Nursing Shortage Fact Sheet

The United States is in the midst of a nursing shortage that is expected to intensify as baby boomers age and the need for health care grows. Compounding the problem is the fact that nursing colleges and universities across the country are struggling to expand enrollment levels to meet the rising demand for nursing care.

The American Association of Colleges of Nursing (AACN) is concerned about the nursing shortage and is working with member schools, policy makers, kindred organizations, and the media to bring attention to this health care crisis. AACN is directing its efforts toward enacting legislation, identifying strategies, and forming collaborations to address the nursing shortage. To keep stakeholders abreast of current statistics related to the shortage, this fact sheet has been developed and will be updated on a regular basis. A companion Web resource has also been created.

Current and Projected Shortage Indicators

• According to a July 2002 report by the Health Resources and Services Administration, 30 states were estimated to have shortages of registered nurses (RNs) in the year 2000. The shortage is projected to intensify over the next two decades with 44 states plus the District of Columbia expected to have RN shortages by the year 2020. The report, Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020, is available online at http://bhpr.hrsa.gov/healthworkforce/reports/rnproject/default.htm
  
  
• According to the latest projections from the U.S. Bureau of Labor Statistics published in the February 2004 Monthly Labor Review, more than one million new and replacement nurses will be needed by 2012. For the first time, the U.S. Department of Labor has identified Registered Nursing as the top occupation in terms of job growth through the year 2012. www.bls.gov/news.release/ecopro.toc.htm
  
  
• According to the National Council of State Boards of Nursing, the number of first-time, U.S. educated nursing school graduates who sat for the NCLEX-RN®, the national licensure examination for registered nurses, decreased by 20% from 1995-2003. A total of 19,820 fewer students in this category of test takers sat for the exam in 2003 as compared with 1995.www .ncsbn.org

Number of Candidates Taking the NCLEX-RN® Exam First-Time, U.S. Educated Candidates Only
Program	1995	1996	1997	1998	1999	2000	2001	2002	2003
Diploma	7,335	6,346	5,240	3,978	3,161	2,679	2,310	2,424	2,565
Baccalaureate	31,195	32,278	31,828	30,142	28,107	26,048	24,832	25,806	26,630
Associates	57,908	55,554	52,396	49,045	45,255	42,665	41,567	42,310	47,423
Total	96,438	94,178	89,464	83,165	76,523	71,392	68,709	70,540	76,618

• According to American Hospital Association's June 2001 TrendWatch, 126,000 nurses are needed now to fill vacancies at our nation's hospitals. Today, fully 75% of all hospital vacancies are for nurses. www.aha.org
  
  
• According to a study by Dr. Peter Buerhaus and colleagues published in the Journal of the American Medical Association on June 14, 2000, the U.S. will experience a 20% shortage in the number of nurses needed in our nation's health care system by the year 2020. This translates into a shortage of more than 400,000 RNs nationwide. http://jama.ama-assn.org

Contributing Factors Impacting the Nursing Shortage

Enrollment in schools of nursing is not growing fast enough to meet the projected demand for nurses over the next ten years.

Though AACN reported in December 2003 that enrollments in entry-level baccalaureate programs in nursing increased by 16.6% over the previous year, this increase is not sufficient to meet the projected demand for nurses. In a report published in the November/December 2003 issue of Health Affairs, Dr. Peter Buerhaus and his colleagues found that “because the number of young RNs has decreased so dramatically over the past two decades, enrollments of young people in nursing programs would have to increase at least 40 percent annually to replace those expected to leave the workforce through retirement.” www.healthaffairs.org

A shortage of nursing school faculty is restricting nursing program enrollments.

• According to AACN's report on 2003-2004 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 15,944 qualified applicants to entry-level baccalaureate nursing programs in 2003 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. In 2002, a total of 5,283 students were turned away from all types of professional nursing programs as well. Almost two-thirds (64.8%) of the nursing schools responding to the 2003 survey pointed to faculty shortages as a reason for not accepting all qualified applicants into entry-level baccalaureate programs. www.aacn.nche.edu
  
  
• According to a study released by the Southern Regional Board of Education (SREB) in February 2002, a serious shortage of nursing faculty was documented in 16 SREB states and the District of Columbia. Survey findings show that the combination of faculty vacancies (432) and newly budgeted positions (350) points to a 12% shortfall in the number of nurse educators needed. Unfilled faculty positions, resignations, projected retirements, and the shortage of students being prepared for the faculty role pose a threat to the nursing education workforce over the next five years. www.sreb.org
  
  
• See also our Nursing Faculty Shortage Fact Sheet.

