One in Five Nurses Could Leave the Workforce by 2027

WASHINGTON -- Experts projected that roughly 800,000 registered nurses (RNs) intend to leave the workforce by 2027 -- on top of the more than 100,000 who left during the COVID-19 pandemic -- during a presentation ahead of a solution-oriented panel discussion at the National Press Club last week.

In other words, close to one-fifth of the 4.5 million RNs in the country intend to leave the workforce, which would likely have ripple effects on the entire healthcare system, said Brendan Martin, PhD, director of nursing regulation for the National Council of State Boards of Nursing (NCSBN), the host of Thursday's panel.

"High workloads and unprecedented levels of burnout during the COVID‑19 pandemic have stressed the U.S. nursing workforce, particularly younger, less experienced RNs," Martin and co-authors wrote in a survey study in the Journal of Nursing Regulation, which was also published on Thursday.

In total, the U.S. nursing workforce fell 3.3% over the last 2 years, they noted.

Of the quarter of a million nurses who left the workforce since 2020 "specifically due to the COVID-19 pandemic," Martin and co-authors confirmed that approximately 100,000 were RNs and approximately 34,000 were licensed practical/vocational nurses (LPNs and LVNs).

Another 184,000 LPNs and LVNs intend to leave the workforce by 2027, Martin said.

But what he found most alarming, he noted, was that 41% of the practicing RNs who left the workforce had a mean age of 36 and less than 10 years of experience in the field.

Of the roughly 800,000 RNs reporting that they intend to leave the workforce, approximately 610,388 have over 10 years of experience -- with a mean age of 57 -- and 188,962 have less than 10 years' experience.

A potential driver of these projected shortfalls is the increased burden on nurses, Martin and co-authors wrote.

Approximately 62% of nurses in the survey sample reported an increasing workload during the pandemic. In addition, 50.8% said they felt emotionally drained; 56.4% said they felt used up; 49.7% said they felt fatigued; and 45.1% said they felt burned out or "at the end of their rope," with 29.4% saying they felt this way as often as a few times a week or every day. Among the nurses with ≤10 years of experience, Martin and team observed that they "consistently reported a 28% to 56% increase in the frequency" of these feelings.

"The most pronounced differences emerged when comparing early career nurses with higher workloads to their more experienced peers with normal workloads," the authors wrote. "In this comparison, early career respondents with high workloads were more than three to four times more likely to report higher frequencies of feeling emotionally drained, used up, fatigued, burned out, or at the end of their rope (all P<0.001)."

"But here's the silver lining," Martin said during the presentation, "the projections ... are not static, but rather manipulable outcomes based on the decisions of policymakers both today and in the near future."

Averting a Crisis

Following Martin's presentation, Maryann Alexander, PhD, RN, chief officer of nursing regulation for NCSBN, led a panel discussion on the workforce crisis, and noted that these projections are "reversible."

Gay Landstrom, PhD, RN, senior vice president and chief nursing officer at Trinity Health System, stressed the importance of creating a "different working environment" for nurses -- one that is "safer," "more flexible," and "more supportive."

She also highlighted the need for strong mentoring given the challenges the pandemic posed to new nurses' education.

In his presentation, Martin cited research on disruptions to pre-licensure nursing programs during the pandemic, which found "significant declines in the clinical preparedness of pre-licensure RN students and similar drop-offs in the practice proficiency of early career nurses," due to the use of remote and virtual simulated education models.

To address these shortcomings, Landstrom suggested leveraging technology to bring more experienced nurses, who may have left the field, back onto care teams to mentor younger nurses.

As for students' clinical training, she pointed out that the U.S. funds nursing education and medical education very differently. Practicing nurses are asked to "help develop and educate students," both at the undergraduate and graduate levels, without any additional compensation, she explained.

Nurse residency or transition-to-practice programs, when they're even available, are also not funded, she added.

"I think we really, as a country, have to look at learning from some of what we've done with medicine that has been successful and look at supporting nursing in the same way," she said.

Rayna Letourneau, PhD, RN, executive director of the Florida Center for Nursing, agreed, noting that even when schools are able to find strong faculty candidates with the appropriate credentials, the salary isn't competitive enough for them to take the positions.

She highlighted one solution: academic practice partnerships, which are arrangements in which two organizations work together -- one in academia and the other a professional practice or clinical institution -- to provide a clinical affiliation for a nursing school and to pool resources and achieve a "shared goal."

Robyn Begley, DNP, RN, CEO of the American Organization for Nursing Leadership, pointed out that during the pandemic, some hospitals and health systems were able to "loan or subsidize" qualified nurse educators to teach and be preceptors for colleges and schools of nursing.

"These are the kinds of partnerships that we really need to continue," she said.

Study Details

For their study, Martin and colleagues used data from the 2022 National Nursing Workforce Survey, which includes the National Forum of State Nursing Workforce Centers' Nurse Supply Minimum Dataset, and a handful of "custom items." The survey included 39 questions across six domains: COVID-19 pandemic, license information, work environment, telehealth, nurse licensure compact, and demographics.

The survey was sent via direct mail and posted online, and remained open for roughly 6 months.

The survey sample included 54,025 respondents across 45 states; 29,472 were RNs, including 2,723 advanced practice registered nurses, and 24,061 were LPNs or LVNs.

Most respondents were women (92.5%), average age was 51, and 79.9% were white. They reported a median of 19 years of experience, with minimal variation by license type. Most reported full-time employment (66.3%), and 4.6% said they engaged in travel nursing.

Limitations to the study included that the survey did not capture pandemic-related feedback from all states, which could limit the generalizability of the study's findings.

In addition, because some nurses hold licenses in multiple states and practice across state lines, there may be a "possible multiplicative effect associated with the potential attrition," Martin and team noted. However, given the limitations in state sampling, they suggested that the projections are more likely to be "conservative regarding the scale of any future loss."

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