Q&A With Kathi Enderes, Senior Vice President at Josh Bersin Company

Kathi Enderes

Kathi Enderes is the senior vice president of research and global industry analytics at the Josh Bersin Company, an HR research, advisory, and professional development company. The company has been working on a massive, year-long study of the health care industry, specifically trends in skills, careers, roles, and organizational solutions in the US. They conducted this research in a number of ways, including analyzing labor statistics and other public sources. They also talked with more than 20 chief HR officers of the US largest healthcare organizations.

What is causing the upcoming healthcare worker shortage?

A number of things. Healthcare is already a big industry in the US and one-in-six people work within it. If you meet seven people, statistically, one of them will work in healthcare. The pandemic has caused a lot of issues with healthcare specifically, due to workers being on the front lines. Turnover, specifically of clinical workers who couldn’t work remotely and had to sometimes sleep in hotels to avoid infecting their families, increased significantly. A lot of people are leaving the industry. Also, about a quarter of nurses are close to retirement age.

A lot of them decided that the industry was too stressful and either left the industry or decided to retire early. While a lot of people are leaving the industry, not a lot of new nurses or clinical people are entering the industry. A McKinzie study shows that 54% of people from healthcare that took a different job during the pandemic actually left the industry altogether. They went to call centers, consulting, office jobs, and other non-healthcare jobs.

In 2022, there were 5.8 million people in the nursing profession, 3 million of them will leave by 2025. Only 1.1 million are expected to enter during that time, either by starting nursing school or transferring into the industry. The demand for nurses is growing, so we have projected a 2.1 million nursing gap over 2-3 years.

Every third seat in the nursing population will be open.

What impacts will this have on the industry?

Healthcare organizations can’t function without nurses, they make up more than 50% of some healthcare organizations. There’s also a lot of regulations that won’t allow organizations to go down too much in nursing staff. There are patient to nursing ratios that are legally mandated, so if there are less nurses, organizations will have to take in less patients. This is a problem for the communities they serve, since a hospital may have to close a floor or ER to meet these ratio requirements.

Chief HR officers say this is the biggest business problem they are facing. When they can’t get nurses on staff, they have to rely on travel nurses, who have much higher salaries compared to regular nurses. It’s a severe situation for these companies. For the first time in 10 years, the issue at the tops of CEOs minds is not financial pressures. It is the nursing shortage.

How are companies working to attract new nurses?

Companies are trying to pull all levers to adapt to these shortages. They are doing systemic HR practices, meaning that they can’t recruit their way out of the shortage. The recruiting side can only fill about 350,000 people of the 3 million spots opening in the nursing industry in the coming years. There are just not enough people out there, and it takes a while to certified for these positions.

Healthcare organizations are looking beyond recruiting and trying to find ways to retain the people they already have. Some organizations have faced turnover rates of 60-to-70% since the pandemic, when the previous rates were just 17-to-20%. They are looking into what they can do to retain these people and have a better experience. This can include higher wages, offering onsite child care, pay equity, and other options. This is challenging, however, as many healthcare organizations are not-for-profit and can’t necessarily afford to pay much higher wages.

Retention could potentially keep about 400,000 people working as nurses.

What other ways are companies attempting to fill these roles?

The next option is reskilling workers and putting them on tuition free, non-linear career pathways. Organizations are looking at areas or departments where they have too many people. For example, a company may have more people working as receptionists than they need, and there are transferable skills from working as a receptionist to being a nursing assistant. Companies look into what skills are transferable into nursing, such as having patient interaction skills, empathy, and other soft skills.

These organizations are providing tuition nursing education and moving workers onto career paths that are more future-proofed. A receptionist could become a nursing assistant, then a registered nurse, and finally chief nursing officer. This helps workers move forward into new careers, but it also helps companies because they don’t have to interview people for these roles because they can fill these roles with internal employees who have been with the company for several years already.

Reskilling could potentially fill up to 500,000 (or more) of the open nursing jobs in the coming years.

Are there any other options that companies have to combat this potential shortage?

The biggest opportunity, however, is designed around decreasing the demand for nurses. The way to this involves redesigning jobs, bringing in augmentation, and changing the employment models. One hospital “Uber-ized” its nursing staff, which essentially allowed nurses employed by the organization to work on an internal gig employment where people could pick their shifts and number of hours they would work each week. This ended up being a big retention factor because people liked that opportunity that the gig-work-style offered, even if they didn’t take advantage of it.