Why Is There a Nursing Shortage? Factors, Impacts & Solutions

Do you already work in the nursing profession or are thinking about joining? Regardless of where you are in your career journey, you are needed. Various factors, ranging from an aging population to a plethora of new procedures and treatments, the complication of compounding diseases, and nurse burnout in the wake of COVID-19, have contributed to an ongoing nursing shortage that has caused a substantial need for nurses — particularly advanced practice registered nurses (APRNs) such as nurse practitioners. These practice-based nurse leaders can use their knowledge and skills to guide the profession through ongoing shortages and emerging nursing trends to deliver high-quality patient care.

There are several factors contributing to the nursing shortage. It’s important for those pursuing an advanced nursing education to dig into the shortage’s contributing factors. By doing so, they can take a more holistic approach to nurse leadership that can help mitigate challenges facing healthcare facilities.

History of the Nursing Shortage

When researching why there is a nursing shortage, it’s important to note that shortages have occurred in healthcare throughout history. Just after World War II, for instance, the U.S. suffered through a nursing shortage so dire, it compelled the U.S. Department of Labor to conduct a study to determine its cause. The results indicated that poor working conditions, long hours and low salaries drove nurses away from the profession. The context surrounding this shortage provides further insight. Specifically, the shortage occurred after a serious global event, and nurses did not return to their roles in anticipated numbers.

While today’s nationwide deficit in nursing professionals does not reflect a one-to-one comparison to the postwar crisis, there are similarities. The global crisis stemming from the COVID-19 pandemic exacerbated this deficit. According to a 2021 research project published by Health Affairs, the total supply of registered nurses (RNs) dropped by more than 100,000 between 2020 and 2021. This was the largest drop in RN workforce since the data was first observed in 1982. 

Future Opportunities

This drop in the workforce suggests opportunities for trained nurses. Projections by the U.S. Bureau of Labor Statistics (BLS) indicate the registered nurse (RN) workforce will grow by 195,400 nurses between 2021 and 2031. The BLS also projects the combined workforce of nurse anesthetists and nurse midwives will increase by roughly 30,200 annually between 2021 and 2031.

Unfortunately, metrics regarding nurses prepared for care delivery via undergraduate or graduate degrees remain short of industry goals. The Institute of Medicine’s seminal 2011 report The Future of Nursing advocated for a minimum 80% increase of bachelor’s degree-holding nurses in the field by 2020 to improve the safety of patients. According to the 2020 National Nursing Workforce Survey released in 2021 by the Journal of Nursing Regulation, only 65.2% of nurses are prepared at either the bachelor or graduate degree level — well short of the Institute’s recommendations a decade earlier.

Why Is There a Nursing Shortage?

Experts point to a wide range of factors contributing to why there is a nursing shortage, including:

• An aging nursing workforce. According to the 2020 National Nursing Workforce Survey, 19% of the RN workforce were 65 and older — a dramatic increase from the 4.4% reported in 2013. The survey also indicated that 22.1% of participating nurses stated that they planned on retiring in the next five years. When applied to estimated population values, this percentage extrapolates to over 757,000 nurses. 
• Overall growth in the demand for healthcare services. This demand will primarily result from the aging baby-boom population. By 2040, the population of people aged 65+ is projected to hit 80.8 million. By 2060, this number is projected to be 94.7 million. In general, older adults 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. Some American nursing schools struggle to develop the infrastructure needed to handle qualified nursing students. According to the AACN’s report 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, 91,938 qualified undergraduate and graduate nursing students were turned away from programs in 2021. The reasons for these rejections included faculty shortages, limited classroom space and a lack of clinical education sites.
• COVID-19. The unique stressors of trying to deliver quality care in the midst of a deadly international pandemic have increased feelings of anxiety and being overwhelmed. These feelings increased burnout. This issue has particularly contributed to younger nurses leaving the profession. The Health Affairs survey notes a 4% reduction in workforce size among RNs younger than 35 in 2021, compared to a .5% reduction among RNs ages 35 to 49 and a 1% reduction among RNs aged 50 and older.
  

A Physician Shortage is Partially Driving the Nursing Shortage 

 A physician shortage has increased the need for nursing staff. Demand for healthcare services is projected to outpace the growth of physician supply, exacerbating the already present nursing shortage. 

