Fact Sheet Updated April 2008 Nursing Shortage | Download PDF version | 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 shortage of Registered Nurses (RNs) and is working with schools, policy makers, kindred organizations, and the media to bring attention to this health care crisis. AACN is working to enact legislation, identify strategies, and form collaborations to address the nursing shortage. To keep stakeholders abreast of current statistics related to the shortage, this fact sheet has been developed along with a companion Web resource. Current and Projected Shortage Indicators The shortage of registered nurses (RNs) in the U.S. could reach as high as 500,000 by 2025 according to a report released by Dr. Peter Buerhaus and colleagues in March 2008. The report, titled The Future of the Nursing Workforce in the United States: Data, Trends and Implications, found that the demand for RNs is expected to grow by 2% to 3% each year. In a statement released in March 2008, The Council on Physician and Nurse Supply, an independent group of health care leaders based at the University of Pennsylvania, has determined that 30,000 additional nurses should be graduated annually to meet the nation's healthcare needs, an expansion of 30% over the current number of annual nurse graduates. According to the latest projections from the U.S. Bureau of Labor Statistics published in the November 2007 Monthly Labor Review, more than one million new and replacement nurses will be needed by 2016.  Government analysts project that more than 587,000 new nursing positions will be created through 2016 (a 23.5% increase), making nursing the nation’s top profession in terms of projected job growth. www.bls.gov/opub/mlr/2007/11/art5full.pdf According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 RNs to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%. The report, titled The 2007 State of America's Hospitals - Taking the Pulse, also found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005. Based on finding from the Nursing Management Aging Workforce Survey released in July 2006 by the Bernard Hodes Group, 55% of surveyed nurses reported their intention to retire between 2011 and 2020. The majority of those surveyed were nurse managers. In April 2006, officials with the Health Resources and Services Administration (HRSA) released projections that the nation's nursing shortage would grow to more than one million nurses by the year 2020. In the report titled What is Behind HRSA's Projected Supply, Demand, and Shortage of Registered Nurses?, analysts show that all 50 states will experience a shortage of nurses to varying degrees by the year 2015. According to a report published in November 2004 as a Web exclusive of Health Affairs, Dr. Peter Buerhaus and colleagues found that "despite the increase in employment of nearly 185,000 hospital RNs since 2001, there is no empirical evidence that the nursing shortage has ended. To the contrary, national surveys of RNs and physicians conducted in 2004 found that a clear majority of RNs (82%) and doctors (81%) perceived shortages where they worked." 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 a 5.4% enrollment increase in entry-level baccalaureate programs in nursing in 2007 over the previous year, this increase is not sufficient to meet the projected demand for nurses. HRSA officials stated in an April 2006 report that "to meet the projected growth in demand for RN services, the U.S. must graduate approximately 90 percent more nurses from US nursing programs." A shortage of nursing school faculty is restricting nursing program enrollments. According to AACN's report on 2007-2008 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 40,285 qualified applicants from baccalaureate and graduate nursing programs in 2006 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Almost three quarters (71.4%) of the nursing schools responding to the 2007 survey pointed to faculty shortages as a reason for not accepting all qualified applicants into entry-level nursing programs. 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. With fewer new nurses entering the profession, the average age of the RN is climbing. According to the 2004 National Sample Survey of Registered Nurses released in February 2007 by the federal Division of Nursing, the average age of the RN population in March 2004 was 46.8 years of age, up from 45.2 in 2000. The RN population under the age of 30 dropped from 9.0% of the nursing population in 2000 to 8.0% in 2004. The total population of registered nurses is growing at a slow rate. 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 2,696,540 in 2000 to 2,909,357 in 2004, this increase (7.9%) was comparatively low considering growth between earlier report intervals (i.e. the RN population grew 14.2% between 1992 and 1996). In 2004, an estimated 83.2% of RNs were employed in nursing. Changing demographics signal a need for more nurses to care for our aging population. According to the July 2001 report, 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 and beyond. 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. Insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession. In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%). According to a study in the October 2002 Journal of the American Medical Association, nurses reported greater job dissatisfaction and emotional exhaustion when they were responsible for more patients than they can safely care for. Researcher Dr. Linda Aiken concluded that "failure to retain nurses contributes to avoidable patient deaths." High nurse turnover and vacancy rates are affecting access to health care. In September 2007, Dr. Christine T. Kovner and colleagues found that 13% of newly licensed RNs had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. These findings were reported in the American Journal of Nursing in an article titled “Newly Licensed RNs’ Characteristics, Work Attitudes, and Intentions to Work.”  In July 2007, a report released by the PricewaterhouseCoopers’ Health Research Institute found that though the average nurse turnover rate in hospitals was 8.4%, the average voluntary turnover for first-year nurses was 27.1%.  This report is titled What Works: Healing the Healthcare Staffing Shortage. In March 2005, the Bernard Hodes Group released the results of a national poll of 138 health care recruiters and found that the average RN turnover rate was 13.9%, the vacancy rate was 16.1% and the average RN cost-per-hire was $2,821. Impact of Nurse Staffing on Patient Care Many recent studies point to the connection between adequate levels of registered nurse staffing and safe patient care. In March 2007, a comprehensive report initiated by the Agency for Healthcare Research and Quality was released on Nursing Staffing and Quality of Patient Care.  