Can advanced practice providers be the answer to the nursing crisis?

The average turnover rate for nurses is now 18.7%, with nearly one-third of U.S. hospitals reporting a nursing vacancy rate of more than 10%.1 While COVID-19 is at the heart of the current mass exodus of nurses, the problem goes beyond the pandemic. Nearly 640,000 nurses are getting close to retirement age, which means we could see more than half a million nurses retire by 2030.2,3 There aren’t nearly enough new nurses entering the field to adequately replace the years of collective knowledge of those who are leaving. The situation is dire.

Impact on patients

When nurses are in short supply, patient care can suffer. Research shows that inadequate nurse staffing levels can result in more adverse events, medication errors and in-hospital mortality.4 As the U.S. population ages, this presents an even greater problem.
 
The U.S. Census Bureau estimates that one in five adults in the United States will be age 65 or older within the next eight years (by 2030) and that this age group will outnumber those under the age 18 by the year 2035.5
 
As our aging population increases, so does the need for care, especially the kind of care provided by nurses. Nearly 80% of older adults have at least one chronic disease while 70% of those on Medicare have two or more.6 Conditions such as cancer, diabetes, heart disease and stroke are typically more complex to treat and result in more acute episodes of care.7 

A growing issue

Even before the pandemic, nurses cited stressful work environments and lack of good management as top reasons for quitting their jobs.8 Burnout was also a top concern. The pandemic has only exacerbated these issues. As nurses leave, those left behind are under even greater stress, which compounds the situation. A more recent study found that 59% of nurses who leave their jobs do so because of “insufficient staffing levels.”9 It’s a costly downward spiral that feeds into itself.
 
The average cost of turnover for a single bedside RN is $40,038. Since the average turnover rate for an RN is 18.7%, the cost to hospitals can run into the millions.10

Opportunities for improvement

Advanced practice providers (APPs) such as nurse practitioners (NPs) and physician assistants (PAs), who entered the market in the 1960s, were originally considered effective in addressing the growing physician shortage.11 But they can also help alleviate the stress of overworked nurses by being a more consistent onsite presence, providing medical care in a timelier manner. In many hospitals, physicians are only present during morning rounds. Having an APP on the floor throughout the day makes hour-to-hour nursing care easier and less stressful.
 
It’s important to note, however, that the quality of APPs is highly dependent on the quality of their training.
 
When choosing an APP partner, look for one that focuses on training. The highest-quality APPs come from intensive training programs that combine didactic and on-the-job training over an extended period of time — often six months or more. The APP should be mentored, tested, and paired with a trained and dedicated clinical instructor to ensure that they can successfully complete the training program and function as an integrated member of a clinical team (A highly qualified APP should be able to see up to 15 patients per day.) Knowledge-based testing should be conducted at the start and the completion of the program.
 
Upon completion of training, oversight of an APP’s clinical activities should continue. Each APP should be paired with a physician for daily discussions concerning the APP’s patients. This is essential as it allows the APP to ask questions and continue to learn beyond the formal program. In short, the best APPs will have received the extensive training and ongoing mentorship necessary to practice at the top of their license.
 
APPs and physician hospitalists can help mitigate the nursing shortage and high turnover rates by reducing stress on overworked nurses. APPs deliver greater value for your organization without the added costs of recruitment, bonuses or benefits.

A better approach

By 2030, the United States could see a shortage of more than half a million RNs.12 This comes at a time when they’ve never been needed more. Leveraging APPs can help mitigate the issues that lead to nurse burnout and turnover.
 
“There is a critical need for rigorous performance standards and innovations that help hospitals and post-acute partners save millions of dollars,” says Doug Mitchell, MD, MBA, co-founder and chief executive officer of Adfinitas Health.
 
Notes:

1. Nursing Solutions Inc. 2022 NSI National Health Care Retention & RN Staffing Report. March 2022. Available from: bit.ly/3NNq2mx.
2. Jacobs A. “’Nursing Is in Crisis’: Staff Shortages Put Patients at Risk.” The New York Times. Aug. 21, 2021. Available from: nyti.ms/3wZpQLj.
3. Buerhaus PI, Auerbach DI, Staiger DO. “How Should We Prepare For The Wave Of Retiring Baby Boomer Nurses?” Health Affairs Blog. May 3, 2017. DOI: 10.1377/hblog20170503.059894.
4. Haegdorens F, Van Bogaert P, De Meester K, et al. “The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study.” BMC Health Serv Res, 19, 864 (2019). DOI: 10.1186/s12913-019-4688-7.
5. U.S. Census Bureau. “Older People Projected to Outnumber Children for First Time in U.S. History.” March 13, 2018. Available from: bit.ly/3lUgdXM.
6. Center for Healthy Aging for Professionals. “Get the Facts on Healthy Aging.” National Council on Aging.” Jan. 1, 2021. Available from: bit.ly/3PPwI5l.
7. Ibid.
8. The Advisory Board. “The top 5 reasons why nurses quit their jobs.” March 11, 2021. Available from: bit.ly/3wWwL84.
9. Berlin G, Lapoint M, Murphy M, Viscardi M. “Nursing in 2021: Retaining the healthcare workforce when we need it most.” McKinsey & Company. May 11, 2021. Available from: mck.co/3t1dmAf.
10. Plescia M. “The cost of nurse turnover by the numbers.” Becker’s Hospital Review. Oct. 14, 2021. Available from: bit.ly/3PNn9Uz.
11. Bean M. “APPs in leadership roles: Key opportunities and considerations for hospitals.” Becker’s Hospital Review. April 24, 2018. Available from: bit.ly/3ajNqJK.
12. Zhang X, Tai D, Pforsich H, Lin VW. “United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit.” Am J Med Qual. 2018 May/Jun;33(3):229-236. DOI: 10.1177/1062860617738328.