Registered nurses are the single largest group of health care professionals in the United States. Yet, the vacancy rate for RNs continues to rise and currently stands at 7.2 percent, according to a report from NSI Nursing Solutions (PDF).

Despite that fact, there is still a growing demand for nurses both in hospitals and the community. Employment of registered nurses is projected to grow by as much as 16 percent by 2024, much faster than the average for all occupations, said the Bureau of Labor Statistics.

Growth will occur for a number of reasons.

Demand for health care services will increase because of the aging population, given that older individuals typically have more medical problems than younger ones. As such, nurses will be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. Also, the Patient Protection and Affordable Care Act (ACA) has opened the doors to health care access in numbers heretofore unprecedented, further increasing demand.

In this post, we examine the reasons for the nursing shortage, its effect on the health care industry, what can and is being done to solve the problem, and the outlook for the future.

Reasons for the Shortage

The factors contributing to the nursing shortage are multifaceted: a diminishing pipeline of new nurses due to a faculty shortage that has resulted in thousands of prospective students being turned away, steep population growth in several states, ACA providing increased access, and a baby boom bubble that will require intensive health care services. And these issues are occurring at a time when a significant number of nurses are retiring.

"The biggest challenges facing healthcare are the demographic changes that are pushing expansion of the workforce and the time it takes to educate and train new health care workers to fill those needs," said Stephen Nichols, MD, chief of clinical operations for SCP. "It seems to me that the shift away from LVNs and LPNs to RNs has exacerbated this in the hospital setting. I would expect a return to a larger team with clear roles would be helpful."

Perhaps the most critical factor affecting the nursing shortage in the U.S. is nursing schools’ inability to increase enrollment due to a scarcity of nursing school faculty.

An American Association of Colleges of Nursing (AACN) survey reported that U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.

Also, more than 56 percent of the 714 nursing schools that responded to the survey reported 1,236 full-time faculty vacancies for the 2014-15 academic year.
The following factors have contributed to the nursing faculty shortage:

  • Low salaries for educators compared to clinicians;
  • Age-delayed trajectory of nurses obtaining higher levels of education;
  • Late point in career development for entering educative roles;
  • Inability to fill open faculty roles;
  • Looming retirement of large numbers of currently employed nursing educators.

However, according to new data from AACN, enrollment in baccalaureate, master’s, and doctoral nursing programs increased in 2014 with the greatest gains found in baccalaureate degree-completion programs: 4.2 percent. In graduate schools, student enrollment increased by 6.6 percent in master’s programs and by 3.2 percent and 26.2 percent in research-focused and practice-focused doctoral programs, respectively.

Other factors contributing to the nursing shortage include:

  • Hospital acuity. Acuity in hospitals has been on the rise due to the declining average length of stay and new technology that allows rapid assessment, treatment, and discharge.
  • Aging population. As a high percentage of Baby Boomers reach retirement age, their need for health care will grow and intensify.
  • Aging workforce. A significant segment of the nursing workforce is nearing retirement age. According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55 percent of the RN workforce is age 50 or older. Also, the Health Resources and Services Administration projects that more than one million registered nurses will reach retirement age within the next 10 to 15 years.
  • Workload and work environment. In response to health care cost pressure, hospitals have been forced to reduce staffing and have implemented mandatory overtime policies to ensure that RNs would be available to work when the number of patients admitted increased unexpectedly. An increased workload may affect the decision to enter or remain in the nursing profession.

Effects of Nursing Shortage on Patient Care

Due to the shortage, nurses often need to work long hours under very stressful conditions, which can result in fatigue, injury, and job dissatisfaction. Nurses suffering in these environments are more prone to making mistakes and medical errors. An unfortunate outcome is that patient quality can suffer, resulting in a variety of preventable complications, including medication errors, emergency room overcrowding, and more alarmingly, increased mortality rates.

Solving the Nurse Shortage Problem

A range of solutions has been offered as a way to solve the nursing shortage problem that include subsidized funding, wage increases, hiring minority and foreign nurses, and campaigns to improve the profession’s image.

