November 19, 2004

Nurse shortage looms despite gains: study

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Nurse shortage looms despite gains: study

The number of registered nurses entering the job market appears to be rising steadily, with a total employment growth of over 200,000 R.N.s since 2001, the largest increase since the early 1980s, but experts at the School of Nursing say it's still not enough to prevent a long-term crisis that threatens to cripple the entire health care system.

The new numbers come from Peter Buerhaus, Ph.D., Valere Potter Professor of Nursing; senior associate dean for Research at the School of Nursing, in an article appearing in the Nov. 17 health policy journal Health Affairs. “While R.N.s over age 50 have provided much of the expansion of hospital employment since 2001, it is striking that in 2003, employment of younger R.N.s grew by nearly 90,000, reaching the highest level observed since 1987,” said Buerhaus. “This entry of younger nurses into the workforce is consistent with reports of substantial gains in enrollments at nursing schools since 2001, and may represent the first wave of two-year program graduates.”

The number of men entering the profession has also been growing at a steady rate over the past two decades, increasing from 5 percent in 1983 with about 60,000 R.N.s in the workforce, to nearly 9 percent, or 160,000, in 2003. “Both of these groups are probably responding to higher wages and opportunities in nursing driven by publicity about the nursing shortage, and many have just graduated from associate-degree nursing education programs,” said Buerhaus. The research shows older women and foreign-born women are still a factor and account for a large share of the growth.

But Buerhaus said the most surprising findings show that even with the significant increase in nurses joining the workforce, the much-ballyhooed nursing shortage is far from over.

“Despite the increase in employment of nearly 185,000 hospital R.N.s since 2001, there is no empirical evidence that the nursing shortage has ended. To the contrary, national surveys of R.N.s and physicians conducted in 2004 find a clear majority perceived shortages of R.N.s in the hospitals where they worked or admitted most of their patients,” Buerhaus said.

He said it is unlikely that the recent increase in younger R.N.s will provide enough new nurses to solve the projected long-term shortage. “The workforce is projected to peak at a size of 2.3 million in 2012 and shrink to 2.2 million by 2020 — a modest increase of roughly 60,000 R.N.s over forecasts without the new data. This total pales in comparison to the Health and Resource Service Administration's latest forecast of 2.8 million full-time R.N.s that will be needed in 2020,” said Buerhaus. “Thus a very large shortage still looms on the horizon, a shortage so large that it could easily cripple the entire health care system, not just hospitals,” he warned.

Buerhaus said the growth in the number of nurses on the job can be attributed, in part, to two straight years of wage increases, relatively high national unemployment, and continued initiatives aimed at increasing overall interest in the nursing profession.

Many hospitals have seriously begun addressing problems in the workplace environment, including here at Vanderbilt Medical Center.

“A number of initiatives have been launched and are under way at Vanderbilt to improve the work environment for nursing,” said Chief Nursing Officer and Director of Patient Care Services, Marilyn Dubree, M.S.N., R.N. “Those efforts include our attention to recruitment and orientation, effective leadership and management, shared governance, nurse wellness, staffing levels, and support for clinical care. The creation of a positive work environment is critical to both successful recruitment and retention; it is ultimately key to a safe environment for patient care.”

Corporations and other groups have also aided the effort to attract more nurses to the profession, providing scholarships to nursing students.

But those programs are only part of the solution, according to Buerhaus. He said replacing the large number of R.N.s born in the baby boom generation who will retire between 2010 and 2020 will require a major and swift expansion in the number of graduates from nursing education programs. Buerhaus said those graduates are typically in their 20s and are more likely to contribute a greater number of years in the workforce.

“Nursing education programs will have to overcome capacity constraints in order to expand and meet the demand, which calls for decisive action and resources. Congress should fund a study to investigate the prevalence and severity of capacity constraints and determine the best ways to quickly resolve them,” suggested Buerhaus.

Buerhaus' study used data from the Current Population Survey (CPS) to construct and analyze national estimates of annual R.N. employment and earnings to examine changes in the nurse labor market in 2003. The CPS is a household-based survey administered monthly by the U.S. Census Bureau. The data analyzed included all individuals between the ages of 21 and 64 who reported their occupation as a R.N. between January 1983 and December 2003.