Do you dream of summer days when the hurried pace of life slows down a bit, and we find just a little more time to take pleasure in the beauty of life around us? Whether your happy place is gardening, walks in the woods, perhaps a round of golf, or just sitting on the deck listening to the sounds of birds - it is important to embrace the moment to pause and renew. I try to savor those moments and silence my thoughts of a new semester, worries about finding enough qualified faculty, retention strategies, student enrollments, and available clinical sites. In academia, we always seem to focus on the future: the next semester, the next class, the next exam, or the recruitment event. We often do not allow ourselves time to simply be in the moment.
The most recent report from the National Council of State Boards of Nursing (NCSBN) projecting "significant workforce shortages and crisis" continues to weigh heavily on my mind (NCSBN, 2023). Reports of a nursing workforce and faculty shortage are far from new. We have been reading about these projections for the past decade, but I had hoped that by now we would be making progress and begin to see the result of our collective innovations to improve the nursing workforce. After all, we have focused on workplace wellness, recruitment bonuses, better working conditions, higher wages, career advancement opportunities, unique partnerships, and funding to support advanced degrees with tuition reimbursements. Regardless of the strategies employed, NCSBN reports that by 2027, almost one fifth of the 4.5 million registered nurses in the United States intend to leave nursing - that is in addition to the 100,000 we lost during the pandemic.
Nurses continue to report heightened burnout, overwhelming stress, and retirement as primary reasons for leaving the profession. Slightly less than 200,000 nurses who plan on leaving, according to NCSBN (2023), were 40 years old or younger. Nurses with 10 or fewer years of experience were those who most often reported feeling "emotionally drained, fatigued, or at the end of their rope." These findings come from nurses across multiple health care settings who hold a variety of academic degrees and licensure. The magnitude of the problem of nurses leaving the profession severely jeopardizes the health of our nation.
The pandemic had a significant influence on these numbers, so I did some research to look at pre-COVID-19 statistics. According to Press Ganey's 2018Nursing Report: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses (I like the optimistic title), more than 17 percent of first-year nurses leave their job within the first year and up to 56 percent leave within two years. The cost of turnover for a bedside nurse ranges from $38,000 to $61,100, costing hospitals upward of $7 million annually. As I read the Press Ganey report, I lost my optimism a bit more and stopped projecting blame entirely on the pandemic.
In true academic form, I looked to the future. The National Student Clearinghouse Research Center (2023) published Current Term Enrollment Estimates: Fall 2022 Expanded Edition. The good news is that undergraduate enrollment has begun to stabilize, although it is still down 1.23 million when compared to fall 2019. Undergraduate enrollment in health professions declined by 3.6 percent for undergraduate programs, 4.5 percent for two-year health-related programs, and 1.6 percent for health-related graduate programs. The American Association of Colleges of Nursing (2023) reported similar results from their 2022 study, indicating BSN programs decreased by 1.4 percent, MSN programs decreased by 9.4 percent, and PhD programs decreased by 4.1 percent. A very slight increase was seen by DNP programs, where enrollments increased by 0.6 percent. According to a report by McKinsey & Company (Berlin et al., 2022), the current trends will result in a 10 percent to 20 percent gap between RN supply and RN demand by 2025.
Nursing education is the foundation and the future of the nursing workforce and ultimately the health of our nation and global communities. The magnitude of the problem facing academia, as well as nursing practice, is becoming increasingly clear. A significant decline in the number of nurses employed in the workforce further taxes the availability of clinical sites and preceptors to educate students and orient new nurses. This increases the workload of the nurses who remain, contributing to further burnout, stress, and exhaustion. The resignation of these often-midcareer nurses reduces the number of candidates seeking to advance their careers, including the graduate studies required for most faculty positions. The shortage of nursing faculty limits student enrollments, which means that we will continue to struggle with fewer graduate-prepared nurses to recruit into academic positions.
The old saying about doing more with less simply does not apply in this situation, and the problem will continue to accelerate. Action is needed simultaneously at each level of the problems identified for there to be sustainable, long-term solutions. This issue transcends all types of nursing degrees, practice settings, credentials, and affiliations. The data are overwhelmingly clear: The nursing workforce, whether in academia, practice, or research, is at a critical crossroad that warrants immediate, transformative, and novel approaches to alter the historical course of the current trajectory.
The thought of continuing to face these challenges with the intentionality, passion, purpose, and vitality that I once had comes into question. Perhaps that is why I am pondering these issues as I stroll down a wooded path, peaceful, hearing only the sounds of my own footsteps and the water from a nearby stream. How can I, or any of us, continue to lead the future nursing workforce, inspire the same passion in educators, and ignite the enthusiasm of nursing students as they tackle a rigorous program of study? As I continued to reflect, I recalled that a friend shared with me an old Japanese concept called ikigai, which simply means "to live and to have reason." Ikigai can guide us in finding our purpose and defining what gives life meaning (Garcia & Miralles, 2017). There are a few aspirational elements of ikigai that have significant meaning for me: What do I love? What am I good at? And what does the world need?
These reflections provide clarity and vision as to how I (we) move forward. I must also say that I continue to hear the powerful voice of NLN President and CEO Dr. Bev Malone urging us to move forward with "purpose, power, and passion." Those words will resonate with me forever.
As educators and leaders, we must not let the statistics overwhelm us but use them to guide and inform us as we design novel plans to address longstanding issues with a renewed sense of enthusiasm and creativity. First, we need to encourage and inspire the dreams of our students and embrace the concept of ikigai in all of us. Focus on what we are all capable of achieving, find value in the simple things in life, be present, and we will find the ability to power through the tough times ahead.
How lucky am I? I have combined my passion, I do what I love, I contribute to making the world a better place, I get to see some of life's greatest miracles, experience moments of pure joy, and meet amazing people. My dear colleagues, as we prepare for another academic year and continue to face some of our profession's most challenging times, let us all find our own ikigai. Each new challenge opens doors for new possibilities, creativity, innovation, and ingenuity. Embrace the opportunity - be part of the solution - this may turn out to be one of your greatest moments.
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