- Published in Global Healthcare Resources Newsletter

Few hospitals have been spared the effects of the current nursing shortage, which was estimated to have reached 126,000 open positions in 2002. The shortage has affected nearly all regions of the country, with California and Florida experiencing the shortage most acutely. The National Center for Health Workforce Analysis estimated that Florida will face 61,000 unfilled positions by the year 2020 and the California Employment Development Department projects a growth of nearly 40,000 RN positions from 1996 to 2006. In the Midwest, Missouri’s vacancy rate for LPNs, RNs, and rad techs have remained above 10% in recent years, while Kansas’ vacancy rate grew from 5.8% to 12.5% in 2001. In the Midatlantic region, Maryland, Washington D.C., and Virginia have also reported insufficient supply of nurses to meet the growing demand.1 In the West, Colorado’s population of nurses is shrinking while their population of baby boomers is growing.

Although this is not the first time the country has experienced a nursing shortage, it may be the longest lasting and most severe. A number of cultural and demographic factors have converged to exacerbate what has typically been a cyclical problem. As the baby boomer generation nears retirement recruitment and retention shortages are projected to grow. The result is that US hospitals will need to increase recruiting efforts while nurses, physicians, and allied health professionals struggle to deliver high quality patient care with limited support.

Demographics of the Nursing Workforce
The two primary contributing factors to the nursing shortage are the aging nursing workforce and the high turnover rate among young nurses. While the average age of RNs in the U.S. is 44, by the year 2020 43% of nurses are projected to be older than age 50. Meanwhile, younger nurses entering the nursing profession are leaving after only a few years of practice. According to one study, 120,000 RNs under the age of 43 were not working in the field. Many are lured away from hospitals by positions that offer better working conditions, better hours, more rewarding work, and higher salaries.

Result of the Nursing Shortage on Patient Care
High numbers of nursing vacancies has been found to lead to reduced patient care and reduced patient outcomes. A Florida Hospital Association study reported that emergency department overcrowding resulted from their inability to fill nursing vacancies.2 A recently published article in the New England Journal of Medicine supported this finding by reporting an association between higher hours of nursing care and improved patient outcomes.

The Response
The imminent nursing crisis has sparked innovative strategies among hospital administration, nursing associations, and policymakers. Think-tanks, strategists, and public relations firms are joining the number of concerned parties who are working to alleviate the factors causing the nursing shortage. New technologies are being developed to reduce the burden of non-clinical tasks, which would provide nurses with more time for patient care. Hospitals are investing in new recruitment and retention initiatives to attract higher numbers of nursing applicants. These programs include signing bonuses varying in price from $5,000 to $12,000, as well as substantial bonuses to employees for nurse referrals.

In response to concerns regarding patient care, hospital administrators and government officials have begun to develop policy to boost the supply of nurses. Policy makers are addressing the issue of reduced enrollment rates in nursing schools by offering scholarships to nursing students. Several California hospitals are collaborating with nursing schools to establish funding to increase nursing education.3 Kansas, Kentucky, West Virginia, and Virginia are a few of the many states that are working to increase funding for nurse scholarship programs.

Hospitals, government agencies, and nursing associations are doing outreach and education in the community to increase enrollment in nursing schools. They are distributing literature in the hospital and community, and speaking to middle school children about careers in nursing. Even the Federal government has become involved by offering financial incentives to work in areas with critical shortages. In a time when immigration laws have become more stringent, the Federal government has eased the restrictions on the legal processing of foreign nurses. Nursing associations, in particular, have been actively developing strategies to improve the nursing shortage. For example, the Washington Nurse Group proposed the following strategies as a means to reduce the nursing shortage: a public relations campaign to improve the image of a career in nursing, higher salaries and benefits to nurses and nurse educators, and a reduction in non-clinical tasks, which contributes to worker dissatisfaction.

Role of Foreign Nurse Recruitment
While these short and long-term strategies are being proposed, discussed, and in some cases, implemented, recruitment of foreign nurses are both an immediate and long-term means to supplement a hospital’s nursing staff. A steady recruitment of foreign nurses can serve to control the variations in the supply of domestically trained nurses in the U.S. workforce. Although more young women and men may be encouraged to enroll in nursing school as a result of recent policy efforts, changing demographics and changing environmental factors will limit their effect. Since gender barriers to medical school have been broken, many women who would have chosen a career in nursing instead become physicians. Furthermore, due to the nature of hospital care, work hours and working conditions can not be dramatically changed. And, as the U.S. population grows and ages, the demand for nurses, particularly bilingual nurses, will inevitably increase as well. Again, a steady recruitment of foreign nurses can complement current recruitment efforts. This solution is one that can spare hospitals from turning away emergency room patients, and can enable them to deliver high quality patient care in a time of critical personnel shortages.

Huslin, Anita. “Region’s Nursing Deficit Deepening.” Washington Post. May 15, 2002.
Allman, Cathy. “FHA Nurse Staffing Issues Survey: Florida’s Nursing Shortage Continues.” October 25, 2002
California Healthcare Association. “CHA Special Report.” http://www.calhealthorg/lpublic/press/doc.asp?ID=69. October 2002
Costello, Mary Ann. “Kansas, Missouri surveys underscore extent of workforce shortage woes.” AHA News. December 17, 2001
Bayer, Alan E., Willis-Walton, Susan M. “The Virginia nursing workforce in the new millennium.” Virginia Nurses Today. July 2002.
Perrault, Michael. “Shortage of caregivers races toward crisis.” March 17, 2002.
Prost, Marlene. “Coping with the Shortage.” Advance for Nurses. April 1, 2002
Costello, Mary Ann. “Researchers look at nurses leaving the field; question validity of ratios.” AHA News. September 9, 2002.
Needleman, J. et al. ”Nurse-staffing levels and the quality of care in hospitals.” New England Journal of Medicine. Vol 346. May 30, 2002.