By Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB

Nurses are essential healthcare infrastructure because patient care cannot function safely or effectively without a strong nursing workforce. Ongoing nurse shortages, burnout, and high turnover threaten patient access, healthcare quality, and system resilience.

Retaining experienced nurses is often more cost-effective and beneficial than continually recruiting and training new staff. Long-term investments in nursing education, workplace support, and career development are critical to building a sustainable workforce.

Treating the nursing workforce as critical infrastructure can help healthcare leaders and policymakers prioritize investments that improve patient outcomes and strengthen the healthcare system.

According to a 2026 Nursing Outlook study, the societal cost of losing a Minnesota specialty nurse reached nearly $3.7 million, highlighting why workforce retention should be viewed as an infrastructure investment rather than simply a staffing concern.

When policymakers discuss critical infrastructure, they typically focus on roads, bridges, power grids, water systems, airports, and telecommunications networks. These assets keep communities functioning and economies moving.

Yet one of the most essential forms of infrastructure rarely receives the same level of attention: the nursing workforce.

Hospitals can have state-of-the-art facilities, cutting-edge technology, and access to advanced treatments, but none of those resources can deliver patient care without nurses. They are the foundation of healthcare delivery, serving as the largest segment of the healthcare workforce and the primary link between patients and the healthcare system.

As healthcare organizations continue to grapple with staffing shortages, burnout, and rising demand for care, it may be time to rethink how we view the nursing profession. Rather than seeing nurses solely as employees within a healthcare organization, leaders should recognize them as a critical component to patient safety and healthcare operations.

What are nursing workforce challenges?

Nursing workforce challenges refer to the issues affecting the recruitment, retention, development, and sustainability of nurses across the healthcare continuum.

Some of the most significant challenges include:

- Ongoing nursing shortages

- High turnover rates

- Burnout and workplace stress

- Workplace violence and safety concerns

- Aging nurse populations approaching retirement

- Increased patient demand

- Limited nursing school capacity

- Faculty shortages in nursing education

- Geographic disparities in workforce distribution

- Rising administrative burdens

These challenges affect healthcare organizations nationwide and have become a major concern for workforce projections, hospital leaders, and policymakers.

According to the National Council of State Boards of Nursing (NCSBN), more than 138,000 nurses left the workforce between 2022 and 2024, and nearly 40% of nurses indicated plans to leave the profession by 2029 if current conditions persist.

What defines critical infrastructure?

The Code of Federal Regulations defines critical infrastructure as systems and assets so vital that their incapacity or destruction would have a debilitating impact on security, public health, safety, or the economy.

By that definition, the nursing workforce meets every criterion.

Nurses are responsible for assessing and monitoring patients, administering treatments, anticipating changes in patient condition, educating families, care coordination, and responding during emergencies. Healthcare delivery cannot function without them.

When staffing levels fall below what is needed, the effects extend far beyond hospital walls. Communities experience longer waiting times, delayed care, reduced access to services, and increased strain on healthcare facilities.

Just as a bridge closure disrupts transportation networks, nursing shortages disrupt healthcare access and ultimately, patient outcomes.

Why does the healthcare system depend on nurses at every level?

Nursing touches virtually every point of care.

Nurses work in:

- Hospitals

- Emergency departments

- Primary care clinics

- Long-term care facilities

- Home health agencies

- Rehabilitation centers

- Schools

- Public health departments

- Hospice organizations

This broad presence makes nursing one of the most interconnected components of healthcare infrastructure.

When shortages occur in one area, the impact often spreads throughout the system.

For example, staffing challenges in long-term care facilities can contribute to delayed hospital discharges. Patients who no longer need acute care remain hospitalized because appropriate post-acute placements are unavailable. This creates bed shortages, emergency department crowding, and increased operational pressure across entire health systems.

Infrastructure functions as a network, and nursing is no different.

What is the growing demand for nursing care?

The importance of nursing infrastructure becomes even clearer when examining demographic trends.

America's population continues to age, increasing demand for healthcare services across nearly every setting. Older adults typically require more frequent visits, chronic disease management, medication oversight, rehabilitation services, and long-term support.

The Bureau of Labor Statistics projects approximately 189,100 RN openings each year through 2034, driven by both workforce growth and the need to replace nurses leaving the profession.

At the same time, workforce planners continue to model significant shortages in many regions of the country as demand outpaces supply. Federal workforce projections released through HRSA highlight ongoing concerns regarding future nursing workforce adequacy and distribution.

This creates a challenge similar to what infrastructure planners face when roads, utilities, or transportation systems age while demand continues to grow.

Without long-term investment, capacity eventually becomes inadequate.

Distinguishing between replacing nurses and replacing equipment

One reason nursing deserves infrastructure status is that nurses are not easily replaced.

If a hospital loses a medical device, a replacement can often be ordered and installed relatively quickly.

Replacing an experienced nurse is far more complex.

Experienced nurses possess:

- Clinical knowledge and judgment developed over years of practice

- Critical thinking

- Specialized knowledge of patient populations

- Interpersonal skills necessary for a positive patient experience

- Crisis management skills

- Leadership abilities

- Institutional knowledge

- Mentorship capacity

These skills are built over time and cannot be instantly recreated through recruitment efforts.

