Nurse shortages in California reaching crisis point (2023)

In summary

COVID-19 burnout is driving many nurses to quit, and hospital administrators say the state’s new vaccine mandate is compounding the shortage, too.

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In the past month, four emergency room nurses — exhausted by the onslaught of patients and emotional turmoil wrought by COVID-19 — have quit at the Eureka hospital where Matt Miele works.

Miele, who has been a trauma nurse for four years, is actively looking for a less stressful nursing position and has colleagues who are, too.

“On the bad days, I think ‘What am I doing and is this what I want to be doing?’” Miele said. “It’s shifting me to my core.”

Nurse shortages in California reaching crisis point (1)

Around California — and the nation — nurses are trading in high-pressure jobs for a career change, early retirement or less demanding assignments, leading to staffing shortages in many hospitals.

Hospitals are struggling to comply with the state’s nurse staffing requirements as pandemic-induced burnout has exacerbated an already chronic nursing shortage nationwide.

But burnout isn’t the only thing compounding California’s nursing shortage: The state’s new vaccine mandate for health care workers is already causing headaches for understaffed hospitals before it is even implemented. Some traveling nurses — who are in high demand nationwide — are turning down California assignments because they don’t want to get vaccinated.

Hospitals say they are reaching a crisis point, straining under the dual forces of more people seeking routine care and surging COVID-19 hospitalizations driven by the Delta variant.

“Oftentimes at hospitals there are long waits and long delays,” said Dr. Tom Sugarman, an emergency physician in the East Bay and senior director of government affairs at Vituity, a physicians’ group. “There’s not enough staff to keep beds open, and patients can languish waiting.”

In March 2020, the California Department of Public Health contracted with Aya Health — one of the nation’s largest traveling nurse providers — to pay up to $1 billion over six months to help hospitals meet nursing and other clinical staff shortages.

Department officials did not respond to multiple requests about the number of hospitals now seeking emergency staffing, and would not release the updated contract.

Last week, Gov. Gavin Newsom signed an executive order reinstating emergency provisions aimed at ensuring adequate staffing. In part, the order allows health care workers from out of state to work in California.

(Video) Nurse shortage could reach more than 1M by end of year

Unprecedented staff shortages

Before the pandemic, nursing shortages were common in most areas of the state, according to the Office of Statewide Health Planning and Development.

Now the pandemic has stretched resources to a breaking point.

Hospitals, some with more COVID-19 patients now than during the winter surge, say they are confronting unprecedented staffing shortages, particularly among nurses.

“All of our hospitals are saying staffing is a big problem,” said Lois Richardson, attorney for the California Hospital Association. “We have fewer personnel than at the beginning of the pandemic and more patients.”

The staffing shortage is so severethat Scripps Health is considering temporarily consolidating some of its outpatient centers. Scripps, which has five hospitals and 28 outpatient clinics in the San Diego area, told CalMatters that it is serving nearly 20% more patients on average than before the pandemic. At the same time, job openings at the hospitals have increased 57% since August 2019. For nursing jobs alone, vacancies have increased 96%.

“We’ve had some staff leave the organization or leave the industry as a whole because they’re burned out,”said Eric Cole, corporate senior vice president of human resources for Scripps.“They’ll wake up in the morning and call off the shift. They’ve done as much as they can do.”

“All of our hospitals are saying staffing is a big problem. We have fewer personnel than at the beginning of the pandemic and more patients.”

Lois richardson, california hospital association

Emotional and physical exhaustion is the primary reason nurses are fleeing the bedside, experts say. It has been a long and brutal 18 months.

“We thought the pandemic would be over soon and could take time later to deal with our emotions,” said Zenei Triunfo-Cortez, president of National Nurses United, the largest nursing union in the country, which has more than 100,000 members in its California association. “Then the second surge hit, and the third and now it’s the fourth.”

Mary Lynn Briggs, an ICU nurse in Bakersfield, said of the dozens of COVID-19 patients she has treated since the pandemic began, only three have survived.

“Some days coming home from the hospital I yell at God, I yell at myself, I yell at COVID and cry. And that’s all before I pull into my driveway,” Briggs said.

