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Healthcare Workforce Issues from the Nurses Perspective

Updated: Aug 17, 2023

By Nala Gilbert, RN, BSN, CPN

Public Health Analyst,

Registered nurses are a critical part of any healthcare system. Nurses are often the first healthcare staff to interact with patients and deliver almost 80% of the hands-on patient care. In 2019, nurses comprised roughly 30% of hospital employment, with nearly 1.8 million jobs nationally (2020)1. However, in 2021, the total supply of nurses decreased by more than 100,000 people in one year – the most significant drop observed among registered nurses in over 40 years2. This shortage of nurses not only costs hospital systems an estimated $46,000 per nurse lost, but a lack of nurses ultimately results in a poorer quality of care, higher errors, morbidity and mortality rates, readmission rates, and more. In some cases, hospitals have closed wards and entire service lines due to insufficient nursing staff to treat patients.

In an effort to develop potential solutions to the challenges faced by the nursing profession, we are reaching out through surveys and interviews to nurses nationwide working across a variety of healthcare facilities and environments to gather insights on the current state of the nursing profession and the problems that exist. We’ve also conducted a literature review (see references) to learn from what others have done in this area. The goal of this outreach and research is to gain an industry-wide view of problems and challenges impacting the nursing profession.

The surveys were conducted via google surveys sent out to Registered Nurses via text and social media platforms including Facebook and Instagram Direct Messages.

Survey Results

The problems that reoccurred the most across the interviews include:

  1. Inadequate Staffing (71%) – an insufficient number of employees on a given unit to complete the assigned tasks.

  2. Ineffective/difficult Workplace Relationships (34%) – resulting from factors, including lack of communication, ineffective communication styles, lack of trust, and workplace bullying, that complicate relationships between nurses and providers as well as among nurses.

  3. Lack of Resources (20%) – having an insufficient number of supplies, equipment, or reliable technology needed to safely perform all tasks needed to provide care.

  4. Pay (20%) – the hourly pay rate is too low for the responsibility and workload expected.

  5. Unsafe Staffing Ratios (20%) – a nurse-to-patient ratio that is too high for the nurse to safely and effectively care for patients given their acuity level.

These findings are aligned with other surveys and research into the nursing profession and must be addressed – in the near term – if the nursing shortage is going to be resolved. And if unresolved, health systems and the communities they serve will be truly challenged going forward.

At Holy Cross Health, a multi-hospital, social safety net health system in suburban, MD and a part of the Trinity Health network, we are convening a Roundtable discussion on Thursday, May 11 of invited experts from within and outside the industry to develop potential solutions that we agree to pilot this year within our hospitals and possibly beyond. This is an effort to search for any and all potential solutions that may alleviate this crisis. We continue to seek insights and potential solutions to this challenge and welcome input from nurses and all clinicians.

To learn more about, click here.


  1. S. Bureau of Labor Statistics. (2020, April 27). Registered nurses made up 30 percent of hospital employment in May 2019. U.S. Bureau of Labor Statistics. Retrieved March 13, 2023, from

  2. Auerbach, D., Buerhaus , P., Donelan, K., & Staiger, D. (2022, April 13). A worrisome drop in the number of Young Nurses | Health Affairs. Health Affairs . Retrieved March 14, 2023, from

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