By Meera Puthenmadom, Anna Yankelev, and Gita Krishnaswamy

A 2020 report by the Illinois Nursing Workforce Center forecasts a daunting shortage of nearly 15,000 registered nurses by 2025 (1). With less than 8,000 nurses in Illinois graduating each year, our healthcare system is under immense pressure, leaving nurses overwhelmed with managing higher patient loads and increasingly complex care demands (2).  The consequences? Worse care for patients, higher costs for health care providers, and more burnt-out nurses leaving the workforce than ever before. This issue disproportionately affects individuals from historically marginalized backgrounds and communities with limited access to healthcare facilities, making the nursing workforce shortage a critical concern for health equity.

The current demographic makeup of the nursing workforce fails to reflect the diversity of our communities, with only 19.4% of registered nurses coming from minority backgrounds, despite over 40% of the U.S. population identifying as people of color (3). This significant gap in representation deepens patient mistrust, particularly in communities historically exploited by or excluded from the healthcare system. For individuals with financial constraints, high medical costs already create barriers to timely access to preventive care. Financial hardship combined with distrust of the healthcare system creates a cycle where individuals delay seeking care until their conditions worsen, heightening the number and complexity of patients and further straining the nursing workforce (4). To advance health equity, we must understand the contributors to the shortage and implement policy and systems changes that build a more robust, representative, and resilient nursing workforce.

Workforce Shortage Contributors:

• Aging Workforce: Over half of the state’s registered nurses are over 55, with one in four nurses planning to retire within the next five years. More nurses also plan to retire early due to increased stress and health concerns exacerbated by the COVID-19 pandemic (5).
• Mental Health Strain: Moral distress and poor mental health compromise the well-being of nurses and contribute to many nurses considering leaving their jobs. According to a survey of 385 registered nurses, conducted by Nurses Take DC between October 2022 and February 2023, 87% of respondents reported experiencing moral distress at work. Moral distress occurs when nurses feel prevented from making decisions they believe are morally correct due to factors like insufficient staffing, limited resources, and challenging work conditions (1). Additionally, two-thirds of the nurses surveyed reported feelings of depression, nearly half faced health issues related to their work stress, and about 30% sought professional healthcare support (1).
• Job Dissatisfaction: A survey in 2022 found that a third of Illinois nurses managed six or more patients at once, and only 27% believed that nurse-to-patient ratios were adequate (5). These conditions have led to widespread dissatisfaction, with many nurses feeling undervalued and overworked.
• Educational Bottlenecks: Barriers in nursing education further exacerbate the shortage. In 2022, 78,191 qualified nursing applications were rejected nationally due to faculty shortages and high costs, disproportionately affecting nontraditional and financially constrained students (6).
• Retention Challenges: In academic institutions, insufficient academic and financial support for students results in high attrition rates (7). In a study of pre-nursing students working toward a Bachelor of Science in Nursing from 2012 to 2016, 57% were lost before completing the nursing program application at the end of sophomore year (6). These losses are higher for minority students, students requiring remedial coursework, and first-generation students (7).

In hospitals, retention rates vary widely. Magnet hospitals (hospitals designated by the American Nurses Credentialing Center as practicing the highest standards of care, professional development, and work culture) exhibit a 92% retention rate for newly licensed registered nurses compared to 77% in non-Magnet hospitals (8). This discrepancy underscores the importance of high-quality work environments in retaining nursing staff.

Racial concordance, or the shared racial and ethnic identity between nurses and their peers or patients, also influences retention; minoritized nurses often face exclusionary work environments, exacerbating stress and burnout (3). These challenges mirror the systemic barriers faced by minority students in educational institutions, such as insufficient support and high attrition rates, suggesting a continuum of inequities that begin in nursing education and persist into the workplace. This reality highlights the critical need for investment in recruiting and retaining nurses of color.

Promising Solutions: To effectively address these challenges, comprehensive policy and systems changes are essential. These changes will also help bridge gaps in care, ensuring everyone—especially those most impacted by health inequities—has better access to quality health services.

Promising policies that have eased the nursing workforce crisis in other states include:

• Setting minimum staffing ratios to ensure safe patient care
• Establishing and fully funding loan repayment programs to alleviate the financial burden on nursing students
• Supporting nursing education programs by funding expanding capacity, addressing faculty shortages, and enhancing student academic and financial support

Systems changes that improve working conditions and increase recruitment and retention include:

• Offering competitive salaries and ensuring that nurses are compensated fairly to attract and retain talent within the profession
• Providing adequate mental health support by implementing programs and resources that address the mental health needs of nurses
• Enhancing professional development opportunities by creating robust pathways for continuous learning and career advancements
• Promoting diversity in hiring and leadership to increase racial concordance within the workforce, ensuring that healthcare teams reflect the diverse communities they serve, and fostering a more inclusive work environment

It is our responsibility to identify and prioritize the most relevant and effective solutions for addressing the nursing workforce shortage in Illinois. We can alleviate the crisis, strengthen the nursing workforce, and create a more equitable and resilient healthcare system through building power and advocating for policy and systemic changes.

Health & Medicine is continuing our work on the Nursing Workforce Shortage. To get involved or learn more, reach out to Andrea Kimpson (akimpson@hmprg.org). 

*Editing support provided by Andrea Kimpson

Citations:

1. Illinois Nursing Workforce Center. (2020). Registered Nurse Workforce Survey Report 2020.
2. American Association of Colleges of Nursing. (2023). New data show enrollment declines in schools of nursing raising concerns about the nation’s nursing workforce. Retrieved from https://www.aacnnursing.org/news-data/all-news/new-data-show-enrollment-declines-in-schools-of-nursing-raising-concerns-about-the-nations-nursing-workforce
3. Bennett M, Lovan S, Smith, M, Ellis-Griffith, C. Nursing’s leaky pipeline: Barriers to a diverse nursing workforce. Journal of Professional Nursing. 2021;37(2):441-450. https://doi.org/10.1016/j.profnurs.2020.05.002
4. Moore, B. (2024, May 8). Limited access: Poverty and Barriers to Accessible Health Care. National Health Council. https://nationalhealthcouncil.org/blog/limited-access-poverty-and-barriers-to-accessible-health-care/
5. Dunn, G., Bruno, R., & Wilson, A. (2024, February 28). Illinois nursing in crisis: A comprehensive survey reveals a continuing systemic level of staffing shortages, moral distress, and attrition among registered nurses. Project for Middle Class Renewal & Illinois Economic Policy Institute. Retrieved from https://illinoisupdate.com/wp-content/uploads/2024/02/pmcr.ilepi_.registered.nurses.survey.final_.pdf
6. American Association of Colleges of Nursing. (2023). New data show enrollment declines in schools of nursing raising concerns about the nation’s nursing workforce. Retrieved from https://www.aacnnursing.org/news-data/all-news/new-data-show-enrollment-declines-in-schools-of-nursing-raising-concerns-about-the-nations-nursing-workforce
7. Blegen, M. A., Spector, N., Lynn, M. R., Barnsteiner, J., & Ulrich, B. T. (2017). Newly licensed RN retention. JONA: The Journal of Nursing Administration, 47(10), 508–514. https://doi.org/10.1097/nna.0000000000000523
8. National Council of State Boards of Nursing (NCSBN), The Forum of State Nursing Workforce Centers. National Nursing Workforce Study. 2020. Available at: https://www.ncsbn.org/research/recent-research/workforce.page