“It’s going to continue and it’s going to get worse”: Short-staffing and the future of nursing

Nurses everywhere have been raising red flags in an attempt to draw attention to short-staffing—one of the greatest issues facing the profession. And for far too long now, it has gone unresolved.

If the nurses of today are labeling the issue as severe as it is sweeping, what will the nurses of tomorrow–10 to 15 years from now–face when the nurse-to-patient ratio has been further agitated by a booming population and an even lower influx of new nurses?

In this week’s episode of “The Nurse Mendoza Show” on ScrubsBeat, Nurse Mendoza urges the healthcare community to consider the future of nursing—a future that’s likely to be your own. Then, share your own thoughts and opinions in the comments section below.

Concerned about inadequate levels of staffing? We encourage you to contribute to the conversation and to keep the comments coming!

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27 Responses to “It’s going to continue and it’s going to get worse”: Short-staffing and the future of nursing

  1. Kandi N Gene Garner

    Short staffing has been a thorn in the side of nursing since I became a nurse in 1979. When we demanded better staffing and gave plenty of valid reasons why a nurse should not have 8 patients…ever…it seemed to fall on deaf ears. We asked for nursing support with nursing technicians, 1 for each nurse. That got ignored also. We were lucky to have one tech for 25 patients. How in the world could that help the Nurse?
    As an advocate for the Union we attempted to get them to agree to 4 patients per nurse. Their response was paperwork that evaluated how ill a patient was and we were to be staffed accordingly. We diligently filled out our papers that clearly showed we needed more nurses and when months went by with no change we asked why we weren’t getting the staff the surveys clearly showed we needed. Their answer? That was yesterday’s evaluation. So we asked why in the world were we using a tool that administration set up which clearly wasn’t going to work? No reasonable answer to that so we just quit filling out the paperwork no one was taking seriously anyway and was wasting precious time that we could have spent doing other things.
    I retired at age 55 because of exhaustion and anxiety having worked in a teaching hospital my entire career.
    If the staffing issue isn’t resolved, if Administrators refuse to take this issue seriously, if Hospital and any other nurses who are overwhelmed with the responsibility and in charge of 8 or more very ill patients on a daily basis, increase pay to commiserate that responsibility as nurses are notoriously underpaid, there will not be nurses for the future. People these days won’t tolerate such horrible working conditions. They will quit and go into another field leaving hospitals full of sick people and no one to care for the.
    Wake Up! This information is BAD! I rarely had less than 6 patients to start with and always got the first admission. The only reason I didn’t leave is that I love healing people, body and soul. And, I cared deeply for my co-workers who were in the same boat and stayed for the same reason.
    When I retired, 3 other nurses decided to retire with me, leaving my unit to struggle until they could find and train nurses to replace us.
    The above comments are my observations and theories only.

  2. ConluvRN

    I am a nurse on a busy Med/surg floor and often have to be Charge Nurse along with team lead an LPN (and her 5 pts) as well as having a patient assignment of my own! Recently I apparently made some medication errors (no patient harm) in documentation and now I am being under investigation! I feel like this would never have happened if I had not been forced to have all of those duties at once! I feel like the administration is setting us up for failure and I am so angry about it!

    • Emerald

      Watch your back, they probably ARE setting you up. I’ve seen it SO MANY times. It sickens me to know I worked along side and for people that do this.

  3. CrisM

    I have been a full-time practicing nurse for almost 40 years. Short-staffing is always a huge problem. Administrators will never see it as long as their bottom line is the almighty $$dollar. We have to be patient advocates, if nothing else. We have to stand up for the safety and ethical treatment of our patients. I surely don’t know what the answer is. But I am very afraid of the nursing staff that will be available to care for all of us. Most of them seem to be in it for the money, because it is a decent paycheck to bring home. Nobody seems to CARE anymore. Yes, I’m burned out. Yes, I am jaded. I have always worked in acute care facilities where there seem to be alot of people making policies, but few who really care taking care of patients. I hope it changes. Young people have the power, if only we knew how to give it to them.

  4. Fiore

    If nurses work together to keep this in the public eye, then the public will see how much the ceo’s of the companies care more about their numbers and profits, than the patients whom the nurses take care of.

  5. greywulf

    The issue with nursing is that we do not act as a group. Physicians have a strong lobby because they stand together and act as a political unit. We do not. If we did act as a unit, including collective bargaining, voting and speaking as a unit to our representatives and especially to administration, we could and would wield tremendous clout. We should be pushing for national licensure, automatic collective bargaining for all nursing professional staff, strict nurse/patient ratios and standard of care protocols with Nursing input on all standards in the institution. This is really just good business. In reality, nursing care is THE unit of production for all health care companies and institutions. We provide the only service that is non-replacable and intrinsic to the system. Only in health care does the decision making process exclude the experts in the very thing that we “sell” as a business.

