The Nursing Shortage and the Future of Nursing Education Is in Our Hands

Beyond the obvious and most dis-cussed risks of prematurely end-ing social distancing restrictions, such as a second and third wave of infec- tions, more illness and deaths, and more long-term damage to the economy, an equally important risk to public health has not received the media attention it deserves: an acute and perhaps dramatic escalation of the national nursing short- age due primarily to the interruption of prelicensure nursing education. Much of what I note in this editorial is applicable to nursing education programs and nurs- ing roles at all levels—and even to other health professions such as medicine, physical, occupational, speech therapy, and so on. However, because of the cen- tral role RNs play in the U.S. health care system, I focus here on prelicensure nurs- ing education, delivered primarily in as- sociate- and baccalaureate-level degree programs in colleges and universities across the United States.

The World Health Organization (WHO, 2020a) recently reported there are 28 million nurses across the globe, with nurses comprising 59% of the total number of global health professionals and 56% of the total number of health profes- sionals in the United States. The National Council of State Boards of Nursing (NC- SBN, 2020) reports there are more than 4 million RNs in the United States.

Perhaps a timely but unwelcome coin- cidence due to the COVID-19 pandemic, the WHO (2020b) has deemed 2020 as “The International Year of the Nurse and Midwife.” As the largest single health profession in the world, nurses form the backbone of health systems across the globe. Nurses greet us at birth and com-

fort us at death. They work when there is a foot of fresh snow on the ground, dur- ing hurricanes, and yes, most assuredly, they work during pandemics. (On a re- lated note, no health care worker should ever be asked to care for patients without adequate protective equipment.)

As many of us have now experienced, throughout March and April of this year, colleges and universities closed across the nation, and traditional clinical learn- ing sites for health professions students, especially hospitals, began to disappear overnight, often restricting students from clinical sites due to a lack of personal protective equipment (PPE) at those sites. With little to sometimes no time to prepare for the transition, college and university faculty in most states across the country and across all academic disci- plines were asked to convert their courses into an online format.

Luckily for nursing education, we have long embraced new learning tech- nologies such as distance learning and simulation. Nursing education leaders and researchers have provided global leadership on how both in-person and virtual simulation can be used in health professions education. I am happy to say that the rapid transition of prelicensure nursing education from a predominantly face-to-face experience to a predomi- nantly online experience in the United States, although not without various and sometimes significant challenges, has gone as well as it could have—so far.

According to aggregate counts from NCSBN (2019), 252,311 new RNs en- tered the U.S. nursing workforce by tak- ing the NCLEX-RN in 2019. Recent es- timates by Buerhaus et al. (2017) suggest

the country needs more than double that number, approximately 550,000, new RNs to enter the workforce in 2020 and 2021 to address a projected shortage of 1.1 million RNs in 2022, thought to be fueled in large part by a wave of RNs starting to age out of the nursing work- force.

With the risks and impacts of COVID-19 on RNs already in the work- force becoming clearer each day, especial- ly for older nurses (Buerhaus et al., 2020), the extent to which nurses leaving the workforce—and perhaps the profession— earlier than planned due to psychological trauma and even physical disability will only exacerbate the nursing shortage fur- ther. Although nursing faculty across the country have done an astonishing job in providing continuity in their students’ ed- ucational programs that were, like almost everything else in the country, brought to a halt by COVID-19, it is still unclear what portion of the prelicensure nursing student population graduated on time in May and June because of regulatory and program requirements that are challenging or im- possible to fulfill in a completely online environment. It is equally unclear, and equally disconcerting on a personal level for many, as to what will happen to the jobs of nursing faculty members whose programs cannot provide sufficient clini- cal education for its prelicensure students, if only for a year.

As states such as Georgia, Texas, and South Carolina became the first to relax social distancing restrictions in late April (Iati et al., 2020), ahead even of federal guidelines for doing so, the nation began to closely observe trends in COVID-19 infection rates in these areas. According

Journal of Nursing Education • Vol. 59, No. 6, 2020 303

to nursing workforce projections through 2030 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (2017), the state of Georgia—pre-pandemic—is al- ready projected to have a shortage of 2,200 RNs by 2030. For Texas, the short- age is projected to be 15,900 RNs. South Carolina has the second highest projected shortage (behind Alaska) in the United States, with a stunning projected shortage of 10,400 RNs—a shortfall of 16.6%— by 2030.

