There is an acute shortage of nurses in hospitals and care facilities across the United States, with the total deficit of nurses numbering in the hundreds of thousands since the beginning of the pandemic. A 2023 survey by AMN Healthcare found that 94 percent of nurses said there is a shortage of nurses in their area, with half saying the shortage is “severe.” This crisis is trending in an increasingly dangerous direction, with up to 900,000 nurses expected to drop out of the workforce by 2027, in large part from burnout.

The shortage of nurses in the US is already at its worst in four decades and, even counting new nurses entering the workforce, is expected by the Bureau of Labor to widen by hundreds of thousands of nurses per year. The International Council of Nurses (ICN) last year described the global nurse shortage as a “global health emergency.”

Nurses working at care facilities, and particularly hospitals, are already working in conditions of chronic understaffing. This exacerbates the widespread burnout of nurses, including the 47 percent of nurses reporting high levels of burnout in the average US hospital, according to the publication STAT, and the two out of three nurses nationwide who report having to take care of too many patients, according to a nationwide “State of Nursing Poll 2024” by Incredible Health.

The WSWS spoke to a nurse who works at Nashoba Valley Medical Center in Ayer, Massachusetts. Nashoba is one of two facilities, the other being Carney Hospital in Dorchester, that Steward Health Care has announced will be closed by the end of August. Dallas-based Steward filed for bankruptcy in May. The for-profit healthcare giant’s predatory and parasitic financial dealings have enriched its executives to the tune of $1 billion, while healthcare workers and patients are paying the price.

The nurse said, “Well, all the social workers on the unit I work on, the GPU (Geriatric Psychiatric Unit), all quit, about a month ago, so there’s no social workers on the unit.

“The way it works, is if you have 15 patients or under, you get three nurses. And if you go over 15, we’re supposed to have four nurses on the 3 to 11 shifts. So, over the course of the last year, people have quit, and they haven’t refilled the positions. I think the last person that they hired was in maybe November or December.”

Understaffing also puts patients’ wellbeing in danger. In the years since the beginning of the pandemic, medical errors have been on the rise, with a 19 percent rise in adverse effects (medical mistakes) reported in 2022 by the Joint Commission, a non-profit that accredits health organizations. This is due to both staff shortages and the reliance on temporary workers. Eighty-eight percent of nurses are concerned that the staffing crisis is taking a toll on patient care quality, according to the Incredible Health poll.

The Nashoba nurse raised how this is affecting patients. “We’ve had patients that have been stuck on the unit for six months, eight months, you know; some of them who probably never should have been brought there in the first place,” he said. “Because generally, the criteria to be sectioned to a psychiatric unit is you have to be a danger to yourself or others,” but some of the people should be in a skilled nursing facility.

“In my unit, they’re taking just straight-up Med-Surg [medical-surgical unit] patients and saying they should be in psych. ‘Oh yeah, this person has multi-organ failure. Their kidneys don’t work; they have a mass on their pancreas and their liver is shut down. So, they’re depressed. We need to put them on the GPU.’”

The pandemic has also inflicted enormous mental trauma for nurses who have been at the forefront of the COVID crisis. Nurses were forced to work in dire conditions in which containment of the virus and even mitigation measures were ultimately abandoned by the federal and state governments.

Not unrelated to the reactionary anti-science social climate that has been fomented during the pandemic has been the rise in patient violence and abuse of nurses. Half of nurses polled by Incredible Health say they face violence and abuse by patients, with 26 percent saying it is driving them out of the profession.

Lack of adequate staffing, high levels of exploitation and challenging care conditions have also resulted in an increase in accidents and drowsy driving for nurses. As the WSWS detailed in a recent article about an accident that saw an exhausted nurse drive off the top of a parking garage in Massachusetts, 95 percent of automotive crashes involving nurses are the result of drowsy driving. A 2019 study revealed that the incidence of drowsy driving has doubled among nurses in the last 30 years. This has doubtless become a more serious problem since the outbreak of the pandemic.

Nurse-to-patient ratios and the staffing crisis have been at the forefront of strikes and petitions to state governments by nurses in the last four years, although they have only received vague concessions from employers. The political establishment has done nothing to enforce what laws exist or have been recently passed on staffing levels.

Staffing problems are not an accident, but a deliberate policy put forward to run hospitals as leanly as possible to maximize profit. Both the Democrats and Republicans defend the for-profit healthcare system, putting forward programs like Obamacare which incentivizes hospitals to slash costs and cut staff in accordance with the wishes of insurance company and healthcare monopolies. Workers are routinely told there is no money for the hiring of new staff or livable wages while $1 trillion is spent on war and healthcare giants rake in hundreds of billions. 

Healthcare workers are fighting back, striking and voicing their opposition across the country. In 2023, half of the 33 major strikes in the US were from healthcare workers. This year, there have been only three strikes of healthcare workers over 1,000 workers. This is not because conditions have improved, but because the trade unions have turned to more aggressive measures to keep opposition at bay. 

Nurses unions have come to rotten deals with the healthcare companies, often resulting in flimsy, unenforced agreements on staffing that are left by the wayside as soon the dust settles from major strikes. It is not from a lack of militancy that nurses have been unable to force healthcare companies to properly staff hospitals and other medical facilities. Instead, it is the betrayals of unions, the corporate controlled political establishment and the criminality of the capitalist profit system itself which is to blame.

In addition, the capitalist drive to a third world war is incompatible with public health and the long-term survival of the world’s population. Tens of millions of lives were sacrificed during the pandemic through what became a deliberate policy of promoting the disease’s spread to keep big business and the stock market satisfied. The pandemic has revealed that the ruling class is hostile to public health and is willing to let hundreds of millions, or even billions, die in furtherance of the conquest of profit.

Appeals to any faction of the ruling class will do nothing to ameliorate this situation in the US and around the world. The Biden-Harris administration’s strategy has been to work together with the labor unions and corporations to isolate and betray the growing militancy of workers across many different sectors.

Nurses must unite independently of the big-business parties and the union apparatus in the building of independent rank-and-file committees to connect the fight of nurses with that of workers across all industries, both in the US and internationally. Only in this way can healthcare workers bring to bear the immense social power necessary to cast off the profit system and establish genuine socialized medical care to provide for the needs of workers and patients alike.