Hospital industry to blame for crisis it created

National Nurses United asserts that the United States is not experiencing a nursing shortage, only a shortage of nurses willing to risk their licenses or the safety of their patients by working under the unsafe conditions the hospital industry has created. By deliberately refusing to staff our nation’s hospital units with enough nurses to safely and optimally care for patients, the hospital industry has driven nurses away from direct patient care. When we add the complete failure by the hospital industry to protect the health and safety of nurses and patients during the Covid pandemic, many nurses have made the difficult decision to stop providing hands-on nursing care in order to protect themselves, their nursing licenses, their families, and their patients.  

Except for a handful of states, there are sufficient numbers of registered nurses to meet the needs of the country’s patients, according to a 2017 U.S. Department of Health and Human Services report on the supply and demand of the nursing workforce from 2014 to 2030. Some states will even have surpluses. The report identifies an inequitable distribution of nurses across the country, rather than a nationwide shortage.

To ensure a strong pipeline of new nurses for the sustainability of the profession, NNU has long advocated for more funding for public nursing schools and better pay for nursing faculty; one of the main barriers to becoming a nurse is the exorbitant expense and lack of admission slots in nursing education programs.  

The hospital industry is crying false tears over the lack of nurses willing to stay in direct care when these untenable working conditions are entirely of their own making.

For decades and even before Covid, the hospital industry has driven nurses away from direct nursing care in multiple ways.

Hospitals intentionally understaff every unit, every shift with fewer numbers of nurses than is actually required to safely and optimally care for the numbers of admitted patients and their severity of illness. Hospitals do this to maximize profits and excess revenue. Hospital administrators prefer to staff shifts with a bare-bones number of nurses, which often fails to account for deterioration in patient conditions; new admissions, transfers, and discharges; coordination of care with other departments; the need for nurses to safely take meal and rest breaks; and other complicating factors. Instead of scheduling greater numbers of nurses to ensure that each RN has a manageable workload and patients are safely and properly cared for, hospitals have historically routinely forced the nurses on duty to sacrifice their own health and safety and make morally distressing choices about how to allocate their available time for nursing care.

In addition to deliberately failing to provide safe RN staffing on each shift, hospitals are not maintaining a robust pool of nurses from which to draw when scheduling shifts. From our experience, hospitals often cancel or “call off” nurses who are scheduled to work on a daily contract basis, will send nurses home who have reported for their scheduled shifts, are not hiring or are extremely slow to hire for open positions, and will cancel contracts with travel or agency nurses.

During Covid, hospitals rejected nurses’ advice from the beginning of the pandemic to prepare and plan for predictable staffing needs, including hiring and training more nurses, and cross-training current staff nurses to work in critical care departments. Instead, hospitals cut and laid off staff from units that had temporarily low patient census, and canceled RN traveler contracts. Again, the industry was shortsightedly looking for immediate ways to cut costs and boost profits instead of planning for patient and public health needs. Hospitals’ actions, and inaction, have resulted in a lack of critical care staff during Covid.

National Nurses United has a simple and effective solution for encouraging the nation’s nurses to return to providing the direct patient care that we desperately need during this pandemic: ensure safe and optimal working conditions for nurses, including scheduling sufficient numbers of nursing staff on every shift, and implementing all the multiple measures of infection control that nurses need to protect themselves and their patients.

The hospital industry’s response to nurses unwilling to work under unsafe conditions is to overload the remaining nurses with more patients and, in states where it is not prohibited, try to force them to work mandatory overtime. This is dangerous for both nurses and patients and will only exacerbate the problem. And during Covid, working under unsafe conditions is even more likely to expose and infect nurses, further sidelining them from caring for patients.

It’s clear that hospitals have no excuse for a staffing crisis they have created. The solution we can start implementing today is for hospitals to immediately staff up every unit, every shift, and create a safe, sustainable work environment where nurses can feel confident about their ability to provide the best nursing care possible for their patients.

National Nurses United is the country’s largest and fastest-growing union and professional association of registered nurses, with more than 175,000 members nationwide.