Tide of new nurses rises but shortages still loom large

November 17, 2004

NASHVILLE, Tenn. -- The number of registered nurses entering the job market appears to be on a steady incline, with a total employment growth of over 200,000 R.N.'s since 2001, the largest increase since the early 1980's, but experts at the School of Nursing say it's still not enough to prevent a long-term crisis that threatens to cripple the entire health care system.

The new numbers come from Peter Buerhaus, Ph.D., Valere Potter Professor of Nursing; senior associate dean for Research at the School of Nursing, in an article appearing in the Nov. 17 health policy journal Health Affairs. "While R.N.'s over age 50 have provided much of the expansion of hospital employment since 2001, it is striking that in 2003, employment of younger RNs grew by nearly 90,000, reaching the highest level observed for younger R.N.'s since 1987," said Buerhaus. "This entry of younger RNs into the workforce is consistent with reports of substantial gains in enrollments at nursing schools since 2001, and may represent the first wave of two-year program graduates."

The number of men entering workforce has also been growing at a steady rate over the past two decades, increasing from 5 percent in 1983 with about 60,000 R.N.'s in the workforce, to nearly 9 percent, or 160,000 in 2003. "Both of these groups are probably responding to higher wages and opportunities in nursing driven by publicity about the nursing shortage, and many have just graduated from associate degree nursing education programs," said Buerhaus. The research shows older women and foreign-born women are still a factor and account for a large share of the growth.

But Buerhaus said the most surprising findings from his research show that even with the significant increase in nurses joining the workforce, the nursing shortage is far from over. Buerhaus said it is unlikely that the recent increase in younger nurses will provide enough new nurses to solve the projected long-run shortage. "The workforce is projected to peak at a size of 2.3 million in 2012 and shrink to 2.2 million by 2020 - a modest increase of roughly 60,000 R.N.'s over forecasts without the new data. This total pales in comparison to the Health and Resource Service Administration's latest forecast of 2.8 million full-time R.N.'s that will be needed in 2020. Thus a very, very large shortage still looms on the horizon, a shortage so large that it could easily cripple the entire health care system, not just hospitals," he warned.

Buerhaus said the growth in the number of nurses on the job can be attributed, in part, to second consecutive year of wage increases, relatively high national unemployment, and continued initiatives aimed at increasing interest in the nursing profession. Corporations and other groups have also aided the effort to attract more nurses to the profession and provided scholarships to nursing students. Johnson & Johnson launched the multi-million dollar "Campaign for Nursing's Future." The campaign focused on the image of nurses, educating the public on the opportunities offered by a career in nursing, improving retention of nurses in clinical positions, raising funds for scholarships and grants, and addressing capacity problems confronted by nursing education programs.

But those programs are only part of the solution, according to Buerhaus. He said replacing the large number of RNs born in the baby boom generation, who will retire between 2010 and 2020, will require a major and swift expansion in the number of graduates from nursing education programs, particularly from baccalaureate programs. Graduates from those programs are typically in their 20s, and are more likely to contribute a greater number of years in the workforce, yet an emerging nursing faculty shortage has forced many nursing schools to turn prospective students away. "Nursing education programs will have to overcome capacity constraints in order to expand and meet the demands, which calls for decisive action and resources. Congress should fund a study to investigate the prevalence and severity of capacity constraints and determine the best ways to quickly resolve them," suggested Buerhaus.

Buerhaus' study used data from the Current Population Survey (CPS) to construct and analyze national estimates of annual R.N. employment and earnings to examine changes in the nurse labor market in 2003. The CPS is a household based survey administered monthly by the U.S. Census Bureau. The data analyzed included all individuals between the ages of 21 and 64 who reported their occupation as a registered nurse between January 1983 and December 2003.
For Web access to the current issue of Health Affairs visit: www.healthaffairs.org. Click on "activate online subscription," enter "media" (no quotation marks) as the user name and "november" (no quotation marks) as the password. The user name and password will be good through Dec. 31.

Vanderbilt University Medical Center

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