Stephanie Witwer: We need to work together to solve the nursing shortage

This means hospitals, skilled nursing facilities, home health agencies, clinics, higher education institutions and state policy makers.

Stephanie Witwer

I would like to add another perspective regarding the nursing shortage, how we got here, why this is so complex, and what might help.

First, having worked in nursing administration for many years in small and large organizations, hospitals, higher educational institutions, and primary and specialty clinics, I believe that we need to first assume that everyone is trying to do the right thing for their communities, organizations, and their staff and their colleagues. Unfortunately the right thing is hard to identify because there is no one right thing. Piecemeal changes without strategy will likely not have the desired impact and may further destabilize the system.

I agree that nurses are tired, stressed. overburdened and feeling like they are not being heard. They want answers now and I wish there were easy answers. However, this is not a problem that will be fixed by one legislative bill. If the KNABA legislation is enacted we need to be prepared for bed closure, patient diversion to other locations or waiting for extended periods in the Emergency Department for a bed to open, and the possibility of negative impact to financially stressed institutions already struggling to make ends meet. And this bill doesn’t help the other 44% of nurses who are struggling and do not work in hospitals.

So how did we get here? The nursing shortage has been predicted for many years. We knew it was coming. But we didn’t really do much. We hoped, and hope is not a strategy. The workforce is aging and we’re not replacing new staff as fast as we are losing older, seasoned staff. The COVID pandemic exacerbated the problem, causing many nurses to rethink their career choice, retirees to leave even sooner than planned, and it incentivized nurses to travel for premium pay, requiring hospitals to pay unsustainable salaries to travel staff with their permanent staff feeling the rub of the difference between their pay and that of the person working beside them.

To start meaningful work on this problem we have to view health care as an interconnected ecosystem and we need to work on this wicked problem together. This means hospitals, skilled nursing facilities, home health agencies, clinics, higher education institutions and state policy makers. What types of things should be considered?


First — higher education. We don’t have enough faculty, funding and slots to admit as many students who apply and qualify for school. What do we need to do?

  • Pay faculty better, especially in community colleges. Who wants to get an advanced degree only to make less than what a new graduate RN would make in practice? Pay a competitive salary and we’ll attract more faculty.
  • Higher education needs to invest more in its foundational programs and slow the continual push to feed graduate programs at the masters and doctoral level. These programs also use faculty that could be re-deployed. You’ll notice I said slow the push, as we can’t turn off this pipeline, but perhaps we could just slow it for a while until we build our solid foundation of LPNs and Associate and Baccalaureate degree RNs to get us back on track.
  • Try innovative and creative educational options to attract a workforce. Let’s try demonstration projects that allow us to pay for student clinicals or give staff release time to attend classes. These are but examples of creative ways we could try to attract more students.

Second — hospitals, clinics, and skilled nursing facilities. As important as hospital nurses are, we can’t turn a blind eye to the importance of nurses in skilled nursing facilities (SNFs), home care agencies, and ambulatory care clinics, as they are interconnected. If SNFs must close beds due to staffing shortages, or home care agencies can’t admit patients due to staffing, hospitals are unable to transfer patients out, and beds don’t open for new patients. If clinic nurses are not there to teach people how to manage their chronic conditions, coordinate care across specialties, and care for patients transitioning out of the hospital, patients are admitted or readmitted unnecessarily using precious hospital resources. KNABA does not address these system issues, only hospital.
No matter if KNABA is enacted or not, this problem is not going away for a long time, so let’s start to think systematically in addressing it. Let’s fund demonstration projects for innovative staffing models in hospitals, SNFs, and clinics to right-size service demand and find ways to best leverage our precious resources. Let’s see if we can find ways to re-engage our nurses who have left the workforce for one reason or another and find satisfying ways they can contribute that will help us get through the next few years as we create a better foundation.

Let’s increase our nursing faculty salaries to help create additional educational capacity. Let’s re-emphasize foundational nursing programs excellence and slow (not stop, but slow) the push toward graduate programs. Let’s create workforce development programs that offer creative ways to finance education and career pathways. And let’s start now.

Most of all, let’s work together and not waste unnecessary energy pointing fingers and causing division.

Stephanie Witwer, of Pine Island, is a member of the American Nurses Association and President-Elect of the American Academy of Ambulatory Care Nursing. She is a retired Mayo Clinic nurse administrator and independent consultant. The column is her personal opinion and not sponsored by any group.

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