Forty-One Percent in Their First Two Years: National Nursing Workforce Trends and What They Are Doing to a Children's Hospital's Medical-Surgical Floors
Student Name
American College of Education
NUR5133: Knowledge of the Healthcare Environment
Module 5 Assignment
Instructor Name
October 5, 2027
The National Picture
The 2022 national survey of nurses run by the state boards of nursing through their national council is the most comprehensive recent source on the registered and licensed practical nurse workforce in the United States (Smiley et al., 2023). An analysis of its data on burnout and stress, drawing on tens of thousands of registered and practical nurses across 45 states, showed that close to two in three nurses said their workload grew while COVID-19 was at its height, and roughly half described feeling drained, used up or exhausted at least a few times each week (Martin et al., 2023). Nurses with the least time in the profession, up to about ten years, reported the heaviest strain, and the authors tied it to a 3.3% shrinking of the nursing workforce across the previous two years.
The pattern matters as much as the total. The nurses leaving in the greatest numbers are not only those near retirement but those early in their careers, the group hospitals depend on to become the next generation of experienced staff and charge nurses. A workforce can hold its headcount steady by hiring new graduates while losing the middle, and still become much less experienced.
The Children's Hospital's Workforce
The composite children's hospital's medical-surgical floors, four units with 96 beds, employ 188 registered nurses. Their vacancy rate is 11.8%, up from 6% five years ago. First-year turnover among newly licensed nurses reached 27% last year. The hospital has filled the gap with travel nurses, who worked an average of 14 full-time equivalents on the four floors last year at about twice the cost of employed nurses.
The most striking change is in experience. Five years ago, 22% of the floors' registered nurses had less than two years of experience as a nurse; today the figure is 41%. The share with more than ten years of experience fell from 38% to 24%. The floors did not lose nurses so much as they lost years of nursing, and years are what a child who is quietly deteriorating needs at the bedside. At the same time, as Module 1 described, the floors are admitting more transfers from community hospitals that closed their pediatric units, and, as Module 2 described, more adolescents in psychiatric crisis waiting for a bed. The patients have become more varied as the nurses have become less experienced.
Why the Trend Hits Pediatrics Harder
Pediatric hospitals feel the national trend more sharply for reasons specific to the specialty. Most prelicensure programs prepare nurses primarily for adult care, and pediatric clinical placements are limited and short. As community hospitals have closed their pediatric units, there are fewer places where students and new nurses can gain pediatric experience at all; between 2008 and 2018 the country lost almost a fifth of its pediatric inpatient units, with steeper losses in rural areas (Cushing et al., 2021). Nurses who might once have moved to the children's hospital after several years on a community pediatric unit now arrive as new graduates or from adult settings, and must learn pediatric assessment, weight-based medication dosing and family-centered care from the beginning. Pediatric nurses who leave for adult hospitals, where pay is often higher and schedules more flexible, take specialized skills that are hard to replace. And children's hospitals cannot easily fill gaps with nurses from other specialties without extended orientation. The children's hospital therefore cannot rely on the regional labor market to supply experienced pediatric nurses; it must grow them.
Operational Effects
The trend shows up in operations in five ways. First, precepting load has grown. With 41% of nurses new to practice, the experienced nurses precept almost continuously, often while carrying a full assignment, and several have said that precepting is the reason they are considering leaving. Second, charge nurse coverage has thinned. On night shift, the charge nurse is now sometimes a nurse with less than three years of experience, because no one more senior is working. Third, costs have risen. Travel nurse spending on the four floors reached about $3.4 million last year, and overtime hours increased by 31%, which matters because long hours are strongly linked with harm to nurses, even if the evidence on harm to patients is less conclusive (Bae & Fabry, 2014). Fourth, skill mix planning has become harder: assignments must now match patient complexity to nurse experience, which the staffing grid was never designed to do. Fifth, patient care signals are appearing. Rapid response calls in which the triggering signs were present for more than two hours before the call rose from 18% to 29% of calls over three years, a pattern the hospital's resuscitation committee attributes partly to less experienced nurses recognizing deterioration later.