Her workplace has lost more staff than they can hire, and that means the ones who are left have to pick up the slack.

“There have been multiple nights where I swear I am tired and I need a night off, and then I get a call from somebody saying we’re going to give the nurse three patients, so I go in because I don’t want anyone to work out of ratio,” Briggs said.

“Some days coming home from the hospital I yell at God, I yell at myself, I yell at COVID and cry. And that’s all before I pull into my driveway.”

Mary Lynn Briggs, ICU nurse in Bakersfield

“Out of ratio” means that a nurse is assigned too many patients. California is the only state that caps the number of patients that can be assigned to a single nurse. Under state requirements, for instance, an ICU nurse can have no more than two patients and an emergency room nurse, no more than four.

In December, during the winter surge, emergency waivers for the ratios were granted to hospitals throughout the state, allowing ICU nurses to see three patients, for instance. Critics say the conditions threatened patient safety.

Newsom’s order last week did not reinstate the waivers of the nurse-patient ratios, which expired on Feb. 8. Individual facilities, however, can still apply for them.

(Video) California Faces Looming Nursing Shortage In Wake Of Pandemic; 40,000 Expected To Retire In Coming Y

“I would not be surprised if they reapply for waivers,” union president Triunfo-Cortez said.

The state health department did not respond to requests seeking information on whether hospitals have applied for staffing waivers in response to the shortages.

Vaccine mandate complicates staffing

Hospital administrators worry that the state’s vaccine mandate for health care workers, which goes into effect Sept. 30, could drive some of their workers out. Already, some report resistance among employees.

“One hospital told us they had 474 unvaccinated employees. They did a big education and incentive push. Only 12 people signed up,” said Richardson, the hospital association’s attorney.

Administrators are particularly concerned about low vaccination rates among support staff like janitors and food service workers. However, some nurses also are wary of the COVID-19 vaccine. Some nurses with large social media followings have participated in protests in Southern California, arguing that the mandates violate their personal freedom.

“If they don’t want to get vaccinated, they are turning down California assignments.”

eric cole, scripps health

The vaccine order allows only for narrow religious and medical exemptions. Until Sept. 30, unvaccinated workers must undergo weekly COVID-19 testing. The state nursing association issued a statement saying “all eligible people should be vaccinated.”

While California was first in the nation to impose a vaccine mandate for health care workers, other states have since joined in, but their mandates aren’t as broad.

Cole of Scripps Health said the state’s testing requirement, imposed this week, already has discouraged some out-of-state, traveling nurses from taking temporary jobs at California hospitals.

“If they don’t want to get vaccinated, they are turning down California assignments,” he said.

Traveling nurses in high demand

To contend with local shortages, hospitals are increasingly turning to hiring temporary, traveling nurses from around the country.

During the past 18 months, Janet Stovall, a traveling ICU nurse for more than 20 years, has worked in hospitals in the Imperial Valley town of Brawley, Visalia, Wichita, Kan., and now Folsom and Alameda — and all of them have been running on “very lean staffing.”

“Last night there were ambulances waiting just to get into the ER to be evaluated… They pulled a nurse from the ICU to help with the ER, and we worked without a charge nurse or a break nurse,” Stovall said.

Stovall said traveling nurses like her are in high demand. At one hospital, “we hadn’t even finished orientation when the VP of patient services called and said ‘You need to leave right now, test out of orientation, and be at work by 11 p.m.,’” Stovall said. “That’s how desperate they are.”

Nurse shortages in California reaching crisis point (2)

Sophia Morris, vice president of account management at Aya Healthcare, said California has the second highest number of positions posted for nurses, exceeded only by Texas.

Nationwide more than 52,000 temporary health care jobs are posted, and Aya is only able to fill about 3,000 per week, she said.

“In the 16 years I’ve been in this space, I have never seen this high a need,” Morris said.

(Video) Stand Up for Nurses says California needs 41,000 more nurses, enrollment capped

That need is creating intense competition for a limited pool of nurses nationwide.

“Nurses are getting paid premiums to work in Texas and Florida where it’s surging right now,” Sugarman said. “Those nurses have to come from somewhere, and I wouldn’t be surprised if some are coming from California.”

