Nursing in 2021: Retaining the healthcare workforce when we need it most

Twenty-two percent : That’s how many nurses indicated in a recent McKinsey survey that they may leave their current position providing direct patient care within the next year. At a time when nurses are most needed, a significant strain in the workforce exists due to the COVID-19 pandemic. Health systems and other employers of nurses recognize this challenge and are actively designing and deploying new strategies.

The pandemic fundamentally forced the healthcare industry to think differently about how care is being delivered and how workforces are managed. On a positive note, providers incorporated technology into care models, enacted new flexibility in workforce planning and deployment, and rapidly reskilled their teams. However, increasing demands placed on healthcare workers created both a physical strain on those working on the frontlines, and a psychological strain for those losing patients, or in some tragic cases, coworkers and loved ones.

Moving forward, pressure will likely arise to quickly “rebuild” healthcare workforces as they once were. But instead of a focus on “rebuild,” we propose a “new” build: a vision for the workforce that incorporates learnings and aspirations for the future of work (for example, technology-enabled care models) and creates a realistic plan to make it happen.

In our 2021 Future of Work in Nursing Survey, we surveyed some 400 frontline nurses across settings to understand their experiences working during COVID-19, their intention to stay in their nursing role and their motivation, their willingness and excitement to try different care delivery models, and what they most want from their employers in terms of support. We offer these insights to help inform healthcare organizations as they evolve their strategies.

We learned—unsurprisingly—that the nursing workforce is an incredibly diverse group of individuals who have had a range of experiences, desires, and opinions. While we found no “silver bullet,” we distilled our findings into four strategies for consideration:

1. Make workforce health and well-being part of the fabric. Surveyed nurses, similar to employees across all sectors, are looking for more support from the organizations that employ them. Recognition (appreciation and economic rewards commensurate with their value), communication, and breaks to recharge are paramount. Also important are increased availability and accessibility of resources (for example, mental health resources).
2. Increase workforce flexibility. COVID-19 accelerated the introduction of scheduling and staffing approaches to create additional flexibility in workforce deployment, and nurses were largely enthusiastic.
3. Reimagine delivery models. Organizations may consider how to leverage digital tools and adapt care models based on patient and employee preferences. For example, some employers may continue (or expand) clinician use of telemedicine platforms, allowing nurses to work remotely more often.
4. Strengthen talent pipelines and build skills for the future. Demand for talent is increasing, and skill sets and capabilities required are shifting. Organizations will need to reskill in some areas, as well as bolster their recruiting pipeline for clinical roles—in some cases leaning on new partners or professional development pathways.

While nurses are strong, the workforce is fragile

Of the 22 percent of nurses who indicated they may leave their current positions, 60 percent said they were more likely to leave since the pandemic began, driven by a variety of factors, with insufficient staffing, workload, and emotional toll topping the list (see Exhibit 1). This level of turnover is costly and disruptive for healthcare systems, and can impact morale, disrupt the nurse and patient experience, and exacerbate an already pressing shortage of qualified talent in key geographies and specialties.

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