A Repeated Cross-Sectional Study of Nurses Immediately Before and During the COVID-19 Pandemic: Implications for Action

Background: The shortage of nursing care in U.S. hospitals has become a national concern.Purpose: Determine whether hospital nursing care shortages are primarily due to the pandemic and thus likely to subside or to hospital nurse understaffing and poor working conditions that pre-dated it.Method: Repeated cross-sectional study before and during the pandemic of 151,335 registered nurses in New York and Illinois, and a subset of 40,674 staff nurses employed in 357 hospitals.Findings: No evidence was found that large numbers of nurses left health care or hospital practice in the first 18 months of the pandemic. Nurses working in hospitals with better nurse staffing and more favorable work environments prior to the pandemic reported significantly better outcomes during the pandemic.Discussion: Policies that prevent chronic hospital nurse understaffing have the greatest potential to stabilize the hospital nurse workforce at levels supporting good care and clinician wellbeing.