Programs & Services

Programs & Services:

Nursing Shortage Information

Evidence of nursing shortage

Fewer nurses entering the workforce (enrollment in schools has been declining since 1993)
24.9% fewer graduates from 1995-1999, the pass rate has also dropped
Aging populations and the declining number of nursing professionals in the academic pipeline (number of people taking the NCLEX exam has declined each year since 1994)
Aging nurses and faculty
- Average Age of RN - 44 years old (RN younger than 30 represents only 10% of working nurse population)
- By 2015, half of all current registered nurses will reach retirement.
- Average Age of Faculty: Associate professors - 52; Assistant professors - 49
- Similar to other health care disciplines
- Fewer faculty translates into fewer students accepted

Causes for decline in nurses

Reimbursement, legislation, regulation (increased paperwork: 1 hr-pt. care= ½ hr paper), and technological advances
Increased market demand - ER visits are up 15% since 1990
Workplace issues
- Dissatisfaction with the job, the supervisor, or career prospects
- Heavy workloads - Average acuity of patients is higher which requires relatively intensive monitoring and care, complicated by demands for documentation, which means less time for direct care.
- Inadequate staffing - shortage of nurses begets shortages (overtime creates burnout)
- Overtime
- Hours (unchangeable)
- Lack of support staff
- Lack of adequacy of wages - Average salary $47,000
Changes in the nature of hospitalization
Hospital reorganization to achieve improvements in critical measures of performance (such as cost, quality, service, and speed)
More career opportunities for women
Lack of accepted expectations about care giving - Nurse/patient relationship cannot be established with hospitalization less than 24 hours.

Impact of nursing shortage

Nation is in danger of experiencing a serious breakdown in the health care system.
Limiting Patient Access
- Some hospitals are closing beds on units
- Diverting patients (new regulations to limit)
- Canceling surgeries
- Limited access to physician in their office = more visits to the ER
Demand will exceed supply
- 2000: for every person over the age 65 there were 5.8 people between the ages of 18-64 (workforce age), by 2020 that ratio will be 2.1:1
- By 2010:
  - Baby boomers reach 60, 70 and beyond
  - Nurses continue to age and 40% will be over 50
- By 2020:
  - People age 65 and older will grow from 13 to 16% of the population
  - Chronic medical conditions will affect 134 million people, compared to 99 million in 1995
  - Increased burden of care placed on nurses, patients, and families
Pressures on families due to shortened hospital stays and outpatient services for formerly inpatient stays
Hospital safety
Nurse dissatisfaction due to staff cuts, overtime, nurses replaced with assistive personnel

Future need for nurses

Approximately 434,000 additional RNs and 136,000 LPNs will be needed by 2020 (nationwide)
Depends on how health care is delivered, where it is delivered, and how it is paid
Increasing age of the general population (baby boomers)
Growing need for management of chronic disease conditions

Number of nursing students expected in the future

The capacity of nursing schools to educate sufficient numbers of RNs to meet future demand
Not enough students are enrolled in schools to replace those who retire
Factors leading to the decline in enrollments
- Nursing is not encouraged by school counselors
- Women's career opportunities expanded
- Bright students go to medical school rather than nursing
- Confusion about requirements, salaries, and opportunity for various degree programs
- Previous layoffs created uncertainty about security
- Increasing stress leads many nurses away

U.S. Department of Health and Human Services Nursing Survey

The U.S. population increased by nearly 14 percent between 1990 and 2000, but the rate of nurses entering the workforce between 1996 and 2000 was just 4.1 percent, down from more than 14 percent between 1992 and 1996
There are an estimated 2,696,540 active, licensed RNs in the United States, an increase of only 137,666 nurses from 1996
81.7 percent or 2,115,815 of active licensed RNs are employed in nursing
12.3 percent or 333,368 of all RNs reported being from one or more racial or ethnic minority backgrounds
5.9 percent of RNs employed in nursing are men, up from 5.4 percent in 1996
The number of nurses working in hospitals increased slightly from 1,270,870 in 1996 to 1,300,323 in 2000

Resolution to the nursing shortage

Education
- Develop career progression initiatives (various nursing degrees, range of options available for nurses such as faculty, researcher, and administrator)
- Equitable compensation based on educational preparation
- Lifelong education for continued competence
- Internship and mentoring
- Reach out to youth to promote nursing as a career
Work Environment
- Retention (greater flexibility in work environment and scheduling, reward nurses who serve as mentors/preceptors to new nurses, appropriate salary/benefit programs)
- Advance the practice of nursing (appropriate management structures, adequate staffing, and sufficient autonomy over their practice settings)
- Redesign work to enable aging workforce to remain active in direct care roles
Legislation/Regulation
- Increase nursing education funding
- Identification of nursing services within Medicare, Medicaid, and other reimbursement systems
- Regulatory relief to decrease the paperwork burden
Technologies, Research, and Data Collection
- Use technological advances to enhance the capacity of reduced nursing workforce
- Develop models for workforce planning for both the need and demand for nursing services
- Consistent data collection to enable appropriate workforce planning

References

Strategies to Reverse the New Nursing Shortage, a policy statement from Tri-Council members.
When Care Becomes a Burden: Diminishing Access to Adequate Nursing, Claire M. Fagin,
February 2001.
Nursing Workforce, Emerging Nurse Shortage Due to Multiple Factors, Report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of Representatives, by
the U.S. General Accounting Office, July, 2001.
Workforce Status in Missouri Hospitals: an Overview, Missouri Hospital Association, August,
2001.
Bush Administration Promotes Careers in Nursing Press Release, February 22, 2002.

Nursing Shortage Links