Schrödinger’s Nursing Shortage

There is a shortage of nurses. There is no shortage of nurses. It appears to depend on where you are, who you are, and what you mean by “shortage of nurses”. This article at STAT by Brittany Trang explores the question:

Hospitals are frustrated with a nationwide nursing shortage that’s only gotten worse since the pandemic. In 2022, the American Hospital Association quoted an estimate that half a million nurses would leave the field by the end of that year, bringing the total shortage to 1.1 million.

At the same time, National Nurses United insists there isn’t a nurse shortage at all. There are plenty enough nurses for the country, they say — merely a shortage of nurses who want to work under current conditions.

From the point of view of hospital administrators:

The “nursing shortage is real,” Tenet Healthcare executive chairman Ron Rittenmeyer said in a radio interview in early 2022, blaming it on nurses leaving staff positions for lucrative travel jobs, nurses contracting Covid-19, and not enough support for nursing education.

Even as the pandemic has subsided in the past year, health care systems including Tenet, HCA, Universal Health Services, and Acadia Healthcare have said in financial guidance documents that they’re experiencing staff shortages, as well as turnover and retention problems. The hospitals are competing with each other for staff, which has driven up wages.

An interviewer at the Bank of America Healthcare Conference in May 2023 suggested to Tenet CEO Saum Sutaria that the contract labor problem could be eliminated if wages for in-house staff were raised, which Sutaria dismissed. “You could increase wages incredibly — you can increase them twice the normal rate, and I still don’t think there would be enough staff to come in and take full time,” he said. “There’s still a shortage, in the end of the day, of nurses, and this becomes an execution game of attracting people to your hospitals versus others.”

while from the point of view of nurses:

For nurses, what would attract them to one hospital over another or keep them from leaving the field is having enough other trained nurses and support staff — nurse techs, CNAs, phlebotomists, lab techs — to make their job doable.

Nurses say they are sick of what they call a “manufactured” staffing crisis. “It’s a little bit of an odd thing because they’re all yelling, ‘Nursing shortage, nursing shortage!’” Aiken said. But “[hospitals] have been chronically understaffing by design for several decades, and the same thing in nursing homes and schools.”

Nurses say hospitals maintain such low numbers of staff that there’s not enough time in the day to do everything required, much less do it well. The unmanageable workload leads nurses to question whether they want to stay in that environment and face the repercussions of making a mistake, said Leo Perez, a nurse at Pomona Valley Hospital Medical Center in California and president of the SEIU 121RN union. “I mean, you heard about what happened [to RaDonda Vaught],” the Tennessee nurse who was charged with negligent homicide for injecting a patient with the wrong medication, he said.

The conditions make it hard to hold on to nurses, contributing to the idea that there is indeed a shortage.

This all looks terribly familiar, hearkening back to what major IT firms have done for decades. They’ve been largely successful, chaffering down wages in IT by importing large numbers H1-B workers and outsourcing. Offshore outsourcing isn’t a strategy open to nursing but importing nurses certainly is.
Since 2011 nurses’ wages have risen about 20%. By comparison physicians’ wages have risen about 50%. Household incomes, generally. have risen by about 50%. It sounds to me like the nurses have a legitimate gripe.