The nursing shortage is threatening both patients and our healthcare system, and future projections paint an ominous picture. We have all read the news stories or have seen the effects first-hand: the Covid-19 pandemic drove nurses to their breaking point, with the sacrifices endured being just too great for many, causing nurses to retire or quit the profession in droves.

An analysis in Health Affairs found that the number of registered nurses (RNs) decreased by more than 100,000 from 2020 to 2021 – the largest drop in the past four decades, and it was younger nurses primarily leaving the workforce. Those positions will be hard enough to fill, but even greater numbers are needed as aging Baby Boomers put further pressure on the healthcare system. The U.S. Bureau of Labor projects there will be more than 203,000 openings for RNs each year through 2031.

Despite the high rates of attrition, interest in pursuing a career in nursing remains high. Unfortunately, many potential nursing students are being turned away because of another, lesser-known shortage that has serious implications for the nursing pipeline – there are too few nursing school faculty and clinical placements to meet student demand. In 2021, U.S. nursing schools turned away 91,938 qualified applicants for baccalaureate and graduate nursing programs according to the American Association of Colleges of Nursing.

At the same time many nursing educators are reaching retirement age, others are being drawn away from teaching by higher-paid work in clinical and commercial settings. In the past academic year, 8% of faculty positions at 935 nursing programs were vacant, the highest rate in a decade.

With nurses in hospital settings feeling overworked by the daily demands of their jobs and unable to take on the added responsibilities of supervising student nurses, fewer clinical training opportunities are available, further limiting the number of students programs can accept.

Steps to fortify the nurse pipeline

Recognizing the threat posed by nursing program shortages, governmental, philanthropic and industry efforts are underway to address the problem. A number of states including Hawaii, Maryland,  Missouri, South Carolina, Virginia and Wisconsin have put forward legislation providing funding and incentives to recruit and support nurse educators. Additionally, the federal government is providing substantial student loan debt cancellation to graduate nursing students who choose to teach, as well as funding programs to train current and former nurses for teaching positions. Healthcare organizations are also focusing on care teams that integrate nurses at different skill levels – LPNs practicing alongside RNs, for example – to maximize their time and impact.

More equitable pay is clearly needed to attract and retain nurse educators. But we must also expand the framework for who is qualified to teach and work as preceptors, as well as the types of clinical training settings that can help increase placement opportunities while also teaching skills that will best serve nurses in an evolving healthcare landscape.

Home-based placements as an essential training ground

While there is, and will always be, a critical need for nurses to be trained and work in acute care hospital settings, the treatment of patients in their home environment has been on the rise for years and dramatically accelerated during the pandemic. Not only is the home being used for traditional post-acute care and for the homebound, but now patients can receive primary, acute, higher level-hospital and skilled nursing care while at home. McKinsey & Company estimates that care delivered in the home for Medicare beneficiaries will increase by as much as fourfold by 2025.

Partnerships between home health practices and nursing programs could provide additional clinical training sites to help ease the shortage in clinical placements. Those experiences would also introduce students to another facet of nursing they may want to pursue as a career.

Home-based clinical training could enhance skills that are relevant for nurses no matter the care setting. Given the intimate nature of home care, it can be very instructive for understanding the need for a holistic approach to patient care, as well as promoting an empathetic touch. The home setting allows for more ongoing and deeper conversations to occur that can build stronger bonds between nurses and their patients. It also provides a window into the individual’s living environment and support systems, clearly illustrating the ways that social determinants impact the health and well-being of their patients. Honing those skills as a student can lead to better patient care overall, as well as a more fulfilling career.

Further, nursing students would gain expertise in telehealth and remote monitoring technologies commonly used in home-based healthcare, but increasingly being integrated into many different practice settings.

Providing home-based clinical experiences could, in the long run, also help with nurse retention.  Flexible schedules and greater autonomy associated with home-based patient care could offer a more sustainable career for those who value and thrive in that environment.

Whether nursing students decide to practice in the home or in another setting, those clinical experiences build important skills for their careers no matter the site of care. They also provide an additional clinical site for training that could help reduce the shortage of clinical opportunities, increase the number of students nursing programs can graduate, and help fortify the nurse pipeline at a time when more nurses are critically needed.

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