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Nursing Workforce
About
the Nursing Shortage
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The Future of the Nursing Workforce in the United States: Data, Trends and Implications
The shortage of registered nurses in the U.S. could reach as high as 500,000 by 2025 according to a report released in March 2008 by Dr. Peter Buerhaus of Vanderbilt University School of Nursing, Dr. Douglas Staiger of Dartmouth University, and Dr. David Auerbach of the Congressional Budget Office. The report, found that the demand for RNs is expected to grow by 2% to 3% each year.
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Monthly Labor Review
According to the latest projections from the U.S. Bureau of Labor Statistics published in the November 2007 Monthly Labor Review, more than one million new and replacement nurses will be needed by 2016. Government analysts project that more than 587,000 new nursing positions will be created through 2016 (a 23.5% increase), making nursing the nation’s top profession in terms of projected job growth.
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Newly Licensed RNs’ Characteristics, Work Attitudes, and Intentions to Work In September 2007, Dr. Christine T. Kovner and colleagues found that 13% of newly licensed RNs had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. Published in the American Journal of Nursing, the nurse researchers provide insights into the characteristics and attitudes toward work of new registered nurses.
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The 2007 State of America’s Hospitals – Taking the Pulse
According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 registered nurses (RNs) to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%. The report also found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005.
- Academic Health Center CEOs Say Faculty Shortages Major Problem
Worsening faculty shortages in academic health centers are threatening the nation’s health professions educational infrastructure, according to a report by the Association of Academic Health Centers released in July 2007. Survey data show that 94% of academic health center CEOs believe that faculty shortages are a problem in at least one health professions school, and 69% think that these shortages are a problem for the entire institution. The majority of CEOs identified the shortage of nurse faculty as the most severe followed by allied health, pharmacy and medicine.
- What Works: Healing the Healthcare Staffing Shortage
In July 2007, PricewaterhouseCoopers’ Health Research Institute released a report titled What Works: Healing the Healthcare Staffing Shortage which advanced several strategies for addressing the nursing shortage, including developing more public-private partnerships, creating healthy work environments, using technology as a training tool, and designing more flexible roles for advanced practice nurses given their increased use as primary care providers.
- Hospitals’ Responses to Nurse Staffing Shortages
In an article published in the June 2006 issue of Health Affairs titled “Hospitals’ Responses to Nurse Staffing Shortages,” the authors found that 97% of surveyed hospitals were using educational strategies to address the shortage of nurses. Specific strategies include partnering with schools of nursing, subsidizing nurse faculty salaries, reimbursing nurses for advancing their education in exchange for a work commitment, and providing scheduling flexibility to enable staff to attend classes. The paper ends with a call for more public financing support for the nursing educational system to expand student capacity.
- What
is Behind HRSA's Projected Supply, Demand, and Shortage
of Registered Nurses?
Released in April 2006 by the Health Resources and Services
Administration (HRSA), federal officials project the nation's
nursing shortage will intensify with more than one million
new nurses by the year 2020. By the year 2015, all 50
states will experience a shortage of nurses to varying
degrees.
- State
of the Registered Nurse Workforce in the United States
Published in the March 2006 issue of Nursing Economic$,
this comprehensive analysis of several national surveys
of the nursing workforce found that majority of nurses
reported that the RN shortage is negatively impacting
patient care and undermining the quality of care goals
set by the Institute of Medicine and the National Quality
Forum. Though many nurses have reported an easing of the
nursing shortage over the past few years, the shortage
is expected to grow to eight times the current size by
the year 2020.
- Act
Now for Your Tomorrow
In May 2005, the National Commission on Nursing Workforce
for Long-Term Care released this report which found that
there are nearly 100,000 vacant nursing positions in long-term
care facilities on any given day, and the nurse turnover
rate exceeds 50%. The shortage is costing long-term care
facilities an estimated $4 billion a year in recruitment
and training expenses.
- New
Signs of a Strengthening U.S. Nurse Labor Market?
According to a report published in November 2004 as a
Web exclusive for Health Affairs, Dr. Peter Buerhaus
and colleagues found that "despite the increase in
employment of nearly 185,000 hospital RNs since 2001,
there is no empirical evidence that the nursing shortage
has ended. To the contrary, national surveys of RNs and
physicians conducted in 2004 found that a clear majority
of RNs (82%) and doctors (81%) perceived shortages where
they worked."
- Is
the Current Shortage of Hospital Nurses Ending?
