Nursing shortages are not new to the healthcare industry. For those who question whether there really is a current nursing shortage or merely a hesitation for employers to hire nurses, examining the root causes outlines the reality that the present-day nursing shortage is not a myth.
The existing nursing shortage is different from the others that have preceded it. The contemporary situation is particularly concerning, as it has been created by both supply and demand, and is fueled by several factors. These include expanded professional and advanced practices roles for nurses, decreased nursing school enrollments, increased patient acuity, and current workforce attrition.
A shortage of professional nurses is not unique to the United States. The scarcity of nurses is present in countries throughout Europe, the Middle East, Africa, and Asia. As global healthcare struggles with rising costs, burgeoning elderly populations, and the need for more efficient ways of addressing disease and disability, the worldwide shortage of nurses has a dynamic impact on the world's health.
The United States is facing a perfect storm that will impact healthcare, in our nation, for years to come. The Bureau of Labor Statistics Employment Projections has forecast that nursing will surpass other professions in terms of job growth for the period of 2014 to 2024 (American Association of Colleges of Nursing [AACN], 2017).
Outlined here are elements unique to the current nursing shortage:
Geography
In the United States, the severity of the nursing shortage is being felt differently in distinct areas and regions. The greatest intensity is experienced in rural hospitals and primary care settings. Nursing schools are usually located in metropolitan areas, and those acute care hospitals tend to attract the most new graduate nurses. There are also urban areas where registered nurse (RN) positions are also more difficult to fill, mainly in rehabilitation hospitals and skilled nursing facilities. The recruitment of candidates to these organizations lags due to inability to compete with expected salaries.
State-to-state supply-and-demand variations are reported, related to shifts in growth, demographics, and population movement. Based on current levels of health status, the greatest shortages of RNs are expected to be felt by 2030 in California, Texas, New Jersey, and South Carolina. Conversely, an excess supply of RNs is anticipated for Florida, Ohio, Virginia, and New York (U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, National Center for Health Workforce Analysis, 2017). We need to be cautious of the implications of these numbers. As a result of state-to-state discrepancies, there may be a tendency to downplay the nursing shortage, which only serves to discredit the approaching crisis and diminish the sense of urgency to find solutions.
Baby Boom Bubble
The nursing shortage endured in the 1970s was driven largely by women who chose additional career options, beyond the nursing and teaching professions. Today's shortage is more complex. We are at a historical milestone. There are now more people in the Unites States older than 65 years than ever before.
The baby boomer population presents an increased need for health services. People are living longer, and many of the diseases that were once lethal are now survived with chronic disease management. Nurses who are part of the baby boomer generation, born between 1945 and 1964, are retiring in greater numbers. One third of the current nursing workforce will potentially be at retirement age in the next 10-15 years (Grant, 2016).
Declining Nursing School Enrollment
It takes a nurse to educate a nurse. While one of the remedies to the nursing shortage is to replenish the supply of nurses, our nursing faculty is also aging and retiring. Nursing programs are challenged with fewer resources to accomplish the goal of preparing nurses of the future. This has resulted in the need to limit nursing school enrollment. According to an AACN report in 2012, nursing schools in the United States turned away almost 80,000 qualified applicants for baccalaureate and graduate nursing programs due to lack of faculty, inadequate space, or financial constraints (Grant, 2016).
Few gains have been made since that report. In 2017, nursing schools declined more than 56,000 qualified applicants from undergraduate programs (Knowles, 2018). Without nursing educators in the pipeline, our profession will not meet the requirement for highly trained nurses at the bedside.
Alleviating the nursing shortage will not be easily achieved. Initiatives include the following: the American Nurses Association push for Congress to allocate funds to nursing schools and organizations that increase access to nursing education, enhancing diversity of nurses to better reflect patient population, and providing loan assistance for graduates who pursue positions in underserved regions.
The current alarm about the nursing shortage is real. Innovative, out-of-the-box thinking is needed to influence its effects before it becomes a crisis for American healthcare delivery. Otherwise, we may not appreciate the outcome, until there is a system failure.
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