Hospitals In Focus

No Silver Bullet: Diagnosing Hospital Workforce Crisis with Peter Buerhaus


One of the biggest challenges facing hospitals during the pandemic is workforce shortages – specifically beside nurses. This crisis started before COVID-19 and will continue after – fueled by a myriad of developing issues. One constant is that we face an increasing need & a decreasing supply of the hospital nurses who are critical to providing the lifesaving care that patients need every day.

Dr. Peter Buerhaus joins Chip to discuss the cyclical nature of these shortages, how COVID has made it worse, and what hospitals and policymakers can do to alleviate some of these challenges.

A nurse by training, Peter is also a health care economist and active researcher on the economics of the nursing workforce. His most recent research was published in Health Affairs titled “Nurse Employment During The First Fifteen Months Of The COVID-19 Pandemic” and detailed critical information about the country’s nursing infrastructure. A short summary of the findings was outlined by Montana State University.

Would you like to hear from a nurse who travelled to one of the nation’s first hotspots to battle COVID-19? Listen to Fighting on the Frontlines with Fiona Chew for a firsthand depiction of saving patients during the pandemic.

Speaker 1 (00:05):

Welcome to Hospitals In Focus, from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn (00:15):

Today, Hospitals In Focus will focus on the nursing shortage. It is only one of the workforce issues faced by hospitals and maybe the most trying because of the size and scope of the current headwinds facing nursing services. Concerns about hospital nursing are front and center on the evening news and the public is becoming very aware of the stress this shortage is placing on hospital care. Clearly the issues facing hospital nursing have been exacerbated by the challenges of COVID-19. Joining me today to look beyond the headlines and examine the root causes of the shortage, as well as examine potential solutions is one of the nation’s top experts on nursing, Peter Buerhaus. Peter is a Professor of Nursing and the Director of the Center for Interdisciplinary Health Workforce Studies at the College of Nursing at Montana State University.

He recently published critically important research findings in health affairs on nurse employment during the first 15 months of the pandemic. His findings will be part of our discussion today, and if you want to read the whole report, you can find the link in our show notes. Needless to say it would be hard to find someone more qualified to speak about nursing than Peter Buerhaus. So let’s dive in. Thanks for joining me today, Peter.

Peter Buerhaus (01:39):

Hey, Chip. Thank you for having me. It’s terrific. I’m look can forward to a great conversation.

Chip Kahn (01:44):

Well, let’s get started. The effects of the current nursing shortage are palpable, but it’s not the first time we’ve experienced to this problem. Before we focus on today’s concerns, will you give us background about previous periods of nursing shortage and the apparent causal factors?

Peter Buerhaus (02:01):

Chip, that’s a great way to begin, and I’d like even start at a 40,000 foot level, and just note that the nursing workforce is composed of roughly about 3.5 million nurses that are working on a full-time basis. Another 400,000 or so are working on a part-time basis. Now of this 3.5 million about two thirds are working in hospitals. And these nurses are working in many different types of positions and in many different types of inpatient units and outpatient units. Some of them are involved in patient care, others aren’t. My best guess is that we’ve got about a million nurses who are in the inpatient care units and somewhere around a third of these are nurses working in ICUs and emergency departments, critical care units. I think we just need to realize that we have a lot of nurses in the country, but not all have been directly impacted by the pandemic as compared to those in the critical care units and the units that have been transformed to take care of COVID patients.

So with that out of the way. To get to your question, I think of shortages in three different types or varieties. First is what I would call your everyday common background shortage. These are that develop from just different forces that temporarily affect the demand or supply of nurses. And these shortages rarely become permanent or have deep, long lasting impacts. And you can think of them as a shortage that might develop when, say on a labor and delivery unit, four out of the seven nurses suddenly are out on maternity leave. And this leaves the hospital facing a very acute shortage of nurses who possess the knowledge and skill needed for that particular patient care setting. Now, you might laugh or chuckle or some of the listeners might, but these actually happen. And they happen in other types of units as well.

