Nursing Workforce in the United States [horizontal ellipsis] Data, Trends, and Implications, Peter I. Buerhaus, Douglas O. Staiger, David I. Auerbach. Boston, Mass: Jones and Bartlett; 2009. softcover, 312 pages, $59.95 (includes special access to power points for instructors who adopt the book for their classes).

Some books provide us expert knowledge. Some books give us unique and different insights to challenges around nursing and healthcare and some books are just must reads. This book is all 3 and more. Although the science and art of nursing is meeting the needs of patients, we tend to allocate economics to economists, financial experts or nurses who happen to be one of those. In this book, the authors challenge us to look at the nursing workforce (registered nurses [RNs] who deliver the service called nursing) through an economic framework. It is within this economic framework that indeed may be the elephant in the room. The authors rightly note that our economists and policy makers have mainly focused their studies on physicians and the costs of the healthcare system. Given that nursing is the largest healthcare profession (the majority being RNs) and given that current nursing studies have demonstrated the significant impact nursing has on quality patient care and access to care, and in light of predictions of the largest ever shortage of RNs developing, I definitely recommend reading this book. The extensive and reliable research conducted and analyzed by the authors, coupled with their powerful and realistic insights around strategies to resolve issues both in the short term and long term provide substantial reason to use this book as a main reference in understanding and combating the current nursing workforce situation. The issues around the nursing shortage and the healthcare system are extremely complex. The purpose of this book review is not to try to explain this complexity but to relay to potential readers that these authors have done nursing an immense favor.

The authors used data from 3 major sources that are as follows:

1. Current Population Survey administered by the US Bureau of the Census;

2. National Sample Survey of Registered Nurses administered by the Health Resources and Services Administration; and

3. private funded surveys of health professionals.*

The purpose of the book is to provide a timely, comprehensive, and in-depth understanding of the RN workforce in the United States.^(p2) The book has 5 sections with 15 chapters. Section One includes an introduction, overview of key trends in healthcare industry and nursing workforce, and data appendix. Section Two addresses demand for RNs. Section Three addresses supply of RNs, including an examination of trends in education. Section Four examines the impact of nursing shortages in the United States. It is in this section the authors give us the good news that work environments are improving and more importantly, hospitals can respond quickly to this important aspect of retaining nurses. And yet, the authors point out, we must continue to look at redesigning models of care and efficiencies of units to best utilize RNs. We can no longer afford to have half their time spent in non-RN activities. Redesigned units will impact management decision making as well. Section Five discusses implications and policy options. The authors provide numerous exhibits demonstrating key data and trends in easily understood language and laid out in user-friendly graphs. All of this is done for the noneconomist reader. And as an added bonus for educators and those leaders teaching courses, should they adopt the book for classroom use, is the authors provide teaching PowerPoint presentations for every chapter. The PowerPoint presentations are clearly laid out and truly supplement the learning for both the teacher and the student. In other words, this book is for both leaders in service and educators.

At a recent education event held at a major large medical center in Tucson, we went through an exercise of physically separating the generations of nurses in the auditorium. It is hard to convey the visual impact of seeing this very large group of boomers in the front of the room, the much smaller group of Xers at the right side, the even smaller group of millennials or generation Ys on the left side with a handful of matures sitting in the middle. Keep in mind, as the boomers retire, they also enter the healthcare system as patients. If a picture is worth a 1000 words, this visualization spoke volumes. What Buerhaus et al do is brilliantly paint this picture with data and language that we can use with all our colleagues to address both the future of healthcare and nursing. Probably the most compelling reason for reading the book and equally important, sharing the book with colleagues, is the conclusion stated in the last chapter.

The seriousness of the challenges facing the nursing profession and the broader healthcare delivery system cannot be overstated. Leaders of the nursing profession, healthcare organizations, and the nation's political institutions must recognize that the magnitude and momentum of the demographic and social forces underpinning the aging RN workforce are so powerful that it will be impossible for the nursing profession alone to address the expected shortage that will be of unprecedented size, duration, and impact.^{(pp 302-303)}

Elizabeth (Betty) Falter, MS, RN, CNAA,BC

President, Falter and Associates, Inc Tucson, Ariz

^*The Johnson & Johnson Campaign for Nursing's Future. [Context Link]