The health care segment in the US accounts for one of the leading areas of employment in the economy. The pressure emanating from the elderly population, especially due to chronic illnesses, highlights the need for specialized care as depicted by the rising demand for palliative and hospice care. Additionally, the health care reforms including the Obamacare initiative have enhanced the accessibility of such services thus increasing the demand for health care provision (MacLean et al., 2014). Despite the 24% growth of the registered nurses (RNs) workforce witnessed over the past decade, the new trends in the sector necessitate additional nursing practitioners as education institutions expand their capacity to contain the growing number of students seeking to pursue the nursing career. Moreover, the 2.6% upsurge in enrollments for the baccalaureate programs in the US nursing education institutions is not enough to meet the rising demand for RNs (Staiger, Auerbach, & Buerhaus, 2012). Therefore, this paper focuses on the US nursing shortage trend by identifying the contributing factors before recommending the strategies that would address the issue adequately.
Current and Estimated Nurses Shortage Indicators
Several projections indicate that the nursing field is experiencing a shortage of practitioners thus necessitating the essence of filling the vacant positions to meet the public’s ever-increasing health needs. The nursing workforce would grow from 2.71 million to 3.24 million RNs between 2012 and 2022, which is a 19% increase. However, the replacement of at least 1.05 million RNs within the same period due to retirement or other factors implies that the sector would experience a workforce shortage not only currently, but also in the long run (MacLean et al., 2014).
Notably, the period between 2010 and 2011 witnessed a considerable increase in job advertisements for RN positions as 121,000 new job vacancies arose thereby accounting for a 46% increase in such ads. Specifically, the staffing agencies and employers required the RNs to fill positions in the surgical and general hospital setting, since such positions accounted for 10% of the posted advertisements (Staiger et al., 2012). In this regard, the upsurge in the number of new vacant positions underlines the extent to which demand outweighs the current supply, especially in the surgical areas of health care provision.
Furthermore, the healthcare sector requires at least 80% of the RNs’ workforce to gain advanced qualifications, especially through the baccalaureate curriculum. Besides, there is a 100% increase in RNs’ population with doctoral degrees to perform specialized functions in the profession. Conversely, the current nursing population does not meet the recommended qualifications, since only 50% have been prepared through the baccalaureate program or have acquired a graduate degree (MacLean et al., 2014).
Despite the relative adequacy of the nursing professionals experienced during the recession, projections show that the period between 2009 and 2025 will experience the most significant shortage of nurses. The magnitude of the inadequacy of the nursing professionals would double as compared to the situation experienced in the sector during the mid-1960s (Staiger et al., 2012). Therefore, intervention should take effect to curb the current trend from becoming a crisis as it has the potential of exceeding the implications of an economic recession in the US setting owing to the economic, social, and political consequences it could evoke.
Additionally, in the next two decades, the RNs’ average age would increase significantly as a considerable number of nurses would retire thus forming a plateau in the sector’s workforce. Consequently, the better half of the coming decade would experience insufficiency in the number of nurses amid the increasing demand for their services in the US health care facilities. As noted earlier, the baby boomers population, which forms a considerable proportion of the nursing population, would exit the profession thereby leaving a gap that should be filled immediately to curb the escalation of the impending nurses’ shortage crisis.
Moreover, owing to the annual vacancy rate of at least 8% in the US nursing sector, the need for increasing the number of qualified nurses from various educational institutions is relevant. Projections point out that the US health care sector should have on average 30,000 additional nursing graduates every year to fill the vacant positions in the nursing field. The growth of the nursing students intake would mean a 30% increase of nursing graduates annually. This move will facilitate the move towards alleviating the shortage of nurses, which is currently threatening the sustainability of the US health care workforce (Duvall & Andrews, 2010).
Factors Contribution to the Nursing Shortage
Various factors have triggered the shortage of RNs in the US health care sector. Notably, issues on the capacity of the nursing school faculty, retirement, demographic changes, unfavorable working conditions, and high nurse turnover account for the leading factors that propel the dangerous trend, prevalent in the nursing workforce (Duvall & Andrews, 2010). In this concern, addressing the issues would play a central role in handling the situation thereby improving the quality of health care provision.
The number of enrollments in nursing programs has gone down over the years due to the scarcity of nursing school faculty in the US education system. Inadequate classroom space, the number of faculties, clinical sites, as well as financial constraints triggered various educational institutions in the US to turn down almost 80,000 qualified applicants for graduate and baccalaureate programs during the 2012/13 academic period. Notably, 33%of the institutions identified the faculty shortage as the reason for rejecting all the qualified applicants for nursing programs (Duvall & Andrews, 2010). Furthermore, a 12% shortage in the number of nursing educators undermines the rate at which institutions providing nursing education enroll applicants, besides other issues, including resignations and anticipated retirements (Shipman & Hooten, 2008). Consequently, the trend poses a threat to the sufficiency of the nursing workforce in the next five years.