With fewer new nurses entering the profession, the average age of the RN is climbing.

• According to the National Sample Survey of Registered Nurses released in February 2002 by the Division of Nursing within the Bureau of Health Professions, the average age of the working registered nurse was 43.3 in March 2000, up from 42.3 in 1996. The RN population under the age of 30 dropped from 25.1% of the nursing population in 1980 to 9.1% in 2000. http://bhpr.hrsa.gov/healthworkforce/reports/rnsurvey/default.htm
  
  
• According to a July 2001 report released by the Government Accounting Office, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), 40% of all RNs will be older than age 50 by the year 2010. www.gao.gov

The total population of registered nurses is growing at the slowest rate in 20 years.

According to the latest The National Sample Survey of Registered Nurses, the total RN population has increased at every 4-year interval in which the survey has been taken since 1980. Although the total RN population increased from 2,558,874 in 1996 to 2,696,540 in 2000, it was the lowest increase (5.4%) reported since the survey began in 1980. Of the total RN population in 2000, an estimated 58.5% work full-time in nursing, 23.2% work part-time, and 18.3% are not employed in nursing. http://bhpr.hrsa.gov/

Changing demographics signal a need for more nurses to care for our aging population.

• According to a July 2001 report released by the Government Accounting Office, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), "a serious shortage of nurses is expected in the future as demographic pressures influence both supply and demand. The future demand for nurses is expected to increase dramatically as the baby boomers reach their 60s, 70s, and beyond." www.gao.gov
  
  
• According to a May 2001 report, Who Will Care for Each of Us?: America's Coming Health Care Crisis, released by the Nursing Institute at the University of Illinois College of Nursing, the ratio of potential caregivers to the people most likely to need care, the elderly population, will decrease by 40% between 2010 and 2030. Demographic changes may limit access to health care unless the number of nurses and other caregivers grows in proportion to the rising elderly population. www.kaisernetwork.org/healthcast/nursing/may01.

Job burnout and dissatisfaction are driving nurses to leave the profession.

• According to a study released in the Journal of the American Medical Association in October 2002, nurses reported greater job dissatisfaction and emotional exhaustion when they were responsible for more patients than they can safely care for. Lead researcher Dr. Linda Aiken concluded that "failure to retain nurses contributes to avoidable patient deaths." www.nursing.upenn.edu/news/detail.asp?t=2&id=23
  
  
• According to a study published by Dr. Linda Aiken and colleagues in the May/June 2001 issue of Health Affairs, more than 40% of nurses working in hospitals reported being dissatisfied with their jobs. The study indicates that 1 out of every 3 hospital nurses under the age of 30 are planning to leave their current job in the next year. www.healthaffairs.org
  
  
• According to a study commissioned by the Federation of Nurses and Health Professionals in April 2001, The Nurse Shortage: Perspectives from Current Direct Care Nurses and Former Direct Care Nurses, currently 1 out of every 5 nurses currently working is considering leaving the patient care field for reasons other than retirement within the next five years. www.aft.org/fnhp/publications/index.html

High nurse turnover and vacancy rates are affecting access to health care.

• According to a February 2002 report on health workforce shortages prepared by First Consulting Group for the American Hospital Association and other trade groups, the average nurse vacancy rate in U.S. hospitals was 13%. Over one in seven hospitals reported a severe RN vacancy rate of more than 20%. High vacancy rates were measured across rural and urban settings and in all regions of the country. Survey respondents indicated that a shortage of personnel is contributing to emergency department overcrowding and ambulance diversions. www.aha.org
  
  
• According to the report Acute Care Hospital Survey of RN Vacancies and Turnover Rates in 2000 released in January 2002 by the American Organization of Nurse Executives, the average RN turnover rate in acute care hospitals was 21.3%. The average nurse vacancy rate was 10.2% with the highest rates found in critical care units (14.6%) and medical-surgical care (14.1%). Nurse executives surveyed indicated that staffing shortages are contributing to emergency department overcrowding (51%) and the need to close beds (25%). www.aone.org

Impact of Nurse Staffing on Patient Care

Many recent studies point to the connection between adequate levels of registered nurse staffing and safe patient care.

