There is good news and bad news... although even the bad news isn't as dire as once predicted.

 

Vanderbilt's Peter Buerhaus, PhD, director of the Center for Interdisciplinary Health Workforce Studies, recently co-authored a study that found a surge in registered nurses has temporarily eased or ended the nursing shortage in many hospitals across the country.

 

However, Buerhaus warned this respite is temporary. The next shortage is expected to develop by 2018 as aging nurses retire. By 2025, labor force experts predict nursing will experience a major gap in supply and demand with a shortfall of 260,000 registered nurses.

 

Despite this large number, Buerhaus actually sees the prediction as a positive trend.

 

"We had, years ago, estimates of huge, mind blowing shortages of 800,000 and some up to a million. Now we're seeing shortages of under or right around 300,000 by the year 2025. That's still a major threat and would do major damage to healthcare, but I'm convinced we have the time and ability to beat that shortage," he stated.

 

Finding long-term solutions are crucial to the healthcare system, Buerhaus added. "If we don't pay attention to these shortages, when they develop downstream, they are going to have safety and quality issues for patients."

 

There are several courses of action that can be taken. Buerhaus said the first is to simply give up on increasing the domestic pool and "try to import as many nurses as possible from other countries." However, he doesn't advocate this step as a complete solution. While foreign-born nurses are now a statistically significant part of the nursing mix in hospitals, Buerhaus said more research is needed on how quality and safety is impacted when there are communication and cultural breakdowns.

 

One such cultural difference is in many countries a female nurse would see herself as subservient to a doctor … particularly if the physician were male. "For safety and quality, we want nurses to question a physician if they think there is a problem or even just to clarify instructions."

 

Another option is to have more non-RNs working in hospitals. Burehaus noted, "I don't think that's going to work, either. Nurses are the glue that holds the whole system together so you have to have technical skills … communications skills … coordination skills … the ability to think in systems. You are not going to get all that with people who aren't nurses."

 

To buy time in order to adequately restock the supply of nurses before a large portion of the current workforce opts out, Buerhaus said it is important to make the workplace as attractive as possible. A key way to do this is to improve the environment of the clinical workplace to keep nurses from being injured on the job.

 

"This is a good time for them (hospitals) to focus on making ergonomic improvements," Buerhaus said. "We're going to have an older workforce. No matter what, we want to keep these nurses. They are highly skilled nurses; they really know what is going on; and you want them in your organization."

 

He added these types of changes aren't necessarily expensive. Buerhaus advocated sitting down with the staff and surveying them about the work environment to see what changes would be helpful. "It sends a message. You care about them. You are interested in their welfare," he pointed out, adding that such an effort goes a long way in retaining good employees.

 

A major issue that must be addressed is finding ways to determine and then eliminate the structural barriers impacting nursing education capacity. "Schools have an aging faculty, a shortage of faculty, and some schools don't have the physical capacity to expand. A lot of schools are having a hard time with clinical sites," Buerhaus said of some of the obvious barriers. He and the study's other authors said it is time to assess private and public sector options that will be most effective and inexpensive to accelerate capacity quickly. Unfortunately, Beurhaus noted, "With the recession, state budgets are under a great deal of stress."

 

Finally, the authors have urged increased effort be given to promoting nursing careers to men and Latinos, two groups currently underrepresented in the nursing workforce. The recent success of attracting younger nurses to the profession underscores the effectiveness of national awareness campaigns.