The Nursing Shortage (page 4)
The nursing shortage is of such huge consequence that it merits more than mere mention. The United States is entrenched in a nursing shortage that will only intensify as baby boomers age and healthcare needs grow. In 2007, the U.S. Bureau of Labor Statistics projected the need for one million new and replacement nurses by 2016, with an estimated 587,000 new nursing positions created through 2016, making nursing the nation's top profession in terms of projected job growth. The U.S. Health Resources and Services Administration (HRSA) estimates that the nation's nursing shortage will grow to more than one million nurses by the year 2020.
According to a research report, titled The Future of the Nursing Workforce in the United States: Data, Trends and Implications and written by Peter Buerhaus, PhD, of Vanderbilt University School of Nursing, Douglas Staiger, PhD, from Dartmouth University, and David Auerbach, PhD, of the Congressional Budget Office, the demand for RNs is expected to grow at 2% to 3% per year, as it has done for the past four decades, while the supply of RNs is expected to grow very little as large numbers of nurses begin to retire. These researchers further noted that the current shortage began in 1998, making it the longest lasting nursing shortage in the past 50 years. The inadequate number of nurses in hospitals has disastrous consequences, as it is associated with reductions in patient capacity, delays in the timeliness of patient care, longer length of hospital stays by patients, interruptions in the healthcare delivery processes, and increased risk of adverse patient outcomes including death.
The American Association of Colleges of Nursing (AACN) and the U.S. Health Resources and Services Administration (HRSA) list several factors that led to the shortage. The first is that enrollment in nursing programs has not grown fast enough to meet the demands. HRSA notes that the United States must graduate approximately 90% more nurses from its nursing programs to meet the estimated growth in demand for RN services. Reasons for the lackluster growth include the increased opportunity for women in the workforce today and a decline in public perception of the attractiveness of nursing as a profession. A second factor is workforce participation. The active supply of RNs is defined as the number of licensed RNs who provide nursing care or who are actively seeking employment in nursing. This supply excludes licensed RNs who are retired, who have temporarily left nursing, and who are working in non-nursing positions. The shortage creates more shortage because some nurses leave their jobs because of the stress from insufficient staffing.
Changing demographics present a third factor. An influx of aging baby boomers will create significant demands on the healthcare system with their needs for wellness opportunities, technological advances, and long-term care—all of which will require more nurses to meet these needs. This increase in older adults will be considerable. According to the National Center for Policy Analysis (NCPA), in 2000 about 35 million people, or 13% of the U.S. population, were 65 and older, but by 2030 that number will rise to 70 million, or 20% of the population. The growth rate for those 85 and older will be an estimated 56%, and this population is even more likely to have healthcare problems that warrant nursing care.
Baby boomers also make up a considerable portion of the nursing population. HRSA's 2005 National Sample Survey of Registered Nurses noted that the average age of RNs was estimated at 46.8 years of age, more than four years older than in 1996 when the average age was 42.3, and a report by the U.S. Government Accounting Office predicts that 40% of RNs will be older than 50 by 2010. In one of his other studies, Buerhaus noted that the current RN workforce will retire in large numbers over the next decade, just as those 80 million baby boomers reach 65 and consume more healthcare.
But baby boomers aren't the only ones guzzling up healthcare. Hospital clients are sicker today than they were 20 years ago. This increase in acuity means that nurses should care for fewer patients than they did in the past because each patient requires more nursing care.
Finally, there is also a nursing faculty shortage, resulting in programs needing to limit their number of students. This shortage, too, is all about supply and demand. One survey showed that 33,000 qualified applicants to nursing programs were turned down and that 76.1% of the surveyed schools indicated that the faculty shortage was the main reason for limiting admissions. Meeting the demand for new nurses by 2020 will also require a significant increase in the demand for nursing faculty. And if hospitals seek nurses with BSNs, the demand for faculty may further increase because the ratio of faculty to students in BSN programs is higher than for other forms of entry level programs.
While most of the nursing shortage literature focuses on RNs, LPNs also play a role. The number of LPNs working in hospitals has plummeted by 153,000, or 47%, in the past 20 years. The decrease primarily resulted from the cuts in nursing staff in the 1990s and the shift from team nursing to primary nursing as the prevailing practice model. But some states show an overall decrease in their number of LPNs. A Pennsylvania Center for Health Careers report shows that the LPN shortage in Pennsylvania will likely be as large as 4,100 by 2010. North Dakota reported a shortage of 200 in 2003 with the predicted decrease in LPN numbers.
Now for the good news. State legislatures and boards of nursing have been addressing the problem. Researchers at Vanderbilt University's Center for Interdisciplinary Health Workforce Studies found that the nursing shortage is lessening. The number of nurses has steadily increased since 2006. Dr. Buerhaus reported that 84,200 nursed entered practice in 2007. He now predicts a shortage of 285,000 nurses by 2020, a number considerably lower than previous projections. Dr. Buerhaus still sees the lack of nurses as a threat to the healthcare system and a sign that there is a need for well-trained, qualified nurses.
What does all this shortage doom and gloom mean for you? It means opportunity. You certainly need to consider the stressors related to working during a nursing shortage, but more importantly, you should consider the advantages. The shortage has helped to increase nursing salaries and improve benefits. Many hospitals offer incentive programs such as recruitment bonuses (ranging anywhere from $2,000 to $20,000), relocation assistance, housing assistance, day care, and tuition reimbursement. You are better able to pick and choose the job you want, and you have greater flexibility for mobility since openings abound. Hospitals may have sicker clients, but other clients are in other settings, offering more variety for your career.
Things are also improving partially due to the increase in second-degree students entering the nursing profession. While many of these students entered the nursing profession after September 11, 2001, to "make a difference," this increase also means that there are people out there who are either dissatisfied with other professions or in need of a job. The Pittsburgh Tribune-Review ran an article in 2007 titled "Nursing hot choice for second career in PA," and mentioned a man who entered nursing after being laid off as an electrical engineer. One study showed that second-degree students choose nursing because of the salary and employment opportunities, the flexibility of their work schedule, and the positive experience they had with nurses who cared for family members. These are but a few advantages and disadvantages to weigh when considering a nursing career.
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