By Anthony Lee
The COVID-19 pandemic has had grave consequences for several industries in the United States. In particular, the healthcare system has experienced considerable strain as limited resources (e.g. healthcare providers, medical supplies, intensive care units) are implemented to treat an ever-increasing number of COVID-19 patients. While the media has extensively covered physicians throughout this crisis, less attention is given to an equally vital subset of healthcare providers: nurses. The medical and economic impact of this profession is considerable, and as the pandemic progresses, nurses will play an increasingly valuable role in ensuring the health of Americans.
According to the American Association of Colleges of Nursing (AACN), projections show that the U.S. will experience a shortage of Registered Nurses (RNs) in the coming years. The AACN attributes this shortage to several factors. First, Baby Boomers are aging out of the workforce; according to a 2018 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 50.9 percent of the RN workforce is age 50 or older, and the Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years. Second, demand for care is rising as the U.S. population ages, but growth in nursing school enrollment is lacking compared to the projected demand (203,700 new RNs each year from 2016 to 2026 according to a Bureau of Labor Statistics report). This problem is a partial result of nursing programs’ inability to enroll more students due to a shortage of nursing school resources (i.e. faculty, clinical sites, classroom space, and clinical preceptors) and budget constraints. Third, poor job satisfaction contributes to high turnover rates in the profession. In light of the current situation, this trend in the nursing profession is disturbing. Given the current pressure on the U.S. healthcare system due to the COVID-19 pandemic, it is imperative that the medical workforce grows in the coming months and years to match the increasing demand for medical services. However, with the proper measures, nurses can provide this supply.
Nurses play a critical role in the healthcare system as a complement to physicians. According to the U.S. Bureau of Labor Statistics, the duties of an RN include “to provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their families,” and in the context of the pandemic, this description translates to providing health education (e.g. proper sanitary procedure) and working in infection prevention and surveillance. While RNs do not have the same scope of practice as physicians, Nurse Practitioners (NPs) have a comparable one. NPs must complete a master’s or doctoral degree program and undergo advanced clinical training among other qualifications to obtain national certification. This certification allows NPs to order, perform, and interpret diagnostic tests; diagnose and treat conditions; and prescribe medication, which overlaps with physicians’ duties. As a result, NPs can serve as a physician extender and improve overall efficiency. This role is especially important in the present as efficiency is key to treating and releasing patients in overwhelmed healthcare settings. Furthermore, RNs and NPs are the frontline workers in nursing homes and long-term care settings and have the responsibility to protect older adults, the most vulnerable population to the virus.
The nursing profession is also a valuable contributor to the economy. A 2009 study from Dall, Chen, Seifert, Maddox and Hogan found that adding 133,000 RNs to the hospital workforce would save 5900 lives per year, increasing national productivity by 1.3 billion dollars, and decreases in length of stay resulting from this additional nurse staffing would translate into medical savings (before labor costs) of 6.1 billion dollars, with increased productivity attributable to decreased length of stay estimated at 231 million dollars per year. (Note: a 2006 study from Needleman, Buerhaus, Stewart, Zelevinsky & Mattke notes that increasing overall nurse staffing would lead to an increase in costs.) As a corollary, nursing schools are an economic engine as well; according to an analysis cited by the Illinois Center for Nursing, the typical nursing school contributes 110 million dollars to the local economy and 115 million dollars to the state economy. NPs also provide an economic advantage because of their cost effectiveness; several studies have shown that NPs provide improved medical care at a lower total cost than physicians. In fact, 2010 statistics from the American Medical Group Association and the American Association of Nurse Practitioners reveal that the median total compensation for primary care physicians ranged from 208,658 dollars (family) to 219,500 dollars (internal medicine) versus 97,345 dollars for the mean full-time NP’s total salary. Moreover, in rural America, NPs have an impact; a study from FC Eilrich declares that given two example scenarios an NP can have an employment effect of 4.4 local jobs and labor income of $280,476 from the clinic in which they work. This finding is particularly significant because of the troubling lack of access to medical care in rural America and the possibility of economic and medical benefits to a rural community during the pandemic.
With winter approaching and the COVID-19 pandemic showing no signs of decline, RNs and NPs are more valuable to the U.S. healthcare system than ever. However, the recent wave of furloughs and layoffs of healthcare providers is a troubling omen for the coming months. As hospitals struggle to provide care to patients and maintain the bottom line, mitigation measures and innovative solutions to this problem have emerged. In March, Congress passed the CARES Act, which bolstered seniors’ access to home health care systems and provided funding for personal protective equipment (PPE), somewhat softening the economic blow to the healthcare system. Meanwhile, in Michigan, pediatric nurse practitioners were deployed as adult critical care providers in a novel approach. However, with the possibility of an extended pandemic looming large, long-term solutions to the increasing demand for healthcare providers and the nursing shortage are required. Over the past few years, several studies have quantified the economic benefits of broadening the scope of practice for NPs and less restrictive regulation of Advanced Practice Registered Nurses (APRNs). Other studies have developed incentive pay plans based on productivity and quality to reduce the high turnover rate. However, the issue of nursing programs’ inability to accept qualified applicants still requires a comprehensive solution. The COVID-19 pandemic may present a unique opportunity to rectify the underlying causes of the nursing shortage as the healthcare industry develops methods to effectively and efficiently provide medical care.