A report released Monday by the Health Resources and Services Administration (HRSA) indicate that efforts to grow and diversify the nursing workforce are showing results—a welcome finding given the looming shortage of nurses and primary care providers in general.

According to the data from HRSA's National Center for Health Workforce Analysis, the nursing profession grew substantially in the 2000s, adding 24 percent more registered nurses (RNs) and 15.5 percent more licensed practical nurses (LPNs). Significantly, the growth in the supply of nurses outpaced growth in the U.S. population, with the number of RNs per capita growing by about 14 percent and the number of LPNs per capita increasing by 6 percent.

The "pipeline" carrying nurses from school to the workforce also expanded during the past decade. The number of would-be nurses who passed national nurse licensing exams to become RNs more than doubled between 2001 and 2011, while the number of LPN test-passers grew by 80 percent. Significantly, the share of licensure candidates with bachelor's degrees increased during that time, as well.

The profession also is growing more diverse, according to the data. Non-white RNs are now 25 percent of the profession, up from 20 percent 10 years ago. Nine percent of RNs are men today, up slightly from 8 percent at the beginning of the decade.

The full analysis is available at HRSA's website.

On Monday, U.S. Department of Health & Human Services Secretary Kathleen Sebelius announced a program that will help military veterans who have health care experience or training pursue nursing careers. The Veterans’ Bachelor of Science in Nursing Program is expected to provide $3 million before the end of this fiscal year (September 30) to accredited schools of nursing to increase veterans’ enrollment, and provide mentorship and other support services.

“The Veterans’ Bachelor of Science in Nursing Program recognizes the skills, experience and sacrifices of our veterans, while helping to grow our nursing workforce,” Secretary Sebelius said in a news release.  “It helps veterans formalize their skills to get jobs, while strengthening Americans’ access to care.”

The funds will also be used to explore ways to award academic credit for prior military health care experience or training.

Read more about the new federal veterans/nursing program.

President Obama’s Fiscal Year 2014 budget proposal recommends a $20 million increase over previous budget proposals for the Title VIII Nursing Workforce Development Programs, the primary source of federal funding for nursing education.

“With the proposed increase to Title VIII funding, the Obama administration continues to recognize the invaluable contribution that nurses make in the delivery of care and the need to strengthen our primary care system,” American Nurses Association (ANA) President Karen A. Daley, PhD, RN, FAAN, said in a statement.

According to the Center to Champion Nursing in America (CCNA), the $20 million increase will expand the pool of primary care Advanced Practice Registered Nurses through the Advanced Education Nursing Traineeship Program.  If enacted, and if the funding is sustained, the increase will produce an additional 1,800 primary care nurses over five years.

“The President's proposal to train 1,800 more primary care nurse practitioners would provide a much needed shot in the arm to our health care workforce,” said Winifred Quinn, MA, PhD, director of legislation and field operations at CCNA. “These new health professionals are key to boosting consumer access to primary and preventive care, and other innovative delivery system reforms we are counting on to improve quality and hold down costs.”

The ANA also applauded other health care investments in the budget, including funding for community health centers, new mental health programs, health reform implementation, medical research, and more.

Read ANA’s statement about the budget.
Learn more about Title VIII Nursing Workforce Development Programs.

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other critically important nursing issues.  These are some of the stories in the April issue:

More Nurses Climbing Education Ladder
Over the last century, nursing education has shifted from hospital-based diploma programs to colleges and universities, which offer associate’s, bachelor’s, master’s, and doctorate degrees in research and practice. Today, enrollment in higher degree nursing programs is on the rise, according to a 2012 survey by the American Association of Colleges of Nursing. Read about RWJF scholars who are continuing their education, and what the Institute of Medicine says about a more highly educated nursing workforce.

In Indiana, Physicians and Nurses Work Together to Transform Nursing
In the Indiana Action Coalition, the partnership between physicians and nurses runs deep. “Nursing can’t change health care alone,” co-lead Kimberly Harper says, and many doctors, pharmacists, and other professionals she works with agree—and are championing the effort to advance nursing because they believe it will ultimately benefit patients. Improving interprofessional education and collaboration is a top priority for the group.

RWJF Scholar Pioneers Innovative Program to Help Low-Income Elderly Age at Home
Sarah Szanton, PhD, CRNP, an associate professor at the Johns Hopkins School of Nursing and an RWJF Nurse Faculty Scholar, has developed a program that sends teams of nurses, occupational therapists, and “handymen” to the homes of low-income, frail elderly participants for 16 weeks. After an assessment of all functional areas, the participant decides on functional goals, such as taking a bath or walking to church, as opposed to medical ones, such as reducing blood sugar or blood pressure levels. The program is having extraordinary success, helping seniors age in place and saving taxpayers money.

See the entire April issue here. Sign up to receive Sharing Nursing’s Knowledge here.

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research and trends relating to academic progression, leadership, and other critically important nursing issues.  These are some of the stories in the March issue:

RWJF Announces Initiative to Support State Efforts to Transform Health Care through Nursing
RWJF has announced a new $3 million initiative to help states prepare the nursing profession to address our nation’s most pressing health care challenges—access, quality, and cost. The Future of Nursing State Implementation Program will bolster efforts already underway in 50 states and the District of Columbia—the Future of Nursing: Campaign for Action—to transform health care through nursing and meet the challenges stemming from an aging and more diverse population. The initiative is providing two-year grants of up to $150,000 to 20 state-based Action Coalitions.