Hospitals have been paying twice as much as pre-pandemic times for travelers, Morris said.

To entice nurses to come to California, the state Department of Public Health agreed to pay up to $145 per hour for Aya Health’s ICU nurses and more if a facility had a “critical need.” Stovall, who works for Aya, said between October and December 2020, she was paid $10,000 per week with an additional $2,000 if she picked up an extra shift.

It’s working — but not without consequences.

The money is pulling full-time staff nurses into traveling positions, further aggravating the staffing shortage nationwide. Stovall, who is based in North Carolina, said her sister-in-law took a week’s vacation from a full-time nursing gig to pick up an $8,000 traveling contract. She also convinced a longtime friend, Candace Brim, to leave her staff position and travel during the height of the pandemic in December.

“Everywhere we go people ask, ‘Can we get your recruiter’s number?’ We’ve given it out 20 times,’” she said.

Traveling has been key to helping them avoid burnout, Brim and Stovall said. It’s rewarding to be able to come in and “save the situation” at hospitals in dire need of extra hands, Brim said, and the money is good enough that they can afford to take weeks off at a time after difficult assignments. Their contracts in Folsom and Alameda last until Thanksgiving.

“By the time we finish our contract in November, we will have enough money to sit home the rest of November and December all through the holidays,” Stovall said.

Time off has helped them cope with the somber realities of treating COVID-19 patients in the ICU: In the past seven months, every COVID patient Brim and Stovall treated has died.

“We took care of about 65 COVID patients in Brawley and not a single one made it,” Stovall said. “We coded one every night.

“Before (COVID-19), you could make a difference in someone’s life. Now I will do anything for a patient, and it does not make a difference. …Three days later they don’t make it.”

Will so many nurses burn out and leave the profession that California will face long-term shortages? It’s possible. Pre-pandemic, one projection said California will be short more than 44,000 nurses by 2030, while other studies suggested that there will be an adequate supply of new graduates.

Low staffing stresses out ER nurses

In Humboldt County, all floors are at full capacity at the hospital where ER nurse Miele works. Humboldt is one of the areas experiencing record-setting COVID-19 hospitalizations.

Miele has had patients who waited 10 to 12 hours in the emergency room. Sometimes, the patients he checks on at 9:30 p.m. before he leaves are still in the waiting room the next morning when he returns to work.

“To me it seems like the lowest staffing levels that I’ve seen at the time we need it the most,” he said, adding that he frequently works at a patient-to-emergency-room-nurse ratio that exceeds the four-to-one required by the state.

People are triaged in the waiting room “like a mass casualty patient event,” getting their initial assessments and tests ordered before ever seeing the inside of an examination room. He said he worries because staff are unable to routinely monitor the patients in the waiting rooms.

(Video) California scrambling to prepare for health care staffing shortage

His hospital hasn’t yet rationed care by prioritizing who gets treated based on who is most likely to survive, but it is being discussed, Miele said.

“Stress is part of the game when you sign up to be an emergency medicine RN,” he said, “but this is another level.”

Our health care reporting is supported by the California Health Care Foundation, Blue Shield of California Foundation and the California Endowment.

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What is the solution to the nursing shortage? ›

Understand the workforce profile and employment needs of older nurses by conducting surveys, focus groups, and nurse labor market analysis. Create flexible work opportunities that are specifically designed for older nurses. Ensure that older nurses have equal access to relevant learning and career opportunities.

Is the shortage of nurses expected to resolve soon? ›

Nursing shortages have been a problem for decades and will persist well after Covid-19 subsides. Not only is the US population aging, but nurses themselves are getting older. Some researchers estimate that 1 million registered nurses will retire by 2030.

What are the reasons of shortage of nurses? ›

What Are the Main Factors Contributing to the Nursing Shortage?
  • Rising demand to provide care for an aging population.
  • Older nursing workforce approaching retirement.
  • Shortage of trained nurse educators and faculty.
  • High turnover rate.

Which state has the highest nursing shortage? ›

California has the worst nursing shortage in the United States. It's predicted that by 2030, California will be in need of over 44,000 nurses. Other states with major hospital staff shortages include New Mexico, Vermont, Rhode Island, West Virginia, and Arizona.

