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Evidence continues to mount that the American health care delivery system is heading towards a major nursing crunch that will make it increasingly harder for you to coordinate quality care for your case management clients. The latest data come from Texas, where fewer young adults enter the field of nursing each year.
Nearly 50% of nurses in Texas are between the ages of 31 and 45, and another 30% are in the 46 to 55 age group. This dominance of nurses in their 40s means that Texas, like the rest of the nation, faces the potential for a deep, long-term nursing shortage over the next 10 to 15 years. But the news from Texas isn’t all bad: More than 60% of nurses said they would enter nursing again today if they "had it to do over." Further, 57% said they would encourage young people interested in the health care field to enter nursing.
"Nurses are concerned about the quality of patient care they deliver," says Nancy Ackley, RN, director of the Texas Nurses Foundation. "Specific workplace practices — more paperwork, sicker patients, and fewer nurses to care for more patients — are seen as negatively impacting the quality of patient care."
The Texas Nurses Foundation in Austin recently released the results of a 453-respondent survey on nursing job satisfaction that is part of the Texas Nurse Workforce Data System project. The project is a collaborative effort of the Texas Nurses Foundation, the Texas Institute for Health Policy Research of the Texas Hospital Association, also in Austin, and the Center for Health Economics and Policy at the University of Texas Health Sciences Center in San Antonio. Its goal is to identify barriers to increasing the supply of nurses and to develop a predictive model regarding nurse supply and demand to help policy makers allocate resources for nursing education.
The study identified three key factors affecting the retention of nurses in the active work force, notes Ackley. Those factors are:
• Work environment practices that contribute to work-related stress, burnout, and attrition. "About 50% of nurses reported increases in required overtime, floating between units depending on patient volume, and the use of temporary nurses," says Ackley.
• The aging of the current RN work force, combined with shrinking applicant pools for schools of nursing and the concurrent aging of nursing school faculty. To work beyond their projected retirement age of 62, RNs surveyed said that "improvements would be needed in patient care — higher ratios of nurses to patients, reduced paperwork, and generally better working conditions."
• Generational differences in women’s career choices that make nursing less attractive. Only 14% of the 453 nurses surveyed were under age 31. In addition, of those surveyed not currently employed as nurses, 18% had changed to "another field," and 11% had enrolled in "an education program."
Other national studies show troubling signs of an impending nursing shortage. Data from the U.S. Census Survey shows that the average age of RNs increased substantially from 1983 to 1998. This trend is expected to lead to a nursing supply shortage that will affect the access to and quality of health care in the United States as early as 2010 — the same year that large numbers of nurses and the first of the nation’s 78 million baby boomers begin retiring and enrolling in the Medicare program.
The total number of full-time equivalent RNs per capita is forecast to peak around the year 2007 and decline steadily thereafter as large groups of RNs retire, according to a study in the Journal of the American Medical Association. Within the next 10 years, the average age of RNs is forecast to be 45.4 years, an increase of 3.5 years over the current age, with more than 40% of the RN work force expected to be older than 50.
Copies of the report, In Their Own Words: Career Fulfillment of Texas RNs, are available from the Texas Nurses Foundation for $45 for members of the foundation and members of the Texas Hospital Association, and $65 for nonmembers, plus $3.50 for tax, shipping, and handling. For more information, call (512) 453-7015.
[See also: Buerhaus PI, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. JAMA 2000; 283(22):2948-2954.]