The Nursing Shortage and What You Need to Know

Nurse in hospital corridor
Nurse in hospital corridor

Do you already work in the nursing profession or are thinking about joining? You may be wondering about job stability. Perhaps you’ve heard talk of a looming healthcare crisis as the American population ages. What does this mean? Currently, nursing is the largest health profession in the United States. The Bureau of Labor Statistics estimates until 2024, employment of registered nurses will grow 16 percent and employment of nurse practitioners, nurse midwives, and nurse anesthetists will grow 31 percent.


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The Nursing Shortage

Shortages have occurred in healthcare throughout history. The 1990s saw a substantial slowing in employment growth, decreased earnings, declining enrollments in nursing schools and two separate hospital nursing shortages. Today, there is a deficit in nursing professionals nationwide. By 2020, the deficit will increase to an estimated 285,000 FTE RNs (almost 3 times larger than any deficit experienced in the U.S. over the last 50 years).

The United States Registered Nurse Workforce Report Card and Shortage Forecast published by the American Journal of Medical Quality projected 48 states would experience nursing shortages by 2030 and an overall shortage of 923,629 RNs. Researchers have reached conflicting conclusions regarding their projections about the nursing workforce and an impending nursing shortage. While most conclude there will be a nursing shortage on the national level, the Health Resources and Services Administration (HRSA) projected the RN supply between 2012 and 2025 will outpace the demand.

Despite this anticipated excess of RNs at the national level, variation is expected at the state level with sixteen states experiencing shortages as their supply of RNs is outpaced by increases in demand. Ten of these states are in the West, four are in the South, and two are in the Northeast.

Factors Contributing to the Nursing Shortage

Experts point to a wide range of factors impacting the impending nursing shortage including:

  • An aging nursing workforce. The recent recession prompted many nurses to reenter the workforce but many were older RNs. With approximately 1 million nurses currently over 50 years of age, one-third of today’s nursing workforce will reach retirement age within 10 to 15 years. It’s estimated that 700,000 nurses will retire or leave the labor force by 2024.
  • Overall growth in the demand for health care services. This demand will primarily result from the aging baby-boom population. By 2030, one in five Americans will be age 65 and older. In general, senior citizens require more complex medical care. Large numbers of newly insured patients resulting from federal health insurance reform, greater access to primary care and an emphasis on preventive care will also add to this increased demand for services.
  • Higher hospital census and greater acuity. Acuity has been rapidly rising in hospitals, with only the sickest patients requiring hospitalization. This has been due to a declining average length of stay and technologies that allow for rapid assessment, treatment, and discharge. Hospitals are taking on the appearance of large intensive care units with most patients receiving specialized treatment.
  • Lower baccalaureate enrollment and a diminishing supply of new nursing students. At the start of the new millennium, entry-level BSN enrollment fell 2.1%, dropping for the sixth year in a row. Every year since then, nursing education programs have had to turn away thousands of qualified applicants due to faculty shortages, limited classroom space, and lack of clinical education sites.

How Will the Shortage Impact Employment?

You can expect an abundance of future job opportunities in the nursing field, fueled by the need to replace workers who retire and the greater number of people needing access to healthcare services. Some organizations are offering large sign-on bonuses and impressive salaries for key specialties to recruit nursing staff. Nurses will be in especially high demand if they can lead multidisciplinary teams, serve as patient educators and managers of care or demonstrate a high level of skill in a specialty unit.

The number of new nurse graduates entering the labor market has increased over time. As a result, some regions of the country have seen stiffer competition for jobs. Sigma Theta Tau International Honor Society of Nursing (STTI) recommends nurses of all educational levels pursue higher education. Nurses who have obtained a Bachelor of Science degree (BSN) will have better job prospects than those with an associate degree.

A nurse may also opt to obtain advanced clinical education and training to become an Advanced Practice Nurse (APN). APNs typically have a master's degree, although some complete doctoral-level training. They can perform many of the same tasks as physicians and serve the public as a source for primary healthcare. Job opportunities for APRNs will likely be excellent in the coming years. APRNs will be in high demand, especially in medically underserved areas.

The nurse shortage will be due to the aging population in some states, but in others, it will be due to the consequence of limited numbers of nurse-education opportunities. Nurses tend to stay in the same markets where they are educated. When there are fewer schools in a region, fewer nurses are available for employment there.

A Physician Shortage is Partially Driving the Nursing Shortage

To understand the impact the nursing shortage will have on APRNs, you need to understand the looming physician shortage. Demand for healthcare services is projected to outpace the growth of physician supply.

