Researchers now have data to confirm a tightening labor market for nurses, following months of anecdotal reports of hospitals and other healthcare facilities struggling to staff beds.
Comparing two five-quarter periods, one prior to the pandemic (October 2018-December 2019) and the other during it (April 2020 to June 2021), revealed lower employment across the nursing field overall, with a 10% decline among nurse assistants (NAs) and a 20% decline for licensed practical nurses (LPNs; P<0.01 for both), reported David Auerbach, PhD, of Montana State University in Bozeman, and colleagues.
Even the non-significant 1% decline among registered nurses (RNs) between the two periods represented a significant departure from the pre-pandemic trend, according to the study in Health Affairs.
“We’ve seen the total supply of RNs has just grown year after year for a couple of decades, pretty steadily,” said Auerbach. “With the onset of the pandemic, it looks like that growth really has stopped.”
Fewer would-be nurses appear to be entering the profession as well, said Auerbach.
“We’ve already known that there’s a big wave of baby boomer RNs who were eventually going to retire, but that is probably happening more quickly than it would have otherwise, and we’re not making up for it on the entry side of the labor force,” he told MedPage Today in a phone call.
Applicants to 4-year nursing programs grew only 1.5% in 2019-2020 compared with 4.5% in 2018-2019 and 8.5% in 2017-2018.
Auerbach added that the data are “hinting in the direction” of long-term problems.
Supply and Demand During a Pandemic
Healthcare workforce demand dropped across all sites at the start of the pandemic, the investigators found, but when patients returned to hospitals and other settings, the supply was not there.
In Massachusetts, for example, someone who didn’t know better might think hospitals have “way more patients” than they used to, but that actually isn’t the problem, Auerbach said. “The number of patients is about the same, historically.”
“You’re down so many beds because you can’t staff them … and that’s probably a phenomenon that’s happening to some extent all over the place,” he explained.
Auerbach and colleagues noted that “the steep employment drop” for LPNs they found was partially due to the fact that a greater share of these nurses work in residential facilities or nursing homes, an area where LPN employment fell 24% (P=0.01). Unlike in every other healthcare sector, total employment among the nurse workforce in nursing homes did not rebound during the pandemic and was 13.2% lower than in February 2020, according to the study.
The team also noted a non-significant drop in supply among RNs ages 50 and older (5% vs 1% for all other RNs; P=0.23).
Unemployment, Salaries, Racial Disparities
Despite the lower employment during the pandemic, there were increases in salaries. Hourly earnings were relatively stable during the pre-pandemic period but rose 9.4% for LPNs and 5.7% for NAs during the pandemic period (both P<0.01), while RNs saw a non-significant increase of 2.0%.
The study noted a rise in unemployment for all nurses in the second and third quarters of 2020, which returned to near pre-pandemic levels only for RNs and LPNs.
In later quarters during the pandemic, Asian, Black, Hispanic, and other non-white RNs and NAs saw higher unemployment than their white colleagues. In the second quarter of 2021, for example, unemployment rates for white RNs and NAs were lower than in 2019. In contrast, unemployment rates among RNs and NAs who belong to a racial or ethnic minority group were 1.6 (P=0.02) and 2.7 (P<0.01) percentage points higher, respectively, than in 2019.
“This corresponds to roughly 16,000 more RNs and 30,000 more NAs in racial and ethnic minority groups who were unemployed in the second quarter of 2021 than there would have been if they had had the same unemployment rate as they had pre-pandemic in 2019,” the researchers wrote.
Auerbach noted that other studies have shown similar trends, suggesting that workers of color had more difficulty reengaging with the workforce.
More Data, More Answers?
For their study, Auerbach and colleagues used monthly data from the Census Bureau’s Current Population Survey (CPS), capturing data from January 2011 to June 2021. They gathered monthly samples of data on the employment status, earnings, and demographic status of roughly 1,300 RNs, 250 LPNs, and 850 NAs.
The researchers were looking to understand how the current slowdown in growth and increased wages could impact long-term trends in the nurse workforce.
Auerbach said the “quicker loss” of more experienced RNs could lead to a 5- to 10-year problem for the workforce. However, if entry in the field is also reduced, he anticipates the problem could last for 10 to 20 years. Predicting future supply depends more on the entry side of the equation than the exit, he explained.
For study limitations, Auerbach noted the small sample size, and stressed the need for more recent data, adding that the group plans to confirm their findings with larger samples from the 2016-2020 American Community Survey, which has been delayed due to the pandemic.
The study was funded by the Johnson & Johnson Foundation, the Robert Wood Johnson Foundation (RWJF), UnitedHealth Group, and the John A. Hartford Foundation.
Auerbach and a co-author reported grants from the Gordon and Betty Moore Foundation, RWJF, John A. Hartford Foundation, Johnson & Johnson Foundation, and UnitedHealth Group.