  6. Sunset

    I have been a nurse for 25 years and in the beginning I absolutely loved my job. I truly felt that I made a difference in my pt’s lives. Through the years nursing has become a burden and the most stressful job I could imagine. I along with my co-workers have cried at the end or even during our shift d/t stress. We no longer have the time to adequately take care of our pt’s. Our nursing license is on the line every single day that we clock in because of staffing. Also over the years nurse bullying has become out of control. I contribute this to poor management along with poor training for newly hired nurses. I feel that something needs to be done ASAP because in the end it’s our pt’s that are neglected and suffering.

  7. 5thcareer

    Nursing is my 5th career. What was shocking to me, and what I heard from so many patients, is the chaos that goes on everyday. Patients and staff complain about it all the time, but it’s never really addressed. Even at a highly respected hospital where I worked 7 years earning my chops, it was very chaotic. Other professions don’t tolerate this and it doesn’t happen. Probably the biggest part of this problem is the chronic understaffing which is done by administrations that only see numbers, and really care mostly about getting their bonus at the end of the year which reward short-term profit-driven goals at the cost of real, lasting improvement.

  8. Emerald

    Interesting you stated not to get into nursing for the money. It seems to me these third world countries are ‘growing’ baby doctors and nurses almost to the point of export commodities. Tell me they’re not in it for the money and make me believe it.

  9. Marie Duvenhage

    I think the whole idea of us nurses become short staff is due to the fact that admin people make mostly the decisions about patient/nurse ratio and they not always have the nursing background like we do. They are more business orientated and profit driven, not that it’s not good but in the process the pressure increase on nurses to perform more than they can handle leading to reduce nursing care,lawsuits etc. In the communities people talk about it and young people are expose to all the negatives in nursing,causing a lot of mind changing in the possible future nurses. Then you start to think about money and first come to mind: is it worth to study four to six year to become a specilized nurse where you can study something else and earn more money. The crux of the whole story is even when your passion is nursing you need money to servive

  10. AngelRn

    Short staffing will be an issue, but as long as we have dedication to the profession, love and understanding of what we do, see our loved ones lying on that hospital bed we can’t turn our backs and say I can’t take care of you because we are short staff. This will be out motivation to do what nursing is all about.

  11. thisnurse334

    I have been an LPN for 11 years and counting. I’ve worked in the hospital, nursing home, internal medicine, family practice, and substance abuse clinic. I have worked with some absolutely amazing nurses in my career so far, both RN’s and LPN’s and some that i wondered to myself “how did that person pass the boards?”, which i know is very judgemental. During the time since I was in nursing school LPN’s have been more and more phased out of hospital nursing and only accepted to work in clinics and nursing homes. However, even doctors offices and clinics are now able to hire MA’s instead of LPN’s for a lower pay rate and still have to train them for things that are not a part of their training and education while going to school for medical assisting. Where does that leave us as LPN’s? It leaves us having a hard time finding jobs. Especially since many LPN students want to go into the hospital to work but its no longer accepted.Therefore we settle for jobs in nursing homes or clinics. I feel that an LPN goes through an equivalent amount of clinical training as an associate level RN. With that being said RN graduates especially BSN grads definitely receive more training and education in management. If the nursing boards did away with the LPN track and created a faster track for current LPN’s into an associate nursing degree it would greatly impact the nursing shortage. I do not feel like it’s unfair idea because there is no significant difference in classes/training required for an associate level nursing degree and an LPN diploma. And if the boards feel like there is a significant difference why not allow LPN’s to take the additional required NURSING courses not more core classes such as English and History. Then this would let LPN’s turned ASN be able to apply for jobs in hospitals further impacting the nursing shortage. There should be a faster track for LPN’s than what is currently being offered. Taking classes more classes in public speaking, english, history, etc.. does not improve how well we nurse nor does it increase our knowledge of nursing in any way. It serves only to provide us with a certain amount of course hours.

  12. KraznyOctobr

    The problem facing nursing and indeed healthcare as a whole is not one of nurse recruitment, but of nurse retention. Nursing schools are pumping out new graduates at an alarming and sometimes dangerous rate. New nurses are emerging with fewer clinical hours due to accelerated courses, are coming out in larger classes and are coming to the hospitals eagerly wanting work. Their numbers are so great that hospitals are starting to get picky about their recruitment with a driver for BSN nurses and experienced nurses. Yet the shortage remains because these new nurses will someday become experienced nurses that look around at their situation and realize they could make similar money elsewhere and for less stress. So I do disagree slightly with the original post that our issue is more about keeping the nurses in the profession and at the bedside than recruiting additional ones.

