21st Century Nursing Shortage

Since Florence Nightingale professionalized nursing in the 19th century, we have had cyclical nursing shortages, especially during times of war. In the past, whenever the demand for nurses exceeded the supply, more nurses were recruited and trained, and the shortages were quickly repaired.

Today's 21st century nursing shortage is different. It is more severe and much more difficult to fix than previous nursing shortages.

Reasons for the Nursing Shortage

Estimations vary according to the type of analysis used, but nearly all experts agree that US healthcare will have a shortfall of somewhere around 1 million registered nurses by the year 2020. Today, there are over 120,000 unfilled openings for nurses in hospitals and other healthcare settings, despite the fact that as recently as the 1990's we had a relative surplus of nurses.

There are several reasons for the suddenness and severity of the current nursing shortage:

o Fewer people choosing nursing as a profession. Nursing has traditionally been one of the few female professions. Today, women have more and better professional opportunities and fewer are choosing nursing. There are more men in nursing than ever before, but it is difficult to attract men to the profession because of the relative pay scale deficit of a traditionally female profession.

o Retirement of baby boomer nurses. At the same time that fewer nurses are entering the profession, many are leaving due to retirement. One source says that 55% of today's nurses will retire by 2020, and there are not enough new nurses available to replace them.

o Nurses leaving the profession. Nursing burnout is reaching epidemic proportions for the same reasons that it is difficult to attract new nurses to the profession. Nursing is exceedingly stressful, physically demanding and exhausting.

o Shortage of nursing faculty. Until late in the 20th century, nurses were mostly taught by physicians and nurses with hospital diplomas or bachelor's degrees. There were few graduate-level programs and virtually no doctoral programs in nursing and most nurses were trained in hospital-based programs. Today, there are very few hospital programs; most nurses are college educated. The minimum educational requirement for a nursing educator is a MSN (Master of Science in Nursing). MSN level nurses are also in demand as nursing leaders, clinical specialists and nurse practitioners - and those positions are much more lucrative than teaching is. Thus, there is a critical shortage of nursing educators, and that shortage is the greatest barrier to relieving the current nursing shortage. Nursing schools are only able to accept a fraction of their qualified applicants each year because of faculty shortages.

o This nursing shortage is a global shortage. In the past, hospitals have been able to fill nursing vacancies by hiring "foreign nurses" who were educated in other countries. Today's shortage is global; all developed and undeveloped countries are experiencing a shortage of nurses, so there is nowhere to import them from.

o Increasing demand. At this same critical juncture when we have large numbers of nurses retiring and are unable to recruit and educate enough nurses to replace them, the baby boomer generation is aging and requiring more healthcare, putting additional strain on an already overburdened healthcare system.

What Can Be Done

Strategies to address the critical shortage of nurses must remedy at least some of the reasons for the shortage. Some factors cannot be addressed - the baby boomers will age, will require health care and will retire. We can, however, address other issues that contribute to the nursing shortage and it is essential that we do so, as quickly as possible.

o Attracting new people to the profession. Although this has been the first and only strategy needed to correct past nursing shortages, it is not the first thing we need to do this time. We currently have more qualified applicants to nursing schools than we can educate. As we correct other problems, however, we will need to attract bright young people - and especially men - to the profession. Nursing must become as attractive a career option as other professions.

o Recruiting inactive nurses. In a 2000 study, about 12% of the nation's nurses were "inactive:" not employed as nurses and not looking for work in the field. Some are employed in other fields and some are taking a career break. Inactive nurses are a neglected reservoir of educated, experienced professionals.

o Educating educators. The lack of nursing educators is a huge bottleneck in solving the nursing shortage. We must create incentives that will attract graduate-level nurses into education. That includes increasing educator salaries so that colleges can compete with other employers and subsidizing advanced education for nurses who commit to teaching for a period of time.

o Improving nursing's image. There are two national media campaigns that focus on attracting people to the nursing profession. Both are educating people about the nursing profession and eliminating inaccurate stereotypes about nurses. These are an excellent first step toward improving nursing's image. We must also improve salaries and benefits and allow nurses more control over what they do.

The 21st century nursing shortage is, indeed, different from all previous nursing shortages. It is more severe and, unless we act quickly to correct it, it will cause a healthcare crisis of cataclysmic proportions. Hospitals and other healthcare organizations cannot continue to provide services without nurses. As the shortage worsens, more and more people will be denied access to healthcare simply because there will be no one to provide it.

The nursing shortage can be solved, but only if we act quickly and decisively to increase the number of nursing educators, recruit inactive nurses and solve the problems that cause people to choose other professions instead of nursing.

Bill Long is the administrator of rnbuilder at http://www.rnbuilder.com - a website offering resources for prospective nursing students including articles, videos and a directory of nursing schools listed by city and state.