Nation’s Nurse Leaders Convene in D.C.
Nurses and health leaders from across the country assembled in the nation’s capital in early March to advance a national campaign to transform the nursing profession in order to improve health and health care. Hundreds of participants from state Action Coalitions shared ideas and developed plans to move their collective agenda forward at the Campaign for Action National Summit. The summit was designed to help Action Coalition leaders and supporters identify their own priorities and understand those of other Action Coalitions, develop strategic plans to actualize those priorities, come up with new ways to increase their impact, and align state-level work with the national agenda.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited shifts for first-year medical residents, or interns, to 16 hours, in an effort to improve their well-being. But two studies published online this week in the Journal of the American Medical Association (JAMA) find that these regulations may not be improving resident well-being—and that they may be decreasing both the quality of care they provide and their educational opportunities.

Although interns worked fewer hours after implementation of the shift length restriction in 2011, researchers found no change in their sleep duration or symptoms of depression. That study, led by Srijan Sen, MD, PhD, of the University of Michigan in Ann Arbor, also found an increase in self-reported medical errors among interns (from 20% in 2009 to 23% in 2011). The researchers hypothesize that the increase in errors may be due, in part, to interns having to perform more handoffs—where medical errors are known to occur—and to a lack of additional clinical staff that may mean “residents [are] expected to complete the same amount of work as previous cohorts but in less time.”

Another study, led by Sanjay V. Desai, MD, of Johns Hopkins University, also found “unintended consequences” of duty hour regulations. Although that study found more consistent sleep patterns for interns, it also found that nurses, as well as the interns themselves, believed the quality of patient care suffered. Desai’s research team found a concerning balance between the interns’ workload and their time spent on educational activities. “Concerns have been raised about the competency achievable with less hospital experience during any fixed duration of training,” they write. “Opportunities were reduced with restricted shifts, many of which occur solely during evening hours, precluding participation in traditional core educational components of medicine residency programs, such as noontime conference and morning rounds.”

Sherry Rogers, RN, MSN, NEA-BC, is Chief Nursing Officer at Redington-Fairview General Hospital in Skowhegan, Maine. She is co-chair of Maine Partners in Nursing Education and Practice, a project of Partners Investing in Nursing’s Future, which is a partnership of the Robert Wood Johnson Foundation (RWJF) and the Northwest Health Foundation.

Maine is a rural state with the least dense population among states east of the Mississippi. The greater Portland area in southern Maine contains 20 percent of Maine’s residents, while northern counties have fewer than one person per square mile. A drive from the state’s southernmost hospital to its northernmost school of nursing would take approximately seven hours by car. The rural nature of Maine provides unique challenges to the state’s 13 nursing schools when it comes to placing students in their needed clinical hospital rotations. I am helping to oversee a program aimed at overcoming those student placement challenges.

Our project, called Maine Partners in Nursing Education and Practice, partnered with the Maine Department of Labor to link the state’s schools of nursing with hospital clinical rotation sites by implementing a Maine region of the Massachusetts Centralized Clinical Placement (MCCP), a web-based program that streamlines the scheduling and management of clinical nursing education placements between health care organizations and nursing programs. The system is owned by the Massachusetts Department of Higher Education (DHE) and can be viewed at www.mcnplacement.org.

This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

A few years ago, Natasha Leland was a professional opera singer. John Pederzolli was in financial sales. And Blake Smith was a high school soccer coach. Today, all are nurses, thanks to support from New Careers in Nursing (NCIN), a program of RWJF and the American Association of Colleges of Nursing.

Since 2008, NCIN has helped facilitate more than 2,700 scholarships for second career nurses entering accelerated degree programs. Thanks to resources and support from NCIN, these students—who are from groups underrepresented in nursing—are quickly entering the workforce, ready to provide high quality patient care and become leaders in the profession.

Before realizing their dreams of becoming nurses, NCIN scholars had a wide variety of professions: customer service, teacher, aviation safety professional, and even professional clown, among others. Each Scholar brings unique life and real-world experience to his or her new career. That makes them well-equipped to handle a fast-paced training program, and the demands of the profession.

Two newly published studies examining different aspects of physician workforce trends suggest that the long-expected shortfall in primary care physicians could be averted or lessened.

A study in Pediatrics finds pediatric residents are more likely to consider primary care or hospital practice––rather than a subspecialty that requires additional training––if they have more educational debt. The researchers found that residents with at least $51,000 in debt were about 50 percent more likely to be planning a primary care or hospitalist career than residents who owed less or no money, Reuters reports. They also found that educational debt rose 34 percent from 2006 to 2010 for pediatric residents.

While an unintended consequence of student loan debt may be that it helps relieve the primary care shortage, another recent study in Health Affairs casts some doubt on the severity of that shortage. Most existing estimates of the primary care physician shortage are based on a simple ratio of one physician for every 2,500 patients, the study says, which does not take into account changing patient demographics and alternative care-delivery methods. The researchers found that the use of health care teams and non-physicians, as well as improved information technology and data-sharing have “the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage.”

Read the study in Pediatrics.
Read the study in Health Affairs.

Jean Giddens, PhD, RN FAAN, is professor & executive dean at the College of Nursing, University of New Mexico and a Robert Wood Johnson Foundation Executive Nurse Fellow. This post is part of the "Health Care in 2013" series.

The beginning of every year often serves as a time to reflect on events from the previous year, to consider opportunities that lie ahead, and make resolutions for things one wishes to accomplish.  As an educator, my New Year’s resolution for the United States health care system is to work toward a more efficient system for educating nurses. 

Nursing education represents a critical link among many efforts to improve the nation’s health care.  Our education system currently lacks the capacity to meet the current and future workforce demands, particularly in rural states.  Goals such as increasing workforce diversity, creating resource efficiency in education processes (particularly for advanced practice nursing education), and enhancing education systems leading to a more educated workforce are among the highest priorities for action in 2013.