ANA Letter to HHS About Staffing Concerns

 In Nurses Weekly

September 1, 2021

The Honorable Xavier Becerra


Department of Health and Human Services

Hubert H. Humphrey Building, Room 509F

200 Independence Avenue SW

Washington, DC 20201


Dear Secretary Becerra:

On behalf of the American Nurses Association (ANA), I write to urge robust and immediate action to address the unsustainable nurse staffing shortage facing our country. Nurses have remained steadfast on the front lines since the beginning of the pandemic, while overcoming challenges, risks to their personal health and safety such as limited personal protective equipment and the physical, emotional and mental health burden of the COVID-19 virus. Now, the Delta variant is causing cases to soar, overrunning hospital and staff capacity. These current circumstances have only exacerbated underlying, chronic nursing workforce challenges that have persisted for years. Since the nation began COVID-19 mitigation and response efforts, much focus has been placed on nurses facing shortages of equipment to appropriately care for patients. Now, it is imperative that the Administration acknowledge and take concrete steps to address a more dire shortage: a crisis-level human resource shortage of nurses that puts our ability to care for patients in jeopardy.

ANA is deeply concerned that this severe shortage of nurses, especially in areas experiencing high numbers of COVID-19 cases, will have long-term repercussions for the profession, the entire health care delivery system, and ultimately, on the health of the nation. To address this crisis and to ensure that we have a strong nursing workforce for the future, ANA urges the Administration to declare a national nurse staffing crisis and take immediate steps to develop and implement both short- and long-term solutions.

Shortages of nursing staff are being reported across the country:

  • Mississippi has reported that it has seen a decrease of 2,000 nurses since the beginning of 2021.
  • Hospitals in Tennessee are operating with 1,000 fewer staff than at the beginning of the pandemic, prompting them to call on their National Guard for reinforcements.1
  • Texas is recruiting 2,500 nurses from outside the state, a number that still will fall short of expected demand.2
  • Louisiana had over 6,000 unfilled nursing positions open across the state before the Delta variant caused a surge in cases.3 This shortage may become more acute as the state deals with the aftermath of Hurricane Ida.
  • To address workforce challenges, Nebraska is recruiting unvaccinated nurses.4
  • According to a survey from Trusted Health, the COVID-19 pandemic has caused 39% of nurses ages 20 – 39 to report that their commitment to nursing had decreased.

The current nursing shortage is not one that nurses alone can solve. As such, it is crucial that the Administration mount a whole of government approach by convening nurses, hospitals, physicians, other health care personnel, state and federal government officials, and key stakeholders to examine, identify, and then implement real solutions to nursing shortages, including:

1) Addressing the current fatigue and mental wellbeing of nurses

2) Developing strategies to retain the current nursing workforce

3) Working with CMS to adopt new payment methodologies that recognize the value that nurses bring to patient care

4) Removing barriers to practice faced by nurses

5) Addressing the persistent barriers that limit the number of qualified nursing students that can be educated each year

6) Building and maintaining a resilient workforce to meet our country’s current and future health care needs.

Enclosed please find an initial outline of ANA’s proposed policy solutions to address the nurse staffing crisis that we hope will help form the foundation of conversations convened by HHS on this topic.

ANA is the premier organization representing the interests of the nation’s over 4 million registered nurses (RNs), through its state and constituent member associations, organizational affiliates, and individual members. ANA members also include the four advanced practice registered nurse roles (APRNs): nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), and certified registered nurse anesthetists (CRNAs). ANA advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. RNs serve in multiple direct care, care coordination, and administration leadership roles, across the full spectrum of health care settings. RNs provide and coordinate patient care, educate patients and the public about various health conditions including essential self-care, and provide advice and emotional support to patients and their family members.

ANA looks forward to continued engagement with HHS as the nation continues to combat the COVID-19 pandemic. Please contact Ingrida Lusis, Vice President, Policy and Regulatory Affairs, at (301) 628-5081 or, with any questions.


Ernest Grant, PhD, RN, FAAN





cc: The Honorable Miguel Cardona, US Secretary of Education

The Honorable Marty Walsh, US Secretary of Labor

Loressa Cole, DNP, MBA, RN, NEA-BC, FACHE, FAAN, ANA Chief Executive Officer

Debbie Hatmaker, PhD, RN, FAAN, ANA Chief Nursing Officer


1 Guenot, M. (2021, August 18). Hospitals in states struggling With COVID-19 are facing severe staff shortages due to burnout, with 2 SAYING patient beds are going unused. Business Insider.

2 Ibid.

3 Chavez, R. (2021, August 27). Surgery by DAY, Bedpans at night: Staffing shortages in Louisiana HOSPITALS mean some workers pull double duties. PBS.

4 Salcedo, A (2021, August 25) Some Nebraskans outraged at state’s recruiting ad for unvaccinated nurses; “It feels insulting to the profession”. Washington Post.

24/7 Crisis Hotline for Impaired Nurses - 1-800-662-0108