For several years now, stories have been popping up in print and broadcast media about the nursing shortage in the United States. Far from an alarmist media tactic to attract viewers and readers, this shortage is real, and it's going to get worse.
The American Hospital Association reported in June 2001 that 126,000 nursing positions were unfilled and that 75 percent of all vacant hospital positions were nursing positions. The U.S. General Accounting Office (GAO) reported that in 2000 the demand for nurses exceeded the supply of nurses by 6 percent. The Greater Cincinnati Health Council, an organization comprised mainly of area hospitals, calculated that the region, which has 6,892 full- and part-time nursing positions, experienced a shortage of 1,038 nurses in 2001.
This deficit is expected to widen. The GAO and the U.S. Department of Health and Human Services (DHHS) estimate that by 2020 the country will need 28.8 percent more nurses than it has, with 46 states experiencing shortages. Ohio's nursing shortage, which was only 2 percent in 2000, is expected to grow to 28.6 percent by 2020.
Such shortages represent a deadly threat. Each surgical patient added to a nurse's workload increases the risk of death by 7 percent, according to a study by University of Pennsylvania researcher Linda Aiken in The Journal of the American Medical Association.
Patients who experience life-threatening complications are less likely to be rescued in hospitals with heavy patient loads, Aiken found. Similarly, an August 2002 report prepared by the Joint Commission on Accreditation of Healthcare Organizations found that insufficient nurse staffing was a contributing factor in 24 percent of the 1,609 hospital deaths and injuries examined.
These dangerous shortages are the result of powerful supply and demand dynamics. On the demand side, blame it on that massive wave of humanity known as Baby Boomers. Born between 1946 and 1964, Boomers will start heading into their 70s in droves by 2020. DHHS estimates that, between 2000 and 2020, the number of Americans who have seen their 65th birthday will grow by 54 percent, with another 30 percent added between 2020 and 2030. This tsunami of seniors will need more medical care and therefore more nurses.
One of the many factors affecting the supply of nurses is the aging of the current nurse work force. According to statistics released by DHHS in 2002, RNs under the age of 30 dropped from 25.1 percent in 1980 to 9.1 percent in 2000. The GAO estimates that 40 percent of the nursing work force will be more than 50 years old in 2010. By 2011 the number of new nurses will not replace those retiring, resulting in a net decrease in the number of nurses, a trend that will continue for years.
Many nurses leave the profession long before retirement due to job dissatisfaction. Twenty percent of all employed nurses considered leaving the patient care field for reasons other then retirement, according to a 2001 study by the Federation of Nurses and Health Professionals (FNHP), a nursing union. Fifty-six percent of those considered leaving because they wanted a less stressful, less physically demanding job, the study found. Of all nurses responding, 55 percent were dissatisfied with staffing levels and 22 percent said too much overtime was required.
As a general rule, about 10 percent of professionals express dissatisfaction with their job when asked. In a 2000 DHHS survey, 30.5 percent of nurses were dissatisfied, and Penn researcher Aiken found that more than 40 percent of hospital nurses were unhappy.
Such dissatisfaction not only drains the profession of capable nurses but also discourages new entrants. In a survey conducted by the American Nursing Association, 54.8 percent of nurses responding indicated that they would not recommend nursing as a career choice, and 23 percent would actively discourage such a choice.
Yet another cause for the nursing shortage is that, given the exodus from the profession, there are too few nurses-to-be in the pipeline. After years of reporting low enrollment figures, the American Association of Colleges of Nursing (AACN) reported a 16.6 percent increase in enrollments in baccalaureate nursing programs from 2002 to 2003. However, this increase, even if sustained annually, will not provide enough nurses, according to Peter Buerhaus, a registered nurse and researcher at Vanderbilt University.
"Enrollments of young people in nursing programs would have to increase at least 40 percent annually to replace those expected to leave the work force through retirement," Buerhaus wrote in the November/December 2003 issue of Health Affairs.
But due to a lack of faculty at nursing schools, enrollment can't increase by 40 percent annually.
"11,304 applicants who satisfied or exceeded admissions requirements were denied admittance to entry-level nursing programs due to insufficient numbers of faculty ... and other factors," according to an AACN report on 2003 enrollments. Of all schools responding, 64.8 percent cited faculty shortages as the primary constraint on enrollment.
A July 2002 article in The Cincinnati Business Courier confirmed that nursing schools in Cincinnati and Northern Kentucky have not escaped this faculty drought.
"Program administrators predict that the region needs an additional 100 instructors, not to mention new professors to replace those retiring," the Business Courier reported. "At Cincinnati State Technical and Community College, hundreds of students are facing an 18-month wait to get into clinical courses."
As with the nursing shortage overall, the shortage of faculty is expected to worsen. Nursing Outlook reports the average age of nursing school faculty with doctoral degrees is 53.5, and the AACN pegs the average age of those with masters' degrees, the minimum required for teaching in most states, at 49. Because faculty members retire on average at 62.5, a wave of retirements is expected in the next 10 to 15 years.
Next week's Statehouse will examine the steps being taken by federal and Ohio lawmakers, nursing organizations and the health-care industry to reverse the supply-side trends causing this dangerous nursing shortage.