Is the American Nursing Shortage Genuine?

Understanding the nursing shortage in 2019, and the implications for future generations of nurses

Within the last two decades, nurses in the United States have listened to an alarming message. They heard predictions of a severe nursing shortage since the year 2000, based upon data assimilated from both an aging workforce as well as the predicted retirement of a significant portion of baby boomer professionals. This message has begun to fall upon deaf ears, however, as millennials found almost the opposite to be true. Jobs in nursing became scarce, especially in metropolitan, specialty markets, as hiring criteria became more robust. 

Nurses began to question the shortage. Was it genuine, or was it fabricated?

To understand the nursing shortage in 2019, and the implications for future generations of nurses, it is important to understand what happened between the dreadful predictions of 2000 and where markets stand today. In the year 2000, when a report by the Journal of the AMA was published, predicting a shortfall of approximately 500,000 nurses by 2020, nursing applicants had been declining for several years. Based on this ominous prediction, schools of nursing across the country worked competitively to seek increased admissions.

Additionally, the country fell into a momentous recession beginning in 2007-2008, making nursing one of the more enticing secondary careers for those who lost their primary positions. A surge of realtors, finance industry workers, and professionals from other realms of business sought relief as healthcare workers to pay bills as income sources grew sparse. The third factor during the recession which assisted the “anticipated” nursing shortage was a delay in retirement for nurses whose husbands or families had to tap into savings to survive the shortfall. A number of those nurses are still working and have no plans to retire. These combined factors have contributed to the number of nurses working as opposed to leaving the workforce.

But scarcities do exist.

Nurses may deny a shortage in the United States is genuine because nurses tend to remain in areas where they train: in urban, heavily specialized and technological centers. However, even in those areas, there is a lack of nurses entering specific fields: teaching, behavioral health, pediatrics, geriatrics, sexual assault, and prosthetics. Newer fields that have been attracting older nurses in recent months include death coaches (death doulas) and self-care coaches.3

One of the aspects that has been identified in the current nursing shortage is that it is geographic. While almost 150,000 new nurses are graduating each year, “they are not where we need them to be.” Rural communities tend to lack the highly technological resources and job opportunities that attract newer and younger nurses. There are less opportunities for nurses to move up or gain additional skills by moving to a rural area, even if the pay is comparable by virtue of the cost of living. For example, if you’re a newer nurse who wants to work in a shiny ICU with highly skilled and experienced Intensive Care mentors, you would be unlikely to achieve those goals in a rural setting. Additionally, with the amount of rural hospital closings within the last decade, you may have less job security; risky for a newer, younger nurse or a nurse with a family.

A lack of nursing faculty has also become critical to producing the nurses we need to keep up with the demands of an aging population. Although many nurses delayed retirement after the recession of 2008, the economy has improved, and nursing faculty has aged in the interim. The average age of doctoral-prepared nurse faculty “holding the ranks of professor, associate professor, and assistant professor were 62.2, 57.6, and 51.1 years, respectively.” This was data for year 2016, when a staggering 64,067 qualified applicants were denied entry to nursing schools due a lack of nursing faculty! This problem will continue, even with the addition of master’s prepared nurses, as most professors and assistant professors at that level of educational preparation are well into their 50’s.

Complicating the shortage further is what is required of nurses when they enter an inpatient setting. It has been well documented that the graying of America is leading to patients that are sicker at entry, with a more complex set of problems. Few hospitals have addressed this issue with a succession planning system that fully integrates the experience and organizational skills of senior nurses while they are still on the clock, by partnering them with younger employees before they enter retirement.3

This qualitative concern has seldom been addressed by hospital administrators, nor has the generational disparagement between baby boomers versus millennials, who often forget both groups went into nursing to optimize care for patients. Experienced nurses need to spend more time with younger nurses working on group projects, sharing patient interaction and unit goals, whether it is early mobility, handwashing, prompt recognition of sepsis criteria, or improving pain management for all patient groups. By meeting common goals, nurses do begin to form common bonds.3

One of the last areas nursing needs to improve is one of diversity. As we examine the nursing shortage, it is still apparent that nursing remains 88% female, and a predominantly Caucasian profession, even at AACN Magnet facilities. Nursing needs to find a voice for increased diversity, with the inclusion of more ethnic expression and global diversity. With the inclusion of additional ethnic voices, nursing will be better prepared to treat aggregate populations in the United States, especially regarding disease-specific needs, such as hypertension, diabetes, or cardiovascular issues.2

Finally, nurses need to learn a healthy dose of self-respect and self-nurturing, including the ability to recognize issues within their own profession, whether one of their own is at risk of depression or requires behavioral health intervention, through pilot programs such as HEAR, which identifies colleagues who might be at risk for suicidal ideation. Female nurses should also be aware they are often paid $6,000 less than male counterparts who are performing the same work (2019 data), often due to the fact they may not negotiate a salary or hourly wage when they interview.1 Burnout is a definite problem in nursing. Losing nurses to stress, fatigue, or frustration is an ongoing problem5, particularly when nurses feel the sting of institutions where corporate profits appear to take precedence over staffing needs.

Does the nursing shortage exist? Yes, it is genuine. It is geographic, situational, and pervasive. We need to improve the amount of nursing faculty, as well as entice diverse populations to the profession. It may get worse, especially in specialty and rural areas. 

The conclusion? 

Hang onto your scrubs, folks, it could be a rough ride!

Websites:

  1. Clinicaladvisor.com “What the 2019 salary survey reveals about the gender wage gap.” Greenhalgh, T., September 20, 2019.
  2. Healthleadersmedia.com “5 things to know about the nursing shortage.” Thew, J., September 28, 2018.
  3. Health.usnews.com “Is there a coming shortage of nurses?” Howley, E., November 28, 2018.
  4. Ncbi.nlm.nih.gov. “Nursing shortage.” Haddad, LM & Toney-Butler, TJ, accessed October 19, 2019.
  5. Thenation.com “There is no ‘nursing shortage.’ There’s just a good job shortage.” Chen, M., August 7, 2019.

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