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America’s nurse shortage is a crisis in the making. Training nurses to be leaders could solve it

After a year defined by the global public health crisis of COVID-19, America’s nursing workforce is in dire straits. Some experts estimate that last year marked the largest retirement of nurses ever recorded in the U.S., and forecasts predict an additional 500,000 nursing retirements by 2022, which will leave the country with a nursing shortage totaling an estimated 1.1 million.

This mass exodus has been decades in the making. Of the approximately 155,000 registered nurses who join the profession each year, as many as half leave the bedside within two years. And it exacerbates one of the most pernicious gaps in the country’s labor force. There is already a severe shortage of nurses in the United States, particularly in the areas that have been the hardest hit by the resurgent pandemic: 35% of facilities in North Dakota, for instance, now report a “critical nursing shortage.” If current projections continue, there is a serious possibility that there may soon not be enough nurses left to care for patients.

In many ways, this shouldn’t come as a surprise. America’s almost 4 million nurses fill dangerous positions, and during the pandemic, more nurses have lost their lives on the front lines than any other health care worker. One recent study reports that nurses have accounted for 32% of all health-care-worker–related deaths owing to COVID, and that nurses have lost their lives at nearly twice the rate of physicians. It’s also no secret that nurses are often unsung relative to doctors, and often underpaid relative to the long hours and dangerous environments in which they work. The pandemic is proving that nurses are the backbone of our country’s health care system—but it is also demonstrating the many ways in which we fall short in supporting them.


For far too long, health care systems have simply seen nurses as a commodity, a never-ending resource—and as a result, those systems have done little to invest in the careers of nurses. Investments into the profession historically seldom went beyond staffing numbers at the bedside, with little thought to career progression, leadership development, or educational opportunities that would enable nurses to have equal opportunities to rise to health care leadership positions. In fact, as demands for health care have increased across the United States, there has actually been decreased investment in the nursing profession by health care systems that previously used to pay to educate nurses—which has placed the onus of continuing education costs on the backs of those who chose nursing and advanced nursing degrees. 

With the average cost of a four-year nursing degree ranging between $90,000 to $250,000, new nursing graduates already often find themselves in dire financial straits. The average nursing salary is around $75,000 per year in the United States, but student loan debt for nurses averages more than $47,000. Being a nurse is increasingly viewed as a job that has few career growth opportunities and where the risks on the front lines outweigh the benefits of a solid paycheck. Today, if a nurse looks for career advancement, he or she must often leave the workforce to take advanced coursework—personally spending tens of thousands of dollars with no guarantee that such education will result in a specific future job opportunity, or an increase in salary. 


At the same time, because hospitals and other health care providers consistently have an overwhelming need for nurses, their focus has shifted to keeping nurses at the bedside, and not seeing the potential of the bedside position as being the first step on a path to higher-paying, more specialized careers in health care. 

Yet these same hospitals and systems are also struggling to fill more senior or specialized positions across a range of job functions, from hospital administration to highly specialized roles needed in specialty areas (e.g., infectious disease, intensive care, operating rooms, emergency rooms), or in fields like quality control and reporting, health IT, and data analytics. Those positions typically require no small amount of experience in health care, making it increasingly challenging to find candidates with the right skill sets and background to fill these positions. 

Veteran nurses often have some, if not all, of the skills and experience required for these jobs. But too often, systems are turning outside the world of health care to recruit people with the business, financial, and technical skill sets they need to run a health care business, creating significant tension between the clinical and administrative sides of health systems. 

The question here should be obvious: What if health care systems invested in educating their existing nursing workforce to prepare them as leaders in the business of health care?

The solution is simple: Hospitals and health systems should create frictionless career pathways for nurses to enter senior leadership positions. It’s an approach that far too few hospitals take today, but there are a few compelling examples. At Sunrise Hospital in Las Vegas, for instance, the StaRN program recruits newly graduated RNs both to meet immediate demand for nurses and to provide training in a structured environment. When the program launched in 2015, the year-over-year nurse retention rate at Sunrise was around 50%. This year, it reached a new high of 93%—demonstrating that investing in nurses, even just within their first years of nursing, can help health systems attract and keep talent.


Simply put, investing in nursing is a smart business decision in health care. Solving the nursing shortage does not come down to creating more nurses—we educate plenty of them. The reason we lose half our trained nurses each year is that we fail to invest in them. It’s time for the health care system to see nurses for the resource they are: intelligent, compassionate, dedicated, and hardworking professionals who became nurses because they wanted to save patients’ lives and take care of others. It’s time to invest in their future.