• A shortage of nurses prepared at the baccalaureate level may be affecting health care quality and patient outcomes. In a study published in the September 24, 2003 issue of the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10 percent increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5 percent. http://jama.ama-assn.org
  
  
• A survey reported in the December 12, 2002 issue of the New England Journal of Medicine found that 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors. Overall, 42% of the public and more than a third of U.S. doctors reported that they or their family members have experienced medical errors in the course of receiving medical care. The survey was conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation. www.kff.org/content/2002/20021211a
  
  
• According to a study published in the October 23/30, 2002 issue of the Journal of the American Medical Association, more nurses at the bedside could save thousands of patient lives each year. Nurse researchers at the University of Pennsylvania determined that patients who have common surgeries in hospitals with high nurse-to-patient ratios have an up to 31% increased chance of dying. Funded by the National Institute for Nursing Research, the study found that every additional patient in an average hospital nurse's workload increased the risk of death in surgical patients by 7%. Having too few nurses may actually cost more money given the high costs of replacing burnt-out nurses and caring for patients with poor outcomes. www.nursing.upenn.edu/news/detail.asp?t=2&id=23
  
  
• In Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis, a report released in August 2002 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the authors found that a shortage of nurses in America's hospitals is putting patient lives in danger. JCAHO examined 1609 hospital reports of patient deaths and injuries since 1996 and found that low nursing staff levels were a contributing factor in 24% of the cases. www.jcaho.org
  
  
• According to a study published in the New England Journal of Medicine in May 2002, a higher proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are associated with better outcomes for hospitalized patients. This extensive study was conducted by Drs. Jack Needleman and Peter Buerhaus. http://content.nejm.org/cgi/content/abstract/346/22/1715

Strategies to Address the Nursing Shortage

• The Call to the Profession is a group of top leaders from national nursing organizations who are working together to ensure safe, quality nursing care for consumers and a sufficient supply of registered nurses to deliver that care. The group released an action plan called Nursing's Agenda for the Future in April 2002. www.ana.org
  
  
• The TriCouncil for Nursing, an alliance of four autonomous nursing organizations (AACN, ANA, AONE, NLN) each focused on leadership for education, practice and research, issued a joint policy statement in January 2001 on Strategies to Reverse the New Nursing Shortage. www.aacn.nche.edu/Publications/positions/tricshortage.htm
  
  
• The Nurse Reinvestment Act was signed by the President on August 1, 2002 and has been sent back to Congress for appropriations. Provisions of this new law include scholarship money to attract new students into nursing, a Faculty Loan Cancellation Program to remove financial barriers to faculty careers, funding to promote best practices in nursing care, and public service announcements to champion nursing careers. All stakeholders are encouraged to contact their federal legislators and indicate support for funding this legislation. www.aacn.nche.edu/Media/shortageresource.htm#legislation
  
  
• In April 2001, a coalition of 23 national nursing organizations issued a joint call to Congress to stem the nursing shortage. The group released a comprehensive plan to address the shortage entitled Assuring Quality Health Care for the United States: Supporting Nurse Education and Training that outlined funding priorities and called for new initiatives to recruit and retain nurses. www.aacn.nche.edu/Media/NewsReleases/consensus.pdf
  
  
• Two national media campaigns have been launched to help polish the image of nursing. Nurses for A Healthier Tomorrow is a coalition of 40 nursing and health care organizations working together to raise interest in nursing careers among middle and high school students. The coalition has conducted nationwide focus groups with students ages 6-15 years; secured over $600,000 in sponsorship; launched a Web site; created a televised public service announcement, and designed print ads that can be downloaded for free from the Web. In February 2002, Johnson & Johnson launched the Campaign for Nursing's Future, a multimedia initiative to promote careers in nursing that includes paid television commercials, a recruitment video, a Web site, and brochures mailed to schools across the country. www.nursesource.org and www.discovernursing.com

The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing. Representing 570 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.

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Last Update: March 8, 2004