Funding options. Many experts recognize the need to increase funding for nursing education, directed toward nursing faculty as well as students.

Nursing schools are forming strategic partnerships and seeking private support to help expand student capacity. For example, the University of Minnesota announced a partnership with the Minnesota VA Health Care System in June 2013 to expand enrollment in the school’s BSN program.

ACA includes loan programs both to nursing students and faculty that are designed to help alleviate the shortage.

  • The Nursing Education Loan Repayment Program (NELRP) is a selective program of the U.S. Government that helps alleviate the critical shortage of nurses by offering loan repayment of up to 85 percent of outstanding loans to RNs and advanced practice registered nurses.
  • The Nurse Faculty Loan Program (NFLP) is intended to increase the number of qualified nursing faculty to facilitate the education of nurses.

Higher wages. Another way to address the nursing shortage would be to devote resources toward increasing RN wages. This approach could affect recruitment as well as retention of RNs already in the workforce.

Increased minorities. Increasing the number of minorities who become RNs could bolster the supply of RNs and have the additional benefit of improving delivery of culturally sensitive care.

Foreign nurses. Hiring foreign nurses would be another way to address shortages in the United States. Proponents of this approach note that hospitals have relied on foreign nurses, often brought to the United States with temporary work visas, to address past shortages. For example, in 1989, 24,400 foreign nurses worked in the United States under temporary visas.

Improved image. Lastly, experts suggest a need to improve the image of nursing. Strategies range from encouraging nurses to communicate more frequently with the press about positive aspects of nursing to launching professional advertising campaigns promoting the profession.

SCP Consulting Services

Perhaps no group understands the challenges of the nursing shortage better than SCP's Consulting Services, which utilizes skills and expertise from practicing clinical consultants to aid in solutions that work for clients and the nurses they employ.

"Many hospitals have tackled this issue for decades by redesigning the care delivery model and optimizing patient care services technical roles, including LPN, LVN, and many others," said Linus Diedling, partner, SCP Consulting Services. "It is critical to approach the problem with a holistic view that the care model must be carefully designed to optimize workflow and roles to enable all care team members to work at the upper limits of licensure. This approach includes being clear about the impact on the scarce nursing resources that the patient and family may have in a continuum based patient centered care model."

Before offering any change recommendation, an analysis always includes the potential impact to nursing in order to maximize the benefit to the patient. By utilizing the unique skill sets of registered nurses and clinical professionals in the consulting division, SCP is able to offer clients solutions while keeping in mind their largest staff audience.

Speaking from personal experience, Traci Shortt, Clinical Operations Specialist and Lead Nurse Practitioner, said, “One of the most satisfying aspects of nursing is the personal interaction experienced in the nurse-patient relationship. In today's technologically demanding environment, when employers can promote this interaction in their processes, nurses and patient’s both win."

Nursing Shortage Future

In spite of these proposed solutions, with demand currently exceeding supply, the nursing shortage is not likely to diminish in the near term. There is hope for the future, however.

A 2014 report from the U.S. Department of Health and Human Services entitled The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025 (PDF) said that the change in RN supply between 2012 and 2025 is projected to outpace demand.

"Assuming RNs continue to train at the current levels and accounting for new entrants and attrition, the RN supply is expected to grow by 952,000 full-time equivalents (FTEs) — from 2,897,000 FTEs in 2012 to 3,849,000 FTEs in 2025 — a 33 percent increase nationally," the report said.

Conversely, the nationwide demand for RNs is projected to grow by only 612,000 FTEs — from 2,897,000 FTEs in 2012 to 3,509,000 FTEs in 2025 — a 21 percent increase, resulting in a surplus in excess of 340,000 RNs by 2025.

Additional reading:

Visit the AACN website to learn more about the nursing shortage and the strategies to address the growing need for more nurses. Also, review the brief, The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions (PDF). Information from both sources were cited in this post.