Then there are other factors that occur on the demand side that cause a background shortage. But the thing to appreciate is they’re usually short lived, they resolve. And any day of the week, you can find a hospital in the country facing what I would call these background shortages. There’s a second type of shortage, what I’ll call a static shortage. These are much more longer lasting shortages and I think of generally hospitals located in rural areas of the country. Chronic shortages of nurses and other staffs don’t ever seem to be able to get beyond them. The third type of shortage is what I think of as a national nursing shortage. These types of shortage impact many, many hospitals, their severity generally will negatively affect access to patient care, quality, safety, and even drive up the costs of care.

These are large shortages. And by that, I mean anywhere between 50,000 and say 150,000 unfilled positions. Those are the big shortages. We had a number of these occur from the 1960s through 2000 and the last major national nursing shortage occurred 20 years ago in the period, 1998 to 2002, when hospitals reported 126,000 open positions that they were trying to fill.

Chip Kahn (05:45):

Wow, it sounds like those shortages, the third category are somewhere between 10 and 15% from the numbers I’m hearing. Right?

Peter Buerhaus (05:56):

Yeah. And in the past, way back in the 50s and 60s, some of the percentages of open vacancies were in the 20%. Hospitals were really struggling back then. So the one we have today or the last one, I mean in 2020, it’s a big one. It’s not the biggest, but it’s certainly a big shortage that occurred 20 years ago.

Chip Kahn (06:19):

This shortage, particularly the last one, did eventually end. What were the mitigation strategies that resolved the shortage? And what do you think made the difference, the real difference there?

Peter Buerhaus (06:33):

I think what happened back then is we had a number of strategies that had been tried in the past. And these involved hospitals, many hospitals created their own internal staffing pools. And they basically said, “If you as a nurse, want to pick up some extra hours or work the evening or the weekends, we’ll allow you to do that and pay you more.” Then other hospitals use temporary staffing agencies, some use travel nurses. Other hospitals sought to bring in nurses from other countries. Eventually many hospitals raised wages to try to boost their supply. So those have been tried in prior shortages. In the last big shortage, there were two other things that came in that were hugely impactful.

We had a recession, an economic recession in 2001, this helped bring in nurses who were out of the market, who now needed to be employed because they were potentially going to be the primary wage earner in their family, and they needed to also obtain health benefits. But the big, I think difference here was the Johnson & Johnson company began a national campaign in 2002 that promoted the nursing profession. It showed very positive portrayals of nurses. It inspired many people to want to become nurses and this campaign was sustained over a number of years. And that was something we had not seen in prior shortages that made a huge difference.

Chip Kahn (08:11):

I think you touched on it, but what are your key takeaways from this past experience that is important for our audience to know?

Peter Buerhaus (08:19):

I think people in healthcare understand this, but others who may not be and are listening in should just realize that shortages are a fact of life in healthcare. As I said, we have the background shortages that are always going on, but then other shortages developed for a variety of different reasons, both occurring on the supply and on the demand side. And there’s severity, how they impact patients and nurses and hospitals. We’ve got a lot of traditional ways of addressing shortages that we’re using in today’s world. But I think looking forward, I think we are at a point where we’ll need to give higher priority to some of the noneconomic factors that are going to be, I think increasingly important from the perspective of many nurses. That is how do we deal with autonomy over time, poor work environments and things like that are going to be, I think, driving more of the conversation about future shortages and how to resolve.

Chip Kahn (09:20):

You’re sort of touching on this, but since 2002, how have the relations between hospitals and the largest part of our workforce nursing changed? And in terms of those relations, how does that influence where we are today? I think you began to touch on it, but…

Peter Buerhaus (09:38):

Yeah, I think that’s an interesting thing to go back because I think we may be in a parallel time. But back in the last great big shortage between 1998 and 2002, couple things developed. One, we published a study that projected the future supply of nurses would begin to decline by 2010, as we started to see retirements of nurses. And we projected large shortages developed unless we changed course. A second study came out. Again, I was fortunate to be part of that, showed a relationship of hospital staffing and patient outcomes. And it sort of said, Hey, here’s some proof that nurse staffing does matter, so we need to pay attention to this, particularly if we’re looking at long run shortages. So I think this grabbed the attention of a number of organizations to take this as a bit of a, not a warning, but as a glimpse of what we need to think about more seriously. The Joint Commission, for example, developed and published several white papers on the nursing workforce.