A considerable proportion of the RNs’ population is approaching the retirement age, since 55% of the workforce comprises individuals at the age of 50 or older (Duvall & Andrews, 2010). Therefore, the need to replace the retiring RNs intensifies to narrow the gap between the demand and supply. Estimates reveal that in the next 10 to 15 years, at least 1 million RNs will retire implying that the sector requires more than a million RNs to join the industry within the same time window. The seriousness of the retirement issue manifests itself in the RNs’ average age increase to 47.0 years in 2010 compared to 42.7 years in 2000. It necessitates that health care professionals have a few years to offer their services before clocking the retirement age (Staiger et al., 2012).
The growing healthcare needs of the aging population depict the effects of the demographic changes experienced in the US that call for specialized nursing care. As such, the demographic changes exert pressure on the current state of demand and supply of the nursing practice as the baby boomers approach the age of 60 and above. The current demand for palliative and hospice care, especially for the elderly population affected by chronic illnesses, portrays the effects of the demographic changes associated with the health care sector. Additionally, forecasts reveal that between 2010 and 2030, the ratio of nurses and elderly patients would decrease by a significant 40%, thus, hindering the latter’s access to nursing and caregiving services (MacLean et al., 2014).
Notably, the inadequate staffing heightens the stress level among RNs resulting in reduced job satisfaction thereby influencing them to abandon the profession. In this concern, 75% of nurses attest that the current workforce shortage in their field undermines the quality of their life at work, patient care quality, and the amount of time they allocate to patient care. As such, the increased stress among nurses due to the shortage prompts a significant 93% of the RNs to exit the profession (Staiger et al., 2012).
Moreover, the high rate of the RNs’ turnover witnessed lately leads to high vacancy rates, and it constrains health care accessibility. Statistics showed that the average turnover for RNs stood at 13.9% while the vacancy rate staggered at 16.1% in 2005. Alarmingly, in 2007, 13% of RNs who had newly acquired licenses switched principal jobs within the initial year of practice as 37% of them claimed they hoped to change jobs in the near future (MacLean et al., 2014). In this regard, the trend unmasks the dissatisfaction among the RNs in the profession partly due to the shortage that subjects them to stressful working experiences. It reveals the need for retaining RNs besides additional recruitments.
Addressing the Nursing Shortage Issue
Due to the danger posed by the nurses’ shortage, the development of appropriate strategies would facilitate an improvement in the current workforce situation. In so doing, the detrimental outcomes of the trend as projected would be curtailed resulting in the improvement and accessibility of health care services. In this case, nursing schools need to engage in partnerships with the aim of enhancing their capacity to enroll qualified applicants for the various nursing programs. Additionally, establishing more opportunities for graduate nursing programs besides the baccalaureate programs would allow more applicants to enroll thus reducing the nurses’ shortage in the future by bolstering education capacity of nursing schools (Duvall & Andrews, 2010).
Moreover, the creation of favorable working conditions would facilitate the improvement of the RNs’ work life. Therefore, the initiative would reduce the rate of the RNs’ turnover in a manner that fosters the sustainability of the current workforce. Furthermore, providing reimbursement opportunities for the RNs to advance their education as a benefit arising from their work commitment would also facilitate their retention besides bolstering their career development (MacLean et al., 2014).
Advocacy efforts influencing the US health sector leaders to realize their essential role in the system would facilitate the development of policies that curb the escalation of the nurse shortage problem. The development of evaluation systems that monitor the relationship between nursing services and patient satisfaction would also create motivation and commitment among the nurses in their line of duty. Furthermore, the development of strategies that seek to enhance the capacity of nursing educators would assist in boosting the adequacy of the nursing workforce (Shipman & Hooten, 2008).
The nurse shortage in US threatens the delivery of the highly demanded health care services to a considerable degree. Contributing factors like the low capacity of the nursing schools, retirement, and unfavorable working conditions require mitigation through various strategies to improve the situation. Mainly, fostering the enrollment capacity of the nursing schools, increasing the number of nursing educators, and improving the working conditions besides other strategies would facilitate the realization of an adequate nursing workforce.
Duvall, J. J., & Andrews, D. R. (2010). Using a structured review of the literature to identify key factors associated with the current nursing shortage. Journal of Professional Nursing, 26(5), 309-317.
MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014). Scale, causes, and implications of the primary care nursing shortage. Annual Review of Public Health, 35, 443-457.
Shipman, D., & Hooten, J. (2008). Without enough nurse educators there will be a continual decline in RNs and the quality of nursing care: contending with the faculty shortage. Nurse Education Today, 28(5), 521-523.
Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2012). Registered nurse labor supply and the recession—are we in a bubble. New England Journal of Medicine, 366(16), 1463-1465.