“Whenever somebody says, I think we have a nursing shortage, I think the answer we should all provide to that is, what do you mean by shortage? And where is it happening? It's really almost the beginning of the question, not the answer,” said Dr. Joanne Spetz, associate director of research at Healthforce Center at UCSF, a leading source for actionable research insights into the health care workforce. 

After decades of studying the issue, Dr. Spetz has deep knowledge of the factors that can influence the appearance of a workforce shortage. And she takes in stride how these factors have manifested during the COVID-19 pandemic, which has stressed our health care system in unprecedented ways and forced festering issues to the surface. Key factors among these are:

• Accelerated retirements. While it has been long anticipated that the retirement of a large number of Baby Boom generation nurses would cost the system a significant amount of experience, the surge happened more precipitously than expected due to the risks of working in a COVID-19 environment.
• Underinvestment in BRN operations. The California Board of Registered Nursing has responsibility for approving changes to nursing school curricula, as well as the pipeline of licensure. California takes 13 weeks to grant a license, while during the pandemic, other states were able to issue licenses in a few days. Overseeing nursing licenses is a challenging job to do for such a big state – with over a half million licenses. How can operations be improved?
• Regional shortages and surpluses. California is a very large state with widely varying regions and populations. So what's happening in San Francisco does not necessarily tell you a lot about what's happening in Bakersfield. Prior to and during the pandemic, data and anecdotes indicate a glut of new nursing graduates in some places alongside a lack of resources to enable hospitals to staff up as needed. Spetz plans to study regional variations in upcoming research.
• Specialized skills gaps. Replacing experienced ICU and ER nurses with new graduates is hardly equivalent. As medical centers have been pushed to the brink, mentoring and onboarding for new nurses has evaporated. One potential solution is for nursing education to focus students on choosing specialties over entering the field as generalists.
• Need for strategic workforce planning. Spetz’s moonshot would be to have all health systems equipped with a database that could track key details regarding the nursing workforce: past roles, specific skills and experience, career trajectories, and changes on the horizon. This would enable more effective management and development of nursing staff.

Ultimately, Spetz acknowledges that we have a lot of data about some of these issues – she has led a biannual survey for the California Board of Registered Nursing since 2006 -- and little to no data about other issues. And, that trying to predict where the health care sector is heading remains a challenge.

Listen to the engaging conversation between Joanne Spetz and Nurse Dan on the Trusted podcast, “Episode 51: How COVID-19 has impacted the nursing workforce.”

See specific research on the nursing workforce.

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