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The US is predicted to experience a shortage of registered nurses (RNs), which is expected to intensify as Baby Boomers age and the need for healthcare increases. Compounding the problem is the fact that nursing schools across the country are struggling to expand their capacity to meet the growing demand for care.American Association of Colleges of Nursing (AACN)is working with schools, legislators, nursing organizations, and the media to bring attention to this health issue. AACN is leveraging its resources to shape legislation, identify strategies, and form collaborations to address the shortage.
Current and projected shortage indicators
- According to the Bureau of Labor StatisticsEmployment Projections 2021-2031, the registered nursing (RN) workforce is expected to grow 6% over the next decade. The RN workforce is expected to grow from 3.1 million in 2021 to 3.3 million in 2031, an increase of 195,400 nurses. The Bureau also projects 203,200 RN openings each year through 2031, when nursing retirements and exits from the workforce will account for the number of nurses needed in the US.
- MondayBLS Occupational Outlook Handbook. Approximately 30,200 new APRNs, prepared in master's and doctoral programs, will be needed each year through 2031 to meet the growing demand for care.
- In accordance withUS Registered Nurses Bulletin and Shortage PredictionPublished in the September/October 2019 issue of the magazineAmerican Journal of Medical Quality, the RN shortage is expected to spread across the country by 2030. In this state-by-state analysis, the authors predict significant RN shortages in 30 states with the most severe shortages in the Western US.
- In April 2022, Dr. David Auerbach and colleaguespublished an analysis of the nursing workforcetheyhealth matters, which found that the total supply of registered nurses decreased by more than 100,000 from 2020 to 2021, the largest drop seen in the past four decades. A significant number of nurses who dropped out of the workforce were under the age of 35, and the majority worked in hospitals.
- The Institute of Medicine in its landmark report onThe future of nursingcalled for increasing the number of nurses with a bachelor's degree in the workforce to at least 80% to increase patient safety. The current nursing workforce does not meet these recommendations, with only 65.2% of registered nurses prepared at the undergraduate or graduate level under thelatest workforce surveycarried out by the National Council of State Nursing Councils.
Factors Contributing to Nursing Shortages
Nursing school enrollments are not growing fast enough to meet the projected demand for RN and APRN services.
While enrollment in Bachelor of Nursing programs increased 3.3% in 2021, the AACN reported declines in PhD and Master of Nursing programs by 0.7% and 3.8%, respectively. These trends raise concerns about the ability of nursing schools to meet the projected demand for nursing services, including the need for more nursing faculty, researchers, and primary care providers.
The shortage of teaching staff in nursing schools is restricting enrollment in the nursing program.
- According to the AACN report on2021-2022 Enrollment and Graduation in the Undergraduate and Graduate Programs in Nursing, US nursing schools rejected 91,938 eligible applications (non-applicants) for undergraduate and graduate nursing programs in 2021 due to insufficient faculty, clinical locations, classroom space, and preceptors clinics, as well as budget constraints.
A significant segment of the nursing workforce is nearing retirement age.
- according to aNational Nursing Workforce Survey 2020conducted by the National Council of State Boards of Nursing found that the average age of an RN is 52 years, which may indicate a big wave in the next 15 years.
- In ahealth mattersBlogPublished in May 2017, Dr. Peter Buerhaus and colleagues project that more than 1 million registered nurses will retire from the workforce by 2030.
Demographic change points to the need for more nurses to care for our aging population.
- OThe United States Census Bureau reportedthat by 2034 there will be 77.0 million people aged 65 and over, compared to 76.5 million under the age of 18. comorbidities.
Amplified by the pandemic, staffing shortages are increasing nurses' stress levels, affecting their job satisfaction and forcing many nurses to leave the profession.
- According to data published on Nurse.comNurse Salary Survey Report 2022, 29% of nurses across all license types are considering leaving in 2021, up from 11% in 2020. more reasonable workload.
- In March 2022, the American Nurses Foundation and the American Nurses Association published the results of theirCOVID-19 Impact Assessment Survey, which found that 52% of nurses are considering leaving their current position primarily due to understaffing, work that negatively affects health and well-being, and an inability to provide quality care. Additionally, 60% of critical care nurses report feeling burned out and 75% report feeling stressed, frustrated and exhausted.
- In September 2021, the American Association of Critical Care Nurses reportedSearch resultsshowing that 66% of critical care nurses considered leaving nursing after their experiences during the pandemic.
Impact of the nursing team on patient care
Many scientific studies point to the connection between adequate levels of RNs and safe patient care.
- In November 2021, new research in Nursing Perspectives examinedChanges in Nursing Bachelor's Education and 30-Day Inpatient Surgical Mortality. The researchers found that having a higher proportion of BSN-prepared nurses in hospital settings, regardless of educational background, is associated with lower 30-day inpatient surgical mortality rates. The findings support the promotion of various BSN educational pathways.
- In the July 2017 issue ofQuality and Safety BMJ, The International Journal of Health Improvement, Dr. Linda Aiken and Colleagues Releasedresults of a study of intensive care hospitalsin Belgium, England, Finland, Ireland, Spain and Switzerland, who found that a higher proportion of professional nurses at the bedside is associated with better patient and nurse outcomes. Reducing the nursing skill mix by adding care staff without professional nursing qualifications can contribute to preventable deaths, erode quality of care, and contribute to nursing shortages.