How do you address the current nursing shortage? ›

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.

How can we stop healthcare staff shortages? ›

These include: Adjusting staff schedules, hiring additional HCP, and rotating HCP to positions that support patient care activities. Cancel all non-essential procedures and visits. Shift HCP who work in these areas to support other patient care activities in the facility.

What is the biggest problem in nursing today? ›

Personal Health

Along with being mentally exhausting, working as a nurse is physically strenuous. Many nurses suffer from back problems and sore feet. Working 12-hour shifts is physically demanding but wearing specially-designed shoes can ease problems and keep nurses on their feet at all times.

Is the nursing shortage getting worse? ›

Nursing shortage looms large and projected to intensify in next 18 months: report. A national nursing workforce report is advocating for dramatic action to better support the nation's nurses amid the current staffing crisis during the global COVID-19 pandemic.

Will there still be a nursing shortage in 2025? ›

Researchers estimated that the US will have a 10 to 20 percent nursing gap by 2025 as the number of patients needing care exceeds the number of nurses. The RN supply could potentially see a low of 2.4 million, while the RN demand could be a low of 2.8 million nurses.

What is true about the current nursing shortage? ›

Current nursing facts and statistics

For nearly a decade, the United States has been facing a critical nursing shortage. The shortage is expected to continue for several more years. In fact, over 1 million new registered nurses (RNs) will be needed by 2030 to meet healthcare demands.

Which hospital pays nurses the most in California? ›

Top companies for Registered Nurses in California
  • Stanford Health Care. 3.9 $82.07per hour. 840 reviews59 salaries reported.
  • John Muir Health. 3.9 $78.95per hour. 219 reviews5 salaries reported.
  • Aya Healthcare. 4.2 $73.21per hour. ...
  • UCSF Medical Center. 4.1 $72.19per hour. ...
  • Adventist Health. 3.7 $71.01per hour. ...
  • Show more companies.
4 days ago

What type of nurse is most in demand? ›

Registered nurse (RN)

BSN-prepared nurses are the most sought-after RNs in the job market and can advance to leadership and management roles more quickly than the ASN nurse.

What state has highest RN salary? ›

Highest-paying states for registered nurses

California tops our list of the highest-paying states, where registered nurses make $124,000 per year on average. Following it is Hawaii, at $106,530, and Oregon at $98,6300.

What is a good thesis statement for nursing shortage? ›

Thesis Statement Research suggests that the nursing profession faces shortages because of insufficient potential educators and high turnover in the sector.

What can be done to improve nurse staffing? ›

Six Strategies To Advance Nurse Staffing
  1. Include direct care nurses in staffing decisions. ...
  2. Examine the nursing workload. ...
  3. Look at time spent documenting in the electronic health record (EHR) ...
  4. Delegate to ensure team member contributions. ...
  5. Use a different skill mix to meet patient care needs. ...
  6. Advocate for appropriate staffing.
15 Jul 2021

How can a nurse overcome short staffing? ›

Top 10 tips for coping with short staffing
  1. Prioritize your assignments. ...
  2. Organize your workload. ...
  3. Be a team player. ...
  4. Use UAPs wisely. ...
  5. Recruit additional talent. ...
  6. Communicate effectively—and nicely. ...
  7. Inform and involve nursing administration. ...
  8. Encourage family participation.

What is causing staff shortage? ›

One of the significant contributing factors to the current labor shortage in the US is workers switching up their career paths. Along with The Great Resignation came people thinking about what they're passionate about and want to do and if their current career aligns with that.

What is the causes of shortage of staff? ›

Typically, a labour shortage occurs when there are not enough available workers participating in the labour market to meet the demand for employees. For example, in the United States, there are nearly 11 million job vacancies, but only 6.5 million workers are listed as unemployed in 2022.

What are the causes of shortage of health workers? ›

Several key factors contribute to the shortages, including a growing aging population, an aging health workforce, rapid increases in chronic diseases, and the limited capacity of health education programs.

What is the hardest part of being a nurse? ›

Seeing the death of their patients.