They created a national nursing advisory committee. American Hospital Association developed several important documents that focused on nurses. The Institute of Medicine released a report in 2004 that focused on nurses work environment. There were many other efforts to bring these issues into greater focus. I think what this did is it helped the relationship of hospitals and nurses through the 2000s. We did a lot of survey work in those periods and we saw, I believe steadily improvements in work satisfaction, career satisfaction, feeling that the hospitals were taking quality seriously, more supportive of nurses. Of course, it’s not a perfect world, but there was definitely an improvement in this relationship through the 2000s. Over the past 10 years, I have felt that the relationship between nurses and the hospitals was relatively stable.

More nurses were being employed every year by hospitals. They were able to obtain and attract the nurses that they needed largely, given the wages that they were paying. So it felt like things were not out of line, and if they were out of line in some areas, it was localized and not a general problem. There were some buildup of issues that I’m sure we’ll talk about as we move forward.

Chip Kahn (12:31):

Well, so that gets us to a day, Peter. Before we take a deep dive into COVID-19, let’s play with the scenario. If we assume that 2020 and ’21 had not been pandemic years, and it looked more like 2019, would we still be facing a hospital nursing shortage anyway, today?

Peter Buerhaus (12:54):

That’s an interesting [inaudible 00:12:57] question and got to think about this. I think that yes, we would be, but it would be a very different sort of shortage. And it wouldn’t be as hyped or in the news as what we have today. So let me try to work myself through this here and explain what’s going on in my mind. I think that over the past 15 years, we’ve done a great job producing nurses. We have really had record growth in the profession. This led us to feel confident about the future. In 2017, we published an article in Health Affairs where we projected that the workforce, the registered nurse workforce would grow by a million nurses from 2020 to 2030. A few months ago, repeated that analysis using data, all the way up through 2019, and again, projected the workforce would grow. So numerically, I think we would have lots of nurses employed. If we were to meet these forecasts over the next nine years or so of this decade, we would still be able to replace an estimated 650,000 RNs, who we expect will retire by the end of the decade.

Now having said that, where I think we would be talking about more is that we will be replacing these retiring nurses with younger, less experienced nurses. And we could be experiencing a qualitative shortage of nurses, not enough nurses with all the knowledge and skill needed to take care of increasing numbers, older people who will be requiring hospitalization, who are very complicated patients medically in nursing for nurses to take care of the multiple chronic conditions and so forth. So we would have to be finding ways to replace that retiring baby boom generation at a time when we really need that knowledge and skill to address the needs of the workforce of hospitals.

Chip Kahn (15:12):

Now let’s go to the next step and add to these fundamentals that you’ve described, the COVID-19 factor. And how has COVID-19 exacerbated the situation that you’re describing was right before us back in 2019?

Peter Buerhaus (15:28):

Yeah. This is really, I think in important and often not appreciated, which we hear in the discussions of COVID and nursing today. But before the pandemic began, we were seeing increases in the demand for healthcare and nursing, both in acute care and non-acute care settings. We were seeing this healthy supply response that I felt fairly comfortable, but at a ground level, we were also seeing a few things develop. The growth in the demand for healthcare that was increasingly driven by the aging of our population. 77 million baby boomers getting older, many of them with chronic conditions. The increases in mental and behavioral health, inadequacies of our primary healthcare system, maternal, and women’s health issues were growing. I did not see yet an adequate response of nurses addressing these issues. So I was beginning to see some real difficulties there in the ability of nurses to handle that.

So I would say that the need to address the inadequate preparation of nurses to address these growing demand, this was starting to build up as an important factor. We also wanted to think about how nurses could address issues involving health equity and social determinants of health. So the other piece, I think that was beginning to show up in the nursing workforce was that some of the retirements in nursing were beginning to show up in the non hospital setting. This is where the workforce is older on average than say most of the nurses who were employed in a hospital setting. So that was another factor that was starting to stir up prior to the pandemic. There’s some more though that you can talk about as well.

Chip Kahn (17:30):

So you’ve made a number of points about the aging workforce and that sort of this confluence of both an aging workforce and then on top of it, COVID fatigue that probably has speeded some of these retirements when nurses were edging towards that age, when they might decide to take a leave from the workforce. What can be done to keep this vital resource of these more experienced nurses on the front line a bit longer?