Responses the Evidence Supports
Because the national data show that the greatest burnout and exits occur early in careers, the hospital's first response should focus on new graduates. In the studies gathered by one systematic review, residency programs for new graduate nurses went along with higher retention of new graduates and greater satisfaction with orientation, although programs varied too much in length and content for precise comparison (Van Camp & Chappy, 2017). The hospital's current orientation is 12 weeks of precepted practice; the proposal is a 12-month residency with monthly seminars, a trained preceptor pool with reduced assignments while precepting and a structured transition from preceptor to mentor at the end of orientation.
The second response addresses the loss of the middle. Nurses with five to fifteen years of experience are most likely to become charge nurses, preceptors and mentors, and the hospital should offer them reasons to stay: a clinical ladder with pay steps for precepting and charge roles, self-scheduling and protected time for professional development. The third response is to design for the workforce the hospital has, not the one it had. That means an experience-weighted assignment tool, a night-shift clinical resource nurse on the medical-surgical floors and a pediatric early warning score embedded in the record to support nurses who are still learning to recognize deterioration.
Measuring the Response
Progress will be judged on six figures. The hospital will track first-year turnover, the overall vacancy rate, travel nurse full-time equivalents, the experience mix on the floors, annual departures among nurses past their fifth year and the delayed rapid response indicator. It will report them quarterly to the nursing executive team, against a target of reducing first-year turnover to 15% and travel use by half within two years. The final module builds these findings into a strategy for the constraint that the Module 4 scan found would decide nearly every other plan.
No single measure will be judged on its own. A fall in travel use achieved by pushing more overtime onto employed nurses would be a false success, and a drop in first-year turnover that coincided with more departures among experienced nurses would mean the burden had simply moved. The nursing executive team will therefore review the six measures on one page each quarter, alongside comments gathered from the residency cohort and the preceptor group, before deciding whether to expand, adjust or stop each response.
References
Bae, S.-H., & Fabry, D. (2014). Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: Systematic literature review. Nursing Outlook, 62(2), 138-156. https://doi.org/10.1016/j.outlook.2013.10.009
Cushing, A. M., Bucholz, E. M., Chien, A. T., Rauch, D. A., & Michelson, K. A. (2021). Availability of pediatric inpatient services in the United States. Pediatrics, 148(1), Article e2020041723. https://doi.org/10.1542/peds.2020-041723
Martin, B., Kaminski-Ozturk, N., O'Hara, C., & Smiley, R. (2023). Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. Journal of Nursing Regulation, 14(1), 4-12. https://doi.org/10.1016/S2155-8256(23)00063-7
Smiley, R. A., Allgeyer, R. L., Shobo, Y., Lyons, K. C., Letourneau, R., Zhong, E., Kaminski-Ozturk, N., & Alexander, M. (2023). The 2022 national nursing workforce survey. Journal of Nursing Regulation, 14(1), S1-S90. https://doi.org/10.1016/S2155-8256(23)00047-9
Van Camp, J., & Chappy, S. (2017). The effectiveness of nurse residency programs on retention: A systematic review. AORN Journal, 106(2), 128-144. https://doi.org/10.1016/j.aorn.2017.06.003
How this NUR 5133 Module 5 example is structured
NUR 5133 Module 5 commonly analyzes nursing workforce trends with current data and their operational effects; your classroom's instructions decide the data sources and whether a response plan is required. This example summarizes national trends from current sources, presents local workforce data, connects the two, analyzes effects on operations in specific terms and ends with evidence-based responses and how their effect will be measured.
NUR5133 Module 5 questions, answered
What does NUR5133 Module 5 usually ask for?
NUR5133 Module 5 commonly asks you to analyze current nursing workforce trends using recent data and to explain their operational effects on your organization, often with proposed responses. Your classroom's instructions decide the data sources and format.
Where can I find current national workforce data?
The National Council of State Boards of Nursing's national workforce survey, published in the Journal of Nursing Regulation, is a strong source, along with federal workforce projections and peer-reviewed analyses of those data.
What counts as an operational effect?
A concrete change in how the organization runs: precepting load, charge coverage, overtime, agency costs, skill mix or measurable changes in patient care. Give numbers where you can.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.