Nursing Shortage Indicators
The nation is facing an impending shortage of nurses, which is expected to peak by 2020; here are some of the prime indicators:
According to projections released in February 2004 from the Bureau of Labor Statistics, RNs top the list of the 10 occupations with the largest projected job growth in the years 2002-2012. Although RNs have listed among the top 10 growth occupations in the past, this is the first time in recent history that RNs have ranked first. These 10-year projections are widely used in career guidance, in planning education and training programs and in studying long-range employment trends. According to the BLS report, more than 2.9 million RNs will be employed in the year 2012, up 623,000 from the nearly 2.3 million RNs employed in 2002. However, the total job openings, which include both job growth and the net replacement of nurses, will be more than 1.1 million. This growth, coupled with current trends of nurses retiring or leaving the profession and fewer new nurses, could lead to a shortage of more than one million nurses by the end of this decade. (For details, see www.bls.gov/emp/#outlook.)
A 21 percent increase in the need for nurses is projected nationwide from 1998 to 2008, compared with a 14 percent increase for other occupations. (U.S. Department of Labor)
The nursing population is aging rapidly.
According to the Health Resources and Services Administration’s March 2004 National Sample Survey of Registered Nurses, the aging of nurses as a demographic continues. In March 2004, the average age of the RN population was estimated to be 46.8 years of age, more than a year older than the average age of 45.2 years estimated in 2000 and more than four years older than in 1996, when the average age was 42.3 years. (This survey is conducted once every four years; for details, see http://bhpr.hrsa.gov/healthworkforce/reports/rnpopulation/preliminaryfindings.htm)
A study by Peter Buerhaus of Vanderbilt University on aging nurses published in the Nov. 17, 2004, issue of Health Affairs, paints a dire picture of the nursing shortage in the years ahead. According to the study, although overall employment of RNs increased by approximately 205,000 since 2001, most of the growth was attributed to nurses over 50 or foreign-born nurses, followed by women in their early 30s and men. The study recommends that schools of nursing increase their capacity to educate new RNs, as well as improve the ergonomic environment, especially to accommodate older nurses.
Buerhaus predicts that over the next two decades, a further aging of the RN workforce will continue, with the largest cohorts of RNs will be between age 50 and 69 years. Within the next 10 years, the average age of RNs is forecast to be 45.4 years, an increase of 3.5 years over the current age, with more than 40 percent of the RN workforce expected to be older than 50 years. By the year 2020, the RN workforce is forecast to be roughly the same size as it is today, falling nearly 20 percent below projected RN workforce requirements.
According to a Government Accounting Office report, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), released in July 2001, 40 percent of all RNs will be older than age 50 by 2010. (See www.gao.gov for details.)
According to AACN's report on 2001-2002 Salaries of Instructional and Administrative Nursing Faculty in Baccalaureate and Graduate Programs in Nursing, the median age of a nurse faculty member is 51 years old. The average age of a doctorally-prepared nurse holding the ranks of professor, associate professor, and assistant professor were 56.3, 53.8, and 50.4 years, respectively.
Nursing Shortage Contributing Factors:
Nurses increasingly are facing deteriorating working conditions at the facilities in which they work. This problem is reflected in the decline in nurse staffing nationwide.
According to a 2001 ANA Staffing Survey, 75 percent of nurses surveyed feel the quality of nursing care at the facility in which they work has declined over the past two years, while 56 percent of nurses surveyed believe the time available for patient care has decreased. In addition, more than 40 percent of nurses surveyed said they would not feel comfortable having a family member cared for in the facility in which they work. And over 54 percent of respondents would not recommend their profession to their children or friends. (Source: ANA Staffing Survey, Feb. 6, 2001. See www.nursingworld.org/staffing/ for details.)
An ANA Health and Safety Survey reveals that 88 percent of nurses reported that health and safety concerns influence their decision to remain in nursing and the kind of nursing work they choose to perform. More than 70 percent said the acute and chronic effects of stress and overwork were among their top three health concerns, with more than two-thirds reporting they work some type of mandatory overtime every month. In addition, nurses cited a disabling back injury (60 percent), followed by contracting HIV or hepatitis from a needlestick injury (45 percent) as also being among their top three health and safety concerns. The survey further revealed that fewer than 20 percent of respondents felt safe in their current work environment. Seventeen percent had been physically assaulted in the past year, and more than half were threatened or experienced verbal abuse. And, nearly 20 percent said their facilities still do not provide safe needle devices. (Source: ANA Health & Safety Survey, Sept. 7, 2001. See www.nursingworld.org/surveys/hssurvey.htm for details.)