Most nurses said seeing the death of patients was the hardest part of their job, including Heather, a nurse from North Carolina, and Chelsey Rodgers, a former nurse who now runs an education company called Tribe RN.

What are three challenges nurses face today? ›

Read on to learn about some of the challenges nurses may face today.
  • Inadequate Staffing. Being short-staffed for brief periods of time is common in most professions, and in many of those situations, it is a minor inconvenience. ...
  • Stress. ...
  • Safety on the Job. ...
  • Workplace Violence. ...
  • Improving Self-Care.

What struggles do nurses face? ›

Among the most pressing of the current nursing chal- lenges and issues are recruitment and retention, an aging workforce, violence and bullying, diversity, undergraduate preparation (particularly in relation to clinical teaching and learning), life-long learning, professional development, post- graduate education, ...

How long will there be a shortage of nurses? ›

Before Covid struck, HHS expected seven states — Alaska, California, Georgia, New Jersey, South Carolina, South Dakota and Texas — to have staffing shortages by 2030.

Is 2022 the year of the nurse? ›

In recognition of the essential role of nursing education during the pandemic, and in celebration of its historic and continuing inspiration to nurses everywhere, the National League for Nursing has announced 2022 as the Year of the Nurse Educator.

What will be the nursing shortage by 2030? ›

According to the report, as many as 13 million more nurses may be needed by 2030; the world's current nursing workforce totals approximately 28 million. The report explains that taking action to sustain and retain workers could minimize the shortage.

Are more nurses leaving the profession? ›

Ninety percent of respondents are considering leaving the nursing profession in the next year, with 71% of nurses that have more than 15 years of nursing experience thinking about leaving as soon as possible or within the next few months.

Why is there a nursing shortage in 2022? ›

Nov. 1, 2022, at 4:16 p.m. Fueled by factors like employee burnout, an aging population and a dearth of training, states across the country are facing a familiar and common problem: a nursing shortage.

Why do California nurses make so much? ›

High demand, the high cost of living and union power underlie the higher salaries of California's registered nurses. Burger said the nurse's union has also played a role in assuring that nurses have access to pension plans and that they retire with health benefits.

How much does a new RN make in California? ›

How much does a New Graduate Registered Nurse make in California? The average New Graduate Registered Nurse salary in California is $74,747 as of October 27, 2022, but the range typically falls between $67,054 and $85,451.

How much do BSN make in California? ›

How much does a BSN make in California? As of Nov 13, 2022, the average annual pay for the BSN jobs category in California is $103,150 a year. Just in case you need a simple salary calculator, that works out to be approximately $49.59 an hour. This is the equivalent of $1,983/week or $8,595/month.

What is the most stressful nursing specialty? ›

The most stressful nursing jobs include ICU nurse, ER nurse, and NICU nurse. In these roles, nurses work in an intense environment with high stakes. They manage emergency situations and care for critically ill patients. Other stressful nursing jobs include OR nursing, oncology nursing, and psychiatric nursing.

What is the most respected nursing specialty? ›

20 Best Nursing Career Specialties
  • Nurse Researcher. ...
  • Psychiatric Mental Health Nurse. ...
  • Trauma Nurse. ...
  • Travel Nurse. ...
  • Pediatric Nurse. ...
  • Geriatric Nurse. ...
  • Acute Care Nurse. ...
  • Oncology Nurse. Oncology nurses care for patients receiving treatment for various stages of cancer.
18 Feb 2021

What is the lowest paid RN specialty? ›

Licensed Vocational or Practical Nurse

Licensed vocational nurses (LVN) and licensed practical nurses (LPN) are some of the lowest-paid nursing roles, but that is due to the fact that the educational requirements are less than most other types of nurses.