Peter Buerhaus (18:03):

I think that this is one of the key areas that organizations need to really address. And I would think there’s three or four things that they could do, but the first is just to gather basic information on their work to ascertain when and how many RNs are expected to retire, and then identify the nursing units, the departments, or the patient populations that will be most affected. Get real facts and there’s so much news out there that is hard to know how accurate it is, but we need to know in your organization what you’re looking at with regard to retirement, then share this information with physicians and other clinicians who could be affected by retirements and seek their involvements in mitigating potential harmful consequences. They may have ideas that could be useful. I think that there will be some nurses who it’s time for them to retire.

And we can say, thank you and appreciate their contributions, but there’ll be other nurses who we think too much of, and we want to keep them from retire. So I don’t have an answer, a magic answer, but I would suggest that we ask them and say, “What would it take to keep you in the workforce another year, another two years? Is it earnings? Is it wages? Is it type of work that you’re during? Is it the hours you’re providing? If we were to allow you to work with younger nurses and mentorship and leadership, would that make a difference?” But ask and find out what would be key to keeping them in the workforce. I think another strategy that hospitals should do that builds on this is very explicitly develop programs or initiatives that bring older nurses in close relationship with younger nurses to help impart the knowledge and skills that these rising nurses and less experienced nurses will need.

How can we more quickly, readily and intentionally focus on and imparting that knowledge from older to younger so we can get the workforce fully up to speed? And then I think succession planning. We know that some nurses are going to be retiring, who are in management positions, let’s get their replacements in working with them six months out. So that when that nurse does retire, the unit keeps moving very efficiently without missing a step. So we need to focus in on, how do we plan for this large retirement of nurses? Which we estimate will be about 70,000 a year.

Chip Kahn (20:46):

Just to close out on the factors in retirement. You brought something up I’d like to follow up on a little bit. You mentioned that there also is this aging or retirement for those nurses in settings, other than hospitals. Is the fact that many of them will be leaving the workforce, is that exacerbate the hospital situation? Is that siphoning off some hospital nurses from the frontline bedside into other settings, is that another factor?

Peter Buerhaus (21:15):

It’s a good point to raise, and I don’t have an empirical or evidence based answer yet, but I do know that in some of those positions that are not inpatient, you have, let’s say a less intense patient population. Maybe your hours are a little bit less demanding. Maybe weekends are off. And I can very readily see some nurses working in inpatient settings, being attracted to those types of patients and those sorts of working conditions. May not pay quite as much, but the trade off would make sense. I think this is something that hospitals should be looking into, being aware of and anticipating whether or not this shift could develop.

Chip Kahn (21:59):

Then there’s the educational pipeline. What can be done to shore that up? I should note recognizing these headwinds for nursing even prior to the pandemic. One of our members, HCA Healthcare even purchased a university to, in a sense, grow their own nurses and other healthcare professionals. So this is HCA Healthcare and others saw this coming before 2020, 2021, but what can be done? Because at the end of the day, the pipeline is everything for this profession.

Peter Buerhaus (22:32):

Yeah. I’m glad you asked. I think of anything I say today in our conversation, this is probably maybe the most important, which is that I think that we need to take immediate steps to rebalance the messaging of nurses and hospitals. From my perspective, I believe that way too much of the current imagery, the tweeting, the media coverage, the social messaging, the texting, et cetera, about nurses and about hospitals is just frankly dreadful. It emphasizes unprecedented shortages, all their negative effects and of course, hospitals are to blame. And I feel we’ve had enough of this. And if we don’t begin to counterbalance with more positive portrayals of nurses, we risk decreasing entry into nursing education programs and failing to grow the workforce that we need over the decade. The projections that I mentioned a minute ago of growing the workforce by a million, they’re at risk.

