manufacturing plant at a Memorial Healthcare facility that had been closed. Available healthcare staff are manufacturing their own PPE there for nurses and front-line staff, whom the system won’t let work without proper protection.
The ability for a particular staff member to be shifted where needed is restricted for some, depending on the state where they’re licensed. According to Thomas, only 28 states and the District of Columbia allow nurse practitioners to practice to the top of their education and training. Among other requirements limiting scope of practice, the remaining states require nurse practitioners to have a written agreement from a physician to provide patient care outside their regular site of employment—a regulation that she called outdated.
“There’s no evidence to support the need for these written agreements when it stops nurse practitioners from providing patient care,” Thomas said. “We are calling on the nation’s governors to suspend legislative and regulatory barriers that prevent NPs from providing patients with full and direct access to all the healthcare services that NPs are clinically educated and prepared to provide.”
Some states and the CMS have temporarily lifted restrictions on NPs, increasing their ability to care for patients during the pandemic.