Our Take

How Covid-19 will impact the nursing workforce

15 Minute Read

Covid-19 will not only fundamentally change nursing supply and demand – it will also accelerate pre-existing trends. Collective experience in the nursing workforce will decline faster as a result of the pandemic, and care delivery will become even more complex. These trends threaten patient safety if left unaddressed.

We recommend provider organizations take four actions to close the growing gap between collective nursing experience and care complexity.

 

The pre-Covid reality

Provider organizations were in the midst of a different-in-kind labor shortage heading into 2020. The shortage was not one of nursing FTEs; in fact, the national nursing supply was projected to outpace patient demand by 2030. The shortage was one of nursing experience as novice nurses replaced retiring baby boomers. While the collective experience of the nursing workforce was declining, care complexity continued to rise. Older, sicker patients required more complex care. The care environment was becoming more complex, too, with larger care teams, shorter lengths of stay, and a growing list of new technologies. Advisory Board called this mismatch between collective nursing experience and care complexity the “experience-complexity gap.”

We worked with progressive nursing leaders around the world to isolate best practices to close the gap and ultimately identified two strategies. First, accelerate the transition from novice to competent for new graduate nurses by teaching them more effectively. Second, better leverage existing nurses’ experience by redistributing them across the organization and deploying expert nurses in new ways. Many member organizations were pursuing these strategies and making progress.

However, most nursing leaders found progress was slower than they hoped. Closing the experience-complexity gap requires significant change – not only to onboarding processes, career pathways, and care team design but also to longstanding professional practice norms. The challenge was figuring out where to start and how to implement the needed changes effectively and consistently, while accounting for professional norms and staff practice preferences.

 

Current reality

Covid-19 will fundamentally change nursing supply and demand. On the supply side, we’d ordinarily expect an economic downturn to bolster nursing supply, with experienced nurses delaying retirement to rebuild their savings. But any delays during this recession are likely to be offset by nurses who leave the profession early, either due to the tremendous stress and burnout caused by working during the pandemic or due to family caregiving obligations. This will cause a net increase in nursing departures and a net decrease in the collective nursing experience. That’s because retiring nurses will be replaced by new nurses with even less experience due to interrupted education and clinical rotations.

On the demand side, Covid-19 will accelerate the rise in care complexity on two fronts. First, patient needs will be more complex. Delays to routine and preventive care will result in more advanced needs later. Second, Covid adds one more layer of complexity to the care environment, bringing a new set of evolving protocols that are challenging for any clinician to stay abreast of, let alone a novice nurse still learning the fundamentals of practice.

In short: the impact of Covid-19 on nursing supply and demand is to widen the experience-complexity gap into a chasm. In response, provider organizations must first retain as many experienced nurses as possible in the coming months. No organization will be able to rely on this strategy alone, but it will help buy some time in the short term to pursue other actions to close the chasm.

The remainder of this briefing outlines four actions executives must take to close the experience-complexity chasm.

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    Bolster emotional support to retain nurses

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    Dramatically slow down the first year of practice

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    Scale the impact of expert nurses

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    Reinforce experienced nurses’ identity as system citizens

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Parting thoughts

Closing the widening experience-complexity gap in nursing is essential for high-quality care. Experienced nurses are displaying tremendous flexibility right now to meet changing patient needs across the organization. Leaders need to normalize this flexibility to help close the experience-complexity chasm.

Now is the time to inventory the staffing innovation happening across your organization: What’s working well and should be adopted more widely? What good ideas were stymied by solvable challenges? What can you learn from the ideas that were good in theory but didn’t work well in practice?

The organizations that are able to make meaningful progress in closing the experience-complexity chasm will be those that resist the temptation to “get back to normal.” These organizations will instead use the lessons learned across 2020 to build a more flexible nursing workforce that can withstand continued retirements and safely meet increasingly complex patient needs.

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