And so I want to go back to the 90s and say, we’ve been through this once before. There’s precedent for this. Back in the 90s, nurses protested vigorously over how hospitals reacted to the growth of HMOs and managed care. And they protested loudly, persistently, around the nation. The media reported extensively nurses and the messages that they portrayed, which were overwhelmingly negative about the profession and about hospitals and careers in nursing. Not surprisingly interest in nursing as a career dropped over the next six years from 1993, through the end of the decade, 2000. The number of nurses enrolling in programs dropped and the number of nurses graduating from our nursing programs decreased substantially. So in ’95 we graduated 97,000 RN, but by 2000 we graduated 30,000, fewer or 67,000 nurses. So these negative images had an important impact on people’s decisions to go into nursing and the numbers that graduated and eventually came into the market.

And so not surprisingly hospitals reported shortages by the end of the decade that as I mentioned earlier, were at around a 125,0000, 126,000 open positions for RNs. Again, that was the last great national shortage. We need to learn from that experience by controlling the messages about nurses and hospitals, and portray more positive public images of nurses and hospitals, or we’re going to risk repeating what happened to us in the 90s. Chip, we do not need a major national shortage in this decade. That is the last thing we need. It’s a shared responsibility for individual nurses and leaders and professional associations, educators, the media, unions, social media. I’m not saying sweep out the difficult and the bad things that are happening. I’m not saying to not acknowledge that, but we need to rebalance this. Or we could really risk a repetition of what happened in the late 90s. And then our educational pipeline would be severely impacted.

Chip Kahn (26:04):

Another issue that needs to be balanced I think, is the issue of nurse professional advancement to nurse practitioners or hospital administrators, or other kinds of management. Advancement is so important to many nurses in their careers. Should more be done to provide incentives for nurses to stay at the bedside?

Peter Buerhaus (26:26):

Yeah, that’s an important question. I’m going to try to answer it, but I do want to pick up on what you brought up with nurse practitioners. Because I think this was something I failed to mention a minute ago, but I don’t know honestly, how many nurses are advancing into management in leadership position. I know there are many that this is what their aspirations are, but in the past decade, so from 2010 to 2020, we saw a very rapid increase in the number of RNs who wanted to become nurse practitioners. Now, I think this is a positive trend for the nursing profession, for healthcare systems, for physicians, and others. But we found in a study that we published that this interest in becoming a nurse practitioner was associated with the reduction of an estimated 80,000 RNs who were no longer in the workforce over this six year period, let’s say 2010 to 2017.

So it was a significant reduction from the workforce. And you combined that with the exit of nurses working, who were retiring, you either exacerbated existing background shortages or in some hospitals, the interest in becoming NPs and retirements created new shortages all together. And this made some hospitals very vulnerable to the pandemic. To your question about incentivizing nurses into remaining at the bedside. Absolutely. And I think that we need to create pathways that keep these nurses, these very skilled nurses where they’re really needed the most, and that doesn’t always mean you have to go to these other positions to find those promotions. That’s something that I think hospitals and nurses need to talk about and figure out the best way of going forward that’s efficient and keeps our costs lower.

Chip Kahn (28:25):

Peter, one of the serious repercussions of COVID-19 in a sense terms of the COVID-19 induced aspect of this nursing shortage. And hopefully this is a short run problem, but we don’t know, is the greater dependence on nurse staffing agencies. These agencies have taken advantage of the situation, raised their prices significantly and gone in and recruited away from front lines with dangling very high compensation for short run work, recruited many, many nurses. This has had all kinds of ramifications. Will you discuss what you think the impact of this is and how do we turn the corner on it?

Peter Buerhaus (29:05):

I think one of the major ways that today’s shortage is different from previous shortages is that the pandemic has simultaneously increased the demand for nurses, very specialized skills needed to treat very, very sick patients. And at the same time decreased the supply of those very nurses that were needed. So it affected both driving up demand and decreasing the supply. And to me, this was like pouring fuel on both demand and supply, that largely explains the surprising degree to which the travel nursing industry has been involved. We’ve seen the travel industry involved in prior shortages, there’s nothing new about this, but the degree has been extraordinary with the pandemic. So I think that we’re caught up in this situation when so many hospitals have such a desperate need for nurse and given the high earnings a nurse can make as a traveler, many nurses have been willing to become travelers and higher earnings.

