For healthcare professionals, 2020 and 2021 have presented the most challenges in recent memory. As essential workers, nurses risked their health to care for COVID-19 patients. The pandemic intensified the stress and unmanageable workload that many nurses were already experiencing, contributing to high levels of burnout and trauma.

Despite the challenges of nursing in the pandemic, 85% of nurses responding to a survey from the American Nurse Journal said they would still become nurses if they had to do it all over again.

A December 2020 survey of nurses by the American Nurses Association (ANA) found that 72% of respondents had experienced exhaustion in the last two weeks. At the same time, many hospitals lost money during the pandemic, causing them to cut healthcare workers’ hours and pay. Despite the challenges of nursing in the pandemic, 85% of nurses responding to a survey from the American Nurse Journal said they would still become nurses if they had to do it all over again.

This page discusses important nursing trends from 2021. We cover nursing issues in education, staffing, legislation, and coding and billing. We also explain how COVID-19 changed the healthcare industry and the virus’s potential impact on the future of nursing.

Education Trends: The Push for the BSN

One of the main nursing trends in education is the push for nurses to earn bachelor of science in nursing (BSN) degrees. An associate degree in nursing (ADN) was the standard credential in nursing for the last several decades, but hospitals increasingly prefer to hire registered nurses (RNs) with BSNs. Some employers require associate-level nurses to earn BSNs within five years of their hire dates, and many employers now only hire new nurses with BSNs or higher.

The Campaign for Nursing’s Future reports that the number of nurses with BSNs or higher reached 56% as of February 2019 — up from 49% in 2010.

A BSN takes about four years to complete compared to two years for an ADN, covering more issues and providing better preparation for many issues in nursing. BSN students get more experience with critical thinking, leadership, research, and communication. The Campaign for Nursing’s Future reports that the number of nurses with BSNs or higher reached 56% as of February 2019 — up from 49% in 2010.

Staffing Trends for Safety

One of the most important current issues facing nurse practitioners (NPs) is the demand for safer staffing numbers. Nursing staff shortages happen for many reasons, including cost-cutting measures by management and the presence of more patients with complex health problems requiring advanced care.

ANA reports that appropriate nurse staffing reduces mortality rates, the length of patient stays, and the number of preventable incidents like infections and falls.

Hospitals asking RNs to care for too many patients at once leads to unsafe situations that can negatively affect patient satisfaction and health outcomes. ANA reports that appropriate nurse staffing reduces mortality rates, the length of patient stays, and the number of preventable incidents like infections and falls.

Staffing ratios greatly affect which hospitals nurses apply to. Hospital systems known for giving unsafe assignments may find it challenging to fill empty RN positions, particularly with the most highly educated and experienced NPs.

Legislation Trend: Independent Practice for APRNs

One of the major nursing trends related to legislation includes the push to give advanced practice registered nurses (APRNs) full authority in their scope of practice. This status allows APRNS to evaluate, diagnose, treat, and prescribe medications for patients under the authority of their state boards of nursing. National groups that offer APRN certifications and represent nursing specializations advocate for expanded independent practice for APRNs in the United States.

APRNs meet national standards for education and certification, but states regulate their practice differently, which gives them different levels of responsibility. Arizona and Oregon offer full practice authority to APRNs, but in many other states, NPs cannot practice without physician supervision or state medical board oversight.

APRN independent practice can help address physician shortages in areas like pediatrics and family care. Studies indicate that in states where NPs receive full practice authority, they practice in underserved and rural areas and meet safety and patient care standards more often. Conversely, states that limit APRN independent practice exhibit primary care shortages, geographic healthcare disparities, and higher rates of chronic disease.

Nursing Shortage: The Demand for RNs and NPs

As one of the longest-running nursing trends in the U.S., periodic RN shortages date to the early 1900s. The current shortage started around 2012, and experts expect the shortage to get worse. Factors contributing to the shortage include large numbers of RNs retiring, increased demand for healthcare services, and burnout causing nurses to leave the profession.

Strong demand for RNs contributes to the excellent registered nursing job outlook. The Bureau of Labor Statistics (BLS) projects a 7% job growth rate (faster than average) for RNs between 2019 and 2029. The BLS anticipates even greater demand for NPs, projecting a 45% job growth rate (much faster than average) for the occupation in the same period.

Some U.S. regions consistently experience nursing shortages, prompting hospitals in those areas to offer sign-on bonuses to qualified RNs and NPs, especially individuals with in-demand nursing specializations. New nurses without 1-3 years of experience may find it difficult to land a position in states with many licensed RNs.

Nursing Shortage: Inadequate Student Enrollment

Inadequate student enrollment in nursing schools, another significant issue in nursing, also contributes to the overall nursing shortage. While student demand persists, a shortage of nursing school faculty keeps many programs from admitting all qualified applicants. Prospective nurses may find it difficult or impossible to get into nursing school, even when they meet admission requirements.

A 2020 American Association of Colleges of Nursing report found that in 2019, nursing schools turned away 80,407 qualified applicants from bachelor’s and graduate nursing programs. Nearly two-thirds of respondent schools named a lack of nursing faculty or preceptors as one reason they could not accept qualified applicants.

Anyone familiar with nursing news knows that the aging U.S. population will only increase the demand for RNs. The U.S. Census reported in 2017 that the number of U.S. residents age 65 or older will hit 82 million by 2030.