Through this meta-analysis, the authors found that the shortage of registered nurses, in combination with an increased workload, poses a potential threat to the quality of care. Increases in registered nurse staffing was associated with reductions in hospital-related mortality and failure to rescue as well as reduced length of stays. In settings with inadequate staffing, patient safety was compromised. Published in the March 2006 issue of Nursing Economic$, a comprehensive analysis of several national surveys on the nursing workforce found that majority of nurses reported that the RN shortage is negatively impacting patient care and undermining the quality of care goals set by the Institute of Medicine and the National Quality Forum. In an article published in the September/October 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and associates found that the majority of RNs (79%) and Chief Nursing Officers (68%) believe the nursing shortage is affecting the overall quality of patient care in hospitals and other settings, including long-term care facilities, ambulatory care settings, and student health centers. Most hospital RNs (93%) report major problems with having enough time to maintain patient safety, detect complications early, and collaborate with other team members. In November 2004, results from the National Survey on Consumers' Experiences with Patient Safety and Quality Information were released and found that 40% of Americans think the quality of health care has worsened in the last five years. Consumers reported that the most important issues affecting medical error rates are workload, stress or fatigue among health professionals (74%); too little time spent with patients (70%); and too few nurses (69%). This survey was sponsored by the Kaiser Family Foundation, the Agency for Healthcare Research and Quality and the Harvard School of Public Health. 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. 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 US 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. 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. 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. 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. Strategies to Address the Nursing Shortage Many statewide initiatives are underway to address both the shortage of RNs and nurse educators. For example, Iowa’s Lieutenant Governor Patty Judge released a report in March 2008 calling for the creation of a statewide Nursing Task Force to address challenges facing the state’s nursing workforce, including low wages. Tennessee Governor Philip Bredesen and state health officials launched a campaign in January 2007 to raise $1.4 million in funding for a scholarship program to help RNs earn graduate degrees needed to teach nursing.  In November 2006, Illinois Governor Rod R. Blagojevich opened the Illinois Center for Nursing to assess the current supply and demand for nurses in the state and develop a strategic plan to ensure that Illinois can educate, recruit and retain nurses. See www.aacn.nche.edu/Publications/issues/Oct06.htm and  www.aacn.nche.edu/Media/PartnershipsResource.htm. In July 2007, PricewaterhouseCoopers’ Health Research Institute released a report titled What Works: Healing the Healthcare Staffing Shortage which advanced several strategies for addressing the nursing shortage, including developing more public-private partnerships, creating healthy work environments, using technology as a training tool, and designing more flexible roles for advanced practice nurses given their increased use as primary care providers. In January 2007, Reps. Nita Lowey (D-NY), Peter King (R-NY), and Lois Capps (D-CA), introduced the Nurse Education, Expansion and Development Act (NEED Act) in the House and a companion bill was introduced in the Senate by Senator Richard Durbin (D-IL). The NEED Act would amend Title VIII of the Public Health Service Act to authorize Capitation Grants (formula grants) for schools of nursing to increase the number of faculty and students. Capitation grant programs have been used to effectively address past nursing shortages.  In an article published in the June 2006 issue of Health Affairs titled “Hospitals’ Responses to Nurse Staffing Shortages,” the authors found that 97% of surveyed hospitals were using educational strategies to address the shortage of nurses. Specific strategies include partnering with schools of nursing, subsidizing nurse faculty salaries, reimbursing nurses for advancing their education in exchange for a work commitment, and providing scheduling flexibility to enable staff to attend classes. The paper ends with a call for more public financing support for the nursing educational system to expand student capacity. Nursing colleges and universities are also forming strategic partnerships and seeking private support to help expand student capacity and strengthen the nursing workforce. For example, Blue Cross and Blue Shield of Florida donated $600,000 in funding to both the University of North Florida and the University of Florida in an effort to address critical issues in nursing education. The State of Florida matched each gift at $420,000. In September 2005, the Osteopathic Heritage Society awarded almost $1 million in funding to five Columbus, Ohio area schools of nursing to recruit more faculty and equip more training facilities. In June 2005, Georgia Baptist College of Nursing is partnering with Piedmont Healthcare in Atlanta to help recruit, educate and ultimately place more nurses in the health system and the community at large. In June 2005, the US Department of Labor awarded more than $12 million in grant-funding through the President's High Growth Job Training Initiative, $3 million of which will help to address the nurse faculty shortage. This latest round of funding brings the DOL's commitment to health care workforce through the High-Growth program to more than $43 million. Details on all grant-funded programs are posted online. In 2002, the Nurse Reinvestment Act (P.L. 107-205) expanded existing law in Nursing Workforce Development (Title VIII, Public Health Service Act) to create new and expanded programs targeted to resolving the nursing shortage. Every year Congress must fund these programs through the appropriations process to maintain or expand the Nurse Faculty Loan Program, Nurse Scholarship Program, and other critical nursing education programs. Two national media campaigns have been launched to help polish the image of nursing. Nurses for a Healthier Tomorrow is a coalition of 44 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, and other visuals. 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.   Last Update: April 1, 2008 CONTACT: Robert Rosseter (202) 463-6930, x231 rrosseter@aacn.nche.edu Top | Media | Nursing Shortage Resource | AACN Home Copyright © 2008 by the American Association of Colleges of Nursing. 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