The U.S. Nursing Shortage: Hope Through Education

The U.S. is facing a serious shortage of nurses that is predicted to worsen if something is not done about the situation. The Health Resources and Services Administration (HRSA), projects that the nation’s nursing shortage will continue to grow until the year 2020. Their findings show that there will be a nursing shortage in all 50 states by the year 2015.

Nurses serve a very critical role in the nation’s healthcare industry. Often they are the first and main point of contact for patients. Increasingly, nurses are being asked to take on more complex job functions. In addition to providing patient care, many nurses are now involved in administrative and managerial functions within hospitals and healthcare facilities around the country. The nursing shortage has resulted in a decrease of available nurses at hospitals where critical care is provided. This puts a strain on many registered nurses (RNs) already in the workforce.

A 2007 report released by the American Hospital Association stated that hospitals need approximately 116,000 RNs to fill vacancies nationwide which creates a national vacancy rate of 8.1%. Figures like these have prompted a response from healthcare industry analysts, policymakers and specialists who are working on finding solutions to the growing shortage.

The lack of nurse educators at nursing school programs also makes the situation difficult. Each year, nursing schools turn qualified applicants away because they don’t have enough faculty to teach students. Federal and state funding has been allocated to address the issue in the form of educational scholarships, recruitment and retention programs. In addition, the 2009 American Recovery and Reinvestment Act attempts to address this issue by providing federal funding towards nurse education and training.

Despite these difficulties, nursing for many individuals continues to be a satisfying and rewarding profession. “With everything in life there is a tradeoff but the benefits to being a nurse to me personally are greater than not being a nurse,” explains Kellye McMillion a seasoned RN who works in the ICU department of a large hospital. After a few years of working in a different profession, she decided to make a career change and enroll in nursing school. She cites the affect that nurses have had on her life as part of her reason for changing careers. “My sister had a chronic disease and I spent a lot of time with her in the hospital. This experience made me understand how nurses really affect your life. They made me want to explore the whole field of nursing. I love that they spend time with you and they know your needs.”

This rewarding occupation has inspired many individuals to switch careers and enroll in nursing school. It is also a promising career with high job security and flexibility in scheduling. Now is a good time for anyone interested in becoming an RN as there are many programs available to assist students.

The Current Nursing Shortage Statistics

According to the U.S. Bureau of Labor Statistics (BLS), employment of RNs is expected to grow faster than the average relative to other occupations. It projects that 581,500 new RN jobs will be created through 2018. The lack of RNs and nurses in general makes it tough for employers to fill positions. Magdy Mahmoud, manager at Everest Medical Services, a medical staffing company based in New Jersey feels the affects of the shortage. His company places nurses in a wide variety of healthcare settings and has found it difficult to locate and recruit nurses.

The problem has gotten so bad that his team is considering recruiting nurses from abroad. “We really work hard to find nurses to place in available positions. We are actually planning to bring nurses to the U.S. from oversees due to this shortage. The problem we are facing is that we try to reach out to institutions and through word-of-mouth referrals, but the market (pool of nursing candidates) is very small. For every nurse there are 2 to 3 jobs out there,” explains Magdy.

States are Hit Hard by the Nursing Shortage

Research conducted by the HRSA found that the nation's nursing shortage will continue to severely increase for the next 20 years. It also found that certain States will face more of a shortage than others. Alaska was found to have the largest nursing shortage with only 58% of nursing jobs filled. Hawaii and Connecticut are facing high nursing vacancies as well. New Jersey will need to increase the number of nursing program graduates each year from 2,000 to 6,000 annually in order to fill vacant nurse positions.

According to Stateline.org, over two thirds of states are allocating funds to nurse education programs in an effort to deal with the current shortage. Many states are putting money into nursing scholarships in order to get nurses to return to school as well as loan forgiveness programs. In 2006 Mississippi approved an increase in salary for nurse educators in order to attract nurses into the teaching profession as well as retain faculty. Kansas also created a $30 million project in an effort to increase the amount of nurses in their state.

History of the Nursing Shortage

Shortages in the nation's healthcare system have occurred in the past, however what makes this current nursing shortage situation unique is that the causes are related to a multifaceted range of issues. The current nursing shortage is connected to both supply and demand factors, demographic changes, population growth, fewer students enrolling in nursing schools, RNs who are retiring or leaving the workforce and a growth in the baby boom population who will demand more healthcare services in the near future. These factors are occurring while many nurses are retiring and more jobs are being created. In addition, the nursing shortage is actually a worldwide phenomena with areas like Western Europe, Australia, Canada and the Philippines facing shortages as well.