    Many newly minted nurses can attest to that horror show of a first year in nursing. Administration gives a nice song and dance with a “welcome” show before teaming that new graduate nurse up with another nurse and sending them out to the floor. Orientation varies from place to place, but in general a new nurse has only a few months at most to gather their bearings and then perform at a level comparable to more experienced nurses. Examine the ridiculous nature of this situation in that four months ago a new nurse was not allowed to even have their own patient, but then are thrust into situations where they are hanging dangerous medications and managing multiple people. That is not an orientation that is a meat grinder. Such a rapid acceleration into the overwhelming is a significant part of why nurses do not last long in this profession along with a steady realization that things do not change for the better.

    More experienced nurses would greatly relieve this situation except older nurses have little to no incentive to remain at the bedside. While the starting pay for a nurse is exceptional considering the requirement is an associates degree or bachelor’s degree, the climb is a steep one from there. Requirements for increased education and training mount for a nurse that remains on the floor, spending a great many hours in front of a computer module or sitting inside a conference room learning for the twelfth time where their hands go during CPR. None of these certifications or education comes with benefits except to remain employed and not be harassed by the unit secretary. Older nurses have to watch over an ever growing population of new nurses, while at the same time managing their own patient load which steadily increases in both size and acuity. All of this while having no real increase in pay. Many of the nurses I know that have worked for over twenty years make at most ten dollars more than myself who has worked not even five years.

    So consider these two forces at work on both ends of the nursing world. New grads are better educated now with associates and bachelor degrees the base entry. A year into nursing at they are confronted with high demand and responsibility. There is little to truly keep these well educated people in this profession if another profession offers more money and less risk. Experienced nurses can easily shift from one job to the next. Positions away from the bedside offer better hours, comparable pay and less hassle. Where is the incentive to stay at the bedside? The only reason to remain is simple love for patient care and that only lasts so long.

    Then we have other factors such as injury, which nursing is one of the top professions for workplace injury. Also there is work place violence with nursing once more at the top of these professions. Then we can go into lack of benefits, lack of compensation, and so forth. As a field bedside nursing is attractive only for a short period of time.

  13. danalord

    I work in a NH, Fri, Sat, Sun nights 6p-6a. We currently have 50 residents. I have been an LVN for 20 years. I ran across an issue this past weekend, we normally have 2 nurses and 2 CNA’s from 10p-6a. The other nurse came down with a virus and had to leave Sat night about midnight. The Administration thought that it would be ok for me to complete the shift alone. What? We have all types of acuity in our facility from alzhiemer patients to hospice patients, trach and gtube, bedridden to active, some with sun downers that roam. The DON said we should be able to handle 50 patients. This is absolutely crazy!!! First of all the ADON was on call and wouldn’t answer her phone so we tried the DON who wouldn’t answer her phone. Next we tried the weekend supervisor who thank God answered and came in but it took an hour of being by myself. Yet they claim the patient is their priority. The almighty dollar is their priority. This facility used to be in the top 5 in the state but now is near the bottom of the list. When are they going to realize that if they take care of the patients with good care the money will come on it’s own. Feel very frustrated but absolutely love my patients.

  14. Exhausted

    I have been in the profession over 30 years. This calamity is escalating to a catastrophic failure for our nation and our profession. If management, including nursing management, does not stop putting the almighty dollar and their greed for it FIRST over the well being and safety of their staff and patients, no one will enter a profession that is a bust and is becoming abusive slavery mentally and physically.

  15. Jaylee Nelson

    I think hospitals need to start looking outside of the box, possibly make the benefits so good they can’t be ignored. I realize the push for all RNs to receive there BSNs is taxing, but I think it is a good thing ultimately. If hospitals looked at ways to ease that burden, I think it would have a positive effect. Whether that is paying for their employees BSN, or possibly paying their employees student loans. There are ways to make their facilities more appealing to new employees. It will cost money, which is generally when the breaks get slammed; but better than having to shut down departments due to low staff.

  16. NurseAPN

    The nursing shortage of the 1980s should have been a wake up call regarding the future shortages of nurses. This is not an occupation for someone looking to make money, many other jobs pay far more. Becoming a nurse means that you want to make a difference in the lives you touch. We need to provide good education to prepare nurses. I believe that this must include a paid one year nurse residency requirement because the nursing programs are not providing adequate preparation for the real world. We also need the media to portray nursing in a realistic manner. Today doctors and nurses work collaboratively and nurses need to have the same knowledge base in a speciality. Finally it is important to recruit new nurses, but the patient nurse ratios must be safe and realistic. We’re not dealing with numbers or dollars and the administration must move from the black and white of business to the ever changing grey areas of healthcare.