Continuing spikes in COVID-19 in- fections due to premature ending of so- cial distancing will continue to stress and overwhelm hospitals and health systems, locally and regionally, as outbreaks move from place to place within the country until effective treatments or vaccines become available. Hospital-based clini- cal learning sites desperately needed by nursing and other health professions education programs will continue restric- tions on student learning as they focus scarce resources instead on their patients and staff. U.S. society has had a strong and long-standing compact with the nurs- ing profession, built on trust and mutual advocacy. This compact is evident in the Gallup organization’s annual public per- ception poll (Brenan, 2018) about the honesty and ethics of various professions, where nurses have been rated as the most trustworthy profession by the public for 18 years in a row.

Nursing has demonstrated its commit- ment to society and to the populations it serves, time and again. Now, society has a chance to demonstrate this mutual re- spect and commitment, and can do so by

strictly observing social distancing guide- lines to prevent inflicting enduring and significant damage to our existing nursing workforce and the workforce pipeline that nursing programs around the country are struggling to fill in these uncertain times. Now is the time for nursing faculty—and even nursing students—to raise their voices on this issue, in every venue where they can be heard. There is no doubt that a function- ing and productive national economy is es- sential, but it is no more essential than the other basic building blocks of a modern society, including a capable, sufficiently large, and well-educated nursing workforce that can skillfully and effectively meet the needs of the populations it serves.

A stark choice is largely up to our federal and local elected leaders and to individuals resisting or ignoring social distancing and stay-at-home orders: fol- low the evidence-based social distancing guidelines strongly endorsed by public health experts or, conversely, compound the burden of COVID-19 that all of us have borne, that nurses have borne in particular, and that vulnerable popula- tions have borne perhaps most signifi- cantly. Let us not waste the progress we have made.

References

Brenan, M. (2018, December 20). Nurses again outpace other professions for honesty, eth- ics. https://news.gallup.com/poll/245597/ nurses-again-outpace-professions-honesty- ethics.aspx

Buerhaus, P.I., Auerbach, D.I., & Staiger, D.O. (2020). Older clinicians and the surge in novel coronavirus disease 2019 (COVID-19). JAMA, 323(18), 1777-1778. https://doi. org/10/ggqsn7

Buerhaus, P.I., Skinner, L.E., Auerbach, D.I., & Staiger, D.O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. https://doi.org/10/ggcht5

Iati, M., Beachum, L., Pell, S., Goff, S., Korn- field, M., Armus, T., Farzan, A.N., Sonmez, F., O’Grady, S., & Mettler, K. (2020, April 20). Georgia, South Carolina and Tennessee governors announce plans to ease coronavirus restrictions. Washington Post. https://www. washingtonpost.com/world/2020/04/20/ coronavirus-latest-news/

National Council of State Boards of Nursing. (2019). 2019 NCLEX pass rates. https:// www.ncsbn.org/13495.htm

National Council of State Boards of Nursing. (2020, April). Active RN licenses: A profile of nursing licensure in the U.S. https://www. ncsbn.org/6161.htm

U.S. Department of Health and Human Services, Health Resources and Services Administra- tion. (2017). Supply and demand projections of the nursing workforce: 2014-2030. U.S. Department of Health and Human Services, Health Resources and Services Administra- tion, National Center for Health Workforce Analysis. https://bhw.hrsa.gov/sites/default/ files/bhw/nchwa/projections/NCHWA_ HRSA_Nursing_Report.pdf

World Health Organization. (2020a). State of the world’s nursing report—2020: Investing in education, jobs, and leadership. https:// www.who.int/publications-detail/nursing- report-2020

World Health Organization. (2020b). Year of the nurse and the midwife 2020. https://www. who.int/news-room/campaigns/year-of-the- nurse-and-the-midwife-2020

Darrell Spurlock, Jr., PhD, RN, NEA-BC, ANEF

Assistant Editor The author has disclosed no potential con-