Nursing, Shortage


Article Author:
Lisa Haddad


Article Editor:
Tammy Toney-Butler


Editors In Chief:
Bette Bogdan
Lori Kerley
Robin Geiger


Managing Editors:
Frank Smeeks
Scott Dulebohn
Erin Hughes
Pritesh Sheth
Mark Pellegrini
James Hughes
Richard Ciresi
Phillip Hynes


Updated:
10/27/2018 12:31:45 PM

Introduction

Nurses are a critical part of healthcare and make up the largest section of the health profession. According to the World Health Statistics Report (WHO, 2013), there are approximately 29 million nurses and midwives in the world, with 3.9 million of those individuals in the United States. Estimates of upwards of one million additional nurses will be needed by 2020 (WHO, 2013).

According to The American Nurses Association (ANA) (2018), there will be more registered nurse jobs available through 2022 than any other profession in the United States. The US Bureau of Labor Statistics (2018) projects 1.1 million additional nurses are needed to avoid a further shortage. Employment opportunities for nurses are projected to grow at a faster rate (15%) than all other occupations from 2016 through 2026 (US Bureau of Labor Statistics, 2018).

Issues of Concern

The nursing profession continues to face shortages due to lack of potential educators, high turnover, and inequitable distribution of the workforce (Sawaenqdee et al., 2016). The causes related to the nursing shortage are numerous and issues of concern. Some potential reasons explored below.

Aging Population

The population, on the whole, is aging with the baby boom generation entering the age of increased need for health services. Currently, the United States has the highest number of Americans over the age of 65 than any other time in history (Grant, 2016). In 2029, the last of the baby boomer generation will reach retirement age, resulting in 73% increase in Americans 65 years of age and older, 41 million in 2011 compared to 71 million in 2019 (Barr, 2014).

As the population ages, the need for health services increases. The reality is that older persons do not typically have one morbidity that they are dealing with, but more often have a multitude of diagnosis and co-morbidities that requires them to seek treatment (Barr, 2014). The population is surviving longer, as a whole, causing increased use of health services as well. Many disease processes that were once terminal are now survivable for the long-term. Treating these long-term illnesses can strain the workforce.

Aging Work Force

Like the populations they serve, the nursing workforce is also aging. There are currently approximately one million registered nurses older than 50 years, meaning one-third of the workforce could be at retirement age in the next 10 to 15 years (Grant, 2016). This number includes nurse faculty, and that presents it's own unique problem, training more nurses with fewer resources. Nursing faculty is experiencing a shortage, and this leads to enrollment limitations, limiting the number of nurses that a nursing school can generate (Cooley & DeGagne, 2016). Decreased and limited amount of faculty can cause not only fewer students but the overall quality of the program and classes can decline as well.

Nurse Burnout

Some nurses graduate and start working and then determine the profession is not what they thought it would be. Others may work a while and experience burnout and leave the profession. Turnover in nursing seems to be leveling off, but only after years of steady climbing in rates. Currently, the national average for turnover rates is 8.8 % to 37.0% (Nursing Solutions, 2016), depending on geographic location and nursing specialty.

Career and Family 

Adding to the shortage problem is the fact that nursing is still majority female, and often during childbearing years, nurses will cut back or leave the profession altogether. Some may eventually return, but others may move to a new job.

Regions

Current shortages and potential growth can be confusing when looking at regions and areas of the United States separately. Some regions have a surplus of nurses and lower growth potential, while other areas struggle to fulfill the basic needs of the local population as a whole.

Nursing shortage amounts can vary greatly depending on the region of the country as well. Higher shortages are seen in different areas depending on specialty of nursing. Some areas have real deficits when looking at critical care nurses, labor and delivery and other specialties.

Growth

The fastest growth potential in the United States projected for West and Mountain regions, with slower growth in the Northeast and Midwest (ANA, 2018). A higher need is seen in areas that have high retirement populations. Even with these differences, every state is projected to have at least 11% growth through 2022 (ANA, 2018).

Violence in the Healthcare Setting

Violence in the healthcare setting plays a role in the nursing shortage, the ever-present threat of emotional or physical abuse, adding to an already stressful environment. Job satisfaction and work effort affected negatively, as the physical and emotional insults take a toll on the well-being of the healthcare professional physically and emotionally. Emergency department and psychiatric nurses at a higher risk due to their patient population. 

A study conducted in Poland between 2008 to 2009 concluded that nurses represent the profession most vulnerable to aggression in the workplace with regards to a healthcare setting. Verbal abuse in the form of being spoken to by a person using loud vocal tones was the most common form of violence nurses were subjected to, with the inpatient nurses suffering more insults than those in an outpatient setting (Kowalczuk & Krajewska-Kulak, 2017).

Health care workers are at high risk of violence in all parts of the world with between 8% and 38% suffering some form of violence in their careers (WHO, 2018).