  17. rnwater3

    My goodness there are many comments and many valid ones
    I have been a nurse for 37 years. I also started my career back as a volunteer and then a nurse’s aid
    I have held many positions, from staff nurse, head nurse, supervisor and acting director of peri op
    I also have done some consulting work getting small ambulatory surgery places up and running and getting accredited with jcah and other firms
    i feel i am a very well rounded nurse ( icu/pacu/operating room/pain management)
    I have worked with many nurses both great and then some that really need to find a new career
    I always found that I will give the respect that I get
    During my career, as a manager, I always felt that you must get your hands dirty and work along side of your staff., yes get in the rooms help with patients etc– This way you keep your skills, you learn things,you learn about your staff and the staff respects you because they see you doing it
    What is the worst is when your manager, has no experience in the area she is managing, and talks to you like you are in kindergarten. I also find it difficult to work with someone who is have the shifts work against each other. I love it when I hear I have an open door policy, but yet can never talk to you , because they have to get a report out or go to a meeting. I always thought patient care should come before a meeting
    Working in an operating room is a very physical stressful job, and we are always understaffed– we keep hearing the same thing we are working on it
    I understand that most hospitals want a bsn– ok so why do you not still hire the experienced nurse who perhaps went to an associate program or a diploma ? Why do you shut the door down to them and not even interview , so you can see what skills, knowledge and life experience they have. Ok so a bachelors , why only in nursing, why not health care adminstration, or psychology or a bachelors in some type of health related area It is wrong to eliminate all these well trained dedicated nurses

    There are formulas that you can use to figure out what the staffing level should be , including adding in benefit time so you can cover the unit.. So why do you allow surgeons to keep booking cases that are elective late in the day so this way you have no place to put the emergencies. I often wonder what would happen if staff did not say yes i will work overtime for you .
    I know i am babbling but i am also so frustrated
    I hate to say it but i think the way the field is going there is an accident waiting to happen and i truly hope i will not be there to witness it
    I am also concerned , who will take care of me when i am in need– very scary
    I also have had numerous family members in the hospital , and I will also say NEVER LEAVE YOUR FAMILY MEMBER ALONE IN A HOSPITAL EVER

    • Anne2024

      I so agree with your comments about the manager.
      When I was the manager of the unit, I answered lights, assisted with care and as I shared my office with the charge nurses, was able to listen to report twice. I knew the patients and I was involved with star and patients.
      I now work nightshift as charge and love it!

  18. carolnye@ymail.com

    I have been a nurse for 20 yrs. With each yr I find the staffing issues on a continuous decline, it takes a toll on the optimum care one nurse can provide to their patients. Currently I work on a behavior Alzheimer’s/Dementia unit and I have 40 residents in my care. This is very frustrating to me I feel my patients are not receiving what they deserve. What are the nurse/patient ratio in this situation can you advise? Thanks

  19. Loretta

    Back in 1969-70, the staff at night was 1 RN and 1 aide on a 28 bed acute surgical unit in a big city hospital! I loved it! I don’t know how I did it! It wasn’t shocking to us then because our Diploma nursing school was on site and we were trained on the units and expected to handle it. People (patients) were also nicer and more respectful of nurses back then, and visitors had rules to follow. I worked until age 66, and I must say over the last 20 years many patients and visitors became very abusive, demanding, aggressive, hostile, and the workload so intensive and stressful,and, even though I still loved the challenge and satisfaction from my work, I’m glad to retire.

  20. Loretta

    There’s way too many “white coat nurses” walking around or sitting in meetings and having long lunchtimes and making all the decisions for the worker bees (acute care bedside nurses) who provide all the selfless care, often without breaks, and are often talked down to by those nurses in the white coats.

  21. MississippiKidRN

    I feel that bedside nursing should be primary geared towards new nurses so they can gain the necessary base experience before moving elsewhere. I understand there are nurses who love direct pt care and could not imaging doing anything else and that’s great. But I feel those nurses are few and far between. It seems like to me the smartest thing to do to prevent bedside burn out is to do 1-2 year med/surg, ICU, ER and then move into areas which give better work life balance such as ARNP, CRNA, CNS, Nurse Ed, Nursing Management, and ambulatory care/ outpatient clinics. I think the way to solve the bedside RN shortage is to advertise almost the same way that MDs do a residency. Encourage new nurses to come in, gain several years of solid experience, then move on and specialize in a particular area of nursing and have a better quality of life. As long as you have solid ancillary staff around such as charge nurses, nurse educates, supervisors and directors who are there and accessible to the new RNs there shouldn’t be much of an issue. If more programs, ADN and BSN, advertised bedside nursing as a stepping stone rather than a career end point I feel that you would have more young career driven individuals looking at nursing as a viable option and thus more bedside RNs overall.

