It is no secret that acute care hospitals and especially critical care units across the United States are suffering from a severe nursing shortage. This dearth of staffing poses a significant risk to hospital operations and patient care and, if continued, to the entire health care system in the U.S.

As bad as the problem is today, a recent survey conducted by the American Association of Critical Care Nurses (AACN) illustrates that it could get worse … possibly much worse.  According to a recent survey of registered nurses, 67 percent of respondents plan to leave their current job within the next three years; 36 percent within the next year.[1] Should these statistics be borne out in nurse turnover, the consequences for critical care units would be nothing less than catastrophic.

Turnover can be attributed to several factors, some of which are beyond our immediate control as a Society. However, we can more directly impact other important factors. For example, among respondents who plan to leave their current job, 50 percent said they would reconsider staying if they received more respect from their administration.[2] Another key issue is appropriate levels of staffing of nurses with the right knowledge and skills. Collectively, these are important issues that we can advocate strongly for together.

Recognizing the importance of strengthening the partnership between doctors, related health care professionals and nurses, AACN established its Healthy Work Environments (HWE) Standards, which include:

• Skilled communication and true collaboration between doctors and nurses.
• Effective decision-making that includes nurses in decision-making in a wide array of hospital operations, including administration, finance, policy, and staffing (is there a nurse at the table?).
• Meaningful recognition by engaging nurses with special knowledge and experience when decisions are needed on clinical and organizational issues and to improve patient care.
• Authentic leadership by administration demonstrating more respect for nurses.
• Appropriate staffing that ensures an effective match between the needs of the patient and family and the knowledge and skills of the nurse.

 What do these standards have in common? They demonstrate a commitment to engagement and partnership between doctors, nurses, affiliated health care professionals, and administrators all working collaboratively to improve patient care.

Addressing the current nursing shortage, which threatens to become much greater in the near future, will not be easy. The first step is to understand the full scope of the problem at individual institutions by collecting and analyzing nurse staffing and retention data and viewing the nursing profession in a broader, holistic approach to providing critical care. Nurses play a key role in patient care and hospital operations; they need to be recognized as true partners.  We must rally now to stem the tide of nurses leaving the bedside in acute and critical care.

Gregory P. Downey, MD, FRCPC ATSF
President, ATS

Amanda Bettencourt PhD, APRN, CCRN-K, ACCNS-P
President, American Association of Critical Care Nurses (AACN)

[1] National Nurse Work Environments – October 2021: A Status Report, page 65.

[2] Ibid.