The root cause of the nursing “shortage” is hospital greed

An essay in the Opinion Today section of the New York Times stated that the real cause of the nursing shortage is hospital greed.

It’s a bleed (nursing shortage) that began many years ago. The root cause? Hospital greed. It is the result of decades of mismanagement in a money—driven hospital system that prioritizes profit over patient safety. Far from a shortage, there’s never been more licensed nurses in America—they’re not being hired.

King, Lucy. “The Root Cause of the Nursing Crisis isn’t Covid.” The New York Times, 19 Jan. 2021.

My last post discussed the various obstacles that led to nurse burnout, which eventually caused nurses to leave the profession. I overlooked hospital greed. Paying more attention to the bottom line, many hospitals limit adequate nurse staffing.

California passed AB 394 in 1999 that established minimum registered nurse-to-patient ratios for hospitals. The final regulations were implemented on January 1, 2004. The law has improved patient care, lowered mortality, and improved nurse retention.

While no other state has passed a nurse-patient-ratio law, two Congresspersons, Jan Schakowsky (D-IL) and Sherrod Brown (D-OH), are introducing a new bill on the national level: Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.

This bill will improve the health of patients by improving nursing care—establishing minimum registered nurse-to-patient ratios in hospitals, providing whistleblower protections to nurses who advocate on behalf of their patients, and investing in training and career development to retain hardworking nurses in the workforce. The pandemic has only magnified the need to support nurses in their work.

What excites me is that rather than states working on individual bills, this bill will direct behavioral change in all USA hospitals. I’ll be keeping an eye on its progression and giving support to its passage whenever I can. I hope you do, too.

Watch this powerful video that shows how insufficient hospital staffing undermines safe nursing practice.

We Know the Real Cause of the Crisis in Our Hospitals. It’s Greed.

click here to view 6 minute video

Nurses would like to set the record straight on the hospital staffing crisis. Video By Lucy King and Jonah M. Kesse

By Marianna Crane

After a long career in nursing--I was one of the first certified gerontological nurse practitioners--I am now a writer. My writings center around patients I have had over the years that continue to haunt my memory unless I record their stories. In addition, I write about growing older, confronting ageism, creativity and food. My memoir, "Stories from the Tenth Floor Clinic: A Nurse Practitioner Remembers" is available where ever books are sold.


  1. This brings back those times years ago that I’d get off work and be gripped with fear about what I may have missed. PM shifts where I was the only RN for 40 patients. We all have war stories, I’m sure. It’s tragic that the situation continues, especially too with a pandemic.


    1. I agree that little has changed. I do hope that the pandemic has shown the public that nurses often work under dangerous conditions and this will help promote legislation that increases nurse staffing .

      Liked by 1 person

  2. I’m an ex NHS nurse / midwife fortunate to work in a public hospital in Australia , so much to read online from USA nurses since covid. Your conditions sound unbelievably hard! Oz has a combined healthcare system , private and Medicare which is free public health. I’ve worked in both much prefer public as better pay , better nurse:patient ratios , adequate supplies , the bottom line patient safety and health improvement not profit for the organisation!


  3. There’s an ethical problem with chronic understaffing that ties in with this editorial.

    In the US, with the cost for nursing rolled into the room rate, what happens when the hospital collects all of the daily room rate charges but doesn’t pay out the salaries and benefits for all of the staff that should have been on duty to take care of those patients?

    It’s possible for nursing (and the hospital) to “make money” by not providing patient care.


    1. Thanks for visiting my site and commenting on this post. Yes I see the ethical dilemma with the scenario you describe. However I am not clear how nursing “makes” money when the hospital does not provide sufficient nurse staffing.


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