This opinion editorial was first published in the Cedar Rapids Gazette.

By Patty Jeffrey, RN
Cedar Rapids Gazette
September 11, 2023

When a West Burlington hospital recently closed its skilled care unit and limited inpatient capacity, administrators pointed to a singular challenge: a stubbornly contracting nursing workforce that’s already too small by a factor. It’s a refrain I hear almost every day now from health care systems in every corner of every state.

Sure, the scary days of the pandemic — when overcrowded intensive care wards vibrated to the rhythmic hum of ventilators artificially breathing for COVID patients — are behind us. But the underlying staffing challenges are more significant than ever, even as the public health emergency ends.

The first is a simple function of population growth and aging. By 2018, a U.S. Department of Health and Human Services report found that 38 percent of registered nurses were 55 or older. Nearly half were aged 50 or older. As baby boomer nurses aged into retirement, thereby widening the already-massive staffing shortage, they joined their cohort in requiring more medical care and intervention.

Under even the best circumstances, this silver tsunami would have crushed hospitals. The pandemic quickened its pace and breadth. After all, how many graying nurses would have the emotional and physical wherewithal to continue treating patients into their sunset years during a pandemic? As it turns out, not many.

Emotional and physical burnout triggered unprecedented rates of early retirement and staff nurse resignations. Citing burnout, one-third of nurses said they intended to quit by the end of 2022. In a December 2022 national survey of more than 500 registered nurses, 75 percent said they might leave medicine long-term if the staffing crisis isn’t solved.

The solution to this math problem — get more nurses to the bedside — is as painfully obvious as it is elusive because the two most promising routes face enormous challenges outside concrete legislative actions.

The first glaring fix is to train more new nurses. Last year, U.S. nursing schools rejected more than 75,000 qualified applications because they lacked enrollment capacity.

The next workable solution lies in recruiting more international nurses. By law, the U.S. only makes specific numbers of employment-based green cards available each year. Despite nurses’ central role in public health and this country’s economy, they compete for the same limited green cards within an enormous applicant universe that includes computer engineers, who dominate the category.

Fortunately, there are legislative solutions. One popular approach, the Healthcare Workforce Resilience Act, would recapture and reallocate thousands of previously issued but unused visas for qualified international nurses. An updated proposal could also provide a pathway to train more nurses domestically.

Congress has talked about the nursing shortage for decades with little to show in the way of progress. unless Washington turns its focus to real solutions to this shortage, ordinary patients — pregnant mothers, heart attack sufferers, dialysis patients — will pay the price.

Patty Jeffrey, R.N., is president of the American Association of International Healthcare Recruitment.