The tradition of New Year's resolutions was first recorded over 4,000 years ago by the ancient Babylonians (Pruitt, 2020). Their New Year celebration was held in March as part of a religious celebration coinciding with the planting of new crops. Ancient Romans were the first to celebrate the New Year on January 1, where they similarly made resolutions for the upcoming year (Pruitt, 2020). Based on this longstanding tradition, it seems appropriate to celebrate this New Year with a resolution to address issues impacting nursing education, practice, and ultimately health care.
My recommended resolution for 2023 is to co-create a sustainable nurse educator workforce development plan to address the current nursing workforce and faculty shortage that will hopefully serve as a future model for nursing. I am not the first to address this long-standing problem, nor do I suspect I will be the last. An issue of this magnitude will take strong collaborative efforts from a broad range of stakeholders within and outside academia, health care, and nursing.
Maintaining the status quo, reacting to each new wave of the nursing shortage, is not a viable long-term solution to the goal of expanding a vibrant, agile, and competent workforce. The pandemic exposed major gaps in academia and practice, including health inequalities and the lack of diversity in the workforce. It also shed light on our tremendous potential to use our ingenuity and problem-solving skills to revolutionize pathways to access and progress in nursing practice and education. Opportunities for nursing students and practicing nurses to advance their professional careers in the direction and pace of their choice, expanded access to programs, increased retention, and the promotion of a more diverse and inclusive workforce would be the best possible outcome.
The pandemic exposed major gaps in academia and practice, including health inequalities and the lack of diversity in the workforce. It also shed light on our tremendous potential to use our ingenuity and problem-solving skills to revolutionize pathways to access and progress in nursing practice and education.
The state of the nation's nursing shortage continues to challenge health care systems. There are continued calls for workflow redesign and innovative care delivery models, along with calls for recruiting and retaining a strong and diverse nursing workforce (Mate, 2022). Nursing shortages tend to be cyclical in nature, and health care systems respond by offering incentives such as scholarships in exchange for employment upon graduation, robust academic partnerships, tuition reimbursement, and sign-on bonuses. As workforce numbers increase, the incentives tend to diminish until the pendulum swings once again. The current shortage, made worse by the pandemic, is more complex and pervasive than shortages of the past and requires broad, long-term solutions. Nationally, the shortage is predicted to reach 1.1 million by 2023 (American Nurses Association, n.d.). Nursing has an opportunity to stop the pendulum swing or at least slow the major shifts.
The current nursing shortage has been attributed to several factors including the lack of qualified educators, high turnover rates, and an aging workforce, with more than 50 percent of the RN workforce, including faculty, over the age of 50 years (Haddad et al., 2022). As reported in U.S. News and World Report (Haines, 2022), the Bureau of Labor Statistics noted that the number of RNs between 25 and 34 years of age (generally the largest share of nurses per age group) declined by 5.2 percent between 2020 and 2021, and the number of nurses ages 35 to 44 years declined by 7.4 percent. These statistics are alarming for our future succession plans. Nurses aged 65 years and older had the highest level of increase, at 21.9 percent. The reduction in the pipeline of younger nurses to replace pending retirees requires nurse leaders to explore new models for retention and expanded professional development and advancement opportunities. Estimates call for more than 203,000 new RNs annually through 2026 to fill the anticipated retirement gap (US Bureau of Labor Statistics, 2022).
As a shortage of nurse graduates reduces the pipeline for the development of nurse faculty, the nurse faculty shortage further limits the number of student enrollments, thus reducing the number of new graduate nurses. Approximately 80 percent of respondents to the NLN Faculty Census Survey of Schools of Nursing Academic Year 2020-2021 (National League for Nursing [NLN], 2022) indicated they had plans to hire faculty, but 317 schools had difficulty recruiting faculty because of lack of qualifications, competitive salaries, and the perception that faculty positions are less attractive than others. With insufficient numbers of qualified faculty, nursing school enrollments simply cannot keep pace with projected workforce demands and must turn away thousands of qualified student applicants, representing the future faculty pipeline (American Association of Colleges of Nursing, 2022).
As noted earlier, diversity of the nursing workforce (practice and academia) continues to lag behind that of the national population (Murray & Noone, 2022). The national population of racial and ethnic minorities was 39.9 percent compared to 23 percent of the RN population in 2020 (Smiley et al., 2021). The NLN (2022) faculty census reports a slight increase of 4.1 percent, bringing the percentage of underrepresented faculty to 20.6 percent between 2016 and 2021. Improving workforce diversity requires increasing diversity in academic environments and establishing inclusive educational processes and support for student and faculty recruitment, retention, and progression (Dominque & Tobell, 2022). The outcome not only expands a critical pool of potential future nurses, but it is well documented that a diverse nursing workforce in academic and health care environments is associated with quality competent care, improved patient outcomes, and promotion of health equity (Alexander & Johnson, 2021).
Together, we must remove barriers to entry into nursing and develop programs that support and allow individualized learning opportunities for a diverse group of students from a wide variety of backgrounds. Together, health care practice organizations of all types and academics across all levels of degree programs must partner to co-create long-standing solutions to achieve our shared goals. Nursing academics need to reconsider the industrialized approach to admitting and training nurses, producing an assembly line of quality-controlled nurse graduates who may meet academic standards but are not fully prepared to enter nursing practice. Current training models will continue to result in low retention rates and high turnover when transitioning into practice.
Competition between academics and practice to recruit nurses reduces the ability of both organizations to optimize resources, retain valuable nurses, and deliver quality education to prepare our future workforce. Exploring models that leverage shared resources between organizations may offer viable solutions that better prepare nurses for the realities of patient care, expand career opportunities, offer solutions to improve nurse workflow patterns, and provide opportunities for nursing within health care organizations to advance in their profession without leaving the organization. One example may be to create joint positions or alternative opportunities for those early career nurses who are thinking of leaving the profession.
However, perhaps I am getting ahead of myself. Perhaps the best New Year's resolution is to explore new ways of treating those chronic conditions that plague our profession by listening, partnering, and truly understanding root causes before attempting to determine solutions. Often, our desire to cure and fix problems prevents us from validating the true core causes and leads us to implement costly yet largely ineffective short-term solutions.
Only 8 percent of New Year's resolutions are completed (Pruitt, 2020). Let's work together to become part of the 8 percent. The health of our profession and the health of our nation are a promise worthy of persistence. Happy New Year to all our NLN members, partners, and friends. Wishing you all a happy and healthy year ahead.
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