Nursing shortages continue after the COVID-19 pandemic

 By Benjamin Mazza-Bergeron

Skyhawk View Staff Reporter

The COVID-19 pandemic exacerbated an existing nursing shortage, causing nurses to feel they were underappreciated and unable to provide quality care, experts and recent research showed.

An ongoing problem for decades, the shortages reached critical heights during the pandemic, negatively affecting the quality of patient care, said David Auerbach, the senior director for Research and Cost Trends at the Massachusetts Health Policy Commission.

Auerbach first researched nursing shortages in 2002 while a doctoral student at Harvard. Two decades later, he said it remains a problem in healthcare.

Even before the pandemic, nursing was having trouble attracting recruits. Auerbach said the reasons behind it were many, including the lack of pay and the retiring nursing population. 

“Overall, the shortage conditions before the pandemic were not ideal,” said Auerbach. 

Then, the pandemic and shortages grew, he said.

A study Auerbach co-authored, titled “Nurse Employment During the First Fifteen Months of the Covid-19 Pandemic,” was published in January 2022 in the Health Affairs Journal, providing insight into how significantly the pandemic affected employment in institutions. 

Auerbach and his colleagues defined a healthcare provider shortage as the lack of necessary support needed to provide adequate care for patients.  

“It’s very easy to say but difficult to measure,” he said. 

The study said nurse employment “fell early in the pandemic because of lack of demand as people reduced their use of health care.” Hospitals shut down all but necessary procedures.

As society adapted to life, healthcare services resumed, but the number of employed nurses was far from providing adequate care, said Auerbach. 

As a temporary relief, institutions offered increased wages and introduced travel nurses. This large influx of new staff created problems, causing extreme stress to permanent nurses who now had to teach new nurses on top of their already overloaded responsibilities, said Auerbach. 

Nurses became extremely stressed physically and emotionally, a term known as burnout, said Auerbach. Nurses would then move locations or leave the profession entirely–a phenomenon called nurse turnover.

Olivia Major, a registered nurse of six years at the University of Vermont Medical Center (UVMMC), said, for a time, there seemed to be a revolving door of new nurses. Permanent staff like Major had to orient a parade of new faces, including many travel nurses, and witnessed much permanent staff leave because they couldn’t cope with the stress.

“I spent less time tending to patients and more familiarizing new staff,” said Major.

Auerbach said that nurse burnout and turnover resulted in hospitals implementing wellness strategies to decrease the number of unhappy nurses. 

Auerbach said the Massachusetts Nursing Association surveyed nurses statewide, asking if high numbers of patients per nurse resulted in inadequate care. Less than 50% of nurses said yes to the question in 2019, but, in 2021 during the pandemic, the number skyrocketed to over 80%. 

Hospitals responded by attempting to decrease the hours nurses could work and decrease the number of patients per nurse, said Auerbach. Despite this, patient care suffered from nurses' lack of ability to tend to patients adequately.

Major said UVMMC did decrease the maximum number of patients per nurse and became more accommodating to schedules.

Despite attempts, the demand for nurses stayed high for much of the pandemic–it took several months to see an increase in nurses because of the influx of patients, said Auerbach.

In his study, Auerbach analyzed vacancy rates of nursing positions in different institutions. He found the rate in hospitals decreased by 2%, home health decreased by roughly 5%, and nursing homes decreased by a staggering 13% from February 2020 to February 2021.

Among all institutions, he found vacancy rates increased from 6% to 13% within the first year of the pandemic.

Auerbach said the nursing home rate is still down by roughly 5% to 10%. He doesn’t think the original baseline of staff will ever recover as they have practically been decimated by the pandemic. 

Hospitals have partially recovered, but nurses continue to feel undervalued and there have been many strikes, said Auerbach. While hospitals responded initially to nurses’ concerns, some of those changes have been short-lived.

“Now that society is back to ‘normal,’ hospitals have slowly stopped appreciating nurses again,” said Auerbach.

Major said it has been her experience that hospitals do not value or pay nurses enough, and they often spend as little as possible on nurses until the staff retaliates with labor actions.

Auerbach said the loss of money in healthcare institutions post-pandemic has contributed to the problem. 

He predicted that shortages will be less of a problem for the next five to ten years because many young people are entering the profession. He said that despite the retiring workforce of the Baby Boomer generation, the youth entering should be enough to replenish nurses.

But he warned that hospitals need to value nurses, or they will continue to leave the profession at high rates and newcomers may not be enough to fill the gaps. 

Auerbach said good patient care relies on the 18 million healthcare professionals in the United States, five million of them nurses.

The pandemic exposed many areas of concern with the country’s healthcare system, not only with nursing shortages but also the lack of available facilities to treat patients and the lack of adequate equipment for COVID patients such as ventilators, said Auerbach.

“Perhaps that was a good thing,” said Auerbach.

He said he believes that the quality of patient care has risen since its low during the height of the pandemic because nurses’ voices were heard, and he hopes those lessons are not forgotten.

He says that now that healthcare institutions have experienced how difficult administering patient care is with a limited amount of providers, they will be better prepared for the next catastrophe.

“Finding the right balance between patient care and nurse satisfaction is crucial, but healthcare administration could be in trouble again if they neglect nurses during calamitous times,” said Auerbach.