A little over a year ago, I walked past the schedule board at the front of the operating room where I worked as an anesthesia technician prior to starting medical school and saw a familiar sight. Multiple patients were waiting in their respective operating rooms for a bed in the post-anesthesia care unit (PACU). It was 8 p.m., and many had been done with their procedures for over an hour. The reason for the delay was a common problem facing our healthcare system: A critical nursing shortage. There were only two nurses in the entire PACU for the level II trauma center that day. Overwhelmed by the volume of patients, the thin nursing staff was unable to provide adequate care for patients recovering from surgery.

According to the United States Registered Nurse Workforce Report Card and Shortage Forecast from 2019, there will be a nationwide deficit of over 900,000 nurses by 2030. The COVID-19 pandemic will likely exacerbate this projected deficit as an estimated 100,000 nurses left the field in 2021 alone — the largest single-year drop in 40 years. The American Association of Colleges of Nursing notes that “a significant number of nurses leaving the workforce [in 2021] were under the age of 35, and most were employed in hospitals .” This disproportionate loss of young nurses means that there will be no one to replace their older counterparts as they retire, exacerbating the shortage. Hospitals will be impacted most severely, a reality that I saw unfold daily as an anesthesia technician.

My role afforded me the opportunity to speak with multiple operating room nurses at the 500-bed trauma center, allowing me to glean some of the causes of the nursing shortage. Several nurses quit during my six months at the hospital due to a toxic working environment, overwork, substandard patient care, and inadequate compensation. I spoke with one nurse who chose to quit because she could no longer bear to see patients receive such poor-quality care. The staff was stretched so thin that providing proper care to every patient was impossible.

The causes of understaffing are varied and include stress and burnout brought on by the recent pandemic, an aging workforce, and inadequate growth of nursing school enrollment. In addition, the pursuit of profit by hospital administrators only worsens the crisis. According to National Nurses United, “hospitals intentionally understaff every unit, every shift with fewer numbers of nurses than is actually required to safely and optimally care for [patients].” Fewer nurses on the regular staff equate to more profit for the hospital system. However, the increased stress placed upon the remaining staff leads to more burnout, the inability to provide sufficient patient care, and often, the difficult decision to quit.

I believe that any solutions to the current nursing shortage must address the problems arising at the administrative level. Although more research needs to be done, a 2009 analysis of the top 100 hospitals in the United States revealed a “strong positive association between the ranked quality of a hospital and whether the CEO is a physician or not.” This data suggests that hospitals should be run by the physicians and nurses who have personally cared for patients and understand what adequate care entails. Moreover, leaders with on-the-ground experience will have personally experienced the unique demands of healthcare and know what conditions are necessary for healthcare providers to perform at their best.

Medicine is an increasingly interdisciplinary field that necessitates teamwork between multiple different healthcare providers. Nurses are central to any healthcare team, and my ability to care for patients as a medical student and future physician depends upon their health and well-being. In order to best care for our patients, it is imperative that we first care for our nurses.

Zach Wilson is a medical student in Washington, D.C., with prior experience as a medical scribe and anesthesia technician.