Economic factors have also contributed to the nursing shortage in the United States. Mark Genovese, spokesperson for the New York State Nurses Association explains, “For many decades the shortage was cyclical but as the economy tightened and as the insurance industry moved to a managed care model, there was less money in the system and hospitals had less money to work with and tighter budgets.”

Budgetary limitations affected the nursing workforce as many nurses began leaving the profession altogether. “They were forcing RNs to do more with less, handle more patients and work more hours. RNs started to leave the workforce because of the working conditions and fewer RNs entered the system,” explains Mark.

Americans are also demanding more quality healthcare services while many RNs are retiring, further exacerbating the problem. The HRSA has stated: "to meet the projected growth in demand for RN services, the U.S. must graduate approximately 90% more nurses from U.S. nursing programs.” Working as a travel nurse and seeing the effects of the shortage first hand, Kellye McMillion explains, “I started seeing it more as a travel nurse rather than as a staff nurse. I have traveled all over the country and I have seen it in different regions of the country. If there is a shortage in the ICU unit, the patients need urgent, critical care and sometimes the care is lacking because there is not enough staff to fulfill their needs.”

Decreased staffing means that there are fewer nurses to work with patients. This impacts job satisfaction and causes work related stress. In some cases it has led to many nurses leaving the profession altogether. A 2010 study published in Health Services Research found that over 75% of RNs feel that the nursing shortage is a huge problem that affects their quality of work as well as patient care and the amount of time that nurses can spend with individual patients.

Another important factor contributing to a lack of nurses is that there is a shortage of nursing school faculty to train a new generation of nurses in colleges and universities. The AACN's 2008-2009 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing report found that nursing programs in the U.S. did not enroll 49,948 qualified students into their bachelor and graduate degree programs because they did not have an adequate number of faculty, clinical practice sites, teaching space, and were constrained by budgetary limitations. Two thirds of the nursing program respondents reported that a big reason for not accepting students was due to not having enough nurse faculty on hand.

The Southern Regional Board of Education conducted a study which found that the nursing faculty shortage in 16 states was caused by vacant faculty positions, retirements, resignations and a shortage of new candidates applying for faculty positions. Shortages like this pose a threat to the availability of nurse education.

Possible Nursing Shortage Solutions

Healthcare industry experts, nursing professionals and lawmakers have provided a number of solutions to address the nation's current nursing shortage. A variety of strategies have been recommended. They include:

• Nurse Education - experts agree that a major obstacle to the shortage is due to inadequate resources for nurse education. This is connected to a shortage of nurse teaching faculty at colleges, universities and nursing schools. Lawmakers have proposed increasing funding to attract and retain nurse educators and provide training facilities and equipment. This includes nursing school scholarships, grants and loan forgiveness programs.

• Nurse Retention - a number of measures have been suggested to improve the working conditions of nurses already employed. This includes salary increases, better retirement benefits. flexible vacation scheduling and time off.

• Awareness of the Issue - experts also suggest that the nursing shortage is a critical issue that needs to be sufficiently addressed and made known to the public. The Center for Nursing Advocacy suggests that the nursing shortage issue receive more media coverage to educate the nation on the seriousness of the shortage and so that public awareness of the problem improves.

What Is Being Done About the Nursing Shortage?

In response to the shortage, policymakers have enacted new legislation to provide funding for nurse education, recruitment and retention on both the federal and state level. On the federal level, as part of the 2009 American Recovery and Reinvestment act, funds have been allocated to enhance the nation’s healthcare workforce (which includes the nursing profession) by providing funding towards professional training and education. Many states have also responded by creating programs to increase the level of nurse staff. These programs provide scholarships and loan forgiveness or repayments to eligible nursing students.

Federal Efforts:

• The 2009 American Recovery and Reinvestment Act signed by President Barack Obama allocates money to the National Health Service Corps, the Nursing Workforce Development Programs and the Health Professions Training Programs. These provisions for health profession training will give nursing students and programs federal funds. The National Health Service Corps provides scholarships to nurse practitioners and certified nurse midwives.

• The U.S. Department of Health and Human Services (HHS) funded the Nurse Education Loan Repayment Program totaling $8.1 million. The program helps RNs pay their nursing school debts -- 60% of their loan balance can be paid off in exchange for two years of work in facilities that are experiencing a critical shortage of nursing staff. Those who work an additional year are eligible for more loan repayment.

• The HHS also funded the Nurse Faculty Loan Program which provides funding to nursing schools that provide graduate and doctoral degrees for nurses who wish to pursue teaching faculty positions at colleges and universities. After obtaining a master’s or doctoral degree in nursing, students are able to cancel up to 85% of their loan principal and interest in exchange for working full-time for four years as a faculty member at a nursing school.

