Breaking Down the Causes and Solutions to the Nationwide Nursing Shortage

Nurses are a crucial part of the healthcare system, outnumbering any other healthcare provider. In 2020, the National Center for Biotechnology Information (NCBI) reported there were “approximately 29 million nurses and midwives globally, with 3.9 million of those individuals in the United States.” Despite the large number of nurses currently in the workforce, the NCBI also said that over one million additional nurses are needed in order to address the nursing shortage, which has been prevalent since the early 2000s.

The COVID-19 pandemic highlighted issues caused by the nursing shortage as hospitals across the country were full of more patients than nurses could feasibly treat. By gaining the advanced education they need to move into in-demand roles, new and experienced nurses can become part of the solution to the nursing shortage and make a bigger difference in the health of their communities.

Where Did All the Nurses Go?

The nursing shortage is a long-term problem that has many elements to consider. Beginning in the early 2000s, national organizations began to forecast a shortage that could last for decades. In 2001, a Policy Statement from the Tri-Council members for Nursing stated that “the supply of appropriately prepared nurses is inadequate to meet the needs of a diverse population, and this shortfall will grow more serious over the next 20 years.”

The Tri-Council cited multiple factors that contributed to a nursing shortage and predicted that these factors would have a huge influence on the future of the field. Since the Policy Statement was published, additional research has shed light on those patterns and their effects. Key causes of the nursing shortage include an aging population, a rising number of nurses and nurse leaders retiring plus an increasing need for qualified nursing faculty.

The U.S. Population Is Aging, and so Are Nurses

In 1990, the U.S. Census Bureau reported that almost 35 thousand North Americans were age 65 or older. By 2000, that figure rose to 35 million. The most recent measure was in 2016 when the U.S. Census Bureau reported that over 617 million people were age 65 or older and that this number was projected to reach the billions by 2030.

While the overall numbers for all age groups were projected to increase along with the nation’s total population, the older age groups grew exponentially faster than any other. The increasing ratio of older Americans to younger Americans can be partly explained by the baby boomer generation.

Baby boomers, a population group of more than 73 million people, reached the ages of 57–75 in 2021. And as the population ages, they need more medical care. The National Center for Biotechnology Information explained that “older persons do not typically have one morbidity that they are dealing with, but more often have many diagnoses and comorbidities that require them to seek treatment.” Treating comorbidities in older people commonly requires teams of specialists from various disciplines.

Not only do aging persons require additional care, but the average life expectancy of Americans has also increased dramatically. According to population data from the United Nations Department of Economic and Social Affairs, the life expectancy of Americans has gone from 69.67 years in 1955 to 79.12 in 2020. Because the population is surviving longer, they are using more health services over a longer period of time. This has put a massive strain on the American health system, and the nursing field has had trouble keeping up.

Adding to the stress of America’s increase in older populations, baby boomers in the nursing profession are at retirement age. The 2018 National Sample Survey of Registered Nurses (NSSRN) revealed that nearly half (47%) of registered nurses in the workforce are age 50 or older. These RNs are now preparing to retire. In 2017, 73% of baby boomer RNs who were surveyed by AMN Healthcare Staffing said that they planned to retire in the next three years.

AMN went on to explain that “the national healthcare system will likely face a drain of knowledge and experience at unprecedented levels at a time when the aging population is growing and thus needing more care.” It is crucial for the nation to add more nurses to the workforce, but a national shortage of qualified nursing faculty adds another layer of difficulty.

More Nursing Faculty Are Needed to Teach New Nurses

The American Association for Colleges of Nursing (AACN) reported that 237,544 new student nurses enrolled in entry-level bachelor’s degree programs in 2019, representing a substantial increase of over 13,500 students since 2018. While impressive, this increase did not meet the demand for the number of nurses required to care for the nation’s expanding, aging population. Rising enrollment numbers are promising, but nursing programs can only admit as many nursing students as they can teach. In the same 2019 report, the AACN revealed that 67,785 qualified applicants were turned away from entry-level nursing programs.

