A Growing Healthcare Challenge

Nurse Staffing Study Provides Insight Into Shortage Across U.S. and Florida


The Avant Healthcare Professionals 2021 Trends in Nurse Staffing Study analyzes the status of registered nurse (RN) job vacancies in the U.S. and the overall welfare of RN staff. It evaluates the training of new nurses, compares the costs of outsourcing labor and includes how COVID-19 has affected bill rates. The responses collected for this survey are from hospital executives with the title of CEO, CNO, and HR executive from various settings like critical access hospitals and state facilities.

Hiring nurses and retaining them as employees are big concerns for healthcare executives. This study provides some strategies organizations have used to help with recruiting nurses. Furthermore, many healthcare facilities that were struggling to meet the demand for nurses before the pandemic began are now feeling an overwhelming stress to have enough available staff. This survey gives a great overview of how hiring was handled in the past year and how it needs to progress in the future. We also spoke with local healthcare facilities to find out what they are experiencing here in Central Florida.

In 2020, 17% of survey respondents had more than 25 nurse openings but fewer than 50. This number more than doubles for 2021 to 34%, with COVID-19 playing a large role in hiring needs across the country. Now, more than 70% of healthcare facilities are expecting to fill their RN positions with new graduates, while only 45% are planning to use internal recruitment strategies. 

Nurse retention has proved to be a formidable challenge, as well. An Elsevier study shows that nationally, an estimated 20% of nurses will leave their first job within the first year. This contributes to an annual loss of up to $7 million per hospital and the cost of replacing each of those nurses is unsustainable. 

This has been a particularly challenging year for healthcare heroes everywhere. Misty Holland, the Chief Nursing Officer for the Polk Region of BayCare Health System, says her recent experiences with nurse staffing have been similar in Polk County.  “It has provided some nurses with more opportunities, who are using this time to try travel nursing or tackle new roles, while others decided to retire,” Holland says. BayCare Health System is a group of 15 local hospitals providing nonprofit health care and is based in the Tampa Bay area. 

The global pandemic is changing healthcare and presenting new challenges in all areas. Nurse residency programs are a great way to provide new nurse readiness, strengthen engagement and support and help decrease turnover rates, but those programs are largely unavailable right now. Searching for the best solutions to high turnover isn’t a new challenge, but many are looking to improve their pay packages and offer sign-on bonuses to nurses to fill their openings. 

At Watson Clinic in Lakeland, they’re experiencing higher than normal turnovers and shortages with their nursing staff. “This is true for RNs, LPNs, and Medical Assistants,” says Kelly Lonsberry, their Senior Associate Administrator of Human Resources. “We are also seeing a significant drop in students from nursing and medical assistant programs.” They normally recruit many students through the program, but numbers are way down this year. Watson Clinic is using new hire bonuses, evaluating its pay structures, and conducting virtual job fairs.

How current and future staffing needs are addressed is important not only to retaining nurses but to patient safety and care, as well. “Patient safety is always our top priority, so we continually assess our needs and adjust staffing accordingly,” says Holland. BayCare Health System has access to many resources with programs in place to recruit, train and reward their nurses, which are a critical part of their team.  “Like other health systems in the study, we also hire travel nurses when necessary,” Holland adds.

More than 90% of survey participants are using travel nurses, mostly due to the increase of COVID-19 patients from the past year. Hospitals were paying double rates for travel nurses. More than half of the respondents offered their staff COVID hazard pay or bonuses to retain them. Unfortunately, these solutions are not cost effective and many are searching for long-term solutions as the average bill rates for RN travel nurses are expected to increase again.

Some specialty nurses are in high demand across the U.S. with 60% of the study contributors needing medical-surgical nurses in 2021, 49% needing ER nurses, and 42% needing ICU nurses. There’s also a higher need for pediatric nurses and behavioral health nurses. Interestingly, the need for labor and delivery nurses is down more than 10% this year. 

“We also have a lot of interest from new nurses in emergency medicine and critical care,” Holland says, “so we offer internships for new graduates in both areas.” 

Watson Clinic has seen more difficulty in staffing primary care offices recently.

The Avant Healthcare survey mentions 80% lost current RNs to other facilities for travel assignments and now more than 40% are employing travel nurses to fill the gaps at a high cost. Healthcare leaders hope to use strategies like tuition reimbursements, flexible work schedules for part-time and full-time employment, and international nurses to help with staffing costs and turnovers. 

A majority of participants said they were spending between $65 and $150 per hour for travel nurses, and almost half reported losing up to 15% of their staff to higher-paying travel assignments. 

Facility executives are also concerned that COVID-19 will significantly reduce the number of nursing school graduates, compounding the shortage. Not only that, but shortages are creating competition for pay and benefits. 

“Staff will leave over these issues and increasing pay and benefits means increased expenses for the organization,” says Lonsberry. “We are also seeing many retire with insufficient trained staff available to replace them, but this is happening in all areas of health care.”

To see the entire study, go to avanthealthcare.com

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