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Massachusetts Nurses Association Fact Sheet
The Burgeoning Nursing Shortage
Editors/Reporters’ Note: For more information
and sources for interviews contact David Schildmeier at 781.821.4625
x717 or email dschildmeier@mnarn.org
Overview:
- Unlike the shortage of the 1980s, this one is
not about sheer numbers of nurses, but about having nurses with
the needed specialties, skills and experience. Nurses are in particular
demand if they can lead multi-disciplinary teams, serve as patient
educators and managers of care across the continuum, or demonstrate
a high level of skills in the operating room, recovery room, emergency
room, Intensive Care Unit, Critical Care Unit, pediatrics, Newborn
Intensive Care Unit, Pediatrics Intensive Care Unit and labor
and delivery.
- A shortage of experienced nurses exists because
hospitals cut staff in an effort to boost profits. They
targeted higher paid, experienced nurses and replaced them with
untrained, unlicensed cheaper staff. Many of the nurses
refocused their skills and experience and found employment elsewhere.
Hospitals now realize their shortsightedness, but are having difficulties
recruiting nurses with the experience required to care for acutely
ill patients.
- In hospitals, where care is primarily restricted
to the acutely ill as a result of tighter restrictions by the
insurance industry, the demand for RNs has never been greater.
People are living longer and have more complex conditions, but
there are not enough nurses in hospitals to meet their needs.
- The shortage has broad implications for the
delivery of cost-effective, quality care. Increased reliance
on high technology, greater patient acuity levels, an emphasis
on cost containment, and a movement away from traditional hospital-centered
care are dramatically changing the health care delivery environment.
These changes affect how and where nurses work and increase the
demand for nurses' services.
How Do We Know There is a Nursing Shortage?
Nursefinders, a temporary help agency with 119 offices
in 36 states, has 8,000 nurses in hospitals, but the company cannot
keep up with the demand. (The New York Times, March, 23, 1999).
Hospitals are taking a variety of measures to entice
nurses: $500 or more employee referral bonuses, $1,500 to
$8,000 relocation allowances, $500 to $5,000 signing bonuses and
$500 to $3,000 continuing education allowances. (Modern Healthcare,
Dec.14, 1998)
A survey of 338 acute care hospitals reveals an
increased demand for experienced, specialized registered nurses.
Hospitals say it takes 90 days to fill a vacancy for clinical care
and operating room nurses and nurse managers. For experienced
nurses in all categories, the average is 45 days. These shortages
contribute to difficult, dissatisfying work environments for nurses,
patients and physicians. Urban hospitals reported significantly
more difficulty in filling nursing vacancies. The Midwest
saw the greatest increase in the time it takes to fill nursing positions.
(AONE survey, released 2/23/99)
Nurseweek magazine is filled with advertisements
for nurses. “Want to make an easy $4,000?” asks an ad for
Beverly Hospital in Los Angeles, which offered the sign-on bonus
to qualified registered nurses. (Sacramento Bee, Jan. 17,
1998).
Why is There a Nursing Shortage?
A number of factors, including: increasing demand,
decreasing supply, maldistribution and geographic shortages, and
salary compression all contribute to the nursing shortage.
An Increasing Demand for Nursing Care
The rapid aging of both the population and the nursing
workforce may result in the supply of nurses not being able to maintain
pace with the growing demand, says Peter Buerhaus, director, Harvard
Nursing Research Institute. (Nursing Outlook, April/May 1998).
Following are factors (identified by researchers
and professional organizations) that have contributed to the increased
demand for nursing services:
- Cost-containment within health care organizations
resulting from managed care and an increasingly competitive health
care environment.
- Hospital consolidation, downsizing and reengineering
- Reductions in inpatient hospitalization rates
- Increased acuity of hospital patients
- A shift of outpatient care to ambulatory and
community-based settings.
- A greater focus on primary care and health promotion.
