Nursing in 2021: Retaining the healthcare workforce when we need it most

How healthcare stakeholders can understand, support, and empower the nursing workforce in the wake of the global health crisis.

Twenty-two percent 1 : That’s how many nurses indicated in a recent McKinsey survey that they may leave their current position providing direct patient care within the next year. At a time when nurses are most needed, a significant strain in the workforce exists due to the COVID-19 pandemic. Health systems and other employers of nurses recognize this challenge and are actively designing and deploying new strategies.

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Insights to impact
Key learnings from the 2021 Future of Work in Nursing Survey

The pandemic fundamentally forced the healthcare industry to think differently about how care is being delivered and how workforces are managed. On a positive note, providers incorporated technology into care models, enacted new flexibility in workforce planning and deployment, and rapidly reskilled their teams. However, increasing demands placed on healthcare workers created both a physical strain on those working on the frontlines, and a psychological strain for those losing patients, or in some tragic cases, coworkers and loved ones.

Moving forward, pressure will likely arise to quickly “rebuild” healthcare workforces as they once were. But instead of a focus on “rebuild,” we propose a “new” build: a vision for the workforce that incorporates learnings and aspirations for the future of work (for example, technology-enabled care models) and creates a realistic plan to make it happen.

In our 2021 Future of Work in Nursing Survey, we surveyed some 400 frontline nurses across settings to understand their experiences working during COVID-19, their intention to stay in their nursing role and their motivation, their willingness and excitement to try different care delivery models, and what they most want from their employers in terms of support. We offer these insights to help inform healthcare organizations as they evolve their strategies.

We learned—unsurprisingly—that the nursing workforce is an incredibly diverse group of individuals who have had a range of experiences, desires, and opinions. While we found no “silver bullet,” we distilled our findings into four strategies for consideration:

  1. Make workforce health and well-being part of the fabric. Surveyed nurses, similar to employees across all sectors, are looking for more support from the organizations that employ them. Recognition (appreciation and economic rewards commensurate with their value), communication, and breaks to recharge are paramount. Also important are increased availability and accessibility of resources (for example, mental health resources).
  2. Increase workforce flexibility. COVID-19 accelerated the introduction of scheduling and staffing approaches to create additional flexibility in workforce deployment, and nurses were largely enthusiastic.
  3. Reimagine delivery models. Organizations may consider how to leverage digital tools and adapt care models based on patient and employee preferences. For example, some employers may continue (or expand) clinician use of telemedicine platforms, allowing nurses to work remotely more often.
  4. Strengthen talent pipelines and build skills for the future. Demand for talent is increasing, and skill sets and capabilities required are shifting. Organizations will need to reskill in some areas, as well as bolster their recruiting pipeline for clinical roles—in some cases leaning on new partners or professional development pathways.

While nurses are strong, the workforce is fragile

Of the 22 percent of nurses who indicated they may leave their current positions, 60 percent said they were more likely to leave since the pandemic began, driven by a variety of factors, with insufficient staffing, workload, and emotional toll topping the list (see Exhibit 1). This level of turnover is costly and disruptive for healthcare systems, and can impact morale, disrupt the nurse and patient experience, and exacerbate an already pressing shortage of qualified talent in key geographies and specialties.

Staffing, workload and the emotional toll of the job are the most important factors in nurse respondents' decision to leave.
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Not all nurses experienced the pandemic the same way, and not all nurses will make career decisions the same way. While differences may exist among populations, the pandemic has created several care settings where nursing workforce dynamics are even more fragile than before. For example, nurses in long-term care or home settings said they were 1.5 times more likely to leave than their inpatient peers. In addition, female nurses were two times more likely than male nurses to say they intended to leave their jobs.

Of the 22 percent of nurses surveyed who indicated that they may leave their current position providing direct patient care within the next year, over half said they were seeking another career path, a nondirect care role, or planning to retire or leave the workforce entirely.

On a brighter note, 17 percent of nurses surveyed said they are more likely to stay in the nursing profession given their experience during COVID-19. The strongest drivers of their decision to stay were economic—including favorable compensation and economic stability—as well as flexibility in hours or shifts. However, nurses also reported support of management, impact on patients’ and families’ lives, and pride of being a nurse as key drivers. Healthcare organizations have an opportunity to bolster sources of engagement and purpose to strengthen their workforce.

