U.S Nursing Shortage Deepens: Experts Reveal Key Hotspots and Insight
The United States is facing a nursing shortage crisis that is expected to continue through 2030. The consequences of understaffing go far beyond financial losses as well – extending to issues such as compromised patient safety, nurse burnout, and also unsatisfactory healthcare services.
Experts from Nursa, a leading healthcare staffing platform, have therefore unveiled the hidden costs of understaffing – that are not just financial. And, by examining additional data on ER visits, they can reveal where understaffing issues could have the most impact.
Nursa CEO, Curtis Anderson.
“In order to attempt to find a solution, hospitals and healthcare systems should look to have strategies in place for both the short-term and long-term. Utilizing historical data to predict hospital needs in the short-term, can aid in better planning and work shift management, giving hospitals the best chance to have the correct amount of staff at the ready. Current workforce policies tend to be overly rigid. To retain staff and increase morale, we need to invest further in career development and flexibility for the individual.”
1. Worsened safety and patient care outcomes
While understaffing comes with financial strains, the cost to both the workforce and patients is even more concerning.
Burnout itself has harmful consequences for patient care and safety, including the following:
- Decreased time spent between provider and patient
- Delays in care and diagnosis
- Increased medical errors
- Increased disparities
- Lower quality of care
- Hospital-acquired infections among patients
In extreme cases, these issues can lead to injury or even fatalities – as approximately 50 percent of adverse medical events are preventable, making medical errors a leading cause of death and injury.
2. Increased costs in training and recruiting
Nurse turnover is costing hospitals millions—literally. With an average turnover cost of $52,350 per registered nurse, facilities can lose up to $10.5 million annually, according to reports. With data also showing that even a 1% drop in turnover could save facilities up to $380,600 annually on average, understanding turnover in facilities is crucial.
With hospital nurse vacancy rates exceeding 10% in over a third of facilities according to reports, the remaining staff face burnout, increased patient risks, and financial strain. This therefore makes the cycle unsustainable for both nurses and the hospitals that rely on them.
3. Penalties for violations of staffing minimums
Whilst there are hidden costs that aren’t financial, there are penalties and fines that can be issued due to understaffing issues. As of June 21, 2024, CMS’s new Minimum Staffing Standards for long-term care facilities are in effect, which means that facilities that fail to meet these requirements risk major penalties, such as losing Medicare and Medicaid funding, civil fines, and bans on new admissions.
This turns understaffing from an internal challenge into a high-risk compliance and financial issue, and ignoring the problem now carries a cost that many facilities simply can’t afford.
4. Premium costs of staffing agencies and overtime work
Understaffing and not understanding turnover issues can also be costly. With too few nurses available, facilities are forced to rely on staffing agencies that charge premium rates. For example, travel nurse pay has more than doubled since 2020, with some contracts exceeding $240 an hour, plus an extra 28-32% paid to the agency.
As a result, hospital labor costs have skyrocketed, and despite these high costs, approximately 95% of healthcare facilities hire staff from contract labor firms. Not only this, but nurses that are available may be forced to work overtime, which can also increase their rates.
5. Lengthened stays and readmissions
Not only can understaffing stretch teams, and lead to increased labor costs, but it can also extend patients stay and readmissions. As well as fines from the CMS, through the Hospital Readmissions Reduction Program (HRRP), hospitals can face additional financial penalties for avoidable readmissions within 30 days of discharge.
These penalties will hit the hardest when care coordination and discharge planning suffer, which can be unavoidable in understaffed environments. This shows that what looks like a staffing issue on the surface can become a financial issue if readmission rates rise.
But which areas could see the biggest impact of understaffing?
Hospital Emergency Room Visits per 1,000 Population
| Rank | Location | State/Local Government | Non-Profit | For-Profit | Total |
| 1 | North Dakota | N/A | 588 | N/A | 588 |
| 2 | Louisiana | 118 | 389 | 67 | 574 |
| 3 | West Virginia | 46 | 446 | 58 | 550 |
| 4 | District of Columbia | N/A | 468 | 70 | 538 |
| 5 | Mississippi | 212 | 213 | 102 | 527 |
*Data as of 2022. Full data set is available here.
The impact of nursing shortages is most likely going to be severe in the areas with the highest ER visit rates. This data shows that regions like North Dakota (588 visits per 1,000 people), Louisiana (574 visits per 1,000) and West Virginia (550 per 1,000 people) could feel the strain the most.
