Remarks to the Nation's Nursing Workforce Forum

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Prepared Remarks of Claude Earl Fox, M.D., M.P.H.
Administrator, Health Resources and Services Administration

Nation's Nursing Workforce Forum
Washington, D.C.

February 14, 2001

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Introduction

Good afternoon.  I am delighted so many of you have gathered here as we examine the nation’s current and future supply of nurses. This focus is critical now because any future shortage of nurses would threaten the very quality of health care available in communities all across America.

This issue is right out of the headlines of many of the nation’s leading newspapers. A recent article in the Atlanta Journal-Constitution said: “Surveys in Georgia, and accounts from hospital executives and RNs themselves, demonstrate that the current nursing shortage is the worst in the state's history--and has approached a crisis level.”

And a recent survey of U.S. physicians sponsored by the Harvard University School of Public Health and the Commonwealth Fund, found that the adequacy of nursing staff levels is their greatest concern about hospital resources. In fact, half of primary care doctors and two-thirds of specialists rated nursing staff levels as fair or poor.

Without a doubt, the dimensions of the problem seem to grow larger by the day.

The Problem

The Census Bureau estimates that some 40 million Americans will be over age 65 in 2010, 5 million more than current numbers. And by 2030, the number is expected to grow to 66 million as a result of the aging of the large number of  “baby boomers” born between 1946 and 1964.

And as the nation’s population ages, so too does the nursing supply. As nurses grow older, more are leaving the profession while still fewer are entering the workforce. In fact, the growth in the RN workforce has not kept pace with the population growth over the past four years.

Here’s the situation. In a statement released just last month, the Tri-Council for Nursing, an alliance of four national nurse associations, cited “a troubling combination of factors including the aging nursing population, the heightened age of nurse educators, the declining number of nursing students in the academic pipeline and the need for more accommodating working conditions for nurses.” It also warned that “without measures to reverse these trends, the nation is in danger of experiencing serious breakdowns in the health care system.”

According to the National League for Nursing, a member of the Tri-Council:

·        Enrollments in all basic registered nurse preparation programs have declined each year between 1994 and 1998, and

·        Consistent with enrollment declines, an overall decline in graduations from all basic RN education programs was 12.6 percent between 1995 and 1998.

To date, we have confirmed spot shortages of nurses—in California and New York.

In addition, we’ve heard anecdotal evidence from a number of states that appears to indicate we’re in the early stages of a national shortage of registered nurses.

Today we’re releasing to you Preliminary Findings of our March 2000 National Sample Survey of Registered Nurses (NSSRN) which confirms that the nation’s registered nurses continue to grow older while the rate of nurses entering the profession is slowing. This survey, conducted every four years by the Bureau of Health Professions’ Division of Nursing, is the most extensive and comprehensive source of statistics on registered nurses with current licenses to practice in the U.S.

National Sample Survey Findings

Specifically, the Sample Survey found that the total number of licensed RNs is estimated to be 2,696,540 -- an increase of just 137,666 from l996.

This increase represents the lowest rate of growth since the Division began collecting national data in 1977. To give you an idea of what I mean, the Division’s 1996 survey found that the rate of growth in nursing was 14.2 percent between 1992 and 1996. However, the rate of growth between 1996 and 2000 declined to just 5.4 percent.

In addition, our 2000 survey found that nearly 82 percent of those RNs who are licensed to practice are employed in nursing, and the average age of RNs working in nursing increased from 42.3 years in l996 to 43.3 years.

The 2000 survey also found a slight increase in the number of racial and ethnic minority nurses. In 1996, about 10 percent of RNs were from minority backgrounds. With this survey, we found that minority RNs represent 12.3 percent of the workforce. Yet, minorities currently represent 28 percent of the total U.S. population.

And, we found that the percent of men working in nursing increased from 5.4 percent in l996 to 5.9 percent in 2000.

Given all these trends, the question for us is: What do we do?

What HRSA Is Doing

Ensuring that an adequate and competent health care workforce is in place to meet the health care needs of all Americans is the role of HRSA. We see this role as fundamental to our mission of 100 percent access to health care and 0 disparities for everyone. HRSA, through our Bureau of Health Professions, will invest more than $353 million this fiscal year in programs to increase the supply, distribution and diversity of the health professions workforce.

HRSA contends that health services to some of our neediest populations will improve when we have the right number of doctors, nurses, medical technicians, and mental health and substance abuse counselors serving in the right places.

Our work in this area is critical because we could spend millions of dollars to build more clinics or even give everyone an insurance card, but it would do no good unless we had in place an adequate supply of health care professionals to provide the needed care.

While the challenges ahead are substantial, HRSA already has put in place a variety of education and training programs that play a critical role in addressing emerging shortages of nurses.

First, let me remind you of several tools we’ve made available recently for planners and policymakers—the State Health Workforce Profiles, the Public Health Work Force: Enumeration 2000, the Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists, and Graduate Medical Education and Public Policy: A Primer.

In addition, four BHPr-funded Regional Centers for Health Workforce Studies are investigating local and regional health workforce issues. The California and New York Centers have found growing shortages of registered nurses in those states.

And, as I mentioned earlier, BHPr’s Division of Nursing conducts every four years the National Sample Survey.

Under Title VIII of the Public Health Service Act, the Division of Nursing administers three broad authorities to permit a comprehensive, flexible and effective approach to federal support for nursing workforce development. These authorities focus on:

• Advanced Education Nursing;
• Nursing Workforce Diversity; and
• Basic Nursing Education and Practice.

In FY 2001, the Division will invest $76.5 million in these three programs—an increase of $11 million. Most of this increase, $9 million, was targeted to our Advanced Education Nursing programs. In addition, our Nursing Workforce Diversity programs received $4.7 million and Basic Nursing Education Practice programs received $12.8 million. And, of course, the Division of Student Assistance offers scholarships and loans for students pursuing a nursing career.

Closing

Based on all of this data and research, the picture is fairly clear—unless something is done now, there may not be enough nurses in the not-too-distant future to meet the nation’s health care needs.

Nurses are the backbone of the American health care system.

A shortage of nurses not only affects the availability of care but also the quality of care.

By coming together at this forum, we have a golden opportunity to figure out how best to keep the nation’s pipeline filled with nurses who are willing to serve in those communities where they are needed most. It is essential that we address this problem with the sense of urgency it deserves.

  

 

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