There Is No Shortage of Nurses

A reactive to Te-Ping Chen, “Nurses Are in High Demand—but They’re Quitting in Droves,” The Wall Street Journal, Oct. 19, 2026.

The nurse who could see the heart attack

Paige Campbell became an emergency nurse in Florida during the pandemic, wanting to make a difference. She was kicked, spat on and shoved to the ground. After a patient strangled her, she left the bedside for a job monitoring patients remotely. She is one of many, and her leaving is not a shortage. There is no shortage of nurses. There is a shortage of formation.

The Wall Street Journal story that opens with her carries a second memory. A decade ago, when Dustin Bass ran emergency departments, he sent his most tenured nurses to triage. With ten or twenty years on the job, they could look across a crowded waiting room and pick out the patient having a heart attack. Today, says Bass, now president of the Emergency Nurses Association, nurses with two or three years of experience are running emergency rooms with 133 care spaces.

The numbers should not add up. Nurses earn a median of $97,550. Most hold a bachelor’s degree. Schools graduate thousands every year. Yet bedside turnover has climbed from 11% about fifteen years ago to roughly 18%, and 43% of nurses say they are likely to leave the bedside within a year. Ask the ones who stay why, and financial necessity tops the list.

I spent 36 years on plant floors, and that is how I read those numbers. The nurse who could see the heart attack was not born with that judgment. She was formed into it, under pressure, by someone who knew how much pressure she could take. When she leaves, two things walk out the door: her judgment and her ability to form the next one. Hospitals record neither loss. They record only the cost of hiring a replacement.

The fix is not another signing bonus. It is to certify the nurses who can form others, give each of them a cohort, and fund a three-year runway long enough for formation to take. That’s the argument.

Sun: what Rick Stork taught me first

In 1999, the last year Buick City built cars, I was a rookie supervisor in the trim shop, with a doctorate in industrial engineering and no idea how a floor actually worked. Rick Stork, a supervisor in Trim 1, had been told to form me.

He did not start with takt time. He taught me what I now explain, borrowing from my own tradition’s four upāyas, as a ladder of pressure: persuade first and reach for the rod last, because every rung down is an admission that the rung above it failed.

Underneath it was the one lesson he would not let me dodge. A supervisor answers for the product and for the people who build it, at once, and is never permitted to trade one against the other.

It took me years to see what Rick was really teaching. Each rung is a stronger dose, and the art is knowing which one this person, on this day, can take. In the Bloom System we call this dimension Sun: learning under pressure. Formation happens under pressure, never away from it. But pressure forms people only when someone who knows the work is measuring the dose.

Abdelhak on night shift

Years later, after two decades in executive roles, I went back to the floor as night-shift production shift leader at Lansing Delta Township. Abdelhak Radjai came to run Trim 1 and Trim 2.

Trim 2 was the bottleneck, often 50 to 60 minutes of downtime in a nine-hour shift. The supervisors before him had struggled with it. So had everyone up the chain, me included.

Abdelhak had spent years as one of the best team leaders on that floor, and he kept behaving like one. He would jump on any job on his line to give someone a bathroom break, the most valuable currency on a floor. Then he started measuring doses.

A new team leader had not yet mastered the six jobs on her team. He took the repairs off her, had another team leader cover them, and sent her back to build confidence and capability with her own people. Less pressure, because she was not ready for more.

Team leaders who never left their zone to chase repairs got the opposite. He came down hard and parked them off the line, inspecting and fixing the defects coming from his team and the four others in Trim 2. More pressure, because they could take it and needed it.

Within a month the shift was closing with under 10 minutes of downtime. No one had certified that judgment. No budget had a line for it. It lived in one man.

Every hospital has its Abdelhaks. They are the senior nurses who know which shift will stretch a second-year nurse and which one will break her, when to take a patient off her, and when to let her struggle a few minutes longer.

When the dosers leave

Now watch what happens when a hospital loses them. The dosing leaves too. New graduates take the full force of an emergency room with nobody measuring it. Some burn out within two years, and the ones who leave take the next generation of dosers with them. The floor gets younger, the pressure goes unmeasured, and more nurses burn out.

Turnover produces more turnover. That is a siphon: a system that drains capability faster than it forms it, while every decision inside it looks reasonable. And the books never see it. Replacing one staff nurse cost an average of $60,090 in 2025, expensed like a utility bill. The judgment that walked out appears on no balance sheet at all.

Certify the Meister

Hospitals borrowed Toyota’s production system twenty years ago. They took the process and left behind the formation of people. The Germans built a whole institution around that missing half: the Meister, a master of the craft who is also certified, and paid, to form the next generation.

Here is how I think it could work in a hospital. The Capability Capital Institute would certify a hospital’s best senior nurses as Bloom Meisters. Not for their clinical skill, which their own boards already certify, but