And I think that in the past, these travel nurses did not face a threat from a disease that could be serious or even fatal or have long term implications. And so I understand that there will be higher earnings obtained by travel nurses, but at the same time, I recognize that the high costs are being incurred by hospitals. I think that this is a situation that will begin to slow down and I don’t want to say dissipate, I’m not sure the right word, but I think we’re going to have less travel nursing as we get past the current surge. So I don’t think that this will be a long term situation to the degree that we have it today.

Chip Kahn (30:54):

At least in the short term, it’s a tremendous economic issue and financial issue for hospitals, and it further exacerbates the situation. Because you’ve got the other frontline nurses sitting next to these travel nurses and seeing the travel nurses making so much money, because they’re just parachuting in and it’s affected the economics of nurse payment in general. So looking at all these factors, we’ve talked about [inaudible 00:31:22] in the short term, in the long term, where hospitals and the nursing community can work together to try to mitigate the situation. But what can policy makers do to try to overcome the problems that we’ve been discussing with the nursing shortage?

Peter Buerhaus (31:42):

I’m going to get to that, Chip, because I think this is an important area. I want to just make a couple points I think I may have neglected earlier, but COVID is a perfect storm that has hit the nurse workforce and hospitals, unlike any situation in the past. And it is because it did drive up both the demand for nurses, particularly certain type of skill of nurses. At the same time, decrease their supply directly and through policy. You certainly had some nurses who had become ill with COVID and have had to leave the workforce. Some on a temporary basis and others more permanently. We’ve had others who have not been in the workforce because they don’t want to increase the risk of exposure to the disease for themselves or bring it home to their families. Other nurses are not able to work due to the cost of childcare or they are at home taking care of parents, raising their children and providing homeschooling.

So that is unlike anything we have seen. Then we have policy activities that has affected the labor supply due to vaccination requirements. And then of course, we’ve got some nurses who have decided, I was going to retire sometime in a few years, but I think it’s going to happen sooner. They’re worn out. So this is part of the supply side of the perfect storm. The demand side was this absolutely stunning surge of very sick patients. It wasn’t just patients, these were sick patients. So what a perfect storm. So some hospitals, as we said, were already experiencing some shortages due to retirement and advancement of NPs and other things, but what to do about. So in addition to immediately rebalancing the images of nurses in hospitals, so we can grow that workforce and avoid the big shortages. I think we need to anticipate and begin to prepare for resetting the relationship of hospitals and nurses.

So I think if policy making on the private side, from organizational and nursing perspective, we need to find our way to the point where we can finally get COVID more in our rear view mirror. It’s not the pressing issue day to day. Maybe we’ll find that point where we can have hospitals and nurses together in the same room, reflecting on the past two years, discuss what worked? What did we really get well? What did we learn from? What was positive and what didn’t? What are our strengths that we found out about ourselves? What are our weaknesses? If we want to get back to normal, what are the changes that we need from both groups to get there? And plan a future that’s better than what we had prior to that. I think that from hospital’s perspective, it would be helpful to survey their nursing staff. Being sure to include the mix of positive and negative experiences. Assess nurses knowledge about what really happened, what didn’t happen, what are the attitudes about it, some of the problems or issue use that they, or talk about.

Take the temperature of nurses and of leadership, are we willing to change? Do we have enough capacity to think about a different future? Can we engage with each other, listen and talk, grasp the fuller understanding? So that’s something that I think from a private policy making that would be useful to do. From a public perspective, I think that a policy maker, a legislator, someone working on Capitol Hill, seeing the economics of the nurse labor market. How dependent hospitals are on nurses. Knowing the public has high trust and high public opinion of nurses. Grasping the truly unprecedented impacts that COVID has had on hospitals and nurses. The amount of dollars involved in paying nurses. It strikes me that it’s in society’s interest that government and payers find ways to participate, helping to reset relationships and grow a strong workforce.

I don’t think hospitals have all the resources needed to economically recognize nurses. So I believe there’s a role for government to provide resources, specifically earmark for nurses during this pandemic and helping nurses and hospitals recover from it. I think back of when the federal government enacted Medicare and Medicaid hospitals were given an extra amounts of dollars to help cover the costs of hiring more nurses needed to take care of the influx of older patients. So there’s a precedent and I hope that any of the policy makers would think about what is their role in supporting hospitals in the nursing workforce.

