Shortage of Nurses at Nursing Homes Keeps Growing

The nationwide nursing shortage, which began before the pandemic and accelerated when overworked nurses joined the Great Resignation, will get a lot worse before it gets better.

According to a new survey from AMN Healthcare Services, nearly one in three registered nurses responded that they’re likely to seek a different job. Consulting giant McKinsey released a study last month warning that the shortfall of nurses in the US is on a trajectory that could top 450,000—double the gap at the end of 2022.

Job openings in health care surged above 2M in April, on a pace to top last year’s record, Bloomberg reported—but the pipeline needed to fill the nursing shortage is shrinking rather than expanding:

Despite record demand, which is pushing up wages for nurses, undergraduate enrollments at nursing schools declined for the first time in more than 20 years in 2022, according to the American Association of Colleges of Nursing.

The nursing profession is imploding as the nursing shortage forces existing professionals to work longer hours and deal with more patients—leading to burnout and making the job unattractive to new recruits. According to McKinsey’s survey, “not having a manageable workload” is the main reason cited by nurses who are planning to quit.

This is really bad news for nursing home operators who have seen their margins shrink from rising labor costs despite occupancy levels that are approaching pre-pandemic levels.

Nursing home occupancy, which plunged to a national average of 67% in January 2021, is tracking above 80% this year. Nursing home staffing is heading in the other direction—at the same time the federal government is preparing to mandate a higher level of care at skilled nursing facilities.

In November, the Biden Administration said it will propose a minimum staffing level for nursing homes based on a 2001 recommendation from the Centers for Medicare and Medicaid Services that nursing homes deliver at least 4.1 hours of nursing care to every resident every day, the equivalent of one nurse for every seven residents on day and evening shifts.

The American Health Care Association (AHCA) has estimated that the 4.1-hour-per-day care standard would add $11.3B annually to cost of operating the nation’s 15,500 nursing homes—and require an additional 191,000 nurses and nurse aides.

Mark Parkinson, CEO of the AHCA, is calling on the industry to mount a “massive battle” to beat back the proposed mandate—a battle that for many nursing home operators may be a fight for survival.

“We’re just not seeing [the worker shortage] recovered,” Parkinson told Skilled Nursing News (SNN), in a recent interview. “It is ridiculous to enforce a staffing mandate…when you’ve got this kind of data.”

Parkinson told SNN he’s not confident the industry will succeed in stopping the staffing mandate, which it managed to quash the last time the proposal was considered, during the Obama Administration. The trade group is hoping to persuade the government to tie any staffing mandate to the availability of nurses in the US.

Bringing overseas nurses to the US has been embraced as one solution to the crisis, but industry analysts say the number of nurses that can be brought over is—to put it in health care parlance—the equivalent of treating a hemorrhage with a Band-Aid.

The Commission on Graduates of Foreign Nursing Schools, which provides certification in the US for foreign nurses, says applications for visas have doubled since the pandemic began; the commission currently is processing about 17,000 applications.

However, the pool of available overseas nurses is limited and the bureaucratic hurdles and delays associated with legal immigration in the US remain in place. Nurses that want to move across the pond have a much faster route to Canada, which has opened its arms to a wave of immigration as a solution to the labor shortage.

Experts say that any solution to the nursing crisis will involve bringing more men into the profession: according to the US Bureau of Labor Statistics, nearly 90% of all of the registered nurses, nursing assistants, licensed practical nurses and nurse practitioners in the US are women.