The solution to the bedside nurse staffing shortage lies in paying nurses more and decreasing the number of patients each nurse must care for, said a majority of staff RNs polled in a national sample survey released by ANA’s union arm, the United American Nurses, AFL-CIO (UAN). Fully 82 percent of those surveyed responded that increased pay was a top solution to the nurse staffing shortage; 85 percent responded that a reduced nurse/patient ratio would improve the shortage. Other highly rated solutions include greater autonomy and control for staff nurses (66 percent) and safer working conditions (65 percent). (Source: Telephone survey of 600 staff nurses conducted Nov. 4-11, 2002 by Lake Snell Perry & Associates, Washington, DC; see www.uannurse.org.)
Nurses also are reporting increasing burnout and widespread job dissatisfaction.
More than 40 percent of hospital nurses reported being dissatisfied with their jobs, according to a study of nurses in five countries by Linda Aiken, PhD, FAAN, FRCN, RN, and colleagues at the University of Pennsylvania School of Nursing. The study, published in the May/June 2001 Health Affairs, found that one out of every three nurses under age 30 is planning to leave her or his hospital nursing job within the next year. (Source: Nurses’ reports of hospital quality of care and working conditions in five countries. Health Affairs, 2001, 20, 43-53.)
A study by Julie Sochalski, PhD, FAAN, RN, at the University Of Pennsylvania School Of Nursing, found higher numbers of new graduates of the nation’s nursing schools are not going into nursing at all. Among the most recent crop of nursing graduates, more than four out of every 100 female nurses were not working in nursing after graduating. And that number is nearly twice as high for new male nurses. (See Health Affairs, September/October 2002 edition, for details.)
One of every five working nurses is considering leaving patient care for reasons other than retirement within the next five years, according to The Nurse Shortage: Perspectives from Current Direct Care Nurses and Former Direct Care Nurses, an April 2001 study commissioned by the Federation of Nurses and Health Professionals.
Salary levels are typically not cited as among the chief reasons for job dissatisfaction among nurses. According to 2004 National Sample Survey figures, the actual average annual earnings of RNs employed full-time in 2004 were competitive at $56,784. And this figure represents an apparent increase over the $46,782 average annual salary reported in 2000. However, when adjusted using the Consumer Price Index (CPI), the “real” earnings of RNs employed full-time in 2004 were estimated at $26,366 compared to $17,398 in 1980 and $23,369 in 2000. A 12.8 increase since 2000, this change is the first up-tick in real earnings since 1988.
Nursing school enrollments are increasing but applicants are also being turned away:
A Dec. 9, 2005, National League of Nursing (NLN) study confirmed that an estimated 147,000 nursing school applicants were turned away from nursing education programs at all levels last year – an increase of 18 percent over 2004. The cause is a continuing critical shortage of nursing school faculty. (For details, see www.nln.org/newsreleases/nedsdec05.pdf)
Enrollments in entry-level baccalaureate programs in nursing increased by 13 percent in fall 2005 over the previous year, according to an annual survey by the American Association of Colleges of Nursing (AACN). Despite this significant gain, 32,617 qualified students were turned away from baccalaureate nursing programs due primarily to a shortage of nursing educators. Increased federal support is needed to counteract this trend and to meet the projected demand for more than a million new nurses over the next decade. According to AACN, this is the fifth consecutive year of enrollment increases with 14.1, 16.6, 8.1, and 3.7 percent increases in 2004, 2003, 2002, and 2001, respectively. Prior to the five-year upswing, baccalaureate nursing programs experienced six years of declining enrollments from 1995 through 2000. For more information, visit the AACN Web site at http://www.aacn.nche.edu.
Effects of the Nursing Shortage:
A study published in the January/February 2006 journal Health Affairs provides new evidence that if hospitals invest in appropriate Registered Nurse (RN) staffing, thousands of lives and millions of dollars could be saved each year. Specifically, the study shows that if hospitals increased RN staffing and hours of nursing care per patient, more than 6,700 patient deaths and four million days of care in hospitals could be avoided each year. In addition, the anticipated financial benefits of savings per avoided patient death or hospitalization may also be significant. This study is important because it highlights the fact that people suffer and die when nursing care is inadequate. It is the latest study in a growing body of evidence that clearly demonstrates that nurses make the critical, cost-effective difference in providing safe, high-quality patient care. For details, see www.nursingworld.org/pressrel/2006/pr0110.htm.