In the November/December 2003 issue of Health Affairs,
Dr. Peter Buerhaus from Vanderbilt University and his
colleagues found that over 100,000 new RNs were hired
in 2002; the majority of which were foreign-born nurses
and nurses over age 50 returning to the workforce in tough
economic times. Though the new hires and a sharp increase
in RN salaries are having a positive effect on the current
workforce supply, Dr. Buerhaus cautions that the current
nursing shortage is far from over and called for immediate
federal attention to address the growing crisis, including
setting national goals for annual nursing school enrollment
increases.
- Health
Care at the Crossroads: Strategies for Addressing the
Evolving Nursing Crisis
Released in August 2002 by the Joint Commission on Accreditation
of Healthcare Organizations, this report illustrates how
the growing shortage of nurses in America's hospitals
is putting patient lives in danger. The solutions proposed
by a special Joint Commission Expert Roundtable focus
on transforming the nursing workplace; creating a clinical
foundation for nursing educational preparation and advancement;
and providing financial incentives for health care organizations
to invest in high quality nursing care.
- Health
Care's Human Crisis: The American Nursing Shortage
This report, funded by the Robert Wood Johnson Foundation,
offers recommendations for turning around the critical
nursing shortage. Findings from the study, released in
May 2002, also illustrate why the current situation is
fundamentally different from nursing shortages in the
past.
Impact
of the Nursing Shortage on Patient Care
Recent
Reports
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Impact of Hospital Nursing Care on 30-day Mortality
for Acute Medical Patients
In the January 2007 issue of
the Journal of Advanced Nursing, a new study validates
the findings of Dr. Linda Aiken and others that baccalaureate-prepared
nurses have a positive impact on lowering mortality rates.
A research team led by Dr. Ann E. Tourangeau from the
University of Toronto and the Institute for Clinical Evaluative
Sciences in Ontario, Canada, studied 46,993 patients admitted
to hospital with heart attacks, stroke, pneumonia and
blood poisoning. The authors found that: "Hospitals
with higher proportions of baccalaureate-prepared nurses
tended to have lower 30-day mortality rates. Our findings
indicated that a 10% increase in the proportion of baccalaureate
prepared nurses was associated with 9 fewer deaths for
every 1,000 discharged patients."
- Is
the Shortage of Hospital Registered Nurses Getting Better
of Worse?
In the March-April 2005 issue of Nursing Economic$,
Dr. Peter Buerhaus and colleagues found that more than
75% of RNs believe the nursing shortage presents a major
problem for the quality of their work life, the quality
of patient care, and the amount of time nurses can spend
with patients. Looking forward, almost all surveyed nurses
see the shortage in the future as a catalyst for increasing
stress on nurses (98%), lowering patient care quality
(93%) and causing nurses to leave the profession (93%).
- National
Survey on Consumers' Experiences with Patient Safety
and Quality Information
In November 2004, results from this national survey
found that 40% of Americans think the quality of health
care has worsened in the last five years. Consumers
reported that the most important issues affecting medical
error rates are workload, stress or fatigue among health
professionals (74%); too little time spent with patients
(70%); and too few nurses (69%). This survey was sponsored
by the Kaiser Family Foundation, the Agency for Healthcare
Research and Quality and the Harvard School of Public
Health.
- Research
in Action: Hospital Nurse Staffing and Availability
of Care
In March 2004, the Agency for Healthcare Research and
Quality (AHRQ) issued a synthesis of nursing research
studies that details the impact that staffing levels,
staff mix, and education levels have on patient outcomes.
The report cites studies showing that hospitals with
lower nurse staffing levels and fewer registered nurses
compared with licensed practical nurses or nurses' aides
tend to have higher rates of poor patient outcomes.
- Keeping
Patients Safe: Transforming the Work Environment
Publishing in November 2003, this Institute of Medicine
calls for substantial changes in the work environment
of nurses in order to protect patients, including changes
in how nurse staffing levels are established and mandatory
limits on nurses' work hours. Despite the growing body
of evidence that better nurse staff levels result in safer
patient care, nurses in some health care facilities may
be overburdened with up to 12 patients to care for per
shift. Long work hours pose one of the most serious threats
to patient safety, because fatigue slows reaction time,
diminishes attention to detail, and contributes to errors.
- Educational
Levels of Hospital Nurses and Surgical Patient Mortality
New research indicates that a shortage of registered nurses
prepared at the baccalaureate and higher degree level
is endangering patients. In an article in the September
24, 2003 issue of the Journal
of the American Medical Association, Dr. Linda
Aiken and her colleagues at the University of Pennsylvania
found that patients experience significantly lower mortality
and failure to rescue rates in hospitals where more baccalaureate-prepared
nurses provide direct patient care. At least 1,700 preventable
deaths could have been realized in Pennsylvania hospitals
alone if baccalaureate-prepared nurses had comprised 60%
of the nursing staff and the nurse-to-patient ratios had
been set at 1 to 4. Unfortunately, only 11% of PA hospitals
have more than 50% of the nursing staff prepared at the
baccalaureate level.
