An influx of nurses won’t solve shortage

Biggest group is older than 50, report says

Older nurses returning to work have helped ease the nursing shortage, but they also create a greater imperative for ergonomic modifications, says Peter Buerhaus, PhD, senior associate dean for research at the Vanderbilt University School of Nursing in Nashville, TN.

Buerhaus, an expert on the nursing work force, reports enormous demographic changes that will have a long-term impact on hospital staffing. "In the last couple of years, I think there has been a much deeper awareness that this shortage probably is different than previous ones because it has a lot to do with the aging of the work force," he continues.

In 2002, more than 104,000 nurses entered the work force, a huge resurgence, Buerhaus reported in Health Affairs.

Two-thirds of that growth came from nurses older than 50. About 15,000 foreign-born nurses came to U.S. hospitals from other countries,1 the report said, which was co-authored by Douglas Staiger, PhD, professor of economics at Dartmouth College, and David Auerbach, PhD, an associate analyst in the health and human resources division of the Congressional Budget Office.

The older nurses were attracted by higher wages (an increase of nearly 5%), when their spouses were facing job insecurity or unemployment in an economic downturn, Buerhaus says.

As the economy rebounds, many of those nurses may once again leave the work force, he points out. "If hospitals change the ergonomic workplace, these nurses may decide to stay."

In fact, Buerhaus grimly notes, "There’s nobody out there but these older nurses. So you better do what you can do and do it quickly."

Few young women are choosing nursing as a career. From 2001 to 2002, the number of RNs younger than 35 actually declined by 8.3%. Twenty years ago, about a third of the nursing work force was younger than 30. Today, younger nurses only account for about 10% of the work force.

That means that just as the baby boom generation is retiring and requiring more health care services, nurses also will be retiring in large numbers, deepening the shortage. Even the kind of surge in employment seen in 2002 wouldn’t be enough to stem a shortage, Buerhaus says.

The nursing supply needs to increase by 40% per year, he says.

Nursing school enrollment rises

The statistics are bleak, but there are some bright spots. The American Association of Colleges of Nursing (AACN) in Washington, DC, reported that enrollment in entry-level baccalaureate programs in nursing rose by 15.9% in fall 2003 compared to the prior year. That is the third year of growth after six years of declining enrollment.

Renewed interest in nursing actually could have produced even more new workers if the schools had the capacity. Tight state budgets and shortages of nursing faculty forced nursing schools to turn away qualified applicants, the AACN reported.

Congress should intervene by providing the funding to rapidly increase the capacity of nursing schools. "I can’t emphasize enough how important it is to have nurses in school," Buerhaus says.

Meanwhile, the influx of foreign-born nurses is four times greater than during previous shortages, he says. That creates a host of other issues, including the impact on shortages of skilled nursing care in other countries and on quality of care. "We’re moving down that path without any debate or discussion about the merits of that approach," he explains.

Enticing older nurses to stay will require changes in the work environment, Buerhaus says. Medicare should provide supplemental payments for hospitals that make improvements to ease the burden on nurses, he adds.

"I think Medicare is very shortsighted in not looking at a payment system that ties payments to hospitals with efforts to improve ergonomic environment," Buerhaus says.

He even suggests that medical device and supply companies provide grants to stimulate the use of ergonomic equipment. After all, in a severe nursing shortage, hospitals would have to close units or floors, which would cut deeply into their revenues and their purchases.

On a more personal level, Buerhaus envisions the impact of a severe nursing shortage on patient care. "I want enough nurses, there. I don’t want them overworked," he says. They’ll [be more likely to] make a simple mistake, and it will cost me my life."


1. Buerhaus PI, Staiger DO, Auerbach DI. Is the current shortage of hospital nurses ending? Health Affairs 2003; 22:191-198.