The biggest reason that nursing programs must limit their enrollment is a lack of qualified nursing faculty. In a 2019 study that more deeply investigated the nursing faculty shortage, the AACN reported that 56% of nursing schools have faculty vacancies that need to be filled, and an additional 15.8% of nursing schools could benefit from additional faculty. These openings are likely to increase given that a large portion of nurse faculty is nearing retirement age.

According to a study published by Nursing Outlook journal, the percentage of full-time nursing faculty aged 60 and older increased from 17.9% in 2006 to 30.7% in 2015, which is nearly a third of all nursing faculty. To complicate matters, nursing faculty need advanced degrees in order to teach. The AACN confirmed that most of the vacant nursing faculty positions in 2019 were ones that required a master’s or doctoral degree. But recent research indicated that the younger segment of the nursing workforce is less likely to pursue the advanced education needed to enter academia.

In their 2017 survey of RNs, AMN Healthcare Staffing reported that 48% of respondents planned not to pursue any further education. That finding was confirmed by Nursing Outlook, which revealed that “younger faculty who are likely to replace the retiring faculty possess fewer doctoral degrees, lower senior faculty ranks and [were] more limited in their ability for graduate-level teaching.” This situation presents a lucrative opportunity for those interested in elevating their nursing career to academic career paths. By moving into high-demand specialties, nurses can become part of the solution to the nursing shortage.

Solutions to the Nursing Shortage

The causes of the nursing shortage are varied, and so are the possible solutions. From hiring managers to university presidents, there are steps everyone can take to help reduce the shortage.

Increase Enrollment in Nursing Programs

The very first step toward increasing the number of nurses in the workforce is to increase the number of nursing students. The Journal of Nursing Management reported that, in 2002, only 29% of graduates received their basic nursing education in baccalaureate programs while 70% of nurses entered nursing through diploma and associate degree programs. The numbers have risen drastically since then, giving more hope to the nursing workforce. In 2020, the AACN reported major growth in nursing school applicants from 2019:

• Entry-Level Baccalaureate: 1.5%
• RN to Baccalaureate: 8.9%
• Master’s Programs: 2.8%
• Research Focused Doctorate: 24.3%
• Doctor of Nursing Programs: 14.0%

While interest in nursing programs is strong, education institutions have had trouble increasing their enrollment. The AACN reported that in 2020, 80,521 qualified applications were not accepted at schools of nursing due primarily to a shortage of clinical sites, faculty and resource constraints. One of the largest barriers to enrollment is a lack of qualified nursing faculty.

Employ Additional Nursing Faculty

Given the persistent shortage of nurse faculty, the AACN remained concerned that 12,871 applications were turned away from graduate nursing programs in 2020, which would limit the pool of potential nurse faculty in the future. According to the Journal of Nursing Management, “When faculty shortages are combined with an inadequate supply of new nurses prepared to teach in an academic setting, shortages are expected to escalate.” Data from a 2021 survey of Florida nursing schools exemplified the issue.

When they asked about faculty vacancies, IHS Markit reported that 16% of Florida RN programs cited a lack of qualified faculty and 13% cited a lack of funding to hire new faculty. The problems were worse for Florida’s LPN programs, 23% of which cited a lack of funding to hire new faculty. The IHS Markit study concluded that Florida nursing schools need to hire 333 more nursing faculty members to effectively address the state’s nursing shortage.

With more nurse faculty, schools can increase their enrollment and graduate more nurses. A great way to procure more nurse educators is to encourage nurses to complete the advanced education they need to move into faculty positions.

Upskill Nurses for In-Demand Roles

Nurses who are currently working in the field can help mitigate the shortage by upskilling into high-demand roles. Types of nurses in high-demand vary depending on location and tenure, but some common ones include:

LPNs

According to the Health Resources and Services Administration (HRSA) a part of the U.S. Department of Health and Human Services, demand for LPNs is steadily rising in many states. By 2030, national LPN demand was projected to reach 1,168,200 openings, an increase of 358,500 (44%) since 2014.

Florida, in particular, will see a considerable need for this type of nurse due to the rising retirement-age population. In a 2021 report commissioned by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida, IHS Markit projected that the population ages 65–74 will increase by 32% through 2035, and the population ages 75 and older will increase by 74%. The same report predicted that over 21,000 additional LPNs will be needed in Florida by 2035.

Registered Nurses

IHS Markit projected that Florida will need an additional 37,400 RNs by 2035. These numbers did not account for the effects of the pandemic, which could mean more demand for RNs to take care of patients. In these scenarios, the IHS Markit report stated that “providers may be inclined to employ LPNs to help address staffing needs.”

Several other states will see a shortage of RNs in the next decade. Looking at each state’s 2030 RN supply minus its projected 2030 demand reveals widespread shortages. California, Texas, New Jersey and South Carolina are a few of the states that will see RN shortages. As new nurses enter the national workforce, current RNs might consider moving into a nurse manager or nurse practitioner role.

Nurse Managers

Nurse managers are crucial to the success of healthcare organizations because they directly oversee nurses as they work to provide the best patient care possible. Nurse managers are responsible for organizing medical records, tracking patient outcomes, reporting to healthcare administrators, recruiting and overseeing nursing staff. Through 2030, the job outlook is excellent for nurse managers and other medical and health services managers. The U.S. Bureau of Labor Statistics reported that over 51,000 openings for medical and health services managers will become available each year through 2030.

Filling these open positions will be crucial for overcoming the nursing shortage because many nurse managers are now retiring. AMN Healthcare Staffing’s 2017 survey of RNs showed that 82% of respondents believed that more nurse leaders were needed in healthcare settings. Specifically, the report concluded that more nurses should work in executive leadership positions at hospitals, health systems, and other healthcare providers.

Nurse Practitioners

The U.S. Bureau of Labor Statistics projected over 335,200 employment opportunities for NPs in 2030. This rapid growth is likely due to Americans increasingly seeing NPs for their primary healthcare needs. The American Association of Nurse Practitioners reported that NPs handled over 1.06 billion visits annually. NPs are being viewed as an essential part of the nursing shortage solution, and more states are pursuing autonomous practice legislation for NPs, including Florida.

The Florida Association of Nurse Practitioners (FLANP) announced new standards for autonomous practice in March 2020, although the standards are not yet in full effect. Soon, Florida NPs will have prescriptive authority in family medicine, general pediatrics and general internal medicine. Along with granting autonomous practice to NPs, other crucial steps toward addressing the nursing shortage are to encourage more nurses to move into teaching positions and to increase enrollment in nursing programs.

Make Nursing Education Accessible

NPR recently reported that, in an effort to encourage more nurses to join their workforce, hospitals across the country are “offering jobs to students even before they graduate, and in many cases offering bonuses and loan repayment as financial incentives.” Once they are on the job, nurses can deepen their skills set with continuing education and specialized training offered by their employers.

These efforts to educate nurses are part of the reason that interest in nursing programs is rising. More applicants are pursuing their bachelor’s degree in nursing because it has increasingly become a requirement for employment. Advanced education is directly correlated to better patient outcomes. The AACN reported that “health care facilities with higher percentages of BSN nurses enjoy better patient outcomes and significantly lower mortality rates.” The knowledge and skills gained from a bachelor’s degree can literally save lives.

A bachelor’s degree is also a prerequisite for master’s programs. With a Master of Science in Nursing (MSN), nurses can advance to leadership roles and broaden their impact. Nurses with their MSN can pursue a position as a nurse manager, nurse executive, nurse educator, nurse practitioner and more.

The nursing profession needs more dedicated, talented individuals with a passion for helping others. The University of West Florida provides accredited online nursing programs that allow students to continue working while they study. In addition to an RN to BSN degree, UWF also offers MSN degrees with emphases in Family Nurse Practitioner, Nurse Executive and Nursing Education. Learn more about UWF’s innovative nursing degrees today, and start on the path toward advancing your nursing career.