The existing nursing deficit in the U.S. -- largely caused by the aging population, increasing prevalence of chronic disease, an aging workforce and limited capacity in nursing education programs -- might be creeping closer to a crisis. In "The U.S. is running out of nurses," which was published Feb. 3 in The Atlantic, freelance writer Rebecca Grant recalls the time her mother was hospitalized, and how the nurses helped her family get through the experience. "Nurses checked on my mother -- and us -- multiple times an hour," she wrote. "They ran tests, updated charts and changed IVs; they made us laugh, allayed our concerns and thought about our comfort. The doctors came in every now and then, but the calm dedication of the nurses was what kept us together. Without them, we would have fallen apart." This, Grant wrote, makes the impending shortage more troubling. Despite being one of the fastest-growing occupations in the country, demand for nurses is outpacing the supply, she wrote. According to Bureau of Labor Statistics projections, by 2022 there will be more than 1 million jobs for RNs. The article cites a 2009 report by Vanderbilt University researchers, which noted the shortage in 2025 will be twice the size of any nurse shortage "since the introduction of Medicare and Medicaid in the mid-1960s."
One factor is the increasing demand for healthcare linked to the aging of the baby boomers, and the accompanying need for more services. "Between 2010 and 2030, the population of senior citizens will increase by 75% to 69 million, meaning one in five Americans will be a senior citizen; in 2050, an estimated 88.5 million people in the U.S. will be ages 65 and older," Grant wrote. As the population ages, many will have more healthcare needs. About 80% have at least one chronic health condition, according to the National Council on Aging, and 68% have at least two. "People with chronic diseases clearly use more healthcare services, and people who are older have more chronic disease," Julie Sochalski, an associate professor at the University of Pennsylvania School of Nursing, Philadelphia, said in the article. "The aging population and chronic disease are creating the perfect storm driving demand for nurses." Nurses are aging and beginning to retire from the field, Grant wrote, which contributes to the shortage. According to a report from the Health Resources and Services Administration at the U.S. Department of Health and Human Services, more than one-half million RNs are expected to retire or leave the workforce by 2022, Grant wrote. Filling the open positions won't be easy. Even though an increasing number of new RNs are entering the workforce, nursing education programs haven't been able to keep pace, Grant wrote. Nurse educators are also aging, and it takes time to develop nurse faculty with doctoral degrees to build up programs, she wrote. Even if RNs do gain their entry-level degrees, many facilities are reluctant to hire brand-new nurses because of the experience gap between them and retiring longtime RNs, Grant wrote. Depending on the geographic area, there also are a limited number of facilities for them to gain training and practical experience.
Is it so severe? And what can fix it?
According to the article, researchers have different opinions on the severity of the shortage and possible solutions. Ed Salsberg, MPH, who studies nursing-workforce issues at the George Washington University School of Nursing, Washington, D.C., said the U.S. is facing a distribution problem, with some parts of the country having a more plentiful supply of nurses and others feeling the scarcity more acutely, according to the article. Other nurse executives Grant spoke with think having national licensing standards for RNs would help address pockets with more severe shortages, because many RNs prefer to work where they can practice to the full scope of their licenses. The article notes several possible solutions to the shortage such as improving access to nurse education, especially in rural or poorer communities, and public-private partnerships and incentives for RNs to become nurse educators. The American Nurses Association is lobbying Congress to increase federal grants to help fund nursing schools and organizations that work to improve access to education, increase diversity in the field and repay loans for students who go on to work in underserved areas. To comment, email [email protected].
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