  22. BICURN

    A nurse for 27 years now and the trend that is disturbing to me is the willingness of institutions to commit tremendous finances for resources: buying equipment, constructing new buildings, renovating old buildings. Anything but share their success with the most essential resource they have – staff. I work in an institution currently that shares a financial report card quarterly and they routinely report increased income compared to ” last year at this time ” or compared to the last quarter but reimbursement to staff has been minimal if not insulting. ” Money for those projects comes from a separate budget “. A line I have heard at every hospital I have worked. BULL! The majority of your money comes from reimbursements from the insurance companies or the government and is not earmarked for any use until you earmark it. Projects have included housing for Residents with the hospital participating in commercial real estate development in the same building. Institutions have exploited nurses’ compassion, desire to provide the same level of care regardless of staffing and other circumstances. Hey, we just bought that medical group for high 8 figures, possibly low 9 figures but our nurses got a 40 cent raise last year. The curtain needs to be pulled back on the priorities of these institutions.

  23. Anne2024

    Who works for CHI? Catholic Health Initiatives?
    In Washington state we are being told this the new norm. Charge Nurses are pulled to do patient and also do the Charges must get done.
    Nurses are leaving.
    We have a ratio of1:6 on our rehab nightshift”. There are no other units with this ratio, M/S has a 1:4 or 1:5 ratio. This is unsafe and as our manage stated “the patient are sleeping, you can get the work done”. Not, patients are awake and are very busy.!!
    This continues to worsen and leadership
    has turned a blind to this disaster.
    My team on nights has moved on, and or quit. Nursing concerns have not been addressed. The turnover rate has increase and only getting worse.’
    Blame goes to the manager and upper leadership. It’s “Profit over Patients”.
    Since nurses are working and taking care of patients at “short staffed” levels, it is the new norm.

  24. Enjonel

    I have been a registered nurse for 40 years. I have been an aide before that, and also a LPN.
    Hospitals have an easy way to save money on insurance, training, vacations etc. and that is mandation. Why hire when all you need to do is hild exhausted nurses over? They have no right to their lives outside of their employment. They are, after all, angels. Angels give… and give… and give.
    So long as hospitals are allowed to mandate, short staffing will be a problem.
    It also helps the hospital because nurses ate too busy and tired,with mandation, to file the unsafe load papers.
    I have long believed that nurses should all be contracted to the places they work through agencies or the government, similiarly to the traveling nurses of today. That way, if your place of employment treats you badly, you move on without loss of benefits or pay. Places of employment would have to treat nurses right, or truely be unable to get nurses. No nurses: you close. In the short run, this would be difficult on keeping hospitals open, but in the long run, places of employment would have to treat staff right, or suffer the consequences. There would eventually be a balance: enough good hospitals and enough treasured nurses. Patient care outcomes would improve.
    Also, there is Mousseau reason for hospital administrators to get paid what they are! Nurses make the hospital money, administrators should be there to support the staff, not get rich.
    To the LPN that stated there is essentially no difference between a LPN, and a diploma graduate: wrong. I have been both. The difference is huge. Additionally, it is not possible for LPNs to receive all the training in one year that diploma grads get in two. In my humble opinion, your belief there is no difference is fostered by the fact you have not been a RN. I have been a nurse a long time, and have never,not once, heard this belief continued after a LPN has gone to school to become a RN. The same is true of aides who believed RNs did nothing but chart and talk to Doctors, being inherently lazy. Once they become RNs, and actually see the responsibility and work of the RN, these beliefs vanish.
    I believe health care teams are important. The aide, LPN and RN all have roles to play and responsibilities to do. A well functioning team utilizes each member to the best of ability and job. Each is treasured for what they do.

  25. 2Fast

    The world of nursing is not what it used to be, namely, taking care of patients with compassion and integrity. Also, the respect is not there anymore. Today, it is a business, plain and simple. Your supervisors and administrators are not your friends. They are minions and executioners for the top of the pyramid. Money and greed is the rule of every day. Everything else is just a facade to make you believe you valued. You are not, let that sink in. – Our values and integrity are under attack. At the same time, everyone wants instant gratification I agree with the folks that say, nursing they way it is today, will not change any time soon. If you decide nursing is for you, wappnen yourself with lots of patience, strength of iron mentality and physically, and obedience!!!!