How to Leverage Advanced Practice Providers to Mitigate the Nursing Shortage and Reduce Nursing Turnover

by | May 5, 2022

Staffing shortages continue to plague hospitals; nearly a quarter have reported shortages at a critical level.[1] Nursing has been especially hard hit with vacancy rates as high as 23.7% in some hospitals.[2] A recent survey found that more than a third of nurses say they plan to leave their jobs by the end of 2022.[3]

“According to the Bureau of Labor Statistics data, it is anticipated that 500,000 nurses will leave the workforce in 2022, bringing the overall shortage to 1.1 million nurses.”[4]

Even though COVID-19 has exacerbated the nursing shortage, the problem goes well beyond the pandemic. Nearly 640,000 nurses are reaching retirement age.[5] This means that by 2030 we could see nearly half a million nurses retire. At the same time, nursing schools are having to turn away qualified candidates due to a lack of faculty.[6] This means there aren’t nearly enough new nurses entering the field to fill those empty positions. Those that do won’t have the years of experience or knowledge of those that are retiring.

The problem for hospitals isn’t just about filling jobs; inadequate nursing levels is implicated in an increase in adverse events, medication errors, and in-hospital mortality.[7] It’s a matter of patient safety and quality outcomes.

The problem likely to get worse—soon

Adding to the gravity of the situation is the aging of our nation. By 2030, one in every five U.S. adults will be age 65 or older.[8] By 2035, this age group will outnumber those under 18.[9] As our aging population increases, so will the need for the kind of care provided by nurses. Today, 70% of those on Medicare have two or more chronic conditions.[10] Conditions like cancer, diabetes, heart disease and stroke—all leading causes of death among the elderly in the U.S.—are typically more complex to treat and result in more acute episodes of care.[11]

What hospitals can do now

While the challenges of the nursing shortage are complex, there are things hospitals can do to reduce turnover. One of those is addressing workplace stress. Even prior to the pandemic, nurses reported stressful work environments, lack of good management, and burnout as top reasons for leaving their jobs. When nurses leave, those remaining have to take on heavier workloads, which compounds stress levels and can lead to even higher rates of turnover.

59% of nurses who leave their jobs do so because of “insufficient staffing levels.”[12]

One great way to address these issues is by leveraging Advanced Practice Providers (APPs) such as physician assistants (PAs) and nurse practitioners (NPs). In most hospitals, physicians are only onsite and available during morning rounds. Once gone, they can be challenging to get in touch with. APPs, on the other hand, are on the floor or in the ward throughout the day. This helps alleviate stress of overworked nurses by giving them an always-available resource, making their hour-to-hour care easier.

How to choose an APP partner

Each hospital is unique and has unique needs. That’s why it’s important to choose a partner that provides extensive, comprehensive training for its APPs. In this way, APPs are well-versed in most any hospital environment. Adfinitas Health is a great example. Adfinitas develops high-functioning APPs, starting with an intensive training program that combines didactic and on-the-job training over an approximate six-month period. The APP “onboarder” is mentored, tested, and paired with a trained and dedicated clinical instructor to ensure they can successfully complete the training program and function as an integrated member of the clinical team. Knowledge-based testing is critical and is done both at the start and the completion of the program.

Upon training completion, oversight of the APP’s clinical activities continues. Each Adfinitas APP is be paired with a physician for daily discussions concerning the APP’s patients. This is essential as it allows the APP to ask questions and continue learning beyond the formal program. Adfinitas APPs receive the extensive training and ongoing mentorship necessary to practice at the top of their license.

In addition to extensive training, hospitals should choose a partner that emphasizes the importance of a synergistic work environment. The last thing hospitals need is an APP who doesn’t engage with the existing staff. This can lead to an “us versus them” culture—a culture that is not conducive to effective collaboration and quality patient care. Dana Levy, MSN, RN, and Chief Nursing Officer at University of Maryland Charles Regional Medical Center (UM CRMC), credits Adfinitas APPs with the high level of job satisfaction among her nursing staff. “When an Adfinitas APP is assigned to a specific area, they make sure to get to know the nurses in that area,” Levy says. “They are much more engaged and always take the time to talk with the nurse.” According to Levy, this has had a positive impact on the patient experience as well.

The time to act is now

We may be reaching a breaking point in our healthcare system. The need for nurses is growing exponentially while the supply is shrinking. The average cost of turnover for a single bedside RN is $40,038. At a typical 18.7% turnover rate, that’s a huge cost that comes at a time when hospital margins are already paper thin due to the pandemic. The bottom line is that managing this level of turnover is not sustainable. Hospitals need to take innovative steps to address issues like workplace stress and burnout. Leveraging highly trained APPs is a great opportunity to do just that.






[4] According to Bureau of Labor Statistics data, it is anticipated that 500,000 nurses will leave the workforce in 2022, bringing the overall shortage to 1.1 million nurses.