• The Graduate Assistance in Areas of National Need (GAANN) created under the Higher Education Act, provides funds for graduate fellowships in an effort to attract nursing students. The fellowships cover tuition fees and student expenses. Nursing has been added to the list of critical need areas which includes chemistry, biology, engineering, computer information science, mathematics, physics and geological sciences.

Efforts to address the nursing shortage have been seen in a number of states. Georgia, Colorado, Minnesota, Nebraska and Texas have made efforts to alleviate the shortage of nurse educators. Maryland, Utah, Kansas and Illinois have passed legislation to address the issue of the shortage over the next five to ten years.

State Specific Efforts:

• The State of Maryland awarded grants to several nursing academic programs in 2006 through its Health Services Cost Review Commission (HSCRC). Funds were allocated to the Nurse Support Program (NSP) to provide grants in order to increase the number of nurses in Maryland hospitals as well as to attract more nurse educators.

• The Kansas Board of Regents approved funds to increase and enhance the nursing workforce. This included funding for nurse salaries, nurse educator scholarships and nursing equipment and facility upgrades.

• Illinois developed a long-term plan to assist the nursing workforce by allocating funds towards nurse education scholarships. Funding will also go towards programs to increase the amount of nurse faculty.

• The state legislature in Colorado passed two nursing shortage bills aimed to deal with deficiencies in nursing education and nurse salaries. The Nursing Teacher Loan Forgiveness Program provides nursing students with up to $20,000 in loan forgiveness for those individuals in master's and doctoral degree programs provided that they teach at a Colorado nursing school program.

• Nebraska passed the Nurse Faculty Student Loan Act which provides loan waivers to graduate and doctoral nursing students. Other loan forgiveness and repayment programs are available in Georgia, Minnesota, Illinois, Vermont and Texas.

What Does This Mean to You?

Policymakers, legislators and healthcare experts all agree that something needs to be done about this nursing shortage and are taking steps to provide solutions. Now is an excellent time to take advantage of these great programs and enroll in nursing school. A BSN degree provides a solid educational foundation for RNs and more career options. It equips nurses with the knowledge needed to be successful in today’s complex healthcare environment. In addition to clinical work, a BSN degree provides opportunities for experienced RNs to obtain healthcare administrative and managerial roles. It is also a stepping stone to obtaining an MSN degree which is required for nurse educator positions – another occupation affected by the shortage and one that is in high demand.

Good Time to Become a Nurse

The U.S. Bureau of Labor Statistics (BLS) projects job opportunities to be “excellent” and have growth that outpaces the national average for other occupations through the year 2018. According to the BLS, Registered Nurses constitute the largest group of professionals in the health care sector at 2.8 million strong.

Where are these nurses finding work? A study released in 2008 titled “The Recent Surge in Nurse Employment: Causes and Implications,” the lead investigator was Peter I. Buerhaus, and published in the journal Health Affairs found that 64% of nurses were working in the hospital setting. This closely matches the BLS employment data, which found that 60% were working in the hospital setting.

Some growth areas in the health care sector where nurses should be able to find employment include Alzheimer’s units and other Long Term Care facilities, stroke car facilities and home health agencies.

Projected growth rates for nurses in various settings as reported by the BLS are as follows:

• Physician offices at 48%
• Home health care services at 33%
• Nursing care facilities at 25%
• Employment services at 24%
• Hospitals both public and private at 17%

The BLS also reported that in 2009:

• RNs held 2,583,770 jobs.
• The mean annual wage for RNs was $66,530 with the highest 10% earning $93,700 and the lowest 10% earning $43,970 annually.
• The states that paid the top RN wages were California followed by Massachusetts, Hawaii, Maryland and New Jersey.

Now Is the Best Time to Enroll in Nursing School

The nursing shortage will continue to provide job security for RNs. Those who hold a BSN will also be in high demand by employers. There are a wide variety of nursing programs throughout the country to help students obtain a nursing degree or advance their nursing education through either a BSN completion program or a graduate level nursing degree program depending on their current status. Scholarships and loan forgiveness programs are available to lessen the financial burden of acquiring a BSN. Those wishing to make a career change can enroll in online nursing degree programs or take courses part-time. It is never too late to return to school or explore another career. The nursing profession provides a wealth of rewards both professionally and personally.

Find accelerated BSN programs, entry to nursing programs listed by state and RN to BSN Online Programs.

(Sources: US Department of Health and Human Services - HRSA Health Professions, Peoria Magazines April, 2009 - The Importance of the Baccalaureate Degree in Nursing Education by Kimberly A. Johnston Ed D, RNC, CNE, Nurses For A Healthier Tomorrow, "States Work to Avert Nurse Shortage" By Pauline Vu, Stateline.org Staff Writer)

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