- In a study published in the journalQuality and Safety BMJin May 2013, investigator Heather L. Tubbs-Cooley and colleagues noted that larger numbers of patients were associated with higher rates of hospital readmission. The study found that when more than four patients were assigned to an RN at pediatric hospitals, the likelihood of hospital readmissions was significantly increased.
- In the August 2012 issue ofAmerican Journal of Infection Control, Dr. Jeannie Cimiotti and colleagues identified a significant association between high patient-per-nurse ratios and nurse burnout with an increase in urinary tract and surgical site infections. In this study of Pennsylvania hospitals, researchers found that increasing a nurse's patient load on a single patient was associated with higher rates of infection. The authors conclude that reducing nurse burnout can improve both nurse well-being and the quality of patient care.
- In a study published in the April 2011 issue ofMedical care, Dr. Mary Blegen and colleagues at the University of California, San Francisco found that higher levels of nursing staffing were associated with fewer deaths, fewer failed rescue incidents, lower infection rates, and shorter hospital stays.
- In March 2011, Dr. Jack Needleman and colleagues published findings inNew England Journal of Medicine, indicating that insufficient nursing staffing was associated with higher rates of patient mortality. These researchers analyzed the records of nearly 198,000 hospitalized patients and 177,000 eight-hour nursing shifts in 43 patient care units at large academic health centers. The data shows that the risk of patient mortality was approximately 6% higher in understaffed units compared to fully staffed units. In the study titled “Nursing Faculty and Mortality in Inpatient Hospitals,” researchers also found that when a nurse's workload increases due to high patient turnover, the risk of mortality also increases.
- A growing body of research clearly links nurses trained with a bachelor's degree to lower rates of mortality and rescue failure. The latest studies published in journalsSearch for health servicesin August 2008 andNursing Administration Magazinein May 2008 confirm the results of several previous studies linking the level of education and patient outcomes. Efforts to address the nursing shortage should focus on preparing more licensure level nurses to ensure access to safe patient care.
- In March 2007, it was published inNursing Staff and Quality of Patient Care. Through this meta-analysis, the authors found that the shortage of registered nurses, in combination with the increasing workload, represents a potential threat to quality. Increases in RNs were associated with reductions in hospital-related mortality and rescue failures, as well as reductions in length of stay.
- The shortage of nurses prepared at the baccalaureate level is affecting the quality of care and patient outcomes. In a study published on September 24, 2003, inJournal of the American Medical Association (JAMA),Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This large study found that surgical patients have a "substantial survival advantage" if they are treated in hospitals with a higher proportion of trained nurses with a bachelor's degree or higher. In hospitals, a 10% increase in the proportion of nurses with a BSN degree reduced the risk of patient death and rescue failure by 5%.
Efforts to address the nursing shortage
- AACN is committed to working with the health and education community to create enough highly qualified nurses to meet the needs of the nation's diverse patient population. To address the nursing shortage, AACN advocates for federal legislation and increased funding for nursing education (Title VIII, FAAN Act); promote a post-licensure nursing residency program to help retain nurses; fostering innovation in nursing programs, including the development of accelerated programs (BSN and MSN high school programs; bachelor's through doctoral degrees); and work with partner organizations to highlight careers in nursing, including those that require preparation at the graduate level.
- Since 2010, AACN operatesenfermagemCAS, the nation's centralized application service for nursing education programs that prepare nurses for basic and advanced roles. One of the main reasons for launching NursingCAS was to ensure that all nursing school vacancies were filled to better serve the national need for RNs, APRNs, and nursing faculty.
- In June 2022, the National Council of State Legislatures issued apresentationOutlining the different legislative approaches that states are using to address nursing shortages, including tailoring the scope of practice laws and providing financial incentives for preceptors,
- in a report onHow to alleviate America's nursing shortageLaunched in May 2022, the Center for American Progress calls for bold policies to address nursing shortages to ensure more patients have access to safe, high-quality nursing services. The report highlights how federal and state policymakers can address shortages through coordinated planning, action, and investment.
- Many state initiatives are underway to address the shortage of registered nurses and nurse educators. For example, in October 2022, the University of Minnesota and the State of Minnesota joined forces to createCoalition for Equity and Excellence in Nursing, which will work with all state nursing schools, health professionals, and other stakeholders to increase enrollment in nursing education programs, expand equity in the nursing workforce, and increase student success. Additional initiatives are also underway inFloridamiLouisianaamong other states.
- Nursing schools are forming strategic partnerships and seeking private support to help expand student capacity.
Recent Articles on the Nursing Shortage
- Buerhaus , P.I. , Staiger , D.O. , Auerbach , D.I. , Yates , C. and Donelan , K. (2022, January).Nursing work during the first fifteen months of the COVID-19 pandemic. health matters, 41(1).
- Buerhaus, PI (2021, September/October).The current nursing shortage could have long-lasting consequences: it's time to change our current course. Economics of Nursing, 39(5), 247-250.
- Firth, S. (2022, May 16).More support needed to strengthen nursing pipeline, experts say.medical page today.
Last update:October 2022
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