- Views
of Practicing Physicians and the Public on Medical Errors
A survey reported in the December 12, 2002 issue of the
New England Journal of Medicine
found that 53% of physicians and 65% of the public cited
the shortage of nurses as a leading cause of medical errors.
Overall, 42% of the public and more than a third of U.S.
doctors reported that they or their family members have
experienced medical errors in the course of receiving
medical care. The survey was conducted by the Harvard
School of Public Health and the Henry J. Kaiser Family
Foundation.
- Hospital
Nurse Staffing and Patient Mortality, Nurse Burnout and
Job Dissatisfaction
According to a study published in the October 23/30, 2002
issue of the Journal of the
American Medical Association, more nurses at
the bedside could save thousands of patient lives each
year. Nurse researchers at the University of Pennsylvania
determined that patients who have common surgeries in
hospitals with high nurse-to-patient ratios have an up
to 31% increased chance of dying. Funded by the National
Institute for Nursing Research, the study found that every
additional patient in an average hospital nurse's workload
increased the risk of death in surgical patients by 7%.
Having too few nurses may actually cost more money given
the high costs of replacing burnt-out nurses and caring
for patients with poor outcomes.
- Health
Care at the Crossroads: Strategies for Addressing the
Evolving Nursing Crisis
Released in August 2002 by the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO), the authors found
that a shortage of nurses in America's hospitals is putting
patient lives in danger. JCAHO examined 1,609 hospital
reports of patient deaths and injuries since 1996 and
found that low nursing staff levels were a contributing
factor in 24% of the cases.
- Nurse
Staffing Levels and the Quality of Care in Hospitals
According to a study published in the
New England Journal of Medicine in May 2002,
a higher proportion of nursing care provided by RNs and
a greater number of hours of care by RNs per day are associated
with better outcomes for hospitalized patients. This extensive
study was conducted by Drs. Jack Needleman and Peter Buerhaus.
Strategies
to Address the Shortage
Recent Reports
- Staff
Nurses and Their Solutions to the Nursing Shortage
According to a study published
in the Western Journal of Nursing Research in October
2006, staff nurses were asked to identify possible solutions
to the nursing shortage. Top suggestions included creating
career ladders, enhancing communication with administration,
and increasing educational opportunities for nurses.
- Hospitals'
Responses to Nurse Staffing Shortages
In a June 2006 study published in Health Affairs,
researchers surveyed hospitals in 12 U.S. markets and
found that the majority of respondents (97%) were making
investments in nursing education as a long-term strategy
to address the RN shortage. These investments include
funding training programs and nurse orientations, partnering
with schools of nursing, and providing financial support
for nursing faculty. However, the authors state that "nursing
school capacity remains an important barrier to future
investments in nursing education" by hospitals, and
they call on policymakers to make a larger financial commitment
to expanding the nursing education system.
- Faculty
Shortages in Baccalaureate and Graduate Nursing Programs
AACN updated this white paper on nursing faculty shortages
in June 2005. Authors of the report summarize the scope
of the problem, discuss issues contributing to the shortage
of faculty, and put forth strategies to expand the capacity
of the current and future pool of nursing faculty.
- President's
High Growth Job Training Initiative
In June 2005, the U.S. Department of Labor (DOL) awarded
more than $12 million in grant-funding through this federal
program, including $3 million to address the nurse faculty
shortage. The latest round of funding brings the DOL's
commitment to health care workforce through the High-Growth
program to more than $43 million. Details on all grant-funded
initiatives are available online.
- Nursing
Shortage and Academic Health Centers: Assessing Options
for Remedy in a Complex System
Released by the Association of Academic Health Centers
in September 2002, this report calls for academic health
centers to develop new strategies to address the nursing
shortage and provide the leadership needed to identify
long-term solutions. Proposed solutions include strengthening
nursing education programs; expanding resources to educate
new faculty; focusing on nursing research; developing
networks with non-university based nursing programs; and
evaluating new models of nursing care.
- In
Our Hands: How Hospital Leaders Can Build a Thriving Workforce
The American Hospital Associations Commission on
Workforce for Hospitals and Health Systems released this
report in April 2002 that contained specific recommendations
to help hospitals address health care worker shortages
now and in the future. The commission called this shortage
a potential major national health care crisis.
Legislation
to Address the Shortage
Recent
Action
Today's Nursing Workforce
Last
update: April 1, 2008 |