Nation Makes Headway in Averting Nurse Shortage, Federal Study Finds

    • January 22, 2015
A critical response medical team walking in a hospital corridor.

The nation is making good progress toward averting a national shortage of nurses, according to a recent report from the federal government.

If registered nurses (RNs) continue to train at the current levels, the nation’s supply of nurses will grow by the equivalent of nearly 1 million full-time RNs over the next decade, from 2.9 million in 2012 to 3.85 million in 2025—a 33 percent jump, the study found.

Demand for nurses, meanwhile, is expected to grow by 21 percent, from 2.9 million to 3.51 million, over the same time period.

These projections, however, do not account for changes in the health care system created by new models of care and a greater emphasis on wellness and prevention, which are expected to add to the demand for nurses. The study also did not analyze the nursing workforce by education level or address whether the nation will have enough nurses with the kind of advanced education they will need to meet growing demand for more highly-skilled nursing care.

“This report is encouraging in that it suggests we are making progress in growing the nursing workforce—something that is urgently needed with demand for nursing care growing as the nation ages, the burden of disease rises, and as millions of people enter the health care system under health reform,” said Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation (RWJF). “But getting enough nurses in place is only the first step; we also need to make sure we have enough highly educated nurses to care for an increasingly complex population of patients in an evolving health care system where nurses will need to play new and expanded roles. That means following recommendations from the Institute of Medicine’s report on the future of nursing, which calls for 80 percent of nurses to have baccalaureate or higher degrees by 2020.”

Erin Fraher, PhD, MPP, said the findings open up opportunities for a greater focus on transforming the nurse education system so that nurses are better prepared to take on new and expanded roles in health care in areas such as care coordination, population health management, informatics, health coaching, and prevention and wellness. Fraher is director of health workforce research and policy at the Cecil. B. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

“We can’t just talk about numbers,” she said. “We’ve got to talk about the content of care that’s going to be required in this new system. People like to talk about these shiny new grads, but it’s really the nurses who are already in the workforce who are going to take on these new roles and transform care. Do they have the educational opportunities to do that? And can we create continuing learning opportunities to enable them to take on these functions, which are critical to transforming health care delivery?”

Nurses, Fraher added, are the largest group of health care professionals. “If any group of health professionals is going to transform care, it’s going to be nurses. So we have to have an education system that’s going to support their ongoing learning.”

Earlier Report Predicted a Shortage

The report—released in December by the Health Resources and Services Administration (HRSA)—comes a decade after HRSA projected that the nation was not educating enough nurses to avert a nursing shortage by 2020.

In the earlier report, HRSA called for an increase in the number of new nurse graduates, and the nurse education system responded. In 2012 and 2013, more than 150,000 students graduated from nursing schools, up from 68,000 in 2001, the 2014 report finds.

The new report also cites recent data showing that older nurses are staying in the workforce for longer periods of time as a result of the recent recession, which is another contributor to projections of a larger-than-expected supply of nurses.

“The report strengthens the position that there will be an adequate supply of nurses to meet the increased numbers of individuals receiving care due to the Affordable Care Act,” said George Zangaro, director of the National Center for Health Workforce Analysis, a division of HRSA. “The increased supply of nurses allows for greater flexibility to fill expanding roles in a changing delivery system and to provide safe, quality care to our nation’s population.”

The report operates under several assumptions that could mitigate its findings, though. It assumes, for example, that the future production of nurses will remain unchanged, despite large fluctuations in nursing school enrollment in the past. But fewer numbers of nurse graduates, or earlier nurse retirements, could result in a stabilization of the nurse labor market or a shortage of nurses in 2025, the report notes.

“A reduction in people choosing nursing as a career or a combination of factors such as early retirement or increased demand, could be sufficient to erase projected surpluses of RNs,” the report states.

It also predicts geographic imbalances in the nursing workforce in the next decade. But these predictions rest on the assumption that nurses will practice in states where they have been trained. If nurses are willing and able to move to states with higher demand, then these states may not experience shortages.

Fraher also noted that the study does not address nurses in different health care settings. “You can talk about the overall number of nurses however you want, but the fact is that hospitals are going to be employing fewer nurses as care shifts to outpatient settings.”