Nursing schools forced to turn away applicants

Biggest growth in ambulatory care

The number of licensed registered nurses in the United States increased 7.9% from 2000 to 2004, to an estimated 2.9 million, according to preliminary findings from the 2004 National Sample Survey of Registered Nurses. But the nursing shortage persists, and nursing schools in 2005 had to turn away more than 32,000 qualified applicants due to capacity restraints.

About 83% of licensed RNs were employed in nursing in 2004, 58.3% full-time. The average earnings of full-time RNs increased 12.8% since 2000, after adjustment for inflation, while the average age of RNs increased to 46.8 years from 45.2 years. The federal Health Resources and Services Administration's Bureau of Health Professions conducts the survey every four years, and expected to publish the complete 2004 results in March.

The data on nursing school enrollment were released by the American Association of Colleges of Nursing (AACN).

"These findings show we are making progress in increasing the supply of nurses, but we must continue these efforts to meet the ongoing and future demand for nurses in this country," says Denise Geolot, director of the Bureau of Health Professions Division of Nursing.

Results from the 2004 Bureau of Health Professions survey indicate a slight trend away from the hospital as the setting for nurses' principal nursing positions, although changes in the structure of hospitals (e.g., more specialty outpatient clinics) may explain some of the change, the report states. Although the estimated number of RNs whose principal position was in hospitals was greater in 2004 than in 2000, the percentage of RNs working in hospitals decreased from 2000 to 2004. In March 2004, out of an estimated 2.4 million RNs employed in nursing, 56.2 % worked in hospital settings compared to 59% in March 2000.

Community and public health settings — which include occupational health nursing — remained the next largest type of predominant employment for RNs; but the percent of RNs employed in these settings also decreased, from an estimated 18.3% of RNs reporting public or community health settings in 2000 to 14.9% in March 2004. The percent of RNs reporting nursing homes and extended-care facilities as their principal setting remained relatively constant between 2000 (6.9%) and 2004 (6.3%).

In contrast, the percent of RNs reporting their principal nursing position in other types of settings, particularly ambulatory care, increased from 2000 to 2004, according to the report. In 2004, 11.5% of RNs were estimated to be employed in ambulatory care settings, including physician-based practices, nurse-based practices, and health maintenance organizations, compared to 9.5% in 2000.

32,000 applicants turned away in 2005

Despite an ongoing nursing shortage and a 13% increase in enrollment in entry-level baccalaureate nursing programs in 2005, nursing schools had to turn away more than 32,000 qualified applicants due to capacity constraints, according to AACN data.

"Despite the successful efforts of schools nationwide to expand student capacity, our nation's nursing schools are falling far short of meeting the current and projected demand for [registered nurses]," says AACN President Jean Bartels. The federal government projects a shortfall of 800,000 registered nurses by the year 2020.

Pamela Thompson, CEO of the American Organization of Nurse Executives, says the AACN data are troubling. "We desperately need to increase the number of students graduating from baccalaureate programs, but the constraints on schools to accomplish this seem to be increasing," she says. "The shortage of faculty and limits to capacity could cripple our ability to graduate enough nurses to meet our future needs. We must continue to search for multiple solutions to this growing problem."

The near 8% increase in the number of RNs from 2000 to 2004 is greater than the 5.2% increase from 1996 to 2000, but lower than the 14.2% increase seen from 1992 to 1996.

Kathy Sanford, president of the American Organization of Nurse Executives, says the group is "pleased that the supply of registered nurses is increasing in numbers." But she noted that "multiple projections indicate we will still have a shortage of RNs because the growing need is outstripping the growth in numbers of nurses."

Sanford points out that as the baby boomer generation ages, there is a greater demand for nursing care coupled with an increasing average age of nurses.

Go to for more information on the Bureau of Health Professions 2000-2004 report, and for the AACN 2005 data.