by James Hardin, MSC, BSN, RN, NE-BC, ASNA President-Elect

Where Are We?

Many nurses would say that they can’t remember a time when they were sufficiently staffed on a consistent basis. In the over 30 years that I have been in healthcare, there has been a “nursing shortage”. The severity of this shortage has been somewhat cyclical, but healthcare organizations in Alabama have been able to ride out the troughs to get to another peak. The question we are now facing is will there be another peak or will we be faced with a perpetual trough.

During the first wave of the Covid-19 pandemic, Alabama nurses reported to ASNA through town hall meetings and anonymous surveys that they were “exhausted”, “feel underappreciated”, and “underpaid”. That was in 2020. Now, 18 months later, nurses at UAB Hospital are protesting for similar concerns (WVTM, 2021). Permanent staff across the state are not only faced with staffing and delivery of care challenges but also the fact that travel nurses in their organization are often making 2-3 times their wage. Does turmoil and turnover in nursing departments impact patient care? The short answer is yes.

How Did We Get Here?

The United States has been facing a nursing shortage for years, and with it, so has Alabama. In 2020, the National Institute of Health estimated a shortage of nurses in the United States of about 1 million nurses (Wall Street Journal, 2021). That means that every state is jostling for positions to attract nurses to their organizations. With Alabama now being a compact licensure state, Alabama nurses may easily work in other states, whether through travel, contract, or simply commuting.

While the attraction of high-paying travel assignments has obviously impacted the number of nurses leaving the state, there are other factors impacting the availability of bedside nurses. Secondary to the stress of the pandemic, many nurses have either left direct care for other positions away from the bedside or retired.  A recent ANA study revealed that 92% of the respondents considered leaving the workforce (WSB, 2021).

Where Do We Go From Here?

There isn’t really an easy answer for anyone. It will take some hard discussions amongst healthcare shareholders across Alabama. The demand across the country isn’t going to go away. As of February 2021, Registered Nursing was the fifth most in-demand job in the country. To add to this dilemma, nearly half of all Registered Nurses are now over the age of 50 (University of St. Augustine, 2021). The idea that the labor market will simply create the number of nurses needed for healthcare isn’t true. Nursing is in a crisis and the pandemic may be the straw that breaks the camel’s back (New York Times, 2021).

As federal funds for crisis travel pay ends, organizations across the country will have to redefine their pay for permanent staff. The pandemic has highlighted the direct impact that nursing has on healthcare systems and a wage assessment will have to reflect that impact (Wall Street Journal, 2021). The concern that is particularly disturbing for Alabama is how nurses were paid going into the pandemic. Alabama ranks 49th in the United States in pay for nurses, just edging out Mississippi by 500 dollars annually. In comparison, Georgia, a state where thousands of Alabama nurses can easily commute, ranks 28th. The average pay in Georgia is 9000 dollars more than Alabama annually (WBRC, 2021). If rates in Alabama do not compete with other Southeastern states, will there be enough nurses to care for all Alabamians?

What is ASNA Doing?

ASNA is an affiliate of ANA, so while we work at a state level, ANA works at a federal level. ANA has requested that the Department of Health and Human Services declare the nursing staffing shortage a national crisis and develop concrete steps to change the trajectory. ANA is asking for staffing solutions, a sustainable nursing workforce, mental health support, and improved recruitment and retention at a national level (WSB, 2021).

At ASNA, we work at a state level to support Alabama nurses through scholarship, educational and career development, advocacy, and legislative efforts. Dr. Lindsey Harris (President ASNA), Dr. John Ziegler (Executive Director ASNA), and I met with the Alabama Hospital Association in the past few weeks to discuss these issues. The Hospital Association was open to discussions and we hope to maintain an ongoing positive relationship. ASNA will expand our reach to other healthcare organizations to encourage solutions to this crisis. We will continue to request ongoing discussions on how all shareholders can impact the recruitment, retention, and development of nurses in Alabama, as well as the responsibility of our elected officials to ensure that nurses are available to provide care for all Alabamians.

What Can Alabama Nurses Do?

The first thing is to be heard, and the best way to be heard is in a chorus. ASNA is a chorus, but it only grows stronger with support from all Alabama nurses. ASNA is not a union, but instead, a supportive network that represents nursing needs to healthcare organizations and legislators that set rules and laws that impact the way Alabama nurses practice. ASNA encourages Alabama nurses to join our voice, but also to continually share yours with both your communities and lawmakers. Make sure that not only the communities you serve understand your needs and frustrations but also the people you voted for. All Alabamians should have full disclosure on the risks of not properly funding and staffing adequately trained nurses in our organizations.

The second thing is the most important. Continue to do what you do best. Take care of your patients as only nurses can. Nurses have been voted the most trusted profession for the last two decades because of the selfless and ethical treatment that we provide. While we all work toward a sustainable nursing workforce for our state, let’s not lose sight of the importance of what we do. We at ASNA applaud the work you do every day, believe that Alabama nurses deserve equivalent compensation for the services they provide and will continue to support the efforts to achieve that goal.

The New York Times (2021) Nursing Is in Crisis’: Staff Shortages Put Patients at Risk. Available at: (Accessed 6 September 2021).
University of St. Augustine for Health Sciences (2021) The 2021 American Nursing Shortage: A Data Study. Available at: (Accessed 6 September 2021).
Wall Street Journal (2021) High Pay for Covid-19 Nurses Leads to Shortages at Some Hospitals. Available at: (Accessed: 7 September 2021).
WBRC (2021) How do Alabama nurse salaries compare to other states? Not well. Available at: (Accessed 8 September 2021).
WSB TV (2021) Area nurses demanding the government declare nursing shortage a crisis. Available at: (Accessed: 7 September 2021).
WVTM (2021) UAB night shift nurses, staff protest pay and working conditions. Available at: (Accessed: 7 September 2021).