The US health-care system needs more nurses. Nursing schools aren’t producing enough graduates, young workers are quitting, and older ones are retiring early. Throughout the pandemic, widespread shortages reduced the quality of care and even cost lives. To bolster the workforce and better prepare for the next crisis, the US must invest in its domestic pipeline and clear hurdles for qualified international talent.
Nursing shortages have been a problem for decades and will persist well after Covid-19 subsides. Not only is the US population aging, but nurses themselves are getting older. Some researchers estimate that 1 million registered nurses will retire by 2030.
In the past, hospitals, nursing homes, clinics and other health-care facilities have turned to staffing agencies during shortages. Travel nurses, as they’re known, crisscross the country, typically working 13-week stints. At the height of the pandemic, they could easily triple or quadruple their pre-pandemic salaries, earning as much as $5,000 to $10,000 a week.
This arrangement sounds like a good deal: Health-care facilities get the staff they need and nurses get paid well. But the rise of travel nursing has had several unintended consequences.
First, staff nurses demanding higher pay are defecting. Contract nurses now comprise 8% to 10% of hospitals’ labor force, up from about 4% pre-Covid. Employers running on razor-thin margins are struggling to boost salaries, at a time when federal Covid funding has dried up. Hospitals spent almost 40% of their total nurse labor costs on travel nurses in January 2022, compared with 5% in 2019, according to the American Hospital Association, which expects labor costs to increase by $86 billion this year. Perversely, fear of attrition is making employers even more reluctant to lose their contract workers.
Travel nurses have their own reasons to worry: While pay is great for now, they have none of the benefits of a salaried job when demand eventually turns. Reports are already emerging about surprise pay cuts. Patients, meanwhile, are the ones who suffer most from higher turnover over the long term.
Some lawmakers want to investigate if the rise of contract nursing has unduly harmed the health-care industry. A better question to ask is why more nurses aren’t making it into the field in the first place.
One reason is a lack of funding. In 2021, nursing schools turned away more than 90,000 qualified applications because they didn’t have enough educators or clinical placement sites. Low or no pay is a primary challenge. Congress should expand funding for tuition reimbursement for nurses who teach and those who commit to work in shortage areas. Public-private partnerships, meanwhile, would better integrate schools and workplaces to facilitate clinical training.
Foreign-trained nurses are another underused resource. The Migration Policy Institute estimates that about 118,000 immigrants with undergraduate degrees in nursing are working below their skill level, many as low-paid assistants, home health aides and domestic help. Streamlining their re-credentialing process would help boost staffing in times of immediate shortage. Prioritizing placement in under served facilities such as nursing homes would also make sense.
Finally, better oversight of the work program for foreign graduates of US universities is long overdue. The Optional Practical Training program grants a three-year work visa to certain STEM majors. It’s inexplicable that drama therapy and journalism graduates qualify when nursing is excluded. Such a change could add tens of thousands of future nurses in a stroke.
Tapping into the large pool of aspiring and qualified nurses already in the US would strengthen the health-care system for the next pandemic, reduce reliance on contractors, and bring out-of-whack labor market dynamics back to reality. A more sustainable nursing workforce will ultimately save money and lives.