A study on the nursing shortage by Linda Aiken of the University of Pennsylvania School of Nursing found that an estimated 20,000 people die each year because they have checked into a hospital with overworked nurses. The study also found that Americans scheduled for routine surgeries run a 31 percent greater risk of dying if they are admitted to a hospital with a severe shortage of nurses. That’s approximately one-fifth of the up to 98,000 deaths that occur each year as a result of medical errors. Nurses in the study cared for an average of four patients at a time, with the risk of death increasing by about 7 percent for each additional patient cared for over that baseline number. This study highlights the fact that people can and do die when nursing care is inadequate. (Source: “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction,” study; see Journal of the American Medical Association, Oct. 23-30, 2002.)
More than one-third of practicing physicians and 40 percent of the public say they or a family member have experienced a medical error, according to a survey reported Dec. 12, 2002, in the New England Journal of Medicine. And, while the two groups diverged on possible causes and solutions, both ranked shortages of nurses; and overwork, stress and fatigue among health care workers as "very important" causes of errors. (Source: Henry J. Kaiser Family Foundation and the Harvard School of Public Health. For full results of the study, see www.kff.org.)
A Harris poll revealed that more than half of Americans believe the quality of health care is affected “a great deal” by a shortage of nurses. Only 4 percent of respondents said the quality of health care that people receive was not affected by a nursing shortage. (Harris Poll, July 7, 1999. Commissioned by Sigma Theta Tau Intl., NurseWeek Publishing Inc.)
Nursing Shortage Legislation and Strategies
Congress has introduced bills and other initiatives to alleviate the shortage, including:
The Nurse Reinvestment Act – President Bush signed this legislation on Aug. 1, 2002. This law provides authority for nursing-student scholarships and loan repayments, and public service announcements to promote nursing. Also included are authority for stipends and other supports, grants to promote the American Nurses Credentialing Center (ANCC) “Magnet” program criteria for best practices for nursing administration, funding for faculty development, and career ladder programs. For the latest on appropriations funding for this legislation, see http://vocusgr.vocus.com/grconvert1/webpub/ana/MultiHome.asp?XSL=Home&PubTypeList=Federal+Center;Federal+Asset.
The Registered Nurse Safe Staffing Act of 2005 (S. 71) and Quality Nursing Care Act of 2005 (H.R. 1372) – This proposed legislation allows for the development of staffing systems that require the input of direct care RNs and provides for whistler-protection for RNs who speak out about patient care issues. Sponsored by Sen. Daniel Inouye (D-HI) in the Senate and Rep. Louis Capps (D-CA) and Robert Simmons (R-CT) in the House, these bills were introduced at the urging of ANA in response to the current nursing crisis. For details, see http://vocusgr.vocus.com/grconvert1/webpub/ana/ProfileIssue.asp?IssueID=3117|Senate&XSL=ProfileIssue&hidLegislatorIDs=.
Safe Nursing and Patient Care Act of 2005 (S. 351 and H.R. 791) – companion legislation introduced in the U.S. Senate and House of Representatives that would strictly limit the practice of forcing nurses to work overtime. (For details, see www.nursingworld.org/pressrel/2005/pr0210.htm.)
Formation of the Congressional Nursing Caucus – a bi-partisan initiative, co-chaired by U.S. Reps. Lois Capps (D-CA) and Steven LaTourette (R-OH). The purpose of the caucus is to educate Congress on all aspects of the nursing profession and how nursing issues impact the delivery of safe, quality care. The caucus was formed after consultation between congressional leaders and ANA.
Strategies to Reverse the New Nursing Shortage:
Today’s Nursing Workforce – At a Glance
International Resources
International Council of Nurses (ICN) First Series of Issue Papers on the Global Shortage of Registered Nurses - "International Migration of Nurses: Trends and Policy Implications and Nurse Retention and Recruitment: Developing a Motivated Workforce" - a commissioned issue paper that outlines important concerns in tackling the nursing shortage worldwide. See the ICN Global Nursing Workforce Project Web site at www.icn.ch/global/#3 for details.
Other General Nursing Shortage Resources
“Healthcare Reform and the Workplace Experience of Nurses: Implications for Patient Care and Union Organizing,” Industrial & Labor Relations Review, Oct. 2001 Vol. 55, No. 1. This study and article looks at 1) whether healthcare reform initiatives are significantly related to nurses' perceptions of the climate for patient care in their hospitals; and 2) whether the climate for patient care is related to intention to vote for a union.
A Congressional Research (CRS) Report for Congress, A Shortage of RNs: Is it on the Horizon or Already Here? (May 12, 2001)
www.bhpr.hrsa.gov/healthworkforce/rnproject/report.htm - “Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020 (July 2002).” U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis.
Date: February 2006
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