Investing in the frontlines of health equity

In New York, and across the country, it is undeniably true that our health care workforce is on the front lines of forging health equity. While this has always been the case, it became especially evident during the COVID-19 pandemic when the energy and support for nurses flourished at an incredibly challenging time. Though the pandemic has waned and many of us have returned to regular working conditions, the pressures on nurses, individually and collectively, persists. According to 2023 re-registration surveys in New York, 15% of hospital patient care RNs between the ages of 20 and 39 reported plans to leave their current position within the next 12 months – nearly the same percentage as nurses ages 60 and up who are planning to soon retire. 

Nurses have always been the backbone of our health care system, serving as the first point of interaction with patients and advocating for them as key intermediaries with physicians. To ensure we have a sustained, skilled and diverse workforce for years to come, the private and public sectors must partner on short- and long-term investments in both the recruitment and retention of nurses.

At a time when New York state’s hospitals face exacerbated nursing workforce shortages, various efforts, such as the Nurses Across New York loan repayment program and permits that make clinical training more accessible, are working to alleviate recruitment challenges. Despite these investments, nurses in every corner of the state, from Buffalo to New Rochelle, are feeling strained and burnt out and are questioning just how long they can stay in their chosen field. 

There are many factors impacting the nursing workforce at large. Our state’s health systems are vast and varied – from urban and rural hospitals to virtual and home care options, work environments are ever-changing and in need of resources that aim to address their specific challenges. Bolstering New York’s nursing workforce requires a deep understanding of these dynamics before making a major financial commitment.

Philanthropy already plays a role in supporting the health care workforce because we recognize the direct connection between a healthy workforce and greater health equity within communities. Strengthening the health care workforce takes multiple pathways, but philanthropic commitments are a prime example of how direct funding and cross-sector collaboration can lead to successful outcomes. 

Investing in research is a key catalyst to identifying the right solutions. A recent study conducted in partnership with the University of Albany’s Center for Health Workforce Studies highlights the nuances in hospital workforces statewide. Through interviews and focus groups across 60 hospitals, the study found a number of challenges contributing to persistent shortages across regions. In urban hospitals, higher rates of workplace violence are contributing to quicker staff burnout. A lack of resources in small hospitals, both rural and urban, are causing nurses to leave their jobs sooner. Among other issues, vacancies in every hospital are more likely to occur in medical-surgical units, emergency departments and critical care units. 

Across the board, patient acuity, staffing shortages and on-the-job risks all play a role in heightened burnout. While no silver-bullet strategy emerged from the study, the hospitals interviewed agreed that, if given the proper resources, they would all focus on three priority areas: improving workplace culture, expanding development opportunities for staff and offering educational assistance to make nursing careers more accessible. While these three areas may sound simple, there are nuances and specific strategies within each that require funding, staff buy-in and the time necessary to implement and spark change in the most thoughtful way possible.

Knowing this, and hearing firsthand from the hospitals and staff experiencing these challenges, allows providers, legislators, nonprofits and more to collaborate on strategies and investments that can drive positive change for New York’s nurses. 

In the philanthropy space, diving into both the qualitative and quantitative research allows us to strategize and adjust our grantmaking to serve the highest priority solutions in the areas that need it most. Each hospital will need a targeted approach and unwavering commitments to reach their goals, reframe their internal culture and strengthen their staff. Throughout the process, it will be important to collectively take a step back and hear directly from our nurses on the ground who best understand both the positive impact of solutions and areas where initiatives need to be amended to fit the needs of staff and patients.

When listening to New York’s health care workforce, it becomes clear that the nursing shortage is a statewide, generation-spanning issue – and it’s an issue deserving of our immediate attention and action. There won’t be an easy or quick pathway to success, but with cross-sector partnerships, long-term investments and consistent research, we can redefine what a career in nursing looks like in New York and, by extension, support the overall health of New Yorkers.