The Instructor Shortage Is a Gift

I know that headline will bother some people.

The healthcare system faces a documented, growing shortage of instructors. There are fewer qualified trainers, compressed schedules, and staff pulled in too many directions. The training infrastructure was straining before the workforce crisis made things worse. The typical response is to treat this as an emergency—scramble for instructors, shorten classes even more, and prop up the current model.

I want to make the opposite argument. The instructor shortage is not an emergency. It is a diagnosis. And for the first time in sixty years, it is forcing healthcare leadership to ask a question the system has successfully avoided: what were those instructors actually providing?

The shortage didn’t create the problem. It removed the camouflage from one that was already there.

1. What the Instructor Was Actually Doing

I have watched BLS training take place within hospital systems for 25 years. I know what it looks like. A group of nurses or residents files into a conference room. Someone dims the lights. A video plays. An instructor walks through a checklist. Students practice compressions on a manikin for a few minutes. Attention wanders — and it wanders fast, because nothing in that room feels urgent, because nothing in that room is real.

At the end, the instructor signs off. Everyone gets a card. The card is valid for two years.

What did the instructor add to that process? In most cases: not much. The instruction was not standardized. Every instructor ran the session differently, emphasized different things, and moved at a different pace. The evaluation of skills was entirely subjective. One instructor’s passing performance was another’s remediation. And if we are being honest, the instructor’s most reliable role was taking attendance.

The instructor didn’t certify competency. The instructor certified presence. Those are not the same thing.

This is not an indictment of individual instructors. Many were skilled clinicians doing their best in a system that gave them little to work with—no objective measurement tools, standardized rubrics, or ways to distinguish truly ready providers from those who simply sat in the right room. The system failed instructors as much as it failed learners.

2. The Numbers That Were Always There

The workforce data making headlines today is alarming. The U.S. is projected to face a shortage of over 100,000 healthcare workers by 2028. More than a quarter of nurses are expected to leave or retire by 2027. In 2023, over 65,000 qualified nursing school applicants were turned away. The reason was not a lack of ability, but rather a lack of faculty or clinical placement slots. The pipeline is constrained at every level.

Here is what those numbers mean for BLS training: the instructor-dependent model was already running out of runway. On one hand, the system needs a credentialed person in a room to transfer a skill that decays in two weeks. On the other, it requiresthat same person to return every two years to pretend the skill is intact. This is not sustainable—it worked only as long as no one looked too closely at its results.

The research has been consistent for years. CPR skills begin to decay as early as two weeks after training. At twelve months — still a full year before recertification is required — only 15-20% of providers retain high-quality skills. The AHA’s own scientific literature acknowledges that current standardized courses are falling short and that this decline directly translates into worse patient outcomes.

The system knew this. It certified people anyway. The instructor shortage just made it harder to sustain that choice.

3. Why Scarcity Is the Right Forcing Function

When a system loses a resource on which it is dependent, it has two choices. It can exhaust itself trying to replace that resource with more of the same. Or it can ask whether the dependency was justified in the first place.

Healthcare has been very good at responding quickly—with shorter classes, online modules, and blended learning. These adaptations preserved the appearance of instructor-led training while hollowing out its substance. The aim was to keep the certification infrastructure running, not to solve the actual competency problem it was meant to address.

The gift of the instructor shortage is that it forces the second response, whether the system wants it or not. If you cannot find enough instructors to certify a workforce that needs recertification every two years, you cannot keep pretending the model works. You have to consider what you actually need. It is not more instructors. It is a fundamentally different approach to measuring and maintaining clinical competency.

Scarcity forces clarity. The key distinction is that the question was never ‘how do we find more instructors?’—it was always ‘how do we actually verify that a provider is ready?’

Research on technology-enabled training makes the alternative clear. A 2024
randomized controlled trial found that virtual reality BLS training modules gave outcomes equal to manikin-based simulation for resuscitation skills. Another study found self-directed learning with feedback produced outcomes non-inferior to instructor-led training. This VR BLS training happened at a fraction of the cost, with no scheduling constraints, and with added objective performance data instead of subjective sign-off.

Self-directed, technology-enabled training cannot fully replicate the stress,
environment, or real-time feedback a true emergency demands. That gap is where
immersive extended reality fits in. It does not replace instructor knowledge, but it does replace the instructor’s weakest function: subjective, attendance-based assessment disguised as competency verification.

4. What CNOs and CMOs Should Actually Be Asking

If you are a CNO or CMO reading this, I want to be direct. You likely believe your
workforce is BLS-competent. You have certification records to prove it. Every provider has a current card. You are in compliance.

That compliance means your workforce is competent at attendance. Competency at resuscitation is another question. The certification card cannot answer it because it was never designed to.

The instructor shortage gives you the chance to ask this question seriously, maybe for the first time. Not ‘how do we keep certifying staff?’ but ‘how do we actually know if staff is ready?’ These are different questions with different answers.

The systems that will emerge strongest from this workforce crisis are not those that found creative ways to keep the old model running. They are those who used the disruption as permission to build something that works: an objective, scalable,
technology-enabled competency infrastructure based on VR in medical training that does not rely on a credentialed human in a conference room.

That infrastructure exists. It is not experimental. The research is solid, the regulatory framework supports it, and its clinical case has built for decades. The only missing piece was enough urgency to adopt it.

The instructor shortage just provided that urgency. That is why it is a gift.