Vacancies in nursing positions across Massachusetts have decreased, according to a recent report on the state’s workforce from the Massachusetts Health and Hospital Association, and while nurse and hospital leaders have acknowledged the positive benefits from this, they say there is still work to do.
The new data show that one in every 10 nursing roles are now vacant compared to other post pandemic years where one in every six roles were vacant — a 5% decrease. This displays improvements, but these rates are now what they were before the COVID-19 pandemic, said Aaron Winston, a registered nurse and committee co-chair for the Massachusetts Nursing Association.
“Before we start celebrating, we need to really take a hard look at what constitutes business as usual,” Winston said. “If you look at this data, there has been such a rush in the health care professions to kind of put the pandemic behind us and go back to ‘normal.’ But normal was not great.”
Valerie Fleishman, executive vice president and chief innovation officer of MHA, said the vacancy decrease shows “major progress” within the past two years. New nurses are entering the field while those who may have previously left are returning, she said.
“There’s still huge gaps and strengths that exist, but we really like where the momentum is going,” said Sam Melnick, MHA’s chief communications officer.
The decrease in nursing vacancies reflects a wider trend across health care in Massachusetts, which reduced industry-wide openings overall by 28%. Nursing related positions made up five out of the top 10 roles that had the largest drops in vacancy rates.
However, in May, the MNA recorded that 78% of nurses said hospital care quality has worsened within the past two years — a 7% decrease from 2023 — with understaffing listed as the top obstacle for nurses.
Several Massachusetts nurses attributed working conditions as the reason why most nurses exit the industry, pointing specifically to long hours, inadequate time for necessary care and attention, insufficient pay and caring for too many patients at once. Most of these problems could be solved with better nurse-to-patient ratios, they said.
“There’s not a shortage of nurses,” said MNA President Katie Murphy. “There’s a shortage of nurses willing to work under these circumstances.”
Murphy, who has been a bedside nurse and currently works as a critical care nurse, said she has heard anecdotally that conditions have gotten better at times but still hears that those changes are not necessarily happening where they should be, which she said is at the bedside.
“We have a long way to go,” she said.
The Nurse Journal ranked Massachusetts as the third best state to work as a nurse, after California and Colorado. It is one of the only states that has a nurse-to-patient ratio law enacted — a 1:1 or 1:2 nurse to ICU patient ratio — but does not have industry-wide requirements.
However, “just because it’s better doesn’t mean that it’s good,” said Winston, who previously worked in Virginia, where he said the conditions nearly resulted in him exiting the industry.
“There is still a burden [in Massachusetts], and the work of nursing is incredibly difficult,” he said. “What seem like relatively simple, innocuous policies in how hospitals are run profoundly affects how we are able to do the work that we have been trained to do.”
Solutions
MHA launched its statewide Healthy Work Environment Academy for a cohort of 10 hospitals this past summer, and it will be starting its second round in March for 10 more hospitals. The program focuses on creating a healthy work culture to retain current nurses and attract new nurses.
MHA has also organized resiliency and peer support programs and looked at ways to provide wraparound services for promoting a better work-life balance. These services include financial counseling, child-support and flexible scheduling.
Anecdotally, responses to the HWE have been “incredibly positive,” Fleishman said.
The American Nurses Credentialing Center currently lists 17 hospitals as “magnet destinations,” so they are recognized for providing a healthy work environment to nurses. MHA hopes to expand this designation to more hospitals statewide through the HWE, Fleishman said. It is also looking into alternative positions for different care-team members including virtual nursing and using AI models.
Patricia Noga, a registered nurse and MHA vice president of clinical affairs, pointed towards the Nurse Licensure Compact — a law allowing nurses to provide care in other compact states — expanding fields like nurse practitioners, midwives and nurse anesthetists and remote monitoring as growing opportunities for nurses.
Fleishman said MHA is providing the “vehicle” for hospitals to develop career-ladder programs, which allows them to train nurses to perhaps move to another area of expertise or another specialty.
However, some nurses said rather than finding other avenues in the industry, what hospitals need to do is improve working conditions so they want to stay at the bedside instead.
Barbara Connor, a registered nurse, said a key staffing issue is nurses become trained and then leave the practice. The reasons, she said, could range from being liable for making a mistake — which could be exacerbated if a nurse is working long hours on an understaffed floor — to experiencing workplace violence.
“You could get a job doing something else that gives you a much better work-life balance, and you don’t have to worry about being sued or hit,” Connor said.
Many nurses have called for mandated nurse-to-patient ratios as the main solution for understaffing alongside stricter laws to protect them against violence in hospitals.
Noga said staffing is an “ongoing process,” since patient’s conditions can change rapidly and care teams then adjust for that. She said additional members of the care team and the training and competencies of nurses on a certain unit are other factors to keep in mind when thinking about staffing ratios.
“We trust that the nurses with their leaders are developing staffing plans that reflect the patient population they’re caring for,” Noga said.
Melnick added that on a broader level there is a focus to “keep people out of the hospital in the first place,” which could lower costs and remove some pressures on caregivers.
MHA’s report states that “additional legislative action and targeted investments” are required to continue the momentum gained from programs like the HWE to close workforce gaps and expand care. It is currently championing a bill alongside the MNA and 1199SEIU Massachusetts to address and prevent workplace violence.