Don’t be fooled
Demographics ensure nursing shortage will return with better economy
As the recession started to accelerate, registered nurses who had eyed retirement found themselves facing an unsure future. Spouses and partners lost jobs, and the value of nest eggs plummeted, causing many to postpone their planned retirements. This has created a false sense of security in the nursing workforce, specifically as it relates to lower turnover and increased retention. Nurses continue to be wary as the economy slowly edges toward recovery, albeit so far a jobless rebound. This amalgamation of events has many in healthcare leadership claiming the nursing shortage is officially over.
Not so fast. This pattern of nurses working past retirement cannot be sustained, and here are the numbers:
In an article in the Journal of Nursing Administration, it was stated that 33% of RNs are 50 years old and over—the baby boomers.
The American Association of Critical-Care Nurses reports that half of RNs indicate their desire to retire within 15 to 20 years.
The pipeline for new nurses continues to be clogged by an aging nurse faculty that also is poised to retire, according to the AACN. The average age of nursing faculty with master’s and doctorates is roughly 60 and 56 years old respectively. AACN also found that nearly 55,000 qualified applicants were not accepted into schools of nursing due to shortages of faculty, adequate clinical sites and other resources.
In his book The Age Curve, Kenneth Gronbach wrote that, compared to the baby boomers who are leaving the workforce, there are 9 million fewer Generation Xers, those born between 1965 and 1984. That represents an 11% decrease in potential nursing school applicants.
In nursing, the shortfall has been estimated by the Bureau of Health Professions to be close to 1 million. This number was calculated before passage of healthcare reform. We have now entered the uncharted waters of reform with a tsunami of anticipated newly insured patients now having access to healthcare goods and services at the precise time when these retirements will start to accelerate. Let’s look at the demand numbers to complete the supply-demand picture.
In the book The Future of the
What works today will become obsolete with new social, economic and political developments
Nursing Workforce in the United States, Peter Buerhaus and colleagues report that the number of people over age 65 is estimated to increase by 127% between 2000 and 2050. By 2030, it is estimated that 71 million Americans (1 in 5) will be over the age of 65. According to the Institute of Medicine’s The Future of Nursing, the passage of healthcare reform will bring in an additional 32 million people as newly insured.
Between 2000 and 2020, the Health Resources and Services Administration projects a 73% growth in the demand for RNs employed in nursing homes and a 91% growth in home health. Between 2000 and 2020, HRSA also projects a 40% growth in the demand for RNs employed in hospitals and in nursing education. To meet the demand for RNs, HRSA officials estimate the U.S. must graduate 90% more nurses from nursing programs.
The Centers for Disease Control and Prevention estimates that as many as 1 in 3 Americans may be diabetic by the year 2050, with diabetes being one of the highest lifetime usages of healthcare resources of all diagnoses.
So, what is a prudent hospital leader to do? You certainly cannot hire unless positions are open. You can tinker with nurse-to-patient ratios, but there are quality and patient satisfaction issues associated with those strategies. However, the visionary leader will understand this developing perfect storm and plan accordingly. The winners in the Nursing Shortage, Part 2, will implement the following strategies:
■ Improve the work environment for nurses, using Magnet principles for which a strong business case has been made.
■ Employ knowledge transfer workshops that allow RNs nearing retirement to share expertise before this major brain drain occurs in your organization.
■ Implement phased retirement for older RNs as a way to keep them in the workforce longer.
■ Work with older employees to transfer within the organization, yet away from the physical demands of direct patient care, allowing them to use their extensive clinical expertise.
■ View nurses as valued professionals, not commodities, with the requisite input into clinical management and decision-making.
■ Utilize the IOM’s recommendations on nursing, particularly recommendation No. 2, which calls on organizations to “expand opportunities for nurses to lead and diffuse collaborative improvement efforts.”
There is no silver bullet. In fact, as the workforce landscape emerges, the best organizations will remain nimble in terms of their planning. What works in today’s market will become obsolete given a new set of social, economic and political developments. But, to be sure—the nursing shortage will be back. It is not a matter of if; it is a matter of when.
From left, Karen Cox is executive vice president and chief operating officer at Children’s Mercy Hospital and Clinics, Kansas City, Mo. Susan Lacey is its director of nursing workforce and systems analysis. Rand O’Donnell is the president and CEO of the hospital.