The Health Resources and Services Administration (HRSA) projects a shortage of 20,400 primary care physicians (PCPs) in 2020. The Association of American Medical Colleges (AAMC) anticipates a projected total physician shortfall of 40,800 to 104,900 physicians by 2030. Projected shortfalls in primary care range from 7,300 to 43,100 physicians. HRSA anticipates a 30 percent increase in the supply of primary care NPs from 2010-2020.

If effectively integrated into the healthcare delivery system, nurse practitioners (NPs) and physician assistants (PAs) could somewhat alleviate the PCP shortage. HRSA estimates that projected increases in NPs and PAs could potentially reduce this shortage by approximately two-thirds.

The Aging Population, Population Growth and Expanded Health Insurance Causing Increased Demand for Primary Care

Growing demand for primary care is related to population growth and aging as well as expanded health insurance under the Affordable Care Act (ACA). Unfortunately, over 58 million Americans currently reside in locations or belong to population groups that are known officially as primary care Health Professional Shortage Areas (HPSAs). Here the supply of PCPs relative to the population falls below federally defined standards.

The proportion of Americans living in HPSAs varies widely by state, but in almost half the states, it’s at least 20 percent of the population are in an HPSA. These are areas where APRNs can make a real difference. Research has shown that primary care NPs are significantly more likely than PCPs to practice in urban and rural areas, provide care in a wider range of community settings and serve a high proportion of uninsured patients and other vulnerable populations.

Many Nurse Practitioners Are Practicing in Higher Need Communities

New research published in the Journal of General Internal Medicine has revealed that physicians, PAs and chiropractors tend to practice in more affluent areas with already high life expectancy, while NPs tend to treat patients in lower income areas with low life expectancy. Areas with the highest income – compared to the lowest – had 30 percent more physicians and 15 percent fewer NPs. The counties deemed the least healthy had approximately 50 percent more NPs than the healthiest counties.

According to study author Matthew Davis, this may imply that NPs are playing a role in communities that need their help. At the AAMC Health Workforce Research Conference, researchers reported that while recent surges in NP and PA workforces could alleviate much of the overall physician shortage, problems getting care in rural areas and treating certain conditions are still likely to persist. Projections still forecast shortages of primary care labor in rural areas and too few available provider hours to treat chronic conditions.  

"The demand for nurse practitioners has never been higher"

According to recruiting and staffing firm Merritt Hawkins, which works with facilities looking to hire health professionals, only family physicians, psychiatrists and internists are more in demand than NPs. Merritt’s annual analysis shows that NPs are rated ahead of more than 15 physician specialties. The company surmises this trend may only escalate as more states change their laws governing APRN practice authority, with APRNs being allowed to perform more services.

"The demand for nurse practitioners has never been higher,” American Association of Nurse Practitioners President Cindy Cooke reports. “With the rise of full practice authority in 22 states and the District of Columbia, more patients than ever have direct access to high-quality nurse practitioner care in every setting – including the veterans’ health system.”

NPs are becoming more widely recognized by the public as a source for primary healthcare.

Nurse Practitioners are a Major Part of Healthcare Delivery Systems in Team-Based Care

As the public seeks out nurse practitioners, retail clinics like those found at CVS and Walgreens are staffed by NPs offering quick access to treat routine maladies. “Nurse practitioners and other allied health professionals are going to be a major part of our healthcare delivery systems, especially with population health and team-based care,” reports Travis Singleton, senior vice president of Merritt Hawkins.

In 2012, approximately 127,000 NPs were providing patient care in the U.S. with roughly half practicing in primary care settings. Studies show that NPs can manage 80-90 percent of care provided by primary care physicians. In addition, evidence from a substantial research literature shows that primary care outcomes and patient satisfaction are comparable between patients served by NPs and those served by physicians.

Rising demand for primary care is taxing an already strained healthcare system. NPs will be increasingly utilized in team-based models of care where they will be needed to provide preventive and primary care. They will be in high demand, especially in medically underserved rural and urban areas.

As pointed out by the HRSA Health Workforce, some communities will likely continue to have a supply of primary care physicians well above the national average while other areas will continue to be below the national average. Preparing yourself for a role as an NP will position you for a rewarding career providing primary care to populations most in need.

While no one is certain to what extent the potential nursing shortage will impact the country in the coming years, you will be well positioned for professional opportunities with an advanced nursing degree. Contact us to find out more about Spring Arbor University Online’s MSN/NP program or other online nursing programs.


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