Strategies To Combat The Nursing Shortage

The nursing shortage is not easing on its own. The U.S. Bureau of Labor Statistics projects about 194,500 registered nurse openings a year through 2033, driven largely by replacement needs as nurses retire or leave. Three forces keep the gap open: too few nurse educators (nursing schools turn away tens of thousands of qualified applicants in a typical year, often around 80,000, for lack of faculty and clinical placements), limited seats at community colleges, and an exodus of nurses leaving the bedside through retirement or for other careers.

So what works? We asked three nurse executives which retention strategies actually move the needle. Six themes came up.

1. Listen to nurses' concerns
2. Prioritize workplace culture
3. Make retention the top metric
4. Increase diversity in the pipeline
5. Grow the supply of nurse educators
6. Use innovation, not just technology

"Unlike any time before, you have the chance to make changes that will shape the future of nursing," says Rebecca Love, chief clinical officer at IntelyCare. "This is an exciting time to be a leader."

1. Listen to nurses' concerns

Listening is the first move, and it is cheap. Nurses want their loyalty to count, not be used against them.

"Nurses want to feel their loyalty to a system is of value, not as though it's being used against them," Love says.

A live example: facilities hire travel nurses at triple pay with signon bonuses and flexible schedules while long-term staff get none of it. Add that most nurses have to request vacation six months out and can still be denied, and resentment builds fast.

2. Prioritize workplace culture

Treat people like they are replaceable and they will leave. Culture is what makes nurses feel supported, valued, and willing to stay.

Mag VanOosten, president and chief clinical officer of UnityPoint at Home, says it starts from the inside out. "We care about creating an easier, more personal work experience. We encourage people to build a family with their colleagues while they make a real difference with patients."

A strong culture supports work-life balance, mental health, career flexibility, retention, and advocacy. At IntelyCare, Love ties happiness directly to retention. "Our frontline people know we hear, see, and value them. We work double time to keep communication and opportunity open to everyone."

3. Make retention the top metric

Retention should be the executive's first priority because it drives both morale and patient safety. Chris Caulfield, chief nursing officer and cofounder of IntelyCare, says shorter shifts and less overtime raised retention at his organization, and that building internal per-diem pools is what makes the flexibility possible.

"The willingness to use outside resources when needed is essential to a workforce that demands better work-life balance," Caulfield says.

Money helps too. UnityPoint runs a critical-care retention bonus that rewards tenured nurses and keeps them through the hardest months, plus shift differentials that pay more for hard-to-fill evening, night, and weekend work. Other levers: expand referral bonuses, build an internal float pool to cut travel-nurse dependence, and invest in clinical leaders.

4. Increase diversity in the pipeline

Representation improves both retention and patient outcomes. The barriers are well documented: unequal access to education for minority communities, and cost.

Caulfield calls on nursing foundations and organizations to fund diversity-focused scholarships and aid. "With education costs climbing, executives and health systems can get involved with local nursing organizations and build scholarships targeted toward diversity."

Admissions deserve a hard look too. "Addressing the application criteria will drive more acceptance of diverse applicants," Love says. She also argues for bringing back hospital-based diploma programs, since hospitals once produced most of the country's nurses and can train a workforce that matches their community. Executives can also back community college programs and lobby to expand LPN/LVN and associate-degree slots.

Bridge programs widen the on-ramp by letting people move into nursing from related roles: EMTs, paramedics, surgical techs, pharmacy techs, and anesthesia techs. Expand entry-level programs, keep tuition reimbursement competitive, and more nurses will pursue higher degrees, which strengthens both retention and skill.

5. Grow the supply of nurse educators

The educator shortage is real, and pay is a big part of it. Some argue there is no shortage at all, only undercompensation. For universities, the cost of hiring faculty is its own barrier.

"Nursing programs are extremely costly to run," Love says. "Studies show nursing school costs two to three times more than business school."

Faculty typically need a master's or higher, but Love values clinical experience just as much and suggests recruiting retiring nurses to teach. "It's an effective way to extend the life cycle of a valuable asset."

VanOosten points to nurse residency programs, which give new graduates a structured start. The American Association of Colleges of Nursing credits residencies with empowering nurses, raising retention, and improving patient satisfaction. "It also lets us build relationships with regional nursing education programs," VanOosten says.

6. Use innovation, not just technology

Innovation matters, and technology is part of it. "CNOs who trial new technologies and proven practices that support a flexible workforce will best address the shortage," Caulfield says.

But not every fix is technical. Personalized, tailored education for nurses counts too. Through its residency program, VanOosten's team trains future nurses in the settings where they are most needed. "It's an effective combination of learning and care delivery that meets a vital need."

The bottom line

Executing these strategies is hard and often costly, but the outlook is not hopeless. Poll your staff often and act on the feedback. Ask nurses to rate their shifts. Build shared-governance decision-making. And keep relationships strong across your team and community.

"Be bold, brave, and strong. Own your decisions about your workforce. Challenge the status quo," Love says.

"The best way to overcome your challenges is to listen actively, support people as much as you can, and keep looking for new ways to solve problems," VanOosten adds.