New National Study Shows Nursing Shortage Easing on Nashville Medical News

New National Study Shows Nursing Shortage Easing

By: LYNNE JETER

Leaders Point to Temporary Respite, Projections Indicate Need for Action

A new national study shows the recession may temporarily end an 11-year-long nursing shortage in many areas, yet the ease represents only a respite for the troubled national healthcare system. By 2025, a shortage of 260,000 RNs is anticipated—a deficiency twice as great as any nursing shortage experienced since the advent of Medicaid and Medicare in the 1960s.

“We need to take advantage of the current increase in nurse employment and easing of the shortage by strengthening the current workforce before the recession lifts and imbalances in the supply and demand for RNs reappear,” said Peter Buerhaus, PhD, of Vanderbilt University Medical Center, author of the study, along with David Auerbach, PhD, of the Congressional Budget Office, and Douglas Staiger, PhD, an economics professor at Dartmouth. The health policy journal Health Affairsreleased the study, “The Recent Surge in Nurse Employment: Causes and Implications.” The June 12 report focused on assessing the impact of the recession on current nurse employment, and on projections of the future age and supply of RNs in the United States.

“A steady stream of new and well-prepared registered nurses is vital to fill the void that will be left by retiring nurses,” said Buerhaus. “It’s ironic and disappointing that despite these projections, nursing education programs continue to turn away approximately 30,000 or more quality applicants each year.”

The study shows that hospital employment of full-time equivalent RNs between 2007 and 2008 increased by 8.6 percent, well above the 5.3 percent average increase during the previous four recessionary periods, beginning with the 1981 economic downturn. During that same time period, RN employment in hospitals rose an estimated 18 percent, accounting for 243,000 full-time jobs. It marks the greatest two-year increase in three decades.

According to the study in 2008, 64 percent of RNs were employed in hospitals, up from 60 percent in 2006. The decrease in employment of RNs among non-hospital settings represented 50,000 full-time positions in 2008, a drop attributed to various factors, including the higher average earnings paid by hospitals compared to non-hospital settings ($27.60 per hour compared to $24.63 in 2008), more generous fringe benefits provided by hospitals, especially health insurance, and the 12-hour shifts frequently offered by hospitals that allow RNs to work three days a week, receive full-time benefits, and still having an opportunity to work overtime hours or a second job.

“The increase of hospital employment of nearly 250,000 RNs in such a short period of time is stunning,” emphasized Buerhaus. “While we expected an increase in employment, we were surprised by the magnitude and by the shift from non-hospital settings into the hospitals. This surge in employment will ease, if not end, the hospital nursing shortage. Consequently, we anticipate it will be tempting for employers and policymakers to focus on other issues. However, relief is likely to be temporary and we need to focus on how the current workforce is changing and the implications for future imbalances in the nurse labor market in the years ahead.”

For example, the study showed the recession has induced older nurses to delay retirement and others to re-enter the workforce. Because two-thirds of RNs are married, many had little choice as spouses lost their jobs or were concerned about layoffs. Between 2001 and 2008, 77 percent of the increase in total RN employment was accounted for by baby boomer RNs over the age of 50, the fastest-growing age group in professional nursing.

Foreign-born nurses are also making their mark. Last year, 16.3 percent of the total RN workforce was comprised of foreign-born nurses, compared with 9 percent in 1994. In 2008 alone, 48,000 foreign-born RNs joined the workforce. Of those, three times as many foreign-born nurses joined hospitals rather than nonhospital settings.

A disturbing yet expected trend taking shape involves aging RNs. When they begin retiring, they will set off a reaction that will lead to a projected shortfall of 260,000 RNs by 2025.

The good news, said Buerhaus, is that younger RNs, ages 23 to 25, joining the workforce increased by 130,000 full-time positions last year, reversing a two-decade-long trend.

“This is a very encouraging finding,” he said, “and suggests that all the effort to promote the nursing profession over the past several years is beginning to pay off. We must find ways to sustain and strengthen this trend because, until we are able to increase the number of younger people becoming RNs over time, it’ll be very difficult to replace all those retiring baby boom RNs and prevent the long-term shortage that we expect will develop during the latter part of the next decade.”

Shorter term, many hospitals may signal an end to their nursing shortage, and new nursing graduates might experience difficulty finding jobs, according to the study. The authors caution that a significant nursing shortage still looms.

Among the issues the authors say deserve a closer look by employers and policymakers to lessen the blow of a potential nursing shortage:

Improve the ergonomic environment of the clinical workplace to keep older nurses from being injured on the job.
Conduct research on patient outcomes and safety to determine if policies are needed to improve communication skills among U.S. and internationally-educated RNs.
Urge the Institute of Medicine (IOM) to conduct an analysis to determine the structural barriers that restrict nursing education capacity. Assess private and public sector options that will be most effective and inexpensive to accelerate capacity quickly.
Promote nursing careers to men and Latinos, who are currently underrepresented in the nursing workforce.

A steady stream of RNs is critical to the overall health of Americans and a vital part of healthcare reform discussions, said Buerhaus.