As essential frontline workers, nurses provide direct patient care in just about every health care setting. They assess patient health problems and needs, develop and implement care plans, and advise patients on health maintenance and disease prevention. Nurse practitioners (those who achieve an advanced degree) can take on additional tasks with a higher level of autonomy like prescribing medications, ordering tests and diagnosing patients. Nursing careers make up thelargest portionof America's health care professions.
Exacerbated by COVID-19, the nation hasfaced a shortageof health care professionals for years, with nurses being one of the hardest-hit professions.Nursing shortagesbrought on by an aging population, aging workforce, nurse burnout, long wait times for licensure approval and extended work hours not only strain health care systems but alsoaffect patient care and overall outcomes. The shortages are particularly dire inrural and underserved areaswhere lower salaries and intense workloads can impact retention.
A recent survey found thatnearly one-thirdof nurses have thought about leaving their jobs by the end of 2022, mostly due to exhaustion and burnout. The demand for health care services ispredicted to increasein the coming years due to an aging population and workforce as well as higher rates of chronic disease. However, the supply of providers isnot expected to keep pace with the demand.
Travel Nurses 101
Travel nurses may provide temporary, immediate assistance to a hospital or other facility seeking short-term nurse staffing solutions. They are oftenemployed by an independent nursing staffing agencyinstead of a single hospital, meaning they may travel across state, county or international borders to practice. Travel nurses may earn three to four times that of a full-time employed nurse.Most states have a price-gouging law, which applied during the pandemic, to prevent an “unconscionable price during a declared state of emergency.”
MinnesotaandIllinoisimplemented wage caps for staffing agencies, meaning they can charge only up to 150% of the median wage rate over the preceding three years. As the pay differential between travel and regular nurse positions continues to grow, hospitals are struggling to fill the regular full-time positions.
State Action
In response to this national shortage, states have examined a variety of options to recruit and retain nurses. Specific policy levers include loosening licensing requirements, changing scope of practice laws, bolstering educational programs, and offering monetary incentives.
Did You Know?
As baby boomers age and retire, theneed for health carewill grow, further straining the nursing profession.
The U.S. Bureau of Labor Statisticsprojects nearly 195,000nursing job vacancies each year for the next decade.
ThePaycheck Protection Programprovided health care professionals an estimated $100 billion to help employers keep their workforce employed during the pandemic.
With many people receiving virtual care during the pandemic, licensure compacts have gained traction as a way to allow various types of health professionals to provide services to patients in other states. Compacts are formed when acertain number of statesenact legislation that includes specific, uniform language or by a certain date, whichever occurs first. Thirty-seven states, Guam and the Virgin Islands have enacted theNurse Licensure Compactlegislation, withVermontandOhiomost recently passing legislation. This compact is for registered nurses and licensed practice nurses. TheAdvanced Practice Registered Nurse Compactwas adopted in 2020 but is not yet active. Seven states are required to enact legislation for the compact to become active, and only four—Delaware,Kansas,North DakotaandUtah—have passed legislation so far.
Among other licensing policy options available to states,Kentuckyallowed the issuance of temporary work permits for registered nurses and licensed practical nurses who are graduates of a foreign nursing school and pursuing licensure in the state. TheOregon State Board of Nursingmay now issue a nurse internship license and interns may perform specific nursing functions within the limits of the nurse education program they are enrolled in.
Statescope of practice(SOP) laws and regulations define the roles and responsibilities for health professionals. States have taken steps to increase the types of procedures and treatments that are permitted by nurse practitioners to address the needs of an evolving health care landscape. Twenty-six states, the District of Columbia, Guam and the Northern Mariana Islandsallow nurse practitionersto diagnose, treat and prescribe medications without physician supervision. During the COVID-19 pandemic,states modifiedtheir SOP provisions by waiving some types of practice agreement requirements to allow increased access to providers. During the 2022 legislative session, states began tointroduce legislationthat would make these provisions permanent.
To bolster education programs,Arizonaappropriated $15 million to establish a nurse education pilot program to increase the number of nurse graduates by 2027. The bill also appropriated $27 million for a student nurse clinical rotation as well as a licensed or certified nurse training program to expand the capacity of preceptor training programs. Legislation inFloridacreated the Linking Industry to Nursing Education fund, which provides matching funds to institutions that partner with health care providers to recruit faculty and clinical preceptors and increase the capacity of nurse education programs. The bill also established the PIPELINE fund to reward school districts and higher education institutions that meet nursing education program performance metrics.
Offering financial incentives for preceptors who are training the next generation of nurses through loan repayment programs is a retention strategy many states are considering.Coloradooffers an income tax credit of $1,000 to advanced practice nurses, registered nurses, and psychiatric nurse specialists, among other providers, who provide a preceptorship in rural and frontier areas of the state.Iowaestablished a mental health practitioner loan repayment program, which includes psychiatric advanced registered nurse practitioners. In return for five years of service, $50,000 of a loan will be forgiven.
Federal Action
TheProvider Relief Fund, which is administered by the Health Resources and Services Administration (HRSA), provides financial support to providers (including nurses) who experienced lost revenues and increased expenses during the COVID-19 pandemic to maintain health system capacity. Since November 2021,HRSA has distributedapproximately $13.5 billion to nearly 86,000 providers and $7.5 billion in American Rescue Plan rural payments to more than 44,000 providers.
TheNational Health Service Corps(NHSC) provides loans and scholarships to medical students with the goal of bringing primary care providers to underserved areas. Awardeesmust committo serving at least two years in a health professional shortage area.In fiscal year 2020, NHSC’s available budget was $430 million, with more than 14,000 providers serving five programs. Nurse practitioners were the highestgroup of recipients, accounting for 26% of the awardees.
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $767,749 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsem*nt, by HRSA, HHS, or the U.S. Government.
