A Vascular Access Discussion on the Nursing Shortage and Impact to Patient Care

Interview by Vickerie Williams with Maya Yearns, RN, VA-BC and Molly Judge, RN, VA-BC, CRNI

A recent study found that 100,000 nurses left the profession during COVID-19, and 800,000 are likely to follow them out the door by 2027.

In March 2022, the American Nurses Foundation and the American Nurses Association published the results of their survey. The survey indicated that 52% of nurses are intending to or are considering leaving their position with 63% of nurses under the age of 35 saying they intend to leave or are considering leaving.

As the headlines are filled with news of the critical nursing shortage, we wondered how this shortage was directly impacting nurses within vascular access. 

Molly Judge, RN, VA-BC, a vascular access nurse who recently left a large acute care facility and Maya Yearns, a current vascular access nurse in a smaller acute care hospital, answered a few questions on their perspectives of the crisis and how it’s impacting vascular access.

 Molly and Maya, thanks so much for talking with me about the nursing shortage and how it has impacted you in vascular access.

 The first question is have you actually seen this shortage we’re hearing about?

I have seen the effect of the nursing shortage on my previous Vascular Access Team.  Our team was staffed, but because of the decrease in staffing on the units and the use of travel nurses, the effects on patient care were very evident.  Nurses were assigned far too many patients for their acuity level.  Since they were spread so thin, assessments were missed.  Our team was often consulted to assess infiltration or extravasation.  Most newer nurses have not had a lot of experience with placing IVs and because of the shortage of staffing, they do not get the assistance they need to become proficient in placing and/or assessing IVs.  This led to multiple venipuncture attempts before the IV was secured. - Molly

For me, I have not seen a nursing shortage within the vascular access setting itself, but I have seen the shortage in most of the nursing units. Fewer nurses means that the remaining staff is stretched thin. This leaves them with less time to assess, troubleshoot, and start IVs themselves. As Molly said, this can lead to worse outcomes when a complication isn’t caught early and can contribute to a lack of skill in IV starting. Many inexperienced nurses will place an IV where it is easiest (hand or AC) and will inadvertently cause increased trauma to a vessel. This leads to more complications in those IVs. I’ve seen infiltrations that might have been prevented had the bedside staff had time to really assess when a pump was beeping, or a patient complained of pain at the IV site. What we usually see is nurses who just aren’t comfortable enough or don’t have the time to start an IV so they call us for all the IV starts. - Maya

So, what do you think is the reason behind the shortage?

 I think it’s multifactorial. Older nurses have retired early or transitioned to roles not at the bedside while nurses of all ages became burnt out during the pandemic. I’ve been a nurse for 13 years and it does feel like the environment has changed a lot during that time with the verbal and physical abuse of nurses increasing in the last few years. It also seems that the younger generations have learned the value of work/life balance and aren’t willing to sacrifice their time or mental health for a job. I also think the lack of nursing educators and clinical sites for those in nursing school who can someday replace those leaving the profession is something that needs to be resolved. – Maya

 I don’t know if I truly believe that there is a nursing shortage.  I think there is a shortage of nurses who continue to be willing to work in high-stress roles with little assistance or appropriate compensation. For me, I was leaving work feeling defeated daily and the entire care team was stressed. - Molly

How have you seen the nursing shortage impact patient care?

 Because of the lack of staff, we are seeing more and more patients boarded in the emergency department because there are no beds or staff to care for them in the acute care setting.   Long-term care settings have a much higher patient-to-nurse ratio and it is not physically possible for nurses to see all their patients safely. I have seen some very bad IV extravasations because of the inability of nurses to assess in a timely manner. – Molly

I completely agree. Nurses spend a great deal more time with patients than physicians in the hospital setting. Nurse assessments are critical to recognizing changes in condition and it is a nurse who contacts the physician with any pertinent information; a good nurse is the first link in the patient safety chain. If nurses are stretched so thin that they cannot provide adequate care for their patients, not only will patient care suffer, but patient safety will also be compromised. – Maya

Do you think vascular access as a field has been isolated from the impact of the shortage?

As a specialty area, I think vascular access will be one of the last areas to be directly affected by the nursing shortage, but as we’ve talked about, we are impacted in indirect ways because of the need to either correct issues caused by lack of bedside nurses, or we end up taking on work that the units typically would do because they just don’t have the time or skills. – Maya

Agreed. Unfortunately, nurses do not get enough training in their programs before graduation and most institutions do not ensure the nurses’ competency except on a fake arm in a skills lab upon hire.  No actual observation is being done with coaching “at the elbow” by a preceptor.  Even within the field of vascular access, there is also a lack of nurses staying up to date on the standards of care.  This is not a field where you can say “This is how we have always done it.”  - Molly

Have you had open discussions about this with your fellow nurses?

Yes - nurses discuss this with their colleagues.  Basically, they do not feel they have the resources needed to provide the kind of care they want to give, and trying to have a conversation with leadership has been a challenge. This is one reason I knew I was done being a bedside nurse. – Molly

Among the nurses I talk to the most, it seems that higher pay and an administration that demonstrates that they value nurses would go a long way toward making them want to stay in the profession. I don’t personally know any nurses who haven’t at least thought seriously about leaving their current job or the profession altogether, so unless things change this is only going to get worse. - Maya

As someone experiencing the impact of the shortage firsthand, what do you think it will take to solve this?

I think we need to do something very different. Nurses need to get reimbursed for the care they provide.  In the acute care setting, we should not be lumped into the room fee.  Nursing is one of the only healthcare professions that do not charge for their care.  I have been working with ANA and the Commission for Nurse Reimbursement to explore a new reimbursement structure. – Molly

I think that increased pay and respect for the nursing profession would help in solving the nursing shortage. Increased respect would include both greater protection from physical and verbal assault by patients/families and greater respect from hospital administration. Nurses are constantly told that taking care of patients is our job and we must do what it takes to make sure this happens. This means that when the kitchen is short-staffed, we deliver meal trays; when housekeeping is short-staffed, we clean rooms; when lab is short-staffed, we draw all the blood, etc… We do this all without additional pay and while those in the position to make positive changes for us seem to go home on time every evening. I believe the frustration among the nursing staff at the perceived workload/pay disparity has contributed to burnout. - Maya

Anything else you think is important for the conversation?

Nurses are notoriously helpers.  That is why we became nurses.  We fill in the gaps when needed.  If a unit secretary is sick, the nurses end up answering phones and doing their role in addition to their own.  Environmental service staff are short?  Nurses take up the slack and strip beds and empty trash. Nurses are drowning.  In spite of all of this, they are going home worried if they did enough for their patients. - Molly