Understand what they want and need—listen to your nurses

Nurses value open lines of communication and input into decision making. Nurses—unsurprisingly—told us that they value a variety of supports from their employers. During COVID-19, nurses reported that their employers took actions across a number of dimensions, including increasing safety equipment (for example, personal protective equipment), compensation, and mental health and well-being resources.

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Insights to impact
Planning for the future

About a quarter of nurses reported that they received mental health or well-being resources or support during COVID-19. A little over 10 percent reported that they received family or domestic support (for example, help with child care). This finding, too, varied within the nursing workforce. Nurses working in the inpatient setting were 20 percent more likely to have received mental health or well-being support and resources. This disconnect between nurses not perceiving adequate mental health support despite employers’ efforts in this area parallels findings in McKinsey’s recent national employer survey, where 71 percent of employers with frontline staff reported supporting mental health well or very well, compared with 27 percent of frontline employees who agreed.

The COVID-19-related changes that nurses were most interested in retaining include compensation increases, scheduling flexibility, and elements of virtual or remote care strategies in the post-COVID-19 world.

When asked about how employers can support their well-being, nurses responded that more appropriate and sufficient recognition, open lines of communication, and more breaks embedded in the nursing operating model would be most effective (see Exhibit 2). Monitoring nurses’ distress, offering proactive outreach, and increasing availability and accessibility of support resources (including mental health resources) were also important.

Respondents said recognition, communication, and embedding more breaks are the most desired initiatives for supporting their well-being.
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Nurses ask for virtual models and flexible schedules

Our survey found that more than 40 percent of frontline nurses have delivered care virtually within the last year, with highest rates reported by nurses practicing in ambulatory and home care settings. As hospital systems contemplate new ways to embed virtual elements into nursing workflows to improve safety, quality, and efficiency, they are likely to find an enthusiastic workforce. Roughly two-thirds of frontline nurses are interested in providing virtual care in the future.

Virtual care has become a more popular option for patients during the pandemic, but it also offers a workforce alternative for nurses. It may be particularly appealing for nurses struggling with the physical demands of direct in-person care who are evaluating whether they want to leave the workforce. By thinking in new ways around these virtual work models, employers may be able to tailor work schedules to incorporate a hybrid option for an expanding set of clinicians.

Strategies to create more flexibility will be critical—our survey indicated nurses that experienced more flexibility in hours and scheduling during the pandemic were highly interested in retaining that flexibility going forward. For those nurses who indicated plans to stay in their current direct patient care role, flexibility in hours and shifts was an influential factor.

Nurses want opportunity to grow and develop new skill sets

One of the most surprising findings from the survey was the extent to which nurses “floated” across units, acuity levels, and settings during the pandemic. More than 60 percent reported “floating” across these multiple contexts last year, nearly two times the rate pre-pandemic. Interest in continuing this kind of work arrangement moving forward varied: of those that floated, about a third were interested in continuing to do so. Looking ahead, identifying and creating opportunities for this interested segment of the workforce could help provide critical flexibility to meet demand across settings and specialties (where clinically feasible).

A critical enabler of these novel care models, and of preparing all nurses for the future, will be training and skilling. In our survey, one-third of frontline nurses said they are not confident that they have the skills necessary for future success in their evolving role. They look to their employers for clearer clinical guidelines (especially with regard to technology) and additional employer-sponsored or on-demand trainings.

Conclusion

Sidebar

The US nursing workforce reflects millions of workers with varied experiences and desires, but also a unified vision in major areas: they seek compensation commensurate with their expertise and effort, support from their employer, and flexibility in their working model.

Although the experiences of 2020–21 have impacted every profession, few have been more impacted than the nursing workforce. The trauma and moral distress of the past year have exacerbated workforce vulnerabilities, but also provide a unique opportunity to accelerate changes (for example, technology-enabled care models) and make bold investments in what the future of nursing could look like. Health systems, higher education institutions, the public sector, and others have recognized this critical need and have a time-sensitive opportunity to recommit to the support and development of the nursing workforce, and ensure all nurses are set up for future success.

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