Predictable Consequences

How Do We Avert a Pediatric Nurse Shortage?

Vicky R. Bowden, DNSc, RN; Cynthia Schmus, MSN, CRNP


Pediatr Nurs. 2021;47(1):5-6,10. 

In This Article

Abstract and Introduction


Since the coronavirus started spreading throughout the United States, there has been a direct impact on health care employment. Concerns that acute care facilities would be overwhelmed by COVID-19 cases that would impact staffing and essential supplies led to decisions to limit non-emergency services, elective services, and routine health visits (including well-child and vaccination services). These decisions have forced health care workers, especially those in ambulatory care, homecare, physicians' offices, and schools, to take furlough. Acute care settings have not remained unimpacted. The stoppage of planned hospitalizations and surgeries, and the simple fear of going to a hospital where patients with COVID-19 are being treated, decreased the need for health care personnel working on non-COVID units. Hospitals have been forced to use creative staffing models, require nurses and others to take furlough or vacation days, and reassign nurses to tasks such as daily screening all employees for COVID. The Peterson Center of Healthcare and Kaiser Family Foundation report that from February through April 2020, more than 1.5 million health care jobs were lost. Although some recovery of these numbers has occurred, health care employment remains 6.0% lower than at the same point in 2019 (McDermott & Cox, 2020).

Adding to the decreased number of nurses employed are also those choosing to leave the profession during the pandemic and those who have died as a result of COVID-19. A variety of issues has impacted the decision by some nurses to quit their jobs. These include concerns regarding the adequacy of supplies to maintain safety and prevent illness during the coronavirus, stress from workload on units heavily affected by the number of COVID patients, emotional strain and negative mental health outcomes, and a need to stay home and care for 'out-of-school' children.

Thus, we can see that unemployment rates, early work stoppage by nurses leaving the profession, and death of nurses due to the coronavirus are outcomes of COVID-19 that were certainly not expected as we began 2020. From the lens of pediatric nursing, we also need to consider the children we serve. According to data collected by the American Academy of Pediatrics (AAP) (2020a), as of January 28, 2021, nearly 2.82 million cases of COVID-19 have been reported among children. A very small minority of these cases resulted in hospitalization (0.06%), with children representing only 1.8% of all hospitalizations (24 states and New York City reported) (AAP, 2020a). With school re-openings, the number of pediatric cases is expected to rise. Yet these same children have missed critical in-person health care visits that include essential screenings, immunizations, safety and wellness guidance, and follow up from illnesses and infections. The AAP (2020b) has shared their concerns regarding the need to ensure continued care for children during the pandemic and issued a guideline, Guidance on Providing Pediatric Ambulatory Services via Telehealth During COVID-19, which emphasizes the need for pediatric ambulatory services to continue. According to Korioth (2020):

These include in-person visits where community circumstances allow. New guidance addresses the provision of telehealth for health supervision visits and acute and chronic care visits through telehealth, delivered by general pediatricians, pediatric subspecialists and pediatric surgeons. It stresses that care should not be delayed during the pandemic, without delay inclusive of and with appropriate referrals. The guidance also urges full payment for telehealth visits at parity with in-person visits.