Which states have the happiest nurses? ›

Best States for Nurses Satisfaction and Happiness
  • Minnesota (Quality of life ranking #2, Hospital rating by nurses 86%)
  • Wisconsin (Quality of life ranking #3, Hospital rating by nurses 88%)
  • Oregon (Quality of life ranking #18, Hospital rating by nurses inconclusive)
15 Feb 2022

What is the highest paid nurse in California? ›

Top 10 highest-paying cities for Registered Nurses
RankCity / Metro AreaAverage RN Salary
1San Jose-Sunnyvale-Santa Clara, CA$155,230
2San Francisco-Oakland, CA$151,640
3Vallejo-Fairfield, CA$146,360
4Santa Rosa, CA$141,440
6 more rows
10 Sept 2022

How do you fix understaffing in nursing? ›

Hire more nurses: If possible, hire more nurses to provide adequate cover for each shift. Another option is to work with a staffing agency to bring on nurses as needed. If your facility has a large enough pool, it's unlikely you'll have difficulty getting enough people to work each shift.

How can we improve nursing units? ›

Build your best nursing unit
  1. Improve your nurse retention efforts.
  2. Develop future nursing leaders.
  3. Evaluate unit processes and build teamwork among nurses.
  4. Improve as a nursing leader.
  5. Put more recognition efforts in place.
  6. Improve the participation of the nurses in your units in the decision-making process.
2 Jun 2009

Why is it important to address the nursing shortage? ›

Clinical Significance

Nursing shortages lead to errors, higher morbidity, and mortality rates. In hospitals with high patient-to-nurse ratios, nurses experience burnout, dissatisfaction, and the patients experienced higher mortality and failure-to-rescue rates than facilities with lower patient-to-nurse ratios.

What do nurses do when short staffed? ›

Top 10 tips for coping with short staffing
  1. Prioritize your assignments. ...
  2. Organize your workload. ...
  3. Be a team player. ...
  4. Use UAPs wisely. ...
  5. Recruit additional talent. ...
  6. Communicate effectively—and nicely. ...
  7. Inform and involve nursing administration. ...
  8. Encourage family participation.

What is the solution to understaffed? ›

In addition to redistributing work, there are a couple common solutions for staffing shortages: hiring replacement employees and outsourcing lower-level tasks. But amid the Great Resignation's persistent talent shortage, many managers are finding that their usual go-to solutions aren't enough.

How would you manage a situation of being understaffed? ›

Six Tips to Resolve Understaffing Problems
  1. Assess Your Staffing Needs. Before you do anything else, your first course of action should be to conduct a careful analysis of what your current staffing needs are. ...
  2. Implement Technology. ...
  3. Add Temporary Staff. ...
  4. Outsource Tedious Tasks. ...
  5. Work With a Staffing Agency. ...
  6. Consider Internships.

What are 10 roles of a nurse? ›

Nurses care for injuries, administer medications, conduct frequent medical examinations, record detailed medical histories, monitor heart rate and blood pressure, perform diagnostic tests, operate medical equipment, draw blood, and admit/discharge patients according to physician orders.

How nurses can create a positive impact? ›

They Use Their Experience to Advocate for Others

Nurses use their voice and experience to advocate for patients within their health-care team, ensuring they get the care they need. Nurses also play a key role in shaping hospital-wide policies for approaches that help patients and their families.

How will nursing change in the future? ›

The U.S. Bureau of Labor Statistics (BLS) projects 9% job growth for registered nurses (RNs) and 45% job growth for nurse practitioners, nurse midwives, and nurse anesthetists between 2020 and 2030. Both percentages are significantly higher than the 8% average growth projected for all professions for the same period.

How can nurses become more empowered? ›

Here are some common tasks that can improve your ability to be empowered. Enhance your leadership skills. Nurses should be encouraged to participate in leadership and management internship programs. Inquire if your employer has formal or informal opportunities for nurses to shadow organizational nursing leaders.

What makes a great nursing team? ›

Team members understand the role and responsibilities of each other. Team members willingly respond to patients other than their own when other team members are busy or overloaded. Team member's value, seek and give each other constructive feedback.

What are the 3 ways all nurses enhance their knowledge? ›

all nurses continually enhance their knowledge through education, experience and self- assessment.

What is the most important issue facing nursing today? ›

Exhaustion and Overworking

However, nurses - especially those who work on the frontlines - are most at risk. They're often overworked and exhausted, with a poor work-life balance. Clinics can hire extra shift workers to help them during busy periods to prevent overworked staff.


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