Sound implausible? Right now, an approaching nursing shortage might seem unlikely. Not so, according to researchers, who predict a severe nursing shortage within the next decade. Approximately 50% of nurses are approaching or already entering their 50s, and many will leave the workforce within the next 10 years, says Peter Buerhaus, RN, PhD, director of Harvard Research Department of Health Policy and Management at Harvard School of Public Health, Boston, MA.

Compounding the problem, believes Buerhaus, is the attraction of the associate degree program for older women. Nursing, the largest healthcare profession, is now the fastest aging occupation in America. Since 1985, the average age of the working RN has increased annually, by one third of a year, he continues, and there is only a small number of RNs in their 20s.

Salary adjustments will not solve the shortage caused by so many RNs aging out of the nursing labor market. From 1983 through 1994, there was an overall growth of inflation-adjusted wages. However, in the early 1990s, RNs began to experience stagnant salaries, and a shift toward employment in lower paying nonhospital settings.

Lower Enrollment Compounds Shortage

According to Dan Mezibov, director of public affairs, American Association of Colleges of Nursing, Washington, DC, enrollment in the entry-level baccalaureate programs has been dropping for the last three years. In some cases, the lower enrollment may not be due to less interest, Mezibov says. A school may choose to take fewer students for other reasons, such as budget constraints, a shortage of professors, or the lack of clinical sites. There is growing competition for clinical sites, he explains, as medical schools now vie for clinical programs in primary care areas that traditionally were used for nursing clinical experience. Added to this dilemma is the fact that hospitals have fewer inpatients.

At the Catholic University of America (CUA), Washington, DC, Sr. Mary Jean Flaherty, RN, PhD, dean of the School of Nursing, reports a 30% lower enrollment in the Fall 1997 class. This is the first decline we've experienced, she reports.

One of the primary reasons for a decline in enrollment, Flaherty says, is the negative image of healthcare portrayed in the media. News about nurses mainly focuses on their being terminated, downsized, or replaced by untrained personnel. This gives the public the view that additional nurses are no longer needed, she theorizes.

Flaherty believes that there is already a shortage of experienced nurses in some areas of practice. I suspect that experienced nurses were let go and replaced with untrained staff, she says, and now hospitals are realizing the need for these experienced nurses. She has been receiving more requests from healthcare organizations to refer new graduates for positions.

Two years ago, CUA revised the entry-level curriculum. It was primarily hospital-based, explains Flaherty. Now all clinical courses include community-based experience as well. They've also added a senior year option in specialized hospital-based areas such as cardiovascular, operating room, and obstetrics.

While entry-level enrollment has declined, enrollment in master's programs has increased nine of the last 10 years, reports Mezibov.

Predicting Market Demand

The Robert Wood Johnson Foundation is currently supporting a national initiative, Colleagues in Caring: Regional Collaboratives for Nursing Work Force Development. Mary Fry Rapson, RN, CS, PhD, national program director, Washington, DC, stresses the value of the collaborative approach. In each of the 20 regional collaboratives distributed throughout the country, all levels of area nurses and educators, all categories of nursing care employers, professional associations, and government agencies are represented. We find that corporations need to be involved with nursing so that they have an understanding and appreciation of nurses, Rapson explains.

Colleagues in Caring is setting up data systems, tools for prediction, and educational service models. Once we can predict demand and need, says Rapson, we want to determine what future roles will be needed.

Each of the sites will gather its own data, assess the community needs, and determine its own solutions. We view all healthcare as local, Rapson explains, and each site will have unique problems created by its geography, climate, population factors, or health and health workforce issues.

Best practices will become evident, Rapson believes, and expertise gained in workforce prediction, service, and educational models will be able to be used in other areas. In some collaboratives, educational changes have already been initiated. Residencies and internships are being developed for new graduates, while reeducation for levels of competencies in different practices is being established. Some regions have indeed identified an impending nursing shortage.

Looking to the Future

While the supply side of nursing is diminishing, there are many societal indications that the demand side for nursing care will increase. Just as our nurses are graying, the general population is also aging rapidly. The over 85 group is the fastest-growing population in the US. As this trend continues, the need for treatment of chronic disease will escalate. In 13 years, a large wave of baby boomers will be signing up for Medicare.

Sharing the Solution

Buerhaus views the media as a positive force that can be used effectively to promote the nursing profession. Americans place a high value on quality healthcare, and the public views the nurse as doing a better job protecting the consumer than any other healthcare professional, Buerhaus says. Nurses need to help the media understand that RNs are vital to healthcare, he adds, on a local, state, and national level.

Flaherty views each nurse as important in advancing the image of nursing. Nurses should work within their own social support system, church school, scouts, she stresses. Part of CUA's recruitment development is to ask alumni to help with recruitment in their areas.

The nursing profession is faced with many challenges as we approach the year 2000. Nursing educators are faced with determining educational changes to meet new market demands and strategies for recruiting students. Consideration needs to be given and studies conducted to determine ways to attract more men and minorities to nursing.

By reinforcing the value of all our possible roles ‹ educator, advocate, spokesperson, and, nurturer ‹ we can promote the quality of nurses that we want when we become the receiver of care in the not-so-distant future.