As the Nursing Outlook study highlighted, the economic impact of nurse turnover extends beyond recruitment and onboarding costs. When experienced nurses leave the workforce, healthcare organizations and communities lose valuable clinical expertise, productivity, and years of educational investment.

Viewed through an infrastructure lens, this makes sense. Losing experienced nurses is comparable to losing highly specialized engineers responsible for maintaining a power grid or transportation network.

The loss affects the entire system.

The hidden risk of infrastructure neglect

Infrastructure problems often develop gradually before becoming obvious.

Roads deteriorate over years before potholes appear.

Water systems age before major failures occur.

The same pattern can be seen in nursing.

Warning signs include:

- Increased turnover

- Rising burnout

- Staffing vacancies

- Team disruptions

- Higher reliance on temporary labor

- Declining employee engagement

- Difficulty recruiting experienced clinicians

If these issues are not addressed, healthcare organizations may experience operational disruptions that directly affect patient care.

Recent workforce surveys have shown ongoing concerns about nurse retention and job satisfaction, with many nurses reporting burnout and considering leaving the profession.

The 2026 Nurse Salary and Work-Life Report found that 62% of nurses felt overwhelmed and 53% experienced burnout during the previous two years, while nearly one in four (24%) reported they were considering leaving the nursing profession. Although six in 10 nurses said they were satisfied with their current roles, many cited workload, leadership, and compensation as key factors affecting their job satisfaction.

These trends resemble deferred maintenance in traditional infrastructure systems. Problems may be manageable initially, but eventually they become more expensive and more difficult to solve.

Resilience depends on workforce capacity

The COVID-19 pandemic demonstrated how essential nursing infrastructure is during periods of crisis.

Healthcare systems relied heavily on nurses to manage unprecedented patient volumes, rapidly changing clinical guidance, staffing shortages, and emotional stress.

The pandemic also exposed vulnerabilities in workforce capacity that had been building for years.

A resilient healthcare system requires sufficient staffing not only during normal operations but also during emergencies.

Infrastructure experts often focus on redundancy and surge capacity. Power systems need backup generation. Transportation systems need alternate routes.

Healthcare systems require workforce resilience. That means having enough nurses available to absorb unexpected demand without compromising patient care.

Organizations that invest in retention, professional development, staffing flexibility, and workforce well-being are effectively strengthening healthcare infrastructure before the next crisis emerges.

Why retention may be more important than recruitment

Much of the public conversation focuses on recruiting more nurses.

While recruitment is important, infrastructure planning teaches a valuable lesson: preserving existing assets is often more cost-effective than constantly replacing them.

For healthcare organizations, retention represents preventive maintenance.

Successful retention strategies may include:

- Flexible scheduling

- Leadership development

- Competitive compensation

- Professional growth opportunities

- Improved staffing models

- Mental health support

Healthcare systems that keep experienced nurses create greater stability, improve continuity of care, and reduce operational disruptions.

Just as infrastructure agencies prioritize maintenance to extend the life of critical assets, healthcare leaders should prioritize retaining skilled nurses.

How do you build a sustainable nursing workforce?

Strengthening nursing infrastructure requires long-term planning.

Key priorities include:

Expanding nursing education capacity

Many nursing programs face faculty shortages and limited clinical placement opportunities. Increasing educational capacity can help build future workforce supply while maintaining quality standards.

Supporting career advancement

Creating clear pathways into specialty practice, advanced practice roles, leadership positions, and education can improve retention and workforce sustainability.

Investing in workplace technology

Technology should reduce administrative burdens rather than add complexity. Well-designed systems allow nurses to spend more time delivering patient care.

Improving workforce flexibility

Modern healthcare environments require staffing models that support both patient needs and workforce well-being. Flexible scheduling and innovative workforce planning strategies may improve retention and resilience.

Strengthening rural healthcare access

Many workforce shortages are concentrated in rural and underserved communities. Targeted investments can help ensure equitable access to care across geographic regions.

A shift in perspective

The conversation about nursing shortages often focuses on vacancies, turnover rates, and hiring challenges.

Those metrics are important, but they may not fully capture the significance of the nursing workforce.

Just as governments invest billions to maintain roads, utilities, and transportation systems, healthcare leaders and policymakers should view investments in nursing workforce development, retention, and support as investments in critical infrastructure.

The future resilience of the healthcare system may depend on recognizing that reality before workforce challenges become even more difficult to reverse.

Frequently asked questions

What are nursing workforce challenges?

Nursing workforce challenges include shortages, burnout, high turnover, an aging workforce, limited nursing school capacity, and increasing demand for healthcare services.

Why should nurses be considered critical infrastructure?

Nurses provide essential patient care in every healthcare setting, making them vital to public health, patient safety, and the overall functioning of the healthcare system.

Why is nurse retention so important?

Keeping experienced nurses helps maintain high-quality patient care, reduces hiring and training costs, and preserves valuable clinical expertise.

What causes the current nursing shortage?

The shortage is driven by factors such as retirements, burnout, workforce departures, growing healthcare needs, faculty shortages, and limited educational capacity.

How can healthcare organizations build a stronger nursing workforce?

Organizations can strengthen the workforce by investing in nurse retention, expanding education programs, offering career advancement opportunities, improving staffing models, and supporting nurses' well-being.