---

About the Nursing Shortage

• Nursing Shortage Fact Sheet
  
  
• AACN Releases New Data on 2009 Nursing School Enrollments
  
  
• Nursing Faculty Shortage Fact Sheet

• Impact of the Economy on the Nurse Faculty Shortage
  
  
• State Nursing Workforce Reports

• Education Policy Initiatives to Address the Nursing Shortage in the United States
  In the July/August 2009 issue of Health Affairs, Dr. Linda Aiken and colleagues from the Center for Health Outcomes and Policy Research at University of Pennsylvania call for adapting federal funding mechanisms (i.e. Title VIII and Medicare) to focus on preparing more nurses at the baccalaureate and higher degree levels. This policy emphasis is needed to adequately address the growing need for faculty and nurses to serve in primary care and other advanced practice roles. The researchers reported that new nurses prepared in BSN programs are significantly more likely to complete the graduate level education needed to fill nursing positions where job growth is expected to be the greatest.

• The Recent Surge In Nurse Employment: Causes And Implications
  In the July/August 2009 Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025.  A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s.  The researchers point to a rapidly aging workforce as a primary contributor to the projected shortage. Because RNs over age 50 will soon be the largest age group in the nursing workforce, their retirement over the next decade will lead to a projected shortfall developing by 2018.

• Impact of the Economy on the Nursing Shortage
  In March 2009, AACN issued a set of talking points explaining how the downturn in the U.S. economy has resulted in the stabilizing of the nursing workforce in some parts of the country. This document describes the short-term easing of the shortage, looks at the current and future need for nurses, and offers advice for new nursing school graduates.

• The Future of the Nursing Workforce in the United States: Data, Trends and Implications
  The shortage of registered nurses in the U.S. could reach as high as 500,000 by 2025 according to a report released in March 2008 by Dr. Peter Buerhaus of Vanderbilt University School of Nursing, Dr. Douglas Staiger of Dartmouth University, and Dr. David Auerbach of the Congressional Budget Office. The report, found that the demand for RNs is expected to grow by 2% to 3% each year.

• Monthly Labor Review
  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.

• Newly Licensed RNs’ Characteristics, Work Attitudes, and Intentions to Work
  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. Published in the American Journal of Nursing, the nurse researchers provide insights into the characteristics and attitudes toward work of new registered nurses.

• The 2007 State of America’s Hospitals – Taking the Pulse
  According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 registered nurses (RNs) to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%. The report also found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005.

• Academic Health Center CEOs Say Faculty Shortages Major Problem
  Worsening faculty shortages in academic health centers are threatening the nation’s health professions educational infrastructure, according to a report by the Association of Academic Health Centers released in July 2007. Survey data show that 94% of academic health center CEOs believe that faculty shortages are a problem in at least one health professions school, and 69% think that these shortages are a problem for the entire institution. The majority of CEOs identified the shortage of nurse faculty as the most severe followed by allied health, pharmacy and medicine.

• What Works: Healing the Healthcare Staffing Shortage
  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.
  

• Hospitals’ Responses to Nurse Staffing 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.
  
  
• What is Behind HRSA's Projected Supply, Demand, and Shortage of Registered Nurses?
  Released in April 2006 by the Health Resources and Services Administration (HRSA), federal officials project the nation's nursing shortage will intensify with more than one million new nurses by the year 2020. By the year 2015, all 50 states will experience a shortage of nurses to varying degrees.
  

---

Impact of the Nursing Shortage on Patient Care

Recent Reports

• Hospital Nurse Practice Environments and Outcomes for Surgical Oncology Patients
  In an article published in Health Services Research in August 2008, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient outcomes. Nurses prepared at the baccalaureate-level were linked with lower mortality and failure-to-rescue rates. The authors conclude that “moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients.”

• Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
  In a study published May 2008 in the Journal of Nursing Administration, Dr. Linda Aiken and colleagues confirmed the findings from her landmark 2003 study (see below) which show a strong link between RN education level and patient outcomes. Titled “Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes,” these leading nurse researchers found that every 10% increase in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of death.

• Impact of Hospital Nursing Care on 30-day Mortality for Acute Medical Patients
  In the January 2007 issue of the Journal of Advanced Nursing, a new study validates the findings of Dr. Linda Aiken and others that baccalaureate-prepared nurses have a positive impact on lowering mortality rates. A research team led by Dr. Ann E. Tourangeau from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada, studied 46,993 patients admitted to hospital with heart attacks, stroke, pneumonia and blood poisoning. The authors found that: "Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."
  
  
• Is the Shortage of Hospital Registered Nurses Getting Better of Worse?
  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%).
  
  
• National Survey on Consumers' Experiences with Patient Safety and Quality Information
  In November 2004, results from this national survey 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.

• Research in Action: Hospital Nurse Staffing and Availability of Care
  In March 2004, the Agency for Healthcare Research and Quality (AHRQ) issued a synthesis of nursing research studies that details the impact that staffing levels, staff mix, and education levels have on patient outcomes. The report cites studies showing that hospitals with lower nurse staffing levels and fewer registered nurses compared with licensed practical nurses or nurses' aides tend to have higher rates of poor patient outcomes.
  