A Decreasing Supply of Nurses–an aging workforce,
poor working environment, closure of nursing schools, nursing faculty
shortages and other career opportunities for women and RNs have led
to a decreasing supply of nurses.
The rapidly aging RN work force is likely to present a serious
and overwhelming supply problem that will be compounded by declines
in enrollments in baccalaureate nursing programs, and by the failure
to attract more men and minorities into the nursing profession.
(Buerhaus, Peter, director of Harvard Research Department
of Health Policy and Management at Harvard School of Public Health.
Is Another RN shortage looming?).
Approximately 50% of nurses are entering their fifties, and many
will leave the work force within the next ten years. Since
1985, the average age of the working RN has increased one third
of a year annually. (Buerhaus, Peter, director of Harvard
Research Department of Health Policy and Management at Harvard School
of Public Health).
Nursing, the largest of the health professions, is also the fastest
aging occupation of all occupations in the United States.
For example, as of 1996, only 10% of nurses were under the age of
30. Other characteristics include: 2.2 million are working
in nursing, 60% are employed in hospital settings, 95% are women,
and only 10% are minorities (National Sample Survey of Registered
Nurses, March 1996, U.S. Department of Health and Human Services).
The hospital industry has created a hostile environment for nurses.
For example, the hospital industry is laying off nurses, replacing
them with cheaper, minimally trained personnel, transferring them
to lesser jobs and battling with them over wages. Meanwhile,
RNs are exposed daily to potentially lethal health and safety risks
such as needlesticks, back injuries, latex allergy and indoor pollution.
Nursing schools and nursing training programs closed or scaled
back their programs when jobs were cut in the hospital setting.
Potential nursing students responded in kind, with fewer enrolling
in nursing school.
As health care facilities strive to meet rising demands for RNs,
enrollments of entry-level bachelor’s degree students in the nation’s
nursing schools fell by 5.5% in fall 1998–the fourth consecutive
year enrollments have declined. (AACN 1998 Survey, released 1/25/99).
Nursing schools also report cutting back admissions because of
nursing faculty shortages. In an informal poll of 159 deans,
most (94) said they had yet to feel the effects of faculty shortages,
but 64 schools reported that recruitment difficulties were hampering
their ability to increase school enrollments. (AACN Issue Bulletin,
April 1999)
Greater opportunities exist for women and for nurses. RNs
can work in a variety of settings other than the hospital, such
as home health, nursing homes, clinics, community settings, doctors’
offices, and their own businesses. With the bedside RN cutbacks,
some nurses began to pursue advanced degrees in order to provide
preventive and primary care as an advanced practice registered nurse
(AACN Issues Bulletin, February 1998)
Maldistribution/Geographic Shortages
One of the main problems is one of maldistribution. An unmet
need exists for RNs with specific skills, such as those required
in the operating room, emergency room, and intensive care unit,
says Peter Buerhaus, director, Harvard Nursing Research Institute.
(Nursing Outlook, April/May 1998).
Urban hospitals are having the hardest time filling nursing vacancies
and reported increased use of agency and contract nurses, as did
larger hospitals in general. Smaller hospitals experienced
greater difficulty and required more time in recruiting obstetrics
nurses. The Midwest saw the greatest increase in the time
needed to fill nursing positions. (AONE study, November 1998)
The shortage has hit the West hard--94 percent of Western region
respondents indicated they have or anticipate having a shortage
as opposed to 75 percent in the Midwest. Half of all the hospitals
indicated that vacancy rates had not changed and one-third believe
vacancy rates are greater than a year ago. (Hay Group Study, Spring
1998)
The shortage might be part of an international trend. Along
with urban areas, other parts of the world, such as Hawaii, Florida,
the northern Midwest, North Carolina, Great Britain, Canada, and
Denmark are also reporting shortages. (AHA News, More areas
report nursing shortages, but analysts don’t foresee a crisis, Sept.
7, 1998.)
