Aug 8 2014
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Nursing Shortage Offset by Older Nurses Delaying Retirement

Peter Buerhaus, PhD, RN, is the Valere Potter Distinguished Professor of Nursing, director of the Center for Interdisciplinary Health Workforce Studies, and professor of health policy at Vanderbilt University Medical Center. He co-authored a new study in Health Affairs that found more nurses are delaying retirement, which is adding to the supply of nurses at a time when shortages had been projected.

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Human Capital Blog: A decade ago, you forecast large shortages of nurses by the middle of this decade. That isn’t panning out yet. Why?

Peter Buerhaus: When we did the original research, which was published in 2000 in the Journal of the American Medical Association, we were using data that was available at that time, which was up to about 1997 or 1998. At the time, we observed that enrollment in nursing schools had dropped nearly 5 percent each year over the previous five years. Based on that and some other factors, our projections suggested that unless something big happened—namely that we would get a lot of new people to enter nursing to replace the aging and large number of retiring Baby Boomer registered nurses (RNs)—we would run into large shortages and the RN workforce would stop growing by around 2014 or 2015.  

Now we’re seeing two new phenomena: First, there has been a great surge of interest in nursing since the mid-2000s, and this has been reflected in a dramatic increase in the number of graduates from associate- and baccalaureate-degree nursing programs. And second, RNs are, on average, spending more time in the workforce—about 2.5 more years than did their peers back in the 1980s and 1990s.

“We have an unexpected increase in the supply of RNs, I don’t know that the increase will be large enough to offset the future demand for nurses.”

HCB: Why is that?

Buerhaus: I think there are a couple of factors. One is that we know that a lot of nurses as they age report higher levels of career and job satisfaction. As they get older, many seem to be generally quite satisfied with nursing. Some 80 to 85 percent of nurses report being satisfied with their careers. These are very high satisfaction levels compared with other groups such as businesswomen and men, physicians, teachers and lawyers. As more and more Baby Boomer nurses are aging, they’re more likely to be satisfied and more likely to want to remain in the job market.

Second, we experienced a recession in 2001 and the Great Recession between 2007 and 2009. Undoubtedly, retirement savings and investment portfolios in many RN households were negatively affected, so there is an economic reason that a great many RNs are staying in the workforce longer. Related to that, many spouses of RNs lost their jobs during these economic downturns.  And some who returned to the workforce may not have found positions that paid them as much as their former jobs.

A third explanation is that people are living longer, and there is some evidence that many are living healthier for longer periods, and it’s possible that we have a healthier stock of older nurses—the ones who survived the back injuries and the physical challenges of working as nurses for many years.

HCB: Will a larger supply of older nurses offset growing demands for nursing care?

Buerhaus: The concern I have had is that we are likely to see a big increase in the demand for health care during this decade and the next decade as a consequence of several factors.  First, the Baby Boom generation is aging. A large proportion of our population is reaching the age of 65, and people over 65 tend to consume about two to four times more health care than people under 65.

Second, there’s a growing number of people with chronic conditions, including diabetes, heart disease, cancer and obesity, which add to the demand for health care. Third, the size of the population in the United States is increasing, so more people need health care. A fourth reason is shortages of physicians, and not just primary care physicians but specialists as well. That adds some increase in demand for nurses, particularly nurse practitioners  

All of those sources of increased demand concerned me long before we had the passage of the Affordable Care Act. Now health reform has resulted in millions of people gaining access to health insurance through Medicaid and the state exchanges, and that adds to demand for nurses as well. I have been concerned that first, we would not grow our supply of nurses to replace the large Baby Boomer generation of nurses, which represents about 35 to 40 percent of the nursing workforce and, second, we would not grow the supply of RNs to meet increases in demand.

While I’m happy that we have an unexpected increase in the supply of RNs, I don’t know that the increase will be large enough to offset the future demand for nurses. But it’s a heck of a lot better picture today than it was in the early 2000s when we didn’t see much reason for optimism. RNs who stay in the workforce for longer periods are helping to provide a larger supply, but will it be enough? We can’t say at this point.

HCB: What are the implications for the health care system if RNs delay retirement?

Buerhaus: I’m going to speculate a little bit because this is not what we studied in our analysis. I see two implications. First, many older RNs have worked in nursing positions for more than 10 to 20 years, and even more. We are lucky to have them providing care to patients in hospitals because they are very knowledgeable. We have long known that many nurses, once they enter into their 50s, have reached a point in their careers where they want more control over their work schedules. Many no longer want to work the night shift or work overtime. Second, the physical challenge of working in a hospital can start to wear their bodies out. Consequently, some older nurses shift out of hospitals and into non-hospital settings such as home care, schools, outpatient clinics and ambulatory centers, churches, and other settings.

It is in these very settings where health care delivery reform is expected to increase the demand for care. The health care delivery system is trying to minimize the number of people cared for in hospitals, and I think it’s a positive development that we will have greater numbers of knowledgeable RNs working in these settings who will apply their knowledge and skill, and who will be encouraged to offer ideas about innovation and improving care delivery. These nurses have a lot of experience, and they have seen how health care can be done well and how it can be done poorly. We want to take advantage of that stock of knowledge. It’s an exciting opportunity.

HCB: Do you have data about when nurses will be retiring en masse?

Buerhaus: No, we don’t. We need to come back to this and try to get a better idea of what our best estimate is for when we might expect to see a rush of retirement. I think that work is within our reach.

HCB: What are the implications of your research for new and unemployed nurses?

Buerhaus: This gets a little bit complicated. I think that there are both positive and potentially worrisome elements. On the one hand, it’s true that we’ve had an increasing production of RNs in the past several years and that many of these nurses have had some difficulty finding employment right after graduating. Nevertheless, we’re finding that RN employment growth has continued at a strong pace since the recession. Now, it turns out that young nurses have not gotten employment in hospitals to the degree that they had in previous years. More are getting employed in non-hospital sites, but they’re still largely finding jobs.

Health reform is unfolding, which appears to have led to some hospitals tightening their employment and being more selective in whom they hire. That’s not surprising, but it’s coming at a time when a lot of RNs are graduating from nursing schools and already employed RNs are staying in the workforce longer. It’s only a matter of time before these factors sort themselves out.

Tags: Health Care Workforce, Nurses and Nursing, Nursing, Voices from the Field