Addressing the Nursing Workforce

A Critical Element for Health Reform

Health Affairs today unveiled a series of six studies examining the nursing workforce in the context of health reform. The papers were released at a forum presented by Health Affairs and the Center to Champion Nursing in America (CCNA) that featured a lively discussion among policy-makers, nursing leaders and researchers, and health reform experts. The Center is a joint initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation.  

According to one of the studies, the continuing recession will contribute to an easing or temporary end to the current registered nurse (RN) shortage, as older nurses delay retirement or return to work, and part-time nurses seek full-time jobs. However, as the baby boom generation’s health needs increase and the economy rebounds, the nursing shortage will intensify again in the next decade, according to the study, which provides detailed workforce and compensation projections. Other studies released at the meeting addressed nursing education, workforce development, increased quality and efficiency and patient satisfaction.

“These important findings demonstrate that nurses have developed and implemented innovative models of care that promote the goals of health reform: expanding access, improving quality and safety and reducing costs,” said Susan Reinhard, senior vice president and director of the AARP Public Policy Institute and CCNA chief strategist.

The forum featured Wendell Primus, Health Counsel to House Speaker Nancy Pelosi; Erik Rasmussen, minority professional staff, U.S. House Committee on Ways and Means, Subcommittee on Health; David Sloane, senior vice president of AARP; Health Affairs Editor-in-Chief Susan Dentzer; and several top nursing experts. 

“The crises facing nursing—and the nation’s health and health care systems—are inextricably connected,” said Susan B. Hassmiller, senior adviser for nursing for the Robert Wood Johnson Foundation. “Today we explored various approaches to ensuring we have enough well-prepared nurses in the future and that insights and innovations from the nursing profession are applied as we work to make our health care system better for all. Americans will not receive the health care they need unless we make an investment in a well-prepared nursing workforce.”  

Publication of the new studies in Health Affairs was supported by a grant from CCNA.

The papers released today include:

Education Policy Initiatives to Address the Nurse Shortage

Linda H. Aiken, Robyn B. Cheung and Danielle M. Olds

We have an historic opportunity to prevent the nursing shortage by acting now to expand nursing school enrollments at a time when applications are at an all-time high, but we must first address the nurse faculty shortage and financially-strapped colleges and universities. Increased public subsidies are needed to provide greater access to nursing education, with an emphasis on baccalaureate and graduate nursing education, where job growth is expected to be greatest.

The Recent Surge in Nurse Employment: Causes and Implications

Peter I. Buerhaus, David I. Auerbach and Douglas O. Staiger

The continuing recession will ease the current nursing shortage in many areas of the country, but the results will be temporary: the United States will face a significant shortage of nurses by 2025. Hospitals and policy-makers should use this respite to strengthen the nursing workforce by addressing issues associated with an increasingly older workforce. Policy-makers should also implement policies to increase the capacity of nursing education programs to avoid future imbalances in the nurse labor market. 

Expanding the Capacity of Nursing Education

Brenda L. Cleary, Angela Barron McBride, Margaret L. McClure and Susan C. Reinhard

The U.S. must ensure a sufficient nursing workforce to care for a more diverse and aging population. To do this, we must change the way nursing education is delivered so that vacant faculty positions are filled and other educational resources bolstered.  

Addressing the Nursing Workforce: A Critical Element for Health Reform

Risa Lavizzo-Mourey and John Rother

For health reform to be effective and the U.S. economy to recover, we must build, empower, and deploy a 21st century health care nursing workforce. Nurses will deliver, coordinate and direct care in hospitals and community-based and home settings, but these nurses will be in short supply unless we address the nursing and nurse faculty shortages.

Nursing: A Key to Patient Satisfaction

Ann Kutney Lee, Matthew D. McHugh, Douglas M. Sloane, Jeannie P. Cimiotti, Linda Flynn, Donna Felber Neff and Linda H. Aiken

Patients’ reports of satisfaction are higher in hospitals where nurses practice in better work environments or with more favorable patient-to-nurse ratios. Improving nurses’ work environments, including nurse staffing, may improve patients’ experiences and their quality of care. 

The Role of Nurses in Improved Hospital Quality and Efficiency: Real-World Results

Jack Needleman and Susan Hassmiller

Because the staffing and organization of hospital nursing affects quality and cost, nurses must be actively involved in process improvement directed at quality and efficiency. Magnet accreditation and the Transforming Care at the Bedside (TCAB) program show how nurses and staff, supported by leadership, can lead the improvement of health care quality and efficiency.


The Center to Champion Nursing in America is a joint initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation. The Center’s goals are to increase funding to expand nursing education to prepare right-sized and richly skilled nursing workforce; to increase the involvement of nurses in decision making about care delivery and management; to increase the number of nurses remaining in the workforce past traditional retirement age; and to decrease turnover amount new nursing graduates.

AARP is a nonprofit, nonpartisan membership organization that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates.  We produce AARP The Magazine, the definitive voice for 50+ Americans and the world's largest-circulation magazine with over 34.5 million readers; AARP Bulletin, the go-to news source for AARP's 40 million members and Americans 50+; AARP Segunda Juventud, the only bilingual U.S. publication dedicated exclusively to the 50+ Hispanic community; and our website, AARP.org. AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. We have staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. 

The AARP Foundation is AARP’s affiliated charity. Foundation programs provide security, protection and empowerment for older persons in need. Low-income older workers receive the job training and placement they need to re-join the workforce. Free tax preparation is provided for low- and moderate-income individuals, with special attention to those 60 and older.  The Foundation’s litigation staff protects the legal rights of older Americans in critical health, long-term care, and consumer and employment situations.  Additional programs provide information, education and services to ensure that people over 50 lead lives of independence, dignity and purpose. Foundation programs are funded by grants, tax-deductible contributions and AARP. 

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country.  As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change.  For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves.  When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print, with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org