TWO DEMANDS ARE PROJECTED for the future nursing workforce: more nurses and better educated nurses. An aging population is expected to increase care demands by an additional 2 million to 3 million patients annually. This volume is in addition to the impact the Affordable Care Act had by introducing 8 million previously uncovered patients. Bigger, more efficient and cost-effective systems are emerging; many through the merger process.

What can be said about the current and near future nursing workforce needed to care for these patients? In the early- and mid-2000s, the looming 2020 shortage was forecast and the profession scurried to mitigate the shortage with new education programs, creative models of care delivery, a focus on second career nurses, and retention strategies for existing nurses. The 2008 economic downturn gave us a temporary reprieve, but that time is past and we again must face supply and demand issues. The US Bureau of Labor Statistics expects nursing demand to increase 16% through 2024, adding 439 300 jobs in addition to the replacement factor from retirements, which HRSA data reports as about one-third of the current workforce during this time.1,2

An accurate inventory of the American nursing workforce has eluded us for several reasons. Nurses who are licensed in multiple states are counted multiple times. Nurses who are not employed in nursing and retired nurses often retain an active license as a "just in case" measure or as a part of their lifelong identity as a nurse. These individuals can be reported as a part of the workforce because of their active licenses. This skews numbers, unless researchers can effectively scrub the data, which is difficult because state-based nurse licensure databases do not always collect the same information for the same time periods.

In addition, the move to a better educated nursing workforce has focused on academic progression. Many nurses have a postlicensure degree completed using an online program methodology, and frequently the degree is awarded in a different state than where they live and work. Boards of nursing have education data on nurses based on education that allows them to take the NCLEX examination, but additional degrees or postlicensure BSN degrees are often not captured.

To mitigate this national workforce data dilemma, the National Council of State Boards of Nursing (NCSBN) has introduced a new nurse license database called ORBS-Optimal Regulatory Board System.3 The NCSBN is in the process of working with individual state boards of nursing to implement ORBS nationally. Workforce data are collected using data sources from state boards of nursing, state boards of education, and employment reports submitted to state departments of labor. Improved and consistent data reporting is expected with ORBS, but national implementation will take several years. The good news is that with a consistent data system nationally, we will be able to track the nursing workforce more accurately for the first time.

A PERSONAL NOTE TO MY NURSING COLLEAGUES

This column will be my last Regulatory Column for Nursing Administration Quarterly (NAQ) after 10 years and 40 columns. My first chief nursing officer position was in 1980 at a 120-bed community hospital in Washington State, and I have remained in nursing administration since that time. I have enjoyed working in hospital systems with bed sizes 380 to 1000, both nationally and internationally. At each juncture, I learned many lessons and had wonderful mentors, including NAQ Founding Editor Barbara Brown.

When I retired in December 2015, I was asked to identify my top 6 lessons from a 40-year career (same length as NAQ's existence!) and 30 years in nursing administration. I want to share these with you, as my nurse leader colleagues. Here they are:

1. The one who sticks his or her head above the group to lead becomes the target;

2. Change is never easy to make or sustain;

3. Concentrating on understanding your opposition's view more than your own is essential to making good decisions;

4. People who like something usually remain silent. If they dislike it, they never shut up;

5. Doing the right thing seldom has any relationship to doing the popular thing, and (most importantly);

6. Most things sort themselves out with time if you leave them alone.

Thank you NAQ, for 10 fun years of writing this column. Thank you, my peers, for your advice, counsel, editing, and friendship. Thank you Nursing, for giving me a great career. Now I am moving on to learn the big lesson we can learn from the millennial generation-there is life beyond work.

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