Nursing Shortage

Legislative Initiatives to Improve the Nursing Shortage

The United States is facing a nursing shortage that will continue to increase as the baby boomers enter their senior years and boost the demand for healthcare services. In 2005, the United States Department of Labor listed registered nursing as the number one occupation for job growth through 2012. The projections indicate that over one million new and replacement nurses will be needed as we enter the next decade (Fastest Growing Occupations, 2005). The potential crisis the United States is facing must be addressed with appropriate legislative actions that will help to augment the number of nurses needed to address this problem.

In 2000, the number of full-time registered nurses was estimated at 1.89 million and the demand was estimated at 2 million. That equates to an approximate shortage of 110,000 nurses or 6 percent (Projected Supply, Demand, and Shortages of Nurses, 2002). Trends in the supply of nurses have been followed in order to estimate the projected shortage in the future. It is expected to grow slowly until 2010 when it reaches 12 percent. From 2010 to 2015, the demand for nurses will begin to exceed the supply and the shortage will increase to 20 percent. Barring effective corrective measures, the shortage will continue to increase and reach 29 percent by 2020 (Projected Supply, Demand, and Shortages of Nurses, 2002).

The projected 29 percent shortage in 2020 is the result of a 40 percent increase in demand between 2000 and 2020 in comparison to a projected 6 percent growth in supply (Projected Supply, Demand, and Shortages of Nurses, 2002). The biggest factor for the increase in demand is the increasing proportion of elderly people. In May 2001, the Nursing Institute at the University of Illisois College of Nursing issued a report stating that "the ratio of potential caregivers to the people most likely to need care, the elderly population, will decrease by 40% between 2010 and 2030" (Nursing Institute at the University of Illinois College of Nursing, 2001). An overall 18 percent increase in population coupled with advances in medicine are major factors as well. Projected growth in supply will reach a peak of 10 percent by 2011 and then begin to decline as more nurses leave the profession than enter it (Projected Supply, Demand, and Shortages of Nurses, 2002). (See Chart 1)

(Chart 1)

Factors affecting the future supply of RNs shed light on what has caused the current shortage. These factors include the declining number of nursing school graduates, the aging of the RN workforce, declines in relative earnings, and the emergence of alternative job opportunities (Projected Supply, Demand, and Shortages of Nurses, 2002). In the spring of 2005, a survey was conducted by the American Association of Colleges of Nursing (AACN) to determine the level of enrollment in baccalaureate nursing programs in 2004 compared to the previous year. An unexpected increase of 14.1 percent was the result. Early indications released on December 15, 2004, had predicted a 10.6 percent increase in enrollment (New Data Confirms Shortage of Nursing School Faculty Hinders Efforts to Address the Nation's Nursing Shortage, 2005).

These findings were collected from 590 nursing schools located throughout the United States and its territories. The surveyed universities comprise 85.9 percent of the schools that grant baccalaureate and/or graduate degrees in the nursing field (New Data Confirms Shortage of Nursing School Faculty Hinders Efforts to Address the Nation's Nursing Shortage, 2005). The total enrollment in all nursing programs leading to the baccalaureate degree increased from 126,954 in 2003 to 147,170 in 2004. Of the 147,170 enrollees, there were 112,180 students enrolled in entry-level baccalaureate nursing programs (New Data Confirms Shortage of Nursing School Faculty Hinders Efforts to Address the Nation's Nursing Shortage, 2005).

However, although the level of educational training is increasing, it is not sufficient to meet the projected demand for services. According to the Health Resources and Services Administration, 44 states, including Florida, are expected to have shortages in registered nurses (RNs) by the year 2020 (Expected Supply, Demand and Shortages of Registered Nurses: 2000-2020, 2000). In the December 2003 issue of Health Affairs, Dr. Peter Buerhaus observed that "because the number of young RNs has decreased so dramatically over the past two decades, enrollments of young people in nursing programs would have to increase at least 40 percent annually to replace those expected to leave the workforce through retirement" (Buerhaus, 2003).

In the second half of the 20th century, the number of new RN graduates decreased every year. From 1995 to 2000, it decreased by 26 percent (Projected Supply, Demand, and Shortages of Nurses, 2002). This decrease combined with the increasing age of current graduating classes and the advancing age of registered nurses has resulted in an increase in average age. As a result, the supply of nurses in 2020 will not be larger, but their average age will be higher (Expected Supply, Demand and Shortages of Registered Nurses: 2000-2020, 2000). (See Chart 2)

(Chart 2)

Salaries will also be a major contributing factor in the declining supply of registered nurses. From 1983 through 2000, the yearly salaries of registered nurses progressively increased (Projected Supply, Demand, and Shortages of Nurses, 2002). However, the increase in salary was offset by the annual rise of inflation. In essence, there has not been an increase in purchasing power. Many nurses may choose to leave the profession or continue their education in search of other healthcare careers due to the decreases in staffing, the resulting deficiencies in the quality of care, and the decline in relative earnings.

The supply of future registered nurses in Florida is predicted to be worse than most of the country. Projections indicate that by 2020, there will be a shortage of 52,061 nurses throughout the state (Projected Supply, Demand, and Shortages of Nurses, 2002). (See Chart 3) The main factor in this shortage will be the continuous entry of the baby boomers into the state combined with their increasing age and healthcare needs.

(Chart 3)

This problem is highly publicized and a major concern to many people throughout the state. Effective solutions have been debated and there are some possibilities, especially through potential legislation, that