Commentary / Coronavirus

Acute Nursing Shortage – Finding Solutions

nurseRegistered nurses – or lack of them – may be the next chokepoint in battling coronavirus. Solutions exist, but we need to think fast. Today, America has 834 nurses per 100,000 citizens. 

That may sound like a lot – but is inadequate for current and projected needs. Honest analysis, creative thinking, conscientious leadership, and international cooperation are needed now. 

If no one predicted the coronavirus crisis, the nursing shortage is not new. According to Registered Nursing.Org, the shortage has long been approaching. The nursing shortage was projected to grow by 12 percent from 2018 to 2028. So, we were behind before we started. 

Several cross-currents now complicate things. Nurses need accredited training, cannot be whipped up overnight. Second, all candidates must pass the National Council Licensure Examination. Finally, nurses must get licensed by the state. All this takes time.

Even as graduation rates creep up, a ballooning baby-boomer bubbled threatens to exacerbate the shortage. Nurse licensing must match two counter-trends: More people are aging into care, and more aging nurses are retiring. 

Now, layer on the coronavirus crisis. First, “hot spots” do not align with where nurses are. States with more than 5000 cases on April 4 included: New York, Louisiana, Illinois, Massachusetts, California, Florida, Washington, Pennsylvania, and Georgia.   

By contrast, the highest number of per capita nurses were in DC, South Dakota, Massachusetts, North Dakota, Rhode Island, Delaware, Missouri, Maine, Iowa, Ohio, Minnesota, New Hampshire, and Nebraska. So, the largest number of nurses per capita exists where fewer cases exist. All the states above, except Massachusetts, Ohio, and Missouri, have less than 1000 cases. 

Worse, Intensive Care Units (ICUs) with ventilators must be attended by nurses. These nurses – usually on rotating 8-hour shifts – are on 12-hour shifts from Boston to Louisiana. We still have too few. Demanding ventilators – administered in ICUs by nurses – is all fine and well. It does not fix state-level deficits in ICU beds and nurses – and these are huge.  

New York’s Governor Cuomo is demanding 30,000 more ventilators from President Trump. New York has only 3,000 ICU beds (some say 1500). Cuomo admits a 140,000 overall bed shortfall. That is not Trump’s fault. More ventilators will not solve the ICU and nurse deficit. 

President Trump is ramping up production of necessary equipment, but what happens if New York – and others criticizing his leadership – do not have the ICU beds or nurses needed? 

The bigger question is not one of politics, but of medicine. What can be done? First, only 85 percent of trained nurses are in nursing – so state incentives could bring more to hospitals.  

Second, state incentives could bring thousands out of retirement, allowing those willing to practice again an added reason to do so, helping justify putting themselves and family at risk. 

Third, licensing requirements should be honored state-to-state, permitting out-of-state nurses to serve in “hot spot” hospitals. Vice President Pence is ahead of the curve, already giving federal permission. States need to make that happen, by MOU or blanket agreement.  

Fourth, nursing programs could offer leave, deploying nursing assistants to supplement projected ICU needs. While an imperfect solution, tasks might be triaged. New York City is especially vulnerable, with 2000 new and unfilled openings for nurses appearing in the past three weeks. 

Fifth, creatively incentivizing nurses to switch from less demanding venues to hospitals – especially to ICU wards – would be appropriate and timely. That, too, is on governors.  

While not all nurses qualify for ICU, other nursing venues can be tapped. Many are slowing or going telemedicine. Ripe venues include “private practices, health maintenance organizations, public health agencies, primary care clinics, home health care, nursing homes, minute clinics … nursing school-operated clinics, insurance and managed care companies, schools, mental health agencies, hospices, the military, industry, nursing education, and healthcare research,” according to the American Association of Colleges of Nursing.  

More immediately, Canada must reverse their April 4 threat to halt 1,600 Canadian nurses from regular cross-border crossing to Detroit if the US does not give Canada more 3M masks. This is the lowest of lowball politics, simultaneously undermining cross-border relations, endangering US lives, and endangering Canadian nurses’ regular employment.  

Moreover, Detroit is the “epicenter of the COVID-19 crisis in Michigan” – so Canadian nurse availability matters. Michigan has 14,225 cases, already 479 dead. Canada has less than 13,000 cases, 187 deaths. Canada’s dispersed population keeps numbers down. By contrast, America has 306,000 cases, roughly 8300 dead to date.  

The Canadian government is pushing for US masks for one reason – they sold theirs to China. In February, Canada sold 16 metric tons of protective equipment – including masks – to China. Now, they want America to correct their error – or face higher mortality in Detroit. This is more than unseemly. Cross-border cooperation on nurses is in order. 

Net-net, the coming spike will be addressed as crises are always addressed, muddling through. We will hope, pray and practice “social distancing” with resolve to keep numbers down. State and federal leaders will – God willing – put their heads together to bridge the nursing gap, and Canada can help. In the meantime, attacks on President Trump for insufficient ventilators ring hollow – when states without ICU beds or adequate nurses aim to pin deaths on this President. 

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