EXECUTIVE SUMMARY

Although reports often emerge with predictions of a pending nursing shortage, some evidence also points to the opposite: plenty of new nursing graduates to meet the demand.

  • Nursing schools are graduating more new nurses than ever, including people who enter the field as a second career.
  • Nursing students increasingly are attracted to BSN degrees and advanced practice degrees, seeing these as a way to more meaningfully connect with patients and develop rewarding careers.
  • Some hospitals and areas do have problems attracting or hiring as many nurses as are needed and could partner with nursing schools to create residency programs.

Periodically, reports and surveys come out describing a nursing shortage in the United States. Nurses and RN case managers will confirm that they’re working harder than ever to cover for unfilled staff positions.

But are there truly more nursing positions available than nurses to fill them, and will this trend worsen? Or is the reality something quite different?

The American Association of Colleges of Nursing (AACN) offers a mixed answer. The economy’s downturn a decade ago led to more people entering the profession, but there still is a shortage in some areas, particularly in the South and West. (More information is available at: http://bit.ly/2UAg5hh.)

“There is no nurse shortage in the U.S., with the possible exception of some isolated rural areas,” says Linda H. Aiken, PhD, FAAN, FRCN, professor of sociology, Claire M. Fagin leadership professor in nursing, and director for health outcomes and policy research at the University of Pennsylvania in Philadelphia.

“Graduations from nursing schools have more than doubled over the past 15 years, with as many as 150,000 or more nurses graduating each year,” Aiken says. “This is far more than needed to replace retiring baby boomer nurses.”

The American Nurses Association (ANA) estimates that the number of nurses leaving the field is about 75,000 per year, while the number of new nurses passing the certifying exam for registered nurses is approximately 140,000 per year. (More information is available at: http://bit.ly/2ROwyNj.)

Aiken points out that college students increasingly are drawn to BSN degrees because the opportunities for steady employment, good salaries and benefits, and professional advancement are better in nursing than in many other fields. It is one of the most popular career choices now, she says.

This trend has continued for more than a decade as people enter first careers that prove less rewarding and return to school to try nursing.

“About half of our undergraduate students who are in basic RN classes are students who had degrees in other fields, including law, engineering, and financial services,” Aiken says. “We have had students who were trained to be attorneys and found the work very boring and wanted to do something more meaningful with their lives.”

It helps that nursing salaries have risen over the past two decades and that nurses increasingly are seeking advanced practice degrees to become nurse practitioners, nurse midwives, and so forth. Nursing is seen as a pathway to clinical practice, more responsibility, and more autonomy.

“It’s all market-driven,” she adds. “Nursing schools have expanded as much as they possibly could have because they have so many great applicants and are turning away 50,000 qualified nursing students each year.”

For case managers, the situation is different.

“We do have trouble filling case manager spots,” says Mary McLaughlin Davis, DNP, ACNS-BC, NEA-BC, CCM, a senior director of care management at Cleveland Clinic in Ohio. Davis also is the immediate past president of the Case Management Society of America.

“Some hospitals have a lot of case management openings because it really is a special skill set,” she says.

The average age of case managers is in the 50s, and it’s not a role that RNs can learn in six weeks, she notes. “It takes time for a good case manager to move from novice to expert level.”

Transitioning patients safely and quickly is intense work that not everyone has the skills and interest to master, Davis adds.

Case management jobs are appealing to new nurses, but it takes time for new nursing graduates to gain the necessary experience for this role, Aiken notes.

“We have relatively more inexperienced nurses, and case management is looking for experienced nurses, so there might be a little, temporary experience gap,” she explains. “Within five years, that will disappear. It’s not too long of a wait for a really larger workforce.”

Meantime, why will some nurses and patients say they are seeing the impact of a nursing shortage? One factor that adds to this perception is that some hospitals are not keeping their nursing departments fully staffed, so there can be bedside nursing shortages.

“People say there are not enough nurses in a hospital, and it’s because the hospital doesn’t have a large enough budget for nurses,” Aiken says.

It’s a mistake to take a shortcut on nursing care because that’s the main reason patients are in a hospital, she notes.

“We’ve reduced hospital admissions by tens of millions of days for people who don’t need continuous nursing care,” she explains. “They can have same-day surgery and go home, so the only reason many patients need to be in the hospital is for nursing care.”

When hospitals treat nursing as a service they want to minimize, they’re forgetting that nursing is a major service and that having adequate staffing levels is what drives every positive outcome. “The more nurses employed at a hospital, the better patient satisfaction is,” Aiken says.

Also, there are nursing shortages in some rural areas that are further from nursing schools. When hospitals are understaffed in nursing for a period of time, they can develop a reputation for having challenging working conditions. This can result in fewer nurses applying for jobs at those locations, she explains.

Another factor in the perception of a nursing shortage is that employers often do not want to give new nurses a chance.

“They’re not willing to make that investment, and it’s the same in every field,” Aiken says.

One solution to this problem is for health systems and nursing schools to team up to develop residency programs for new-to-practice nurses, she suggests.

Case management directors also should consider hiring nurses with less that five years of experience for case management jobs, Aiken says.

“These nurses that are closer to their education could be very good,” she says. “What they’re learning is fresh in their minds.”