The Experience-Complexity Gap Nursing Shortage

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

My leadership development and coaching work takes me to every region of the country. It is always intriguing when I ask the question as to whether a particular geographic region is experiencing a shortage of nursing applicants. Some areas are in the midst of severe shortages which includes a limited supply of even new graduates. Others don’t seem to have the same problems. The NSI 2019 staffing report reflects similar findings. They found that although the nationally the RN vacancy rate slightly decreased to 8.0%, only one in five (21.9%) hospitals reported an RN vacancy rate of “less than 5%” while approximately a quarter (23.7%) reported a vacancy rate exceeding 10%. The RN Recruitment Difficulty Index increased to 86 days on average, regardless of specialty.

Yet when I ask the question about challenges finding enough experienced nurses to fill staffing gaps, every nurse leader’s hand in the room inevitably goes up. When we talk about “a nursing shortage” – we are really talking about two types of shortages. The first type is the challenge of finding any RN candidates for vacancies. The second type of shortage is what Nurse Advisory Board describes as the experience-complexity gap nursing shortage. It is this second type of shortage that is both pervasive today and contributing to stress and burnout in nursing.

In an article in this month’s Journal of Nursing Administration, authors from the Nurse Executive Center Advisory Board discuss the impact of the growing number of inexperienced nurses currently working on units where patient acuity continues to rise and ADTs have increased. These changes are driven by the growing number of Baby Boomer retirements, the growing time it takes to develop clinical competence coupled with RN shorter job tenures in certain settings. Whitney Johnson is a leadership expert who studies S learning curves organizations. She recommends that leaders should ideally staff their workplaces with 15% of staff at the lower end of the learning curve, 70% at the competency level of the learning curve and 15% at the highest level of mastery. In showing nurse leaders the S curve, most tell me that greater than 50% of their staff today are at the beginning level of the curve. With this challenge, it becomes very difficult to provide good onboarding and coaching. It is not a recipe for safe and high-quality patient care.

The nursing shortage in the experience-complexity gap deserves more time and attention in nursing. Right now, many front-line nurse managers are left to struggle with staffing decisions around this experience-complexity gap that create ethical dilemmas for them. In my conversations with managers, some have frankly told me that sometimes they stay on their units 12-14 hours a day because they worry about leaving inexperienced staff by themselves. We have always known as leaders that just because your vacancies are filled does not always mean that you have the skillset that you need to properly care for patients.

Read to Lead

Johnson, W. (2018). Build an A-Team: Play to Their Strengths and Lead Them Up the Learning Curve. Harvard Business Review.

2019 NSI National Health Care Retention & RN Staffing Report. Available at http://nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

Virkstis, K., Herleth, A. & Rewers, L. (2019). Closing nursing’s experience-complexity gap. Journal of Nursing Administration. 49(12). 580-582.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave