The nursing shortage is nothing new: it began as a supply side shortage in the 1990s Join host Susan Dolan and her guest, Dr. Peter Buerhaus, healthcare economist and professor of nursing at Vanderbilt University Medical Center, as they explore the history of the nursing shortage. Where we are today, and how we can prepare to minimize the looming shortage in years to come? While there are fewer vacancies in nursing today than in years past, the fact is that many nurses are retiring, schools are turning away nursing students, and, all the while, demand for nursing is steadily increasing. Listen in to find out what can be done about the predicament.
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FOCUS ON FUTURE MEDICINE
Every New Year, we look to the future and dream of what is possible. ReachMD Radio is proud to present our special series, Focus on Future Medicine.
Just how serious is the nursing shortage. You are listening to ReachMD, The Channel For Medical Professionals. Welcome to Focus on Future Medicine. We are discussing the outlook for the nursing profession. I am Susan Dolan, your host and with me is Dr. Peter Buerhaus, the Director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tennessee.
SUSAN DOLAN:
Dr. Buerhaus, welcome to the Clinicians Roundtable.
DR. PETER BUERHAUS:
Well, thank you. I am happy to be here.
SUSAN DOLAN:
Tell us when did the current nursing shortage begin and how did it began?
DR. PETER BUERHAUS:
This shortage began in 1998 and so today it has lasted easily 10 years and now moving into its 11th year, which makes it one of the longest lasting shortages that the nation has experienced and is easily half a decade. Now, this shortage is unusual in that it began on the supply side. Now, we have all kind of gone through a number of shortages as many of our listeners have experienced, but most of these shortages grew out of an increase in the demand for nurses for whatever reason and it took a while for nurses who are currently not working in the labor market to learn that there was a shortage and then rejoin the workforce and then over time for schools to produce more nurses to satisfy this growing demand. This is sort of a normal experience when the demand goes up and it takes a little while for the supply side to catch up, satisfy the market, and the shortage goes away. Now in 1998 though, the shortage began on the supply side and by that Susan, I am thinking about the experience of hospitals who are saying, where are all these intensive care units nurses? I need them and the shortages were developing there and it turned out that there were just not enough younger nurses in the workforce to satisfy hospital's need for nurses in the intensive care units. It turns out that many young nurses like that environment. There were old, cocky, they could do it all and there were younger who were beginning to run out of it and then briefly, the hospitals were also reporting that the shortages were breaking out in the operating rooms and the postanesthesia recovery unit and we discovered that this was the area where the aging of the RN workforce was already taking hold. In other words, we were seeing older nurses in each particular specialty areas and they were beginning to retire out. All that started back in 1998 on the supply side. In another couple years, demands for RN started to pick up and then it kind of moved over into a classic demand side shortage.
SUSAN DOLAN:
Is there anything different about the current nursing shortage that distinguishes it from other shortages?
DR. PETER BUERHAUS:
Yes, in some ways in that today the response of nurses to this current shortage has been occurring largely among in older population of RNs, i.e., RNs who are over the age of 50. So, we have structurally today a much older workforce than any previous shortage that we have experienced since way back in the mid 60s when Medicare and Medicaid began. So, the response on the supply side has been driven largely by older RNs returning to work and secondly, by a huge increase in the number of nurses from other countries fully a third of RNs who have been employed in hospitals over the past 6 years are from overseas.
SUSAN DOLAN:
How serious is this nursing shortage?
DR. PETER BUERHAUS:
This shortage today is not as serious as it was a few years ago. The current shortage probably reached its height at around 2002, and it was then estimated that about 125,000 positions across the country were vacant and that was a pretty serious shortage. The hospitals at that time were reporting that they had to close certain nursing units. They could not fully operate certain facilities and services. Outpatient hours were restricted. There were real concerns at that time. Hospitals then began to raise wages significantly and take steps to improve the environment in their organization and that has led to sort of an increase in the number of RNs employed plus one other factor, the increasing unemployment rates in the country. That shortage back in 2001 and 2002 roughly 125,000 has gotten better over time. Estimates today are that the current vacancy rates are anywhere from 5% to 7% on a national average basis, so its not as bad as it used to be, but still many hospitals across the country still don’t have enough nurses and this does have an impact on the quality of patient care.
SUSAN DOLAN:
What are the projections for the future in terms of nursing shortage?
DR. PETER BUERHAUS:
Right now, the most recent projections that we have published and they are the latest of anything that is out there show that if we just sort of move along in the same direction that we have been taking over the past several years, by the year 2020, the shortage of an estimated 285,000 RNs would exist. Now, that would be almost 3 times larger than any shortage that has existed in this country going back 50 years. Now, we have taken our estimates even further and that shortage grows out to about 500,000 by the year 2025. So, the net shortage of 500,000 would be such a magnitude that it would really, I think, seriously alter the ability to provide safe care or have any access to patient care. It would really do some significant destruction to the healthcare industry.
SUSAN DOLAN:
If you have just joined us, you are listening to Focus on Future Medicine on ReachMD, The Channel For Medical Professionals. I am Susan Dolan, your host and with me is Dr. Peter Buerhaus, the Director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tennessee discussing the outlook for the nursing profession.
Dr. Buerhaus, describe what can be done to prepare for the future nursing shortages.
