he pandemic has had a significant impact on nurses, particularly as large numbers of younger workers leave the profession, according to recent analyses published in Health Affairs—and experts say new efforts are needed to sustain the nursing workforce in the long term.
According to data from the U.S. Bureau of Labor Statistics, there was a decline in overall health care employment during the first 15 months of the pandemic between February 2020 and June 2021—an unprecedented situation that has not been seen in decades.
The decline in employment varied by sector, with many, including physician offices, outpatient care centers, and home health care, seeing the largest declines in April 2020. Since then, most sectors, aside from nursing homes, have seen their employment rates largely return to pre-pandemic levels.
Among nurses, unemployment was highest in the third and fourth quarters of 2020. In 2021, the unemployment rates for LPNs and RNs largely declined to their pre-pandemic levels, but they remained elevated for nursing assistants (NAs). In addition, nurses who were Asian, Black, Hispanic, or from other racial/ethnic minority groups continued to see higher unemployment rates than white nurses during the first two quarters of 2021.
Overall, employment of LPNs and NAs decreased by 20% and 10%, respectively, when comparing the pandemic (April 2020 to June 2021) with the period right before it (October 2018-December 2019). In comparison, RN employment saw just a 1% decrease during the pandemic compared with the period before it. However, this decline was still a significant departure from the steady growth seen between 2011 and 2020.
According to Health Affairs, the total supply of RNs decreased by more than 100,000 workers over the course of 2021—the largest decline observed in over four decades. In total, the RN workforce decreased by 1.8% in 2021 compared to before the pandemic.
The decline was largely driven by RNs under 35, who saw the largest reduction in numbers at 4%. RNs over the age of 50 saw the second largest decline at 1%, while RNs between ages 35 and 49 saw the smallest at 0.5%.
This decline in the nursing workforce was particularly significant when compared with what a model predicted if the pandemic had not happened. In the model, the nursing workforce was projected to grow by 4.4% between 2019 and 2021, rather than declining by 1.8%. This resulted in a difference of approximately 200,000 fewer workers (6.2%) than expected. Among RNs younger than 35, there were 80,000 fewer workers (8.8%) than expected.
Going forward, the nursing workforce is likely to be impacted by younger RNs leaving the profession, which could significantly decrease the workforce and disrupt the labor market.
According to Health Affairs, "A sustained reduction in the number of younger age RNs would raise ominous implications for the future workforce. Because RNs typically remain working in nursing over their career, a reduction of younger RNs in the workforce would exert an impact that is felt over a generation, in contrast to a relatively modest reduction in long-run RN supply due to early retirement of the baby boomer RNs working into their 60s and 70s."
And as more younger RNs leave the profession, there may also be a reduced interest in nursing overall. In fact, the number of applicants to four-year Bachelor of Nursing programs, which is often used as an early indicator of long-term nursing supply, grew just 1.3% in 2020, compared with 4.5% and 8.5% in the two previous years. If the number of applicants further slows or decreases in 2021, the nursing workforce could be further reduced in the future.
Overall, "[s]ignificantly larger efforts to support and sustain early-career nurses, who have had a trial by fire in their new profession, may be needed, along with more effective strategies to reward those who remain at the front lines and those who are needed to return," Health Affairs writes. (Auerbach et al., Health Affairs, 4/13; Buerhaus et al., Health Affairs, Jan. 2021)
Dr. Buerhaus and team's study is a much-needed infusion of information about the clinical workforce—at a time when health care leaders have never been more concerned about staffing. Broadly speaking, the team's findings are consistent with what my fellow experts are hearing from C-suites across the country and care continuum: the health care labor market is on shaky ground, and stabilizing the workforce will be one of the industry's major focuses for years to come.
But how should leaders make sense of this information? See our five takeaways below.
The bottom line: The data we are observing continues to reflect clinical shortages will be an ongoing challenge. Leaders are likely entering a future in which they will need not only to re-shape their organization's employee value proposition, but fundamentally change the way they deliver care so our systems can do so safely and effectively with a fewer number of clinicians.