Shortage of nurses not as dire as predicted, but challenges remain to meet America's needs

Ten and more years ago, economists had been predicting a shortage of hundreds of thousands of nurses as baby boomers retired in large numbers. Currently, there are more than one million registered nurses over age 50 and most are expected to leave the workforce during the next 10 years.

But national initiatives to spur nursing as a career and more students choosing nursing after the recession of 2008 have dramatically changed that outlook, Buerhaus and his fellow researchers found. Nursing school enrollments doubled over the decade of the 2000s, as have the number of young registered nurses in the workforce.

Buerhaus, director of Center for Interdisciplinary Health Workforce Studies at MSU, co-authored the research with healthcare economists David Auerbach, who is affiliated with the center, and Douglas Staiger from Dartmouth College. Their work appears in the current issue of Medical Care, the official journal of the American Public Health Association. It was funded by a grant from the Gordon and Betty Moore Foundation.

"Overall, we project that the registered nursing workforce will increase from roughly 2.7 million full-time equivalent registered nurses in 2013 to 3.3 million in 2030," said Auerbach, the paper's lead author. "However, this is contingent on people still entering the nursing profession at the current rate -- which is higher than anyone anticipated."

"It's important to keep in mind that this doesn't get us out of the woods, the woods just are not as dark and scary as they appeared. We still project the nation will have a shortage of around 130,000 nurses by 2025, which is by no means a small number, but not the overwhelming shortage that we had once anticipated," Buerhaus said.

The dramatic decline in the nursing workforce predicted a decade ago was predicated on baby-boom nurses retiring in greater numbers than new nurses entering the workforce.

"Seeing this coming cliff in nursing, there were national campaigns to encourage more people to go into nursing, which helped provide information about the nursing profession and create interest in a nursing career," Buerhaus said.

This information was particularly helpful when the economic recession developed and baby-boomers saw losses in their net worth and decided to stay in the nursing workforce longer, Buerhaus said.

"And as the health care industry continued to hire people while other industries were laying people off, students started migrating towards degrees that offered a better chance at getting a good paying job, and a job that was likely to bring personal satisfaction and reward," Buerhaus said.

Despite these gains, the registered nurse workforce is at an important cusp--the implementation of health reform is adding new nursing roles and responsibilities affecting how nurses work with physicians to assure quality and access to care, Auerbach said.

"At the same time, almost 40 percent of registered nurses are over the age of 50. The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020. Meanwhile, the dramatic growth in nursing school enrollment over the 2000s has begun to level off," Auerbach said.

The U.S. Health Resources and Services Administration, HRSA, recently forecast robust growth in registered nurse demand over the next 10 years. Part of the demand stems from the healthcare needs of aging baby boomers. The researchers found that at current rates of workforce entry, nursing supply will fall roughly 4 percent, or 128,000, shy of meeting this demand.

"Finally, as important as having the right number of nurses is having nurses with the right skills to master an evolving health care environment," Buerhaus said.

Buerhaus and his co-authors plan to continue to monitor the size, geographic distribution and degree mix, among other factors, of the nursing workforce in the coming years.