Clinical Significance

All of these potential reasons nurses choose to leave the profession, add to nursing turnover, thus affecting staffing ratios. Staffing ratios are of clinical concern.

Staffing Ratios

Bedside nurses, actually deciding acceptable nurse-patient ratios, instead of managers, will lead to better job satisfaction, higher retention rates, and less desire to leave one's chosen profession. Appropriate staffing levels will decrease errors, increase patient satisfaction, and improve nurse retention rates.

Nursing shortages lead to errors, higher morbidity and mortality rates (Nurse Stand, 2016; Stead, 2016). In hospitals with high patient-to-nurse ratios, nurses experience burnout, dissatisfaction, and the patient’s experienced higher mortality and failure-to-rescue rates when compared to lower patient-to-nurse ratios (Aiken, Clarke & Sloane, 2002). Some states have begun to pass legislation to limit patient-to-nurse ratios. Despite this, when staffing is short, ratios go up to meet the need.

Other Issues

Technology 

Introduction of the Electronic Medical Record (EMR) and other technological advances can also affect nurses staying in the profession. While some specialties such as nursing informatics in booming (ANA, 2018), that adds to the shortage problem by removing nurses from direct patient care areas. Some seasoned nurses struggle with the technology and remove themselves from the profession at an earlier rate.

Empowerment

Organizations must be creative in meeting the needs of nurses while providing the best and safest care to the patients. An environment that empowers and motivates nurses is necessary to rejuvenate and sustain the nursing workforce. Empowerment in autonomy in staffing ratio decisions taking into consideration high volume and acuity levels will lead to less burnout, and strong desire to leave the workforce. Many organizations have endorsed and sought after the Magnet Certification as a way to provide superior nursing processes and high level of safety, quality and patient satisfaction (ANCC, 2018).


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE courses, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Nursing, Shortage - Questions

Take a quiz of the questions on this article.

Take Quiz
Which of the following is the projected nursing shortage in 2020?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The nursing profession continues to face shortages. What factor is not a potential cause of this shortage?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
According to the World Health Statistics Report of 2013, there are approximately how many nurses and midwives in the world?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
According to 2018 data from the American Nurses Association (ANA), every state is projected to have at least what percentage of growth potential for nurses through 2022?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
All of the following statements are reasons nurses may choose to leave the workforce. Which statement is false?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Nursing, Shortage - References

References

Global Nursing Issues and Development: Analysis of World Health Organization Documents., Wong FK,Liu H,Wang H,Anderson D,Seib C,Molasiotis A,, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 2015 Nov     [PubMed]
Thai nurse cohort study: cohort profiles and key findings., Sawaengdee K,Tangcharoensathien V,Theerawit T,Thungjaroenkul P,Thinkhamrop W,Prathumkam P,Chaichaya N,Thinkhamrop K,Tawarungruang C,Thinkhamrop B,, BMC nursing, 2016     [PubMed]
Nurse shortage linked to higher neonatal mortality.,, Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2016 Feb 17     [PubMed]
Nursing: a priority case., Stead L,, Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2016 Mar 9     [PubMed]
Transformative Experience: Developing Competence in Novice Nursing Faculty., Cooley SS,De Gagne JC,, The Journal of nursing education, 2016 Feb 1     [PubMed]
Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers., Drennan VM,Halter M,Gale J,Harris R,, Journal of nursing management, 2016 Nov     [PubMed]
Job control, work-family balance and nurses' intention to leave their profession and organization: A comparative cross-sectional survey., Yamaguchi Y,Inoue T,Harada H,Oike M,, International journal of nursing studies, 2016 Sep 19     [PubMed]
New Careers in Nursing: Optimizing Diversity and Student Success for the Future of Nursing., DeWitty VP,Huerta CG,Downing CA,, Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 2016 Sep-Oct     [PubMed]
The New Careers in Nursing Program: A Strong Investment in the Future of Nursing., Krol DM,, Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 2016 Sep-Oct     [PubMed]
Implications of the California nurse staffing mandate for other states., Aiken LH,Sloane DM,Cimiotti JP,Clarke SP,Flynn L,Seago JA,Spetz J,Smith HL,, Health services research, 2010 Aug     [PubMed]
Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study., Vahedian-Azimi A,Hajiesmaeili M,Kangasniemi M,Fornés-Vives J,Hunsucker RL,Rahimibashar F,Pourhoseingholi MA,Farrokhvar L,Miller AC,, Journal of intensive care medicine, 2017 Jan 1     [PubMed]
Patient aggression towards different professional groups of healthcare workers., Kowalczuk K,Krajewska-Kułak E,, Annals of agricultural and environmental medicine : AAEM, 2017 Mar 31     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Professional and Ethics. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Professional and Ethics, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Professional and Ethics, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Professional and Ethics. When it is time for the Nurse-Professional and Ethics board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Professional and Ethics.