With an expected influx of millions of new patients courtesy of the Affordable Care Act, health experts are warning of a doctor shortage in the coming years. It is a problem that has gotten plenty of press already; one that has overshadowed another looming provider shortage—that of nurses.
The nation could see itself 260,000 nurses short of demand by 2025, according to a 2009 study by researcher Peter I. Buerhaus of the Vanderbilt University School of Nursing. That would be more than twice as large as any shortage of registered nurses (RNs) since Medicare and Medicaid were introduced in the mid-1960s.
How could this happen? There are two primary reasons, says Peter McMenamin, a senior policy fellow at the American Nursing Association (ANA). And both, he says, have to do with the economy.
For one thing, the recession and its sluggish recovery have actually masked the impending shortage, as older nurses delayed retirement and stayed on the job. The average age of employed RNs in the U.S. is 45, up from 40 in 1980, and 40 percent of working RNs (1 million of the 2.6 million employed in nursing) are age 50 and above. In 1988, by comparison, 53 percent of RNs were under age 38. At the moment, those delays in retirement have actually led to a glut of nurses. According to a 2011 survey of recent nursing school grads by the National Student Nurses Association, 36 percent of newly licensed RNs were not working as registered nurses four months after graduation.
But once those 1 million older nurses do start retiring, there won’t be nearly enough new RNs to replace them and to meet the coming demand. Enrollment in nursing colleges has more than doubled in the past decade, but it’s still not enough, says McMenamin. “About 149,000 nurses entered the workforce last year,” he says, “but at that rate we’d need eight years to replace the 1 million.”
So why don’t nursing schools prepare more graduates? Again, it’s the economy. The nation’s nursing colleges don’t have enough teachers. Teaching usually requires a cut in pay, which is something most RNs can’t afford these days. More than 54,000 qualified applications were turned away from nursing programs in 2010, far and away the highest number in any recent year, reports the American Association of Critical-Care Nurses. And more than 11,000 applications were rejected by master’s and doctoral degree programs.
This isn’t the first time the nation has faced a nursing shortage. President Lyndon B. Johnson signed the $300 million Nurse Training Act of 1964 to address a predicted shortfall of 300,000 nurses by 1970. The act was part of the Title VIII programs under the Public Health Service Act, the primary source of federal funding for undergraduate and graduate nursing education. The ANA and other advocates are pushing for similar new funding, but McMenamin is not optimistic: “Real funding for Title VIII would need to be multiplied five times to get back to the 1970s level, and that is not going to happen.”
Nursing groups also advocate other initiatives, including an Institute of Medicine recommendation to allow properly trained nurses to work across multiple specialities. The hope is that everything aligns so the number of retiring nurses somehow matches the influx of new nurses. If that doesn’t happen, “we could have a substantial and deep shortage,” McMenamin says. “Right now we are on a knife edge. It could go well, or it could go terribly bad.”