The Nursing Shortage: Changing Nurse Responsibilities and Competencies

It is hard to imagine that there is an employment group more critical to healthcare than nursing. Nurses are the largest staff pool of the healthcare workforce, and work with every segment of the healthcare delivery system – both providing and coordinating care. Good nurses are in high demand. Some good news is that the number of RNs is expected to grow 16% by 2024, but supply of qualified nurses is still not projected to meet projected demand. Forecasts show that in the near future, the growing nurse shortage will be scary, and nursing roles will change. states that more than half of working nurses are over 50 and the U.S. is going to need over 1.05M new nurses by 2022, while nurses who passed the NCLEX RN exam in 2017 only number about 245,000, up just 1% from the year before. This results in longer times to fill roles, usually on stagnant recruiting budgets. The demand for nurses is outpacing supply.

Getting more young people to nursing school is important, but will not fill immediate needs. With a changing care delivery system, nurse skills and expectations are evolving quick – nurses will have to adapt to technologies and sharpen abilities in data analysis, and be strong in behavioral skills like collaboration, communication, and critical thinking. How are nursing roles and expectations changing?
• Technology will play an even bigger role in providing care, and more care will go outside the traditional acute care hospital. Traditional hospitals will have slower growth, while ambulatory care, preventive and assistive living will show fast growth. Chronic disease management, geriatrics and hospice will be even larger demand areas.
• Care coordination responsibilities will increase, and these responsibilities will put different tasks on RNs to ensure the right care is given and communicated to patients and families. This is a change from nurses providing traditional bedside care only.
• There will be a demand for nurses who specialize in data analysis, communication, and health system navigation.
• Nurses will collaborate more with other providers and health disciplines. Nurses will be responsible for seeing that money and resources are used efficiently.
• These new roles and expectations mean that behavioral skills, including communication, critical thinking, supervisory skills, and financial awareness are more important than ever.

Nursing is a tough job. Patient care is strenuous, long shifts, inadequate staffing, exposure to sickness, and nurse injuries make it hard to retain great nurses. To boost retention, consider multi-faceted tactics:
• Clarify work expectations. Staff get upset quick when they find out a job is not what was expected.
• Allow nurses to have input on critical issues.
• Give scheduling flexibility if possible
• Build a culture of teamwork
• When possible, ease nurses administrative burden. Use support staff to fill appropriate tasks.
• Reward superior performance and do not tolerate substandard performance. Underperformers undermine co-workers who are performing well, and the better performers are usually the first to leave a unit.
• Support nurse career development
• Prepare nurses to lead. The relationship with the immediate supervisor is critical to job satisfaction. Obviously prepare Nurse Managers, but also prepare your Charge Nurses with the support they need. Prepare Charge Nurses with those behavioral skills needed in the evolving nurse expectation landscape, including communication, critical thinking, supervisory skills and financial awareness. Early preparation for the Charge RN role will obviously boost retention, but will also prepare your next wave of leaders to apply for Nurse Manager roles in the future. It can be hard for nurses in the Charge Nurse role to switch from a nurse peer to nurse leader. But it is critical that they learn, because if a nurse has a bad first leadership experience they are often unlikely to pursue higher roles in the future, or may pursue other employment.

Consider a curriculum like NCharge: Nurses Learning to Lead to prepare nurses with the leadership and behavioral skills they will need as nurse roles and expectations change. Courses like Charge Nurse Fundamentals, Critical Thinking Skills for Charge Nurses, and Supervisory Skills for Positive Outcomes help boost behavioral skill learning. These courses teach participants business skills such as the financial implications of VBP, using critical thinking to make informed decisions, implementing strategies to improve staff productivity, and expanding qualities for successful leadership. NCharge also supports career development
needs of the first-level nurse supervisor.

The Atlantic 2018: “Health Care and American Jobs,” Derek Thompson, January 9, 2018;; National Council of State Boards of Nursing;; National Healthcare Retention and RN Staffing Report (Nursing Solutions); 2017 Healthcare Recruiting Trends Report; “The Nursing Shortage” Select International by Bryan Warren Dec 2017