Changes in Coding and Billing

Constant changes in coding and billing — one of the current trends in healthcare — create more work and cause stress for RNs who need to keep up with revisions of correctly documenting patient interactions. Although most nurses do not receive formal training in billing and coding, APRNs input codes when charting.

APRNs need to know what billing codes mean and how to use them correctly. This trend in nursing especially affects NPs in independent practices who lack coding and billing specialists. NPs need to understand how to use codes from the International Classification of Diseases, 10th Revision and Healthcare Common Procedure Coding System.

Mistakes in coding and billing can affect insurance reimbursements, lead to audits, and negatively influence clinical patient care. Some hospitals and practices give incentives to providers that bill a certain percentage of visits at a higher level, creating an additional source of stress for NPs.

COVID-19 Trends

One of the most important nursing issues for 2021 started in 2020: the impact of COVID-19 on the profession. The ongoing pandemic affected every aspect of the healthcare system and profession of nursing in 2020 and 2021. As frontline workers providing direct patient care during the pandemic, nurses experienced staffing shortages, a lack of personal protective equipment, and fear of infection.

In January 2021, the International Council of Nurses found that nurses worldwide faced mass trauma from their experiences with the pandemic. The “COVID-19 effect” may result in more RNs leaving the profession, causing an even greater shortage of RNs and imperiling the future of nursing.

Remote Positions and Telehealth

Increased demand for telehealth due to COVID-19 is another major trend in nursing. During the early days of the pandemic, patients avoided medical offices and emergency rooms out of fear of contracting COVID-19. In April 2020, the number of telehealth visits was 78 times higher than in February 2020.

Nursing news indicates telehealth is likely here to stay, although numbers have stabilized from the high seen in April 2020 to 38 times higher than before the pandemic as of July 2021. Patients and providers both express more comfort and willingness to use telehealth than they did before the pandemic. Also, regulatory changes improved access to and reimbursement for telehealth.

The registered nursing job outlook may include an increase in remote positions and telehealth jobs. Expanding telehealth options for patients when it is safe to do so can help areas of the country that lack access to care.

Reduction in Seeking Preventative Care

Another current trend in healthcare brought on by the pandemic was a reduction in patients seeking preventative care.

Because of a fear of catching COVID-19 in medical settings, individuals did not keep up with preventive care. However, avoiding medical care can mean that cancer and other diseases go undetected and untreated, putting patients in potentially life-threatening situations.

Healthcare professionals conducted fewer cancer screenings like mammograms and colonoscopies, and vaccination rates among children decreased. Studies show that delaying preventative medical care might increase the chance of death or disease.

Because many nurses play a role in offering preventative care and educating patients on its importance, it is one of the biggest issues in nursing. NPs and RNs can continue to advocate for patients, educating them about the importance of continuing routine care for detailing new symptoms, managing mental health issues, and performing yearly screenings.

Patients Avoiding or Delaying Care

Patients avoiding or delaying urgent, emergency, and routine care contributes to another current issue facing NPs.

A CDC report found that 41% of American adults delayed or avoided getting medical treatment (including preventative and urgent care) by June 30, 2020, because of COVID-19 concerns. Black and Hispanic adults were even more likely to avoid or delay medical care due to fear of coming into contact with COVID-19, potentially exacerbating existing issues in health equity during the pandemic.

This delay in receiving care for both adults and children sometimes leads to acute and chronic medical problems getting worse by the time a patient seeks attention. RNs and APRNs can help patients understand the risks of delaying care by providing education in outpatient care settings.

COVID-Fueled Furloughs and the Future Job Outlook

Although it seems counterintuitive, many medical practices furloughed or laid off APRNs due to a lack of revenue during the pandemic. Patients delayed or avoided medical care, and many non-emergency practices had to close for parts of the pandemic.

This reduction in medical services translated to financial problems for healthcare providers. Some offices permanently closed because they experienced such a decreased patient volume, causing some NPs to lose their jobs.

In April 2020, 1.4 million healthcare workers lost their jobs. Although the healthcare industry has mostly gained jobs each month since, 30,000 healthcare jobs also disappeared in January 2021.

Although COVID-19-caused furloughs and layoffs may still affect the healthcare industry, the BLS reports an excellent registered nursing job outlook between 2019 and 2029.

The Future of Nursing

Nursing trends in 2021 demonstrate the lasting impact of COVID-19, the ongoing struggle to eliminate the nursing shortage, and the importance of higher education and increased credentialing for nurses. The pandemic exacerbated and drew new attention to many long-standing issues in nursing, particularly staffing for safety and the problem of burnout.

The future of nursing will rely on increasing nursing school enrollments, pushing for further education for nurses, and improving working conditions for RNs to continue providing excellent patient care. The projected demand for NPs to meet the requirements of an aging population indicates the need for highly educated, licensed, and certified nurses.

Contributions from:

Portrait of Elizabeth Clarke, FNP, MSN, RN, MSSW

Elizabeth Clarke, FNP, MSN, RN, MSSW

Elizabeth Clarke (Poon) is a board-certified family nurse practitioner. As a native of Boston, Massachusetts, Clarke grew tired of the cold and snowy winters and moved to Coral Gables, Florida, to complete her undergraduate degree in nursing at the University of Miami.

After working for several years in the UHealth and Jackson Memorial Medical systems in the cardiac and ER units, Clarke returned to the University of Miami to complete her master of science in nursing. Clarke has since worked providing primary and urgent care to pediatric populations.

She is part of the paid review network for RV Education, ensuring our content is relevant and accurate.


Featured Image: Ridofranz / iStock / Getty Images Plus

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