THE BUSINESS OF HEALTH CARE: STRATEGIES FOR A SUSTAINABLE NURSING WORKFORCE
The pandemic saw many nurses leaving the profession for a variety of reasons including fear of exposure, unsureness regarding the vaccines, fatigue, lacking in work-life balance, thus exacerbating a nursing shortage that has been evident for decades. When we explore further why nurses are leaving the profession, we find/hear a plethora of other reasons: respect, not having a voice in their practice, poor working environments, compensation, lateral violence, flexibility, and impending retirements, to name those most often voiced. So, what can be done to stem the tide of nurses leaving the workforce or perhaps encouraging a return.
This issue is dedicated to exploring strategies aimed at sustaining a nursing workforce for now and in the future. Additionally, this issue provides the reader with articles focused on the financial aspects of health care and nursing's role in speaking the language of the finance team. In this issue, Sanford addressed similarities and disparities between the H1N1 pandemic over a century ago to the COVID-19 pandemic and explores lessons learned. From there she moves on to discuss that the shortage we see in nursing today, unlike a century ago, is now exacerbated by the fact that shortages exist in multiple health care fields, with practitioners voicing the same dissatisfaction as nurses. The Sanford team moves to employing strategies incorporating vision, mission, and values that staff have a voice in creating and designing tactics that as implemented will sustain an engaged workforce for the long term.
Creating new opportunities for experienced nurses to remain in the workforce adds not only to increased satisfaction for nurses but also improves health care for patients. Knighten explores the strategy of "recovering" nurses who would otherwise leave the workforce by creating a transition for experienced medical-surgical nurses and others to move into perioperative practice. This maintains a pipeline in the organization and provides experienced practitioners for an area that often relied on less experienced nurses with longer transitions. Simpson and team on the other hand share the opportunities for advanced practice providers such as nurse practitioners (NPs) to enter the realm of radiation oncology. While NPs have education and background in their specific practice such as family and gerontology, they are not equipped with the skills and knowledge to enter into radiation oncology without further training and/or certification. They share opportunities and a call for institutions, education and practice, to develop programs to assist NPs in becoming qualified to practice in radiation oncology practices, thus providing additional cost-effective care for patients and improved satisfaction for them and their families as well as other providers.
Novice nurses, those with less than 1 year of experience, are among the largest group to leave their positions and/or the profession. McBride and her team explore how academic-practice partnerships can provide the novice nurse with stability and enhanced resilience and self-care. In addition, collaborative partnerships with health care agencies and other educational institutions provide opportunities for recruitment and establishment of programs to sustain and enhance the workforce.
While we think more often about the nursing workforce in terms of staff nurses and hospitals, there is a faculty shortage that impinges upon the overall nursing workforce. Colleges and schools of nursing throughout the country often have to turn away qualified applicants due to a lack of faculty to meet their needs. This is especially true in underserved areas. S. Welch and her team are engaged in a project to increase the number of MSN-prepared nurses with a specialty in education who become faculty. This project is designed as a collaborative partnership between colleges of nursing and academic institutions with "large nursing student populations from underserved communities." Sustainability over time is linked to the Nursing Faculty Loan Program, thus addressing financial concerns and longer-term outcomes.
T. Welch and Smith provide us with guidance on strategic planning and the use of implementation science to put words into action. They address the issues and steps strategic thinkers within an organization need to take in order to accomplish cultural change in their organizations.
Workforce concerns and projected shortages can only be changed through proactive actions designed not only to mitigate but also to sustain change. Nursing is a complex profession that requires dedication, resilience, interpersonal relationships, and collaborative efforts to sustain and support its workforce. Continuing to address issues on a short-term basis will not do justice to our nurses and will not stop the exodus from the profession. Nurse leaders, both academic and practice, need to include nurses in decision-making, work toward collaborative practice, improve environments, and create a culture of inclusion in all senses of the word. Positioning the workforce for the future is a dynamic process that needs long-term commitment across all areas of nursing and health care organizations.
-Angeline Christine Delucas, DNP, MPH, RN, NEA-BC
Guest Editor