The workload increases. They can’t onboard nurses fast enough. The nurses pull in longer and longer hours. Eventually one gets burned out and takes some time off. The workload piles on the remaining nurses. Another gets burned out. The workload piles on even fewer nurses…
Solution A: bring in temp nurses. Problem, they cost more.
Solution B: go overdrive on onboarding. Problem, more time spent training less on patient care. Additional problem, there is a shortage.
Solution C: massively increase salary and find the workaholics. Problem, the insurance companies won’t change their pricing structure.
Added to all this is cost disease. You need about the same number of nurses per patient as you did decades ago.