If action is not taken soon, consumers may find RNs hard to find. Nursing workforce experts are sounding the call: more nurses needed.

Paging More Nurses

Nursing workforce experts predict that demand for RNs will outpace supply in the next millennium, with estimates of when this will occur ranging from 2005 to 2010. But the alarm is ringing now, as shortages, particularly in high-demand specialties such as critical care and home care, are being reported across the United States. The east and west coasts are feeling the pinch the most, but if past trends hold, the shortage will soon spread throughout the country.

Basic economics — increased demand, decreased supply — have set up the shortage.

Older and sicker

Patients are older and sicker than in previous decades and more complex technology is available to treat them. Although we have conquered many diseases, we are now faced with others, including an increase in infectious diseases resistant to traditional therapy. Federal experts predict that the increased complexity of acute care will boost the need for RNs in hospitals 36% by 2020. Moreover, the sheer volume of patients will continue to increase, hitting a peak in 2015 when the oldest Baby Boomers turn 65. Add to this the fact that the fastest growing segment of the population is 100 and over and you have the makings of a serious problem.

The problem isn’t limited to hospitals. As healthcare has shifted into the community, the demand for RNs in nonhospital settings, such as health maintenance organizations, home care agencies, managed care companies, and primary care centers have skyrocketed. A shift in focus from care of the ill to illness prevention and health promotion has also occurred. This has created a higher need for RNs, whose education background, scope of practice, and nursing orientation make them experts in prevention and promotion.

Nurses with higher education, including advanced practitioners, are particularly in demand. According to the American Association of Colleges of Nursing (AACN), 72% of entry-level bachelor’s degree students had jobs waiting after graduation between 1996 and 1997, but the percentage was 94% for those graduating with a master’s degree and 86% for those graduating from master’s-degree nurse practitioner (NP) programs. The demand for NPs is particularly acute in high-managed care states such as California, Massachusetts, Oregon, Arizona, Colorado, New York, Hawaii, and Maryland.

"We have a specialty nurse shortage now," explains Geraldine Bednash, PhD, RN, FAAN, executive director, AACN. "Hospitals, HMOs, and other employers are scrambling not only for more RNs in critical care and other high-need specialties, but for nurses with bachelor’s and graduate degrees to handle the more complex demands of today’s patient care."

Although the booming economy has been welcomed by consumers, it, too, contributes to the increased demand: As people’s incomes increase, they tend to buy more healthcare. And as RN spouses’ wages increase, there is a tendency for nurses’ participation in the workforce to decrease. A related factor is the recent policy changes, such as the State Children’s Health Insurance Program, that have expanded insurance coverage, allowing many previously underserved individuals access to need healthcare.

The scope of the rocketing need for nurses can be summarized by this fact: The Bureau of Labor Statistics predicts that RNs will have the fastest employment growth of any occupation through 2006 (21% vs. 14% for all occupations).

Turnover without replacements

The average age of employed RNs in the United States is now 42, up from 36 in 1980. And more than half of all currently employed RNs will reach or near retirement age in the next fifteen years. With these nurses out of the market, a shortage will exist that hasn’t been seen since the 1980s. However, the problem won’t be solved by an influx of young nurses. AACN reports that in 1996, 60% of nursing graduates came from two-year associate-degree programs that tend to attract older students. With the average age of new graduates being 31, these nurses will spend less time in the workforce.

A look at enrollment numbers further defines the problem. AACN reports that although enrollments of master’s degree nursing students rose 1.6% between 1996 and 1997, enrollment of bachelor’s degree students declined more that 6% during that same time, the third such annual drop in a row. Bachelor’s degree students are especially needed as federal agencies and other organizations continue to push for a BSN as the entry-level requirement.

Other factors contributing to declining enrollment include a reduction in nursing faculty, stagnant or declining wages for the past six years, and negative media coverage: When faced with news stories of hospital mergers and RN layoffs, is it any wonder that students don’t look to nursing as a career?

A closer look reveals that the reported decline in the RN workforce is misleading. Despite downsizing, the number of working RNs has increased in recent years to its current number of 2.1 million, according to the latest data from the US Department of Health and Human Services. Peter Buerhaus, RN, PhD,FAAN, director, Harvard Nursing Research Institute, and a nursing workforce expert says that "Employment in hospitals rose 3% during 1992 to 1996, and many RNs now practice in outpatient settings." Buerhaus adds that the numbers don’t tell the whole story because not all nurses in hospitals directly care for patients. And, he says, "more nurses are needed to care for sicker patients."

Unlicensed assistive personnel (UAP) will likely not be stepping in to fulfill the demand for nurses. The trend toward increasing employment of UAPs for outpatient settings is slowing, with some hospitals returning to all-RN units. A more common model is likely to be an RN/UAP mix, but with the emphasis on UAP as assistants to nurses, rather than active participants in direct patient care.

What can consumers do?

According to a national survey by the Kaiser Family Foundation and Harvard School of Public Health, 83% of consumers said that nurses are doing a "good job", far outperforming the next group of providers — 69% for physicians. Clearly nurses are valued by consumers, who need not sit idle as the supply of nurses dwindle. Here are some suggestions:

• Talk about the nursing shortage with others in your community. Many people are unaware of the impending problems related to a short supply of nurses.
• Find out what school counselors are doing to encourage nursing as a career. Link nurses from your local hospital to the schools, or suggest that school nurses talk to students about nursing as a career.
• Become politically active, especially at the local level, where many key healthcare issues are decided. Be sure that policy makers consider the shortage of nurses in their decisions.
• If you or someone you’re close to is in the hospital, be sure to talk with the registered nurse, not just anyone in a white uniform. He or she can answer many of your questions, and you can show your support.
• If you’ve had a positive experience with an RN, write your local newspaper about it.
• Talk with a nurse. Learn about how nurses practice differs from other professionals. If you don’t know any nurses, contact your local state nurses association. You might want to contact them anyway and ask how you can help.
• Support TV shows, books, and movies that show nursing in a positive light. Don't purchase products advertised by negative images of nurses.
• Encourage those who show an interest in nursing. It’s a career that provides tremendous opportunities from managing patients with complex technology needs in the critical care unit to teaching community groups in underserved areas. And although the profession remains dominated by women, more men are realizing that nursing is an opportunity they can’t pass up.

The most important action is to take action. Our nation’s future health depends on a sufficient supply of nurses.