  
• Keeping Patients Safe: Transforming the Work Environment
  Publishing in November 2003, this Institute of Medicine calls for substantial changes in the work environment of nurses in order to protect patients, including changes in how nurse staffing levels are established and mandatory limits on nurses' work hours. Despite the growing body of evidence that better nurse staff levels result in safer patient care, nurses in some health care facilities may be overburdened with up to 12 patients to care for per shift. Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, diminishes attention to detail, and contributes to errors.
  
  
• Educational Levels of Hospital Nurses and Surgical Patient Mortality
  New research indicates that a shortage of registered nurses prepared at the baccalaureate and higher degree level is endangering patients. In an article in the September 24, 2003 issue of the Journal of the American Medical Association, Dr. Linda Aiken and her colleagues at the University of Pennsylvania found that patients experience significantly lower mortality and failure to rescue rates in hospitals where more baccalaureate-prepared nurses provide direct patient care. At least 1,700 preventable deaths could have been realized in Pennsylvania hospitals alone if baccalaureate-prepared nurses had comprised 60% of the nursing staff and the nurse-to-patient ratios had been set at 1 to 4. Unfortunately, only 11% of PA hospitals have more than 50% of the nursing staff prepared at the baccalaureate level.
  
  
• Views of Practicing Physicians and the Public on Medical Errors
  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.
  
  
• Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction
  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 low 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.
  
  
• Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis
  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 1,609 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.
  
  
• Nurse Staffing Levels and the Quality of Care in Hospitals
  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 Shortage

• State Legislative Initiatives to Address the Nursing Shortage
  
  
• Partnerships and Grant-Funded Initiatives in Nursing Education
  (compiled from past issues of AACN News Watch)
  
  
• Using Strategic Partnerships to Expand Nursing Programs
  
  
• Accelerated Programs: The Fast-Track to a Nursing Career
  
  
• Effective Strategies for Increasing Diversity in Nursing Programs
  
  
• Strategies to Reverse the New Nursing Shortage: Tri-Council for Nursing Organizations
  
  
• Nursing Schools Employ Strategies to Boost Enrollments
  
  
• Nurses for a Healthier Tomorrow - National Image Campaign and Newsletter
  
  
• Johnson & Johnson's Campaign for Nursing's Future

Recent Reports

• A Systematic Assessment of Strategies to Address the Nursing Faculty Shortage, U.S.
  In the November/December 2008 issue of Nursing Outlook, Dr. Janet Allan and Jillian Aldebron assess a variety of efforts underway nationwide to alleviate the nursing faculty shortage, a primary driver of the larger nursing shortage. In the article, the authors highlight the most promising strategies in four domains - advocacy, educational partnerships, academic innovation, and external funding – and identify exemplars that are substantial, sustainable, and replicable.

• Staff Nurses and Their Solutions to the Nursing Shortage
  According to a study published in the Western Journal of Nursing Research in October 2006, staff nurses were asked to identify possible solutions to the nursing shortage. Top suggestions included creating career ladders, enhancing communication with administration, and increasing educational opportunities for nurses.
  
  
• Hospitals' Responses to Nurse Staffing Shortages
  In a June 2006 study published in Health Affairs, researchers surveyed hospitals in 12 U.S. markets and found that the majority of respondents (97%) were making investments in nursing education as a long-term strategy to address the RN shortage. These investments include funding training programs and nurse orientations, partnering with schools of nursing, and providing financial support for nursing faculty. However, the authors state that "nursing school capacity remains an important barrier to future investments in nursing education" by hospitals, and they call on policymakers to make a larger financial commitment to expanding the nursing education system.

• Faculty Shortages in Baccalaureate and Graduate Nursing Programs
  AACN updated this white paper on nursing faculty shortages in June 2005. Authors of the report summarize the scope of the problem, discuss issues contributing to the shortage of faculty, and put forth strategies to expand the capacity of the current and future pool of nursing faculty.
  
  
• President's High Growth Job Training Initiative
  In June 2005, the U.S. Department of Labor (DOL) awarded more than $12 million in grant-funding through this federal program, including $3 million to address the nurse faculty shortage. The 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 initiatives are available online.
  
  
• Nursing Shortage and Academic Health Centers: Assessing Options for Remedy in a Complex System
  Released by the Association of Academic Health Centers in September 2002, this report calls for academic health centers to develop new strategies to address the nursing shortage and provide the leadership needed to identify long-term solutions. Proposed solutions include strengthening nursing education programs; expanding resources to educate new faculty; focusing on nursing research; developing networks with non-university based nursing programs; and evaluating new models of nursing care.
  
  
• In Our Hands: How Hospital Leaders Can Build a Thriving Workforce
  The American Hospital Association’s Commission on Workforce for Hospitals and Health Systems released this report in April 2002 that contained specific recommendations to help hospitals address health care worker shortages now and in the future. The commission called this shortage a potential “major national health care crisis.”
  
  

---

Legislation to Address the Shortage