Brenda Cleary is Working to Avert the "Mother of All Nursing Shortages"

    • June 24, 2009

The problem: The recession has made jobs for new nursing graduates in some areas of the country harder to find. But the current nursing workforce dynamics are temporary phenomena that create the false impression that the nursing shortage has been solved when this economic downturn may, in fact, end up making it worse in the long run.

Background: Brenda Cleary, Ph.D., R.N., F.A.A.N., took an early interest in caregiving as a child in a small town in the rural Midwest. As a young girl, she toted around a pretend doctor’s kit and cared for unsuspecting playmates. Later on, she looked after a grandfather with multiple chronic conditions and tended to an elderly neighbor after school.

Cleary cultivated her blossoming passion for caregiving as a student at the University of Indiana, where she earned a bachelor’s degree in nursing in 1973 and a master’s in 1980. Nine years later she graduated from the University of Texas with a doctorate and became a tenured professor and nursing school dean.

It was as a nurse educator that Cleary learned first hand about the cyclical ebbs and flows in the nursing workforce. But she didn’t fully appreciate the magnitude of the coming shortage until she took a position in 1994 as executive director of the North Carolina Center for Nursing in Raleigh, N.C., an agency that monitored the supply and demand for nurses in the state. As head of the agency, Cleary picked up on early signals that the next nursing shortage would be far more severe thanks to the simultaneous aging of the general population and the nursing workforce. Demand, in other words, was projected to skyrocket, while the supply of nurses was on track to plummet. “It was the perfect storm,” she says. “And it wasn’t going to be solved by wage increases or simply producing the number of new nurses that we had in the past.”

Cleary began to sound the alarm in the 1990s, assembling state and national workforce data on the coming shortage, devising ways to educate health care professionals, policy-makers and the public about the problem, and chairing the national steering committee of the forum of state nursing workforce centers. She developed a reputation as an expert in nursing workforce issues, which led to her current position as director of the Center to Champion Nursing in America (CCNA), a joint initiative of the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation. This Washington, D.C.-based advocacy group works to ensure that the supply of nurses meets demand.

As the center’s director, Cleary has devoted countless hours to getting the message out about the severity of the nursing crisis and the urgent need to take steps to avert it. But the recession has at times undercut Cleary’s message: These days, the news media are trumpeting stories about nursing graduates who are unable to find jobs, causing some to conclude that the nursing shortage has been resolved.

Nursing jobs, of course, are harder to find these days. Part-time nurses are picking up more hours to compensate for lost income from a laid-off spouse or a shrinking retirement account, and nurses are staying in the workforce past the traditional retirement age. New nursing graduates are having a particularly tough time finding work in some parts of the country because they require more extensive mentoring than experienced nurses. And that phenomenon has led to a number of stories about nursing school graduates—once thought to be holding degrees worth their weight in gold—who can’t find work.

Cleary has a quick response to that message: There may be a temporary reprieve in the demand for nurses, she says, but the shortage still looms. The recession, in fact, may exacerbate the looming crisis because cash-crunched state legislatures and health care philanthropies are cutting funding for the kind of nurse education programs needed to train the next generation of nurses. And blaring headlines declaring the end of the nursing shortage generate complacency about the need for serious intervention. “If we are complacent now, it could be disastrous,” Cleary says.

At the Center to Champion Nursing in America, Cleary has gone on the offensive to counter misleading stories in the national news media. She has worked with the CCNA team to develop background material, communications strategies and regional data for national and state groups. And she collects, tracks and compiles research and publishes it on the center’s Web site, which serves as a sort of clearinghouse on the nursing shortage.

Results: She can already see the fruits of these labors. Despite headlines suggesting the contrary, focus group studies show that the public still believes a nursing shortage looms, she says. And policy-makers are taking unprecedented actions to solve the problem. “We are getting some high-level people to understand that what we’re seeing is just temporary,” she says. “They understand that if we don’t invest now, this mother of all shortages will occur, and it will cripple the nation’s health care system and our nation’s health.”

Cash-crunched states are still finding ways to contribute to nursing education programs, Cleary says. Even California, which faces massive budget deficits, managed to find $60 million to support the state's nursing education programs. And lawmakers at the federal level are making serious commitments to curbing the coming shortage. At the beginning of the year, Congress included in the economic stimulus package $200 million for nursing and other health care workforce development programs and $250 million for job training and placement programs in high growth jobs like nursing.

The federal government hasn’t stopped there. This spring, Congress enacted a fiscal year 2009 budget that included increases of nearly 10 percent for nursing education programs and 46 percent for nurse faculty loan-repayment programs. And in May, President Obama submitted a budget for fiscal year 2010 that includes an additional $95 million for nursing education—a 50 percent increase from 2009. “I’ve been doing this a long time and I’ve never seen higher visibility and earlier results than I’m seeing right now,” she says. “It’s worth all the long hours.”

RWJF perspective: The Foundation has long recognized the severity of the looming shortage and its potential impact on the nation’s health care system and health. To avert the crisis, the Foundation has taken a multi-pronged approach that includes initiatives to encourage more nurses to pursue academic careers; promote future leaders in nursing education; identify strategies to retain experienced nurses and reduce turnover among new nurses; and fund community-level projects to develop strategies to curb, and potentially reverse, the coming shortage.

Learn more about Brenda Cleary’s work at the Center to Champion Nursing in America at its revamped Web site,