DR. PETER BUERHAUS:
I think there are a couple of things that we should be paying attention to. Number 1 is to adopt a long-run perspective and by that what I mean is currently today here in as we move in to 2009, many hospitals are beginning to find that they have all the nurses that they need. The shortage is beginning to even go in a way in some areas. That's been driven by the increase in the national unemployment rates in the country; 70% of nurses are married. So, what happens to their spouses' economic well being really is an important driver of whether or not a nurse will be working and how many hours that work. So, as more and more RN spouses lose their job or worry that they could be, it's driving the RN back into the labor market if she or he wasn’t in it or if they are only working part-time. So as a result, hospitals are going to find they have got more nurses available to them than they have had in the past and there is a worry that it will sort of conclude, oh well, not a problem, no more shortage, move on to some other topic that meanwhile downstream, we have this blooming development in which we will see the bulk of the nursing workforce continue to age and after the year 2015, begin to retire out in large numbers just as more and more baby boomers are reaching 65, consuming more healthcare, demanding more healthcare, demand going up in the future, and the supply of nurses shrinking or at breath-holding study as we see this increased retirement.
SUSAN DOLAN:
Do you believe it's possible to prevent a future nursing shortage from developing?
DR. PETER BUERHAUS:
Boy, not got a lot of sleep in my life because I worried about that a lot. I am sleeping a lot better because I think that there are policies that are available to us that we can beat this long-term pessimistic outlook that I have been discussing and the way I think we need to do that is come to terms with the fact that today or actually over the past 4 to 5 years, we have had an inadequate capacity in our nursing education program to take in all the people who want to become nurses and educate them so that they can join the workforce. We have been turning away safely between 25,000 and 50,000 qualified applicants who want to become nurses each year for the last 5 years. All those people that we need to replace that soon to be retiring workforce that we have talked about in the next decade, we need those people today to become nurses and yet we have been turning them away, so the first thing we really need to do is to determine why we don’t have enough capacity in our education program and quickly resolve that. Expand the number of slots, if that’s the problem, raise budgets so that we can afford faculty and view with this aging of our faculty, the faculty in nursing are aging even more rapidly than the workforce. So, we are going to have to get innovative in getting enough faculty who are available to teach future students. Item number 1, increase the capacity of nursing education program, then the second thing I would suggest is a target on men and Hispanics. Men and Hispanics are woefully underrepresented in the nursing profession and if we could just double the number of men from the current level of 200,000 to 400,000, doubling that percentage of nurses that would bring us up to about 18% to 19% of all the workforce being men and if we could double the percent of nurses who are Hispanics, we would add another 200,000 to 300,000 RNs. We could do that and we could prevent the shortage that we talked about from developing and go after that, we can beat this thing.
SUSAN DOLAN:
Does the nursing instructor shortage exist?
DR. PETER BUERHAUS:
It's reported to exist in a number of schools. Several surveys have been conducted of the nation's nursing education program. This is one of the top 3 issues reported by faculty, so the data suggests that yes, there is a shortage and is likely to grow because of the impending retirement of so many faculties.
SUSAN DOLAN:
How you get innovative and expand that capacity when you are facing that shortage?
DR. PETER BUERHAUS:
Well, I think what I would like to see is to first of all if the society or government policy makers recognize this problem for what it is. It's an important social problem. If we don’t have enough nurses, this is not good for our personal healthcare ourselves or our patients. It is certainly not good for employers and if this nursing shortage were to develop as fully as our models and others are projecting, this would have an impact on the nation's economy. By dragging down the healthcare industry, you are putting at risk millions and millions of jobs, not just any job, but good paying jobs. So, I think we need to begin to see that the nursing profession is this glue that holds it all together and that glue is beginning to unravel. So, we need to address this at a pretty significant policy level across the country, target the resources to address these problems on the nursing education capacity, and get it done in the next couple of years, not wait to address this problem when it becomes fully a crisis.
SUSAN DOLAN:
Is migration a solution?
DR. PETER BUERHAUS:
It is in some respects for some people who feel that there should be no barriers for trade or commerce across the country line and in fact that is how our workforce here in our nation has been dealing with the current shortage. We have seen an increase of over 100,000 nurses from other countries coming in to this country since the year 2001, and I think that we are doing this because of our own failure to address the educational capacity problems, our failure to target men, to target Hispanics. We have been successful in nursing in increasing the number of African-Americans. It used to be there were 2% to 3% of all nurses and in over a 15-year period, we brought that up to the point where now 11% of the workforce are African-Americans. So, we know we can do these things and to accomplish that we just need to get targeted and focused.
SUSAN DOLAN:
Thank you to Dr. Peter Buerhausfor joining us to discuss the nursing shortage. I am Susan Dolan and you've been listening to Focus on Future Medicine on ReachMD, The Channel For Medical Professionals. Please visit our web site at reachmd.com, which features our entire library of on-demand podcasts or call us toll free with your comments and suggestions at 888-639-6157. Thank you for listening
Thank you for listening to ReachMD radio on XM160 and this month's special series, Focus on Future Medicine. Every New Year, we look to the future and dream of what is possible. ReachMD radio is proud to present our special series, Focus on Future Medicine.
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Overview
The nursing shortage is nothing new: it began as a supply side shortage in the 1990s Join host Susan Dolan and her guest, Dr. Peter Buerhaus, healthcare economist and professor of nursing at Vanderbilt University Medical Center, as they explore the history of the nursing shortage. Where we are today, and how we can prepare to minimize the looming shortage in years to come? While there are fewer vacancies in nursing today than in years past, the fact is that many nurses are retiring, schools are turning away nursing students, and, all the while, demand for nursing is steadily increasing. Listen in to find out what can be done about the predicament.