People Keep Saying There’s a Shortage of Nursing Jobs. The Truth Is Actually More Subtle and Disturbing.

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Imagine, for a moment, that you are a nurse. A cancer patient on your ward asks for pain medicine, and it’s easy enough to get it ready: Just go to the locked narcotics cabinet, punch in a code, draw the drug up into a syringe, and give it to them. But before you can do that, the wife of a different very sick patient calls to ask how her husband is doing. After that conversation ends, a transporter unexpectedly arrives to take another patient to a needed scan. The transporter is not allowed to wait more than five minutes, so the patient has to be ready now. Next, a consulting endocrinologist stops by to explain that a diabetic patient’s insulin is being switched to better control his blood sugars because regular doses of steroids are sending them sky-high. Twenty minutes have passed by the time the patient finally gets his pain relief, and a family member in the room jokes, “Well, we can’t expect you to do anything in a hurry, can we?”

Every nurse has moments like this, and I was no exception. The shame of being mocked has lingered, as has the anger of being expected to do several time-sensitive activities simultaneously. No wonder many nurses, myself included, struggle with constant feelings of failure. And no wonder that amid such a challenging work environment, the U.S. is having trouble filling nursing jobs. According to the Health Resources and Services Administration , the country will experience a shortage of 267,330 RNs by 2028. And by 2029, 40 percent of nurses —1.6 million people—intend to leave the profession. This has led some to declare a nursing shortage , but the truth is actually much more subtle and disturbing. There are still plenty of registered nurses in the United States, enough to fill most empty positions, but there’s a shortage of jobs they’re willing to take. Why? Because most nurses find those demands and clinical responsibility impossible and inhuman.

National Nurses United, the country’s largest professional association of RNs, blames this on “the industry’s systematic failure to invest in safe, quality, human-to-human patient care.” In other words, “hospital management has created a staffing crisis.” Staffing costs money that hospital administrators would rather not spend on nurses, even though a recent analysis of New York Medicare patients found that appropriate nurse staffing would have saved $720 million over two years if most nurses had no more than four patients to care for, rather than the six, or even 10, that are typical. Such short staffing can result in working conditions that are not only untenable but fatal. Multiple studies have shown that when nurses are overworked, patients die who would not have otherwise .

You’d think that hospitals would hang on to these hardworking nurses for dear life. Not so. Unlike physicians, nurses’ services are not billed to insurance companies (but are included in patients’ room charges). Because nurses don’t directly earn money for hospitals, eliminating their positions saves hospitals money.