Geographic shortages reflect demographic patterns. For example,
Florida needs more gerontological nurse practitioners. (American
Association of Colleges of Nursing, February 1998).
Salary Compression
The spread of managed care in the 1980s, with its pressure for
efficiency and lower costs, dampened job growth for nurses and contributed
to a drop in their real wages. Between 1994 and 1997, employment
growth for RNs was just under 2 percent a year while wages, after
adjusting for inflation, dropped an average of 1.5 percent each
year. Wage and job growth fell first in states with high enrollments
in HMOs, then spread to other states as managed care also spread.
(Health Affairs, January/February 1999)
The hourly salary has remained flat. A nursing graduate and
an engineering graduate might start out at the same salary – approximately
$32,000, but after five years the engineer is making close to $70,000;
whereas, the nurse is making about half that amount. (Florida Nurses
Association).
More Key Facts on the Nursing Shortage…
- The Bureau of Labor Statistics reports that
jobs for RNs will grow 23 percent by 2006. That’s faster than
the average for all other occupations.
- About half of the RN workforce will reach retirement
age in the next 15 years.
- The average age of new RN graduates is 31; they
are entering the profession at an older age and will have fewer
years to work than nurses traditionally have had.
- RN enrollments in schools of nursing are down.
Entry-level BSN enrollment has fallen 6.6 percent from a year
ago, dropping for the third year in a row, according to the American
Association of Colleges of Nursing.
Registered Nurses with a BSN:
| Year |
2000 |
2010 |
2020 |
| #Nurses Available |
596,000 |
656,000 |
635,000 |
| #Nurses Needed |
854,000 |
1,385,000 |
1,754,000 |
RNs with a Masters or Doctorate:
| Year |
2000 |
2010 |
2020 |
| #Nurses Available |
175,000 |
250,000 |
315,000 |
| #Nurses Needed |
377,000 |
532,000 |
822,000 |
Courtesy of the Bureau of Health Professions, U.S.
Department of Health and Human Services
Possible Solutions
The hospital industry should put patients ahead of profits.
Aggregate profits at the nation's hospital climbed 3% in 1997 to
a record $21.9 billion, new data from the American Hospital Association
(AHA) show. Those dollars give hospitals a profit margin of
6.6% -- the second highest aggregate margin ever. (Modern Healthcare,
January 11, 1999, p. 2).
Rather than cutting their nursing staffs to save money; thus, creating
a nursing shortage, hospitals should look at decreasing CEO salaries,
as well as capital and technology expenditures. While the
average salary of a RN is $38,000, the hospital industry focuses
its attention on cutting this source of direct patient care. (ANA
President, The American Nurse, 1998).
The American Nurses Association continues to emphasize:
Improving the terms of employment by:
1. Improving the workplace environment by providing adequate support
systems; increased decision making and autonomy; and, appropriate
health and safety protections.
2. Enhancing compensation packages for nurses through implementation
of: flexible benefit packages; improved lifetime earnings; and,
career ladders.
3. Increasing federal support for nursing education.
4. Offering retraining for nurses throughout their careers.
5. Altering curricula within nursing schools to meet the changing
needs of the health care system, which has moved from traditional
hospital-based care to managed and community-based care. New
proposed outcomes for undergraduate educations include the following
skills: relationship-centered care; care management; primary care;
and, community focus. (1997 Nursing Data Review; Wilkinson,
J.M. (1996). The “C” word: A curriculum for the future.
N & HC Perspectives on Community, 17(2), 72-81.)
6. Promoting collaboration between nursing education, practice
and research to facilitate nurses’ continuing education.
7. Utilizing widespread availability of nursing information to
avoid preparing an indeterminate number of nurses. The nursing
community needs to take advantage of this technology in order to
avoid an imbalance in the supply and demand of RNs that health care
has experienced in the past and could experience in the future if
the available information is ignored. (1997 Nursing Data Review).
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