Kristian Nunnelee, University of Montana, Missoula, Montana

Cindy Jimmerson, Lean Healthcare West, Missoula, Montana

August, 2005

From birth and the beginning stages of life, nearly everyone will experience the contributions of a nurse. For most, interaction with these healthcare professionals will last throughout their lives.

Our nation currently faces a shortage of nurses to provide adequate care, with a dismal future looming. In 2002 the Joint Commission on the Accreditation of Hospital Organizations (JCAHO) reported 126,000 unfilled nursing positions. This is projected to worsen as the first of the Baby Boomers, scheduled to begin retiring in 2006, creates a hole in the healthcare workforce. At the conclusion of 2004 there was a 6% shortage of nurses to meet the current patient demand.

By 2020 the shortage is estimated to rise to 29%, due to trends related to a 40% increase in demand, 6% increase in supply and an 18% increase in population. With the offset of the current population (78 million Baby Boomers who anticipate retirement and 42 million Generation X-ers to fill their shoes) by the year 2011 the number of nurses retiring from the profession will exceed the number of nurses entering nursing. As the population of Baby Boomers moves toward age 65, the US needs to begin to prepare for a workforce crisis in healthcare. The average age of registered nurses (RN) in United States in March, 2005 was 49. By 2020 the Health Resource and Services Administration predicts a shortage of 808,000 RNs.

In addition to the shortfall created by retiring professional nurses, the decline in salaries for these 24/7 occupations has not attracted necessary replacements. While actually earnings increased from 1983 to 2000, real earnings (amount available after adjusting for inflation) have not increased since 1991. Compared to elementary school teacher wages which have increased steadily (in 1983 teacher wages exceeded RN wages by $4000, in 2000 teacher salaries were $13,200 greater annually).

RN’s in 2000 who had been employed for 5 years made approximately 16% more than new nurses entering the field, but at the 15-year mark the increase from year 5 was only 2%, offering a negative incentive to remain in service. Many nurses leave for further education or other careers.

According to events reported to JCAHO in 2002, low staffing levels have accounted for 24% of the 1609 unanticipated events leading to injury, loss of function or death.

According to Press Ganey and Associates, there is a perfect correlation between hospital employee satisfaction and patient satisfaction. Consider these numbers:

  • 41% current nurses are dissatisfied with their job
  • 43% scored high on a range of “burn out” measures
  • 22% plan to leave the profession in the next year
  • 55% would not recommend their profession to family or friends

One factor that has stumped human resource departments for years is the effort to staff acute and long term care facilities day and night, on weekends and holidays. In a profession still dominated by women who struggle to juggle families and careers, many leave for regular hours that are easier to assimilate with family life.

Currently university baccalaureate and 2-year AD programs are turning applicants away with a shortage of faculty and clinical training opportunities. Instead, efforts to recruit foreign nurses to fill the current void resulted in 95,000 of the 2.7 million nurses in the US in 2004 coming from outside the States. These nurses come primarily from the Philippines, China and India. The US also drains precious healthcare resources from Mexico, the Caribbean and South Africa, worsening the healthcare picture in those countries.

According to the National Council of State Boards of Nursing, in 2004, between January and September, 28,000 foreign nurses applied for licenses in the US. This accounted for 27% of the total nurses taking the test, nearly doubling the number who applied in 1999.

HRSA, Projected supply demand and shortage of Registered Nurses: 2000-2020. July, 2002

HRSA, Projected supply demand and shortage of Registered Nurses: 2000-2020. July, 2002

HRSA, Projected supply demand and shortage of Registered Nurses: 2000-2020. July, 2002

Borden, Teresa. Visa Quotas Exacerbate Shortage of US Nurses. Cox News Service, December 2004.

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