Twenty-Somethings: Cure for the Nursing Shortage?

    • December 13, 2011

Ten years after they predicted a substantial nursing shortage by 2020, a group of researchers has found qualified good news in data that shows promising growth in the nursing workforce the country will need to care for an aging population with increasingly complex health care needs.

What's behind the rosier outlook? Young people, ages 23 to 26.

An unexpected number of young women entered the nursing workforce from 2002 to 2009, according to the study published in the December 2011 issue of Health Affairs, causing faster growth in the supply of nurses than anticipated. The number of full-time registered nurses (RNs) age 23 to 26 increased steadily, by 62 percent, during that time. That rate of growth in the nursing workforce has not been seen since the 1970s.

It offers hope, experts say, that the well-educated nursing workforce may be growing—but considerably more progress is needed if the country is to meet fast-growing needs for highly skilled nurses at a time when the population is aging, more people are living with chronic conditions, and health reform is poised to dramatically increase the number of people seeking care.

The new study, "Registered Nurse Supply Grows Faster Than Projected Amid Surge In New Entrants Ages 23-26", is authored by: David I. Auerbach, PhD, a health economist at RAND Health; Peter I. Buerhaus, PhD, RN, FAAN, a health care economist and professor of nursing at Vanderbilt University; and Douglas O. Staiger, PhD, a professor of economics at Dartmouth College.

The new young nurses it identifies "will provide 30 percent more full-time-equivalent RNs than the baby-boomer cohort who are now nearing retirement," the authors write. "Instead of declining in absolute and per capita terms as previously projected, the nurse workforce is now projected to grow at roughly the same rate as the population through 2030."

Young people have responded to growing opportunities in nursing, they explain, and have taken advantage of degree options—like two-year associate degrees and accelerated nursing degrees—that allow them to enter the workforce earlier than in the past.

The accelerated degree option has hastened the growth of nurses with baccalaureate degrees, channeled students into advanced practice master's programs and helped to diversify the profession, according to The Future of Nursing: Leading Change, Advancing Health, a report on the nursing profession released last year by the Institute of Medicine (IOM).

But those are not the only education options gaining favor. Preliminary data from an annual survey conducted by the American Association of Colleges of Nursing (AACN) finds increased demand for nursing education at all levels.

From 2010 to 2011, there was a 3.9 percent enrollment increase in entry-level baccalaureate programs. Graduate education also showed enrollment increases: master's programs reported a 7.6 percent increase, Doctor of Nursing Practice programs a 20.6 percent increase, and research-focused doctoral programs a 6.6 percent increase. New nurses are not the only ones going to school; AACN found a 13.4 percent increase in baccalaureate degree completion programs (RN to BSN programs).

A more highly educated nursing workforce is a key way to advance comprehensive health care change and help ensure that all Americans have access to high-quality, patient-centered care, according to the IOM report. It recommends that 80 percent of nurses have bachelor's degrees by 2020.

"With the Institute of Medicine and other leading authorities calling for significant increases in the number of nurses with baccalaureate and graduate degrees, moving to prepare a more highly educated nursing workforce has become a national priority," AACN President Kathleen Potempa said in a news release.

One of the authors of the Health Affairs study agrees. This "is the first really positive news that eventually we might be able to replace the retiring Baby Boom nurses," Buerhaus says. "This replacement, however, is not going to happen over the next few years, and the real impact may not be realized until the next decade. While it is truly fantastic that we are finally seeing some evidence that the supply of RNs is likely to grow, this growth will only occur as long as younger people remain interested in nursing, and there is no guarantee that this will continue … ."

"I personally do not feel confident that, even if we are able to sustain the trends reported in Health Affairs, that the supply of RNs will match the large increases in demand that are unfolding during this decade," Buerhaus continued. "Taking actions now that would stop the flow into the nursing profession would be very risky and an unwise gamble. By no means does our article come anywhere close to suggesting that we curtail the pipeline of new nurses into the workforce, which may indeed threaten the health of the nation."

Cautious Optimism

Although the new data is good news, challenges still remain to building the nursing workforce. The Health Affairs study and the AACN data agree: qualified applicants are still being turned away from schools of nursing. "There continues to be a bottleneck in nursing education that could narrow the future pipeline of nurses below optimal levels," Auerbach and his colleagues write.

AACN found that more than 51,000 qualified applicants were turned away from entry-level baccalaureate nursing programs in 2011. This is only slightly fewer than last year's record high, and the number is expected to increase when the final data on qualified applicants who were turned away is completed next spring. Funding and a lack of faculty and clinical placement sites continue to be the primary barriers to accepting students.

One way to address that problem is to double the number of nurses with doctorate degrees, the IOM report says. That will bolster the ranks of nurse faculty who can prepare the next generation of nurses. Schools of nursing should also create more competitive salary and market packages to recruit and retain more nurse faculty, and funders should support efforts to expand baccalaureate educational programs by hiring more faculty and taking other steps.

The economic downturn has also complicated the nursing workforce growth, making jobs harder to find for new graduates and young RNs. Although its effects are still unclear, the uncertainty may discourage some from entering the nursing profession, the researchers caution.

"These new reports offer some encouraging news, but there is a lot of work still to do to ensure that the nation has the well-prepared, skilled nursing workforce it will need to meet future health care needs," said Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation, which supported the IOM nursing report. "The Future of Nursing: Campaign for Action is working at the federal and state levels to help more nurses assume positions of leadership, make it possible for more nurses to achieve higher levels of education through an improved education system, promote nurses as full partners in the redesign of our nation's health care system, and ensure that nurses can to practice to the full extent of their education and training."