Report: Two-thirds of licensed registered nurses are active in New York state

Only two-thirds of licensed registered nurses are active in New York State, according to a new study released at Mother Cabrini Health Foundation’s Healthier Communities, Healthier People Summit Wednesday. 

Among those active nurses, 61% work in patient care, leading to visible declines in healthcare quality across the state, the Center for Health Workforce Studies’ “Understanding and Responding to Registered Nursing Shortages in Acute Care Hospitals in New York” report found. The analysis released at the summit, held at the Museum of New York and presented by City & State, centered on statewide registered nurse shortages and delved into the causes behind low retention and recruitment levels, as well as what can be done to tackle this long-standing issue.

“When you think about, in the simplest terms, the impact of the health care shortages affects access. We know that health care demand is increasing, it's also changing,” said keynote speaker Valerie Grey, senior vice chancellor for health and hospital affairs at the State University of New York. “Because of the shortage, costs are increasing and that's making health care less affordable. More importantly is the impact that [these shortages] can have on quality and outcomes.”

The study showed a lack of diversity among active nurses. For example, LatinX registered nurses represented only 8.7% of active nurses, despite representing 19.5% of the state’s population. “Because of this lack of diversity that we have in our healthcare workforce, we don't have as many [culturally competent] providers as we need. Patients really respond much better when they are communicated in the language that they speak and by people that look like them, and they can relate to,” Grey told attendees. 

Registered nurse shortages were felt most strongly in acute care hospitals. Major contributing factors included lack of supply in rural hospitals, lower-levels of nurse preparedness (as a result of the COVID-19 pandemic), burnout and generational differences driving declines across the state. Panelist Margaret Franks, the Lower Hudson/NJ regional director of the New York State Nurses Association, also spoke of troubling healthcare workplaces that included widespread spikes in hospital violence, which greatly contributed to registered nurse shortages. 

“These days we’re more likely to be spat at, cursed, kicked, have knives pulled on us, have guns brought in and have our families and ourselves threatened. This is something that is pervasive in every hospital and every healthcare setting in the state and in this country. It has to stop,” Franks said at the event. 

“Every hospital will tell you that they have a zero-tolerance policy towards workplace violence. This is not true. We do tolerate it. We tolerate it because we want those patient satisfaction scores. We tolerate it because it has to be somebody else's fault. This is an environment and culture that has to change” Franks continued.

While the study pointed to “Generation Z priorities” of work-life balance being a factor in registered nurse shortages, some at the summit said they found recent nursing graduates to be as equally mission-driven and insightful as previous generations. More evident were the gaps in training seen in recent registered nursing graduates, who due to the COVID-19 pandemic had considerably less direct patient contact, resulting in difficult transitions into practice. 

“My only complaint about it is that it’s very class oriented. And I think the real learning takes place on the floor,” Franks said. “I think that this is more valuable to people in the long run, the more hands on that we can give our young nurses the better, because they're terrified. They're coming into situations that they have not been prepared for. So it's up to us to make sure that they have an environment where they can become more confident […] make sure that they get that nurturing environment."

While the study identified no single “silver bullet” to solve shortages across various hospital approaches, geography and available resources, it did highlight priorities for strengthening recruitment and retention including: improving workplace culture (such as addressing burnouts and increasing salaries), to expanding workforce development and providing robust education assistance plans. 

Workforce development initiatives were recommended to support hospital staff, including expanding nurse residencies, leadership development programs and preceptor training. 

According to Jean Moore, director of the Center for Health Workforce Studies at the School of Public Health at SUNY Albany, preceptors are essential to guiding registered nurses into the field.  

“From our study, we learned that nurse residency programs are successful because they have experienced nurses serving as preceptors to mentor new nurses,” Moore said. “As older nurses exit from patient care, the facilities have less experienced nurses to draw from, which makes it a lot harder, not just to run the residency programs, but also to just acclimate new graduates to units.”

Additionally, expanding the healthcare educator pipeline to guarantee effective and compensated registered nurse training were highlighted as incentives for recruitment. These incentives included: tuition assistance, loan repayment programs, reductions in both training timelines and entry thresholds, and more robust support for graduates entering the workforce. In terms of improving RN retention, additional strategies included having hospitals adopt Magnet or Pathways to Excellence status, while heightening tenets of diversity, equity and inclusion through pathways for recent immigrants to enter the healthcare workforce.

“We think despite anyone's socio economic background, if they're interested in health care, they should be able to achieve that degree licensure, certification, whatever it may be, but they would require assistance in order to achieve that,” panelist Lauren Ford, senior director of data analytics and strategy at the Iroquois Healthcare Association said. 

Ford also spoke of new training programs emerging thanks to the 1115 Medicaid Waiver.

“The 1115 Waiver does include about $650 million that will be allocated to three Workforce Investment organizations. There will be three across the state, one downstate, upstate and in the western region, over a three-year period,” Ford explained. “They have a major new responsibility of implementing a program called the Career Pathways Training program, which will target workforce shortage areas in healthcare and provide educational case management and tuition assistance to those interested in particular positions. And this will hopefully increase access to culturally appropriate services.” 

While the report highlighted the use of virtual nursing and technological tools among its retention recommendations, healthcare leaders stressed the importance of strengthening leadership through effective communication and valuing the insight of frontline professionals. 

“I think if we looked then at all these people that we've heard from today, I think that we would probably agree then that they gave us much food for thought, but even more so they gave us much room for action,” Msgr. Gregory Mustaciuolo, CEO of Mother Cabrini Health Foundation told attendees. “And we're committed to working with other funders, because […] when the public, private and the philanthropic sectors all come together, there's nothing that can stop us. So we're all determined to work together to improve and strengthen the health care and health care workforce.”