Domestic Shortage of Nurses Requires Regulatory Support for Innovative Strategies

Throughout my decades serving as a physician and hospital executive, I’ve witnessed firsthand how time and time again that nurses can make all the difference in delivering patient-centered care. Nurses do it all: thoroughly monitoring vital signs, carefully implementing care plans, and providing comfort and support to those they serve. These medical professionals are truly on the frontlines during all stages of everyone’s health journeys, from before they’re born to the very last moments of their lives. 

During the COVID-19 pandemic, even more was asked of America’s three million nurses, who spent endless shifts caring for extremely ill and highly contagious patients. Long hours leading to high levels of stress and burnout among nurses are sadly not new but worsened due to the COVID crisis and have persisted even after the impact of the virus on hospitals has transitioned to less critical levels. While there have been concerns about nursing shortages for several decades, the large-scale retirement of hospital-employed domestically trained nurses has reached a critical level. Acute care beds and operating rooms have remained empty due to this increased shortage, causing hospitals to fall way behind revenue targets. 

Sadly, there does not seem to be an end in sight. As the aging population grows, so, too, will the need for nurses. McKinsey estimates that, without any meaningful solution, the U.S. could face upwards of 450,000-nurse shortage by 2025, amounting to a potential 20 percent gap in demand and capacity.

It’s clear that to protect our current nursing workforce from being stretched thin, we must replace retired nurses and ensure that patients continue to receive compassionate and high-quality care, hospital executives must take steps to increase the number of available nurses. As in the past, health systems rely on travel nurses. These nurses, professionals hired through contracts with third-party staffing companies, have been used over the years to fill gaps in health care’s employed nurses’ workforce, though at great expense. Over the past year, these unbudgeted expenses, combined with the unanticipated decline in revenues, have dramatically affected hospitals’ bottom line.

Health systems and community hospitals, long recognizing the need to build a sustainable nursing pipeline, have aggressively recruited nurses fresh out of training, offering signing bonuses and competitive salaries. But many of these nurses are too inexperienced to manage the sicker patients and man the operating rooms. Given the state of the current workforce and nature of the existing pipeline, it’s time for health care to take a more innovative approach to stabilizing and growing its workforce. 

Many of these entities are now looking to foreign-educated nurses who are highly trained and well-qualified to care for a variety of patients and in a wide array of settings. This strategy is a win-win for the future of health care. These nurses can learn from and advance their careers in the country with the world’s best health care. They can earn a great living, which may allow them to send money to their families at home. This can help reduce global poverty, especially in the developing world. And if they return to their home countries, they can employ what they’ve learned in America to foster better health outcomes for their patients and even instruct their colleagues in our techniques and standards of care.

Policymakers and leaders in the health care industry must do all they can to cut any red tape associated with foreign-educated nurses obtaining the requisite licensure to practice in the U.S. They must not kowtow to political interests who see these health care professionals as stiff competition. Instead, they must understand the severity of the staffing shortage crisis in health care, and knowing just how important these professionals are to the well-being of an ever-increasing patient population, do all they can to ensure more nurses can practice in the United States.

In America, health systems and individual care centers will benefit from a desperately needed injection of new nurses. They’ll fill the void of missing nurses, ensuring American patients receive the care they deserve. They’ll also provide relief for nursing teams around the country who have endured so much over the past several years. They’ll finally be able to enjoy a normal work-life balance that will allow them to take less stress home, which means they’ll be even better equipped to take their jobs head-on every day.

Jonathan Ellen, M.D., is a pediatrician, epidemiologist, former CEO of Johns Hopkins All Children’s Hospital, and currently CEO of Connections for Health, a full-service social determinants of health (SDOH) solution for healthcare and pharmaceutical companies.