Chip Kahn (36:56):

Great. Well, this is just been so such a helpful and thorough discussion, Peter. I deeply appreciate you taking all this time with us today, and look forward to any comments we get from our audience on this really pressing subject. At the end of the day, so much of healthcare depends not on the hospitals, not on the physicians, but really patients and healthcare depends on those nurses who are treating the patients 24/7 and really helping them get well. And so this discussion is really about the glue that seals the healthcare that we provide in hospitals. So with that, just thanks a lot.

Peter Buerhaus (37:38):

And thank you, Chip. I really appreciate that you and your staff took the time to do this, and I’m very grateful for this opportunity. So thank you.

Speaker 1 (37:51):

Thanks for listening to Hospitals In Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHhospitals and follow Chip @chipkahn. Please rate, review, and subscribe to Hospitals In Focus. Join us next time for more in depth conversations with healthcare leaders.


Dr. Peter Buerhaus is a nurse and a healthcare economist, and is well known for his studies and publications focused on the nursing and physician workforces in the United States.  He is a Professor in the College of Nursing and Director of the Center for Interdisciplinary Health Workforce Studies at Montana State University. Before coming to Montana State University, Dr. Buerhaus was the Valere Potter Distinguished Professor of Nursing (2000-2015) and Professor of Health Policy (2013-2015) at Vanderbilt University, and assistant professor of health policy and management at Harvard School of Public Health (1992-2000).  During the 1980s he served as assistant to the chief executive officer of The University of Michigan Medical Center’s seven teaching hospitals (1983-1986) and assistant to the Vice Provost for Medical Affairs, the chief executive of the medical center (1987-1990).

Dr. Buerhaus maintains an active research program involving studies on the economics of the nursing workforce, forecasting nurse and physician supply, developing and testing measures of hospital quality of care, determining public and provider opinions on issues involving the delivery of health care, and assessing the quantity and quality of health care provided by nurse practitioners.  Of the more than 100 articles he has published in peer-reviewed journals, five publications are designated as “Classics” by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network.  Other publications have ranked among the most widely accessed articles published in the health policy journal Health Affairs.  Dr. Buerhaus is co-author of the 2008 book The Future of the Nursing Workforce in the United States: Data, Trends, and Implications.  He has editorial responsibilities with many peer reviewed health services research and nursing journals, and has advised policy makers and legislators on nursing workforce policy.

In 2003, Dr. Buerhaus was elected into the National Academies Institute of Medicine and since1994 has been a member of the American Academy of Nursing.  He has served on the Advisory Council of the National Institutes of Health National Institute of Nursing Research (2001-2006), National Quality Forum Steering Committee on Nursing Quality Performance Measures (2004-2005), Board of Directors of Sigma Theta Tau International (2001-2005), and The Joint Commission’s Nursing Advisory Committee (2003-2010).  He is currently an expert advisor for the Bipartisan Policy Center’s health care workforce initiative, and is a member of the Institute of Medicine Committee on Graduate Medical Education Governance and Transparency.

Dr. Buerhaus earned his baccalaureate degree in nursing from Mankato State University (1976), a master’s degree in nursing health services administration from The University of Michigan (1981), master’s degree in community health nursing from Wayne State University (1983), a doctoral degree from at Wayne State University (1990), and a Robert Wood Johnson Foundation post doctoral faculty fellowship in health care finance at The Johns Hopkins University from 1991-1992.

On September 30, 2010, Dr. Buerhaus was appointed to Chair the National Health Workforce Commission that was established under The Patient Protection and Affordable Care Act.  Among other responsibilities, the Commission (once funded) will provide advice to the Congress and to the President on national health care workforce policy.

For a full listing of Dr. Buerhaus’ publications visit his Google Scholar Citations Page HERE

I think one of the major ways that today’s shortage is different from previous shortages is that the pandemic has simultaneously increased the demand for nurses with very specialized skills needed to treat very, very sick patients. And at the same time decreased the supply of those very nurses that were needed. So it affected both driving up demand and decreasing the supply. And to me, this was like pouring fuel on both demand and supply.

Dr. Peter Buerhaus