The Association of American Medical Colleges (AAMC) anticipates a projected total physician shortfall of between 37,800 and 124,000 by 2034. Breaking this down further, the AAMC projects a shortfall between 17,000 and 48,000 physicians in primary care specialties such as family medicine, general pediatrics and geriatric medicine. They also project a shortfall between 21,000 and 77,100 physicians in nonprimary care specialties. The AAMC also acknowledges that this shortage could result in a pronounced negative impact on rural communities, marginalized minority populations and the uninsured.

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

Part of knowing why there is a nursing shortage and its effects on care delivery is understanding the growing demand for primary care. The increasing need for primary care is related to population growth and aging as well as expanded health insurance under the Affordable Care Act (ACA). Unfortunately, over 99 million Americans currently reside in locations or belong to population groups that are known officially as primary care Health Professional Shortage Areas (HPSAs). These are areas in which the supply of PCPs relative to the population falls below federally defined standards.

APRNs can make a real difference in these areas by applying their knowledge and skills toward practicing in urban and rural areas. This would enable them to provide care in a wider range of community settings and serve a high proportion of uninsured patients and other vulnerable populations.

How Will the Shortage Impact Employment?

There is an expected 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.

A nurse may also opt to obtain advanced clinical education and training to become an APRN. APRNs 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 of 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.

In some states, there are a limited number of nurse education opportunities. Nurses tend to stay in the markets where they are educated. When there are fewer schools in a region, fewer nurses tend to be available for employment there.

The Demand for Nurse Practitioners

The nursing shortage translates to a strong demand for nurses, and a particularly strong job market for APRNs. The BLS projects a 6% job growth for registered nurses between 2021 and 2031, which is on par with the 6% projection the BLS gives for the average profession. The BLS also projects a 40% job growth for nurse anesthetists, nurse midwives and nurse practitioners, which is more than six times the 6% percent job rate given for the average profession. 

Nursing Shortage Solutions

APRNs can play a key role in mitigating the effects of the advanced practice nursing shortage. Yet nursing shortage solutions don’t solely rest on the shoulders of prospective practice-based nurse leaders. Many factors contribute to the nursing shortage, so the problem must be approached from multiple angles.

For instance, it is important to rectify the shortage issues surrounding nurse educators. Developing strategies that prepare nurses to educate the next generation and stay in the position for an extended period of time can potentially reduce the instances of qualified nurses being turned away from programs. APRNs can help here as they can apply the knowledge and skills cultivated in an advanced nursing program toward an educational role.

Another big piece of this puzzle involves granting APRNs full practice authority or care delivery that can be done without physician supervision. As of October 2022, 28 states offer full practice authority, and California will begin granting full practice authority in 2023. This action can allow nurse practitioners to provide essential care to areas underserved by physicians, such as rural or marginalized communities.

Make a Much-Needed Difference

There are several reasons why there is a nursing shortage. However, finding solutions to mitigate its impact can ultimately deliver a positive impact on patients. Those that are currently in nursing or just getting started can steer their career path in a way that can help bring about improved patient outcomes — even during times of major health concerns. Plus, preparing for a role as a nurse practitioner will position nursing professionals for a rewarding career providing primary care to populations most in need, especially if they practice in a state with full practice authority.

While no one is certain to what extent the potential nursing shortage will impact the country in the coming years, those with an advanced nursing degree will be well positioned for professional opportunities. Find out more about Spring Arbor University Online’s BSN to MSN/NP program or other online nursing programs and start your faith-based nursing education today. 
 

Recommended Readings

Self-Care for Nurses: How to Prioritize Yourself When Caring for Others
6 Nurse Practitioner Specialists to Consider
Top Nursing Team Building Strategies

Sources:

Administration for Community Living, Projected Future Growth of Older Population
American Association of Colleges of Nursing, Nursing Shortage
American Association of Nurse Practitioners, State Practice Environment
American Progress, “How to Ease the Nursing Shortage in America”
Association of American Medical Colleges, AAMC Report Reinforces Mounting Physician Shortage
HealthAffairs, “A Worrisome Drop In the Number of Young Nurses”
Health Resources & Services Administration, Health Workforce Shortage Areas
Journal of Nursing Regulation, “The 2020 National Nursing Workforce Survey”
Institute of Medicine, “The Future of Nursing: Leading Change, Advancing Health”
U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners
U.S. Bureau of Labor Statistics, Registered Nurses
Wiley Public Health Emergency Collection, “Nurses’ Burnout and Associated Risk Factors During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis”
WWMT, “Stressed Out and Overwhelmed: Michigan Nurses Burned Out From COVID-19”