Is the Nursing Shortage Real?
Posted On: February 4,2015
Checking and Understanding Various Nursing Workforce Demand Data Sources
Students today have more career data and statistics available than ever before. Before beginning a registered nurse education program, for instance, you can research job statistics such as average pay, number of employed RNs, projected demand and job growth, school accreditation, and NCLEX pass rates from reliable sources with a simple Google search. However, just because you can find a plethora of data doesn’t mean it all translates into something that is easy to understand. It is quite possible that you could find data predicting a nursing shortage in your area right alongside a recent article talking about area hospital layoffs. So is the nursing shortage real?
While a heart for helping others may have led you to nursing, we understand that you also want to find a job after investing time and money in your nursing education. Instead of relying on anecdotes about nursing shortages and layoffs or trying to wade through the statistics and projections on your own, this article will review the main data sources and backgrounds for nursing workforce projections and help you understand why the question, “Is the nursing shortage real?” is actually more difficult to answer than you might think. In fact, it deserves much more than a yes or no answer.
A main cause of confusion about whether the nursing shortage is real stems from the wide range of data sources that discuss nursing demand. Several organizations work to predict healthcare demand in general and nursing demand specifically. Nursing is the largest healthcare profession and continues to grow at a higher rate than U.S. employment overall.
The varied sources also use different models, methodologies, and timeframes for their nursing workforce projections, so it is important to understand the background of each. Also, overall projections for the U.S. may not match demand in your state, and even statewide projections may not match demand for nursing in your particular city or area. As with other careers, many nurses have discovered that a longer commute or move to a different city can open up additional job opportunities.
Let’s briefly explore some of the main nursing workforce projection sources:
U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)
In December, 2014, the HRSA released The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025. The model uses a 2012 baseline of 2.9 million RNs active in the US workforce and assumes that the supply of RNs equals the employment demand at this baseline level. A detailed description of the methodology and projections is available here. The HRSA’s 2025 RN projection indicates a surplus of 340,000 RNs in the U.S. overall (projected demand for 3,509,000 RNs but projected supply of 3,849,000 RNs.) However, 16 individual states are projected to have a shortage of RNs by 2025, with the largest shortages (at least 10,000 fewer RNs than needed) predicted in Arizona, Colorado, North Carolina and Maryland.
The Bureau of Labor Statistics (BLS)–Employment by industry, occupation, and percent distribution for 2012 and projected for 2022
In December, 2013, the BLS released employment projections by occupation, which showed that employment of registered nurses is projected to grow 19% from 2012 to 2022– higher growth than the overall average of 11% for all occupations. Overall, this predicts growth from 2,711,500 employed RNs in 2012 to 3,238,400 in 2022. While the BLS does not quantify supply projections along with employment demand, it does state that job opportunities for RNs are expected to be good.
United States Registered Nurse Workforce Report Card and Shortage Forecast
In January, 2012, the American Journal of Medical Quality published an article entitled “United States Registered Nurse Workforce Report Card and Shortage Forecast” that details projected shortages of RNs by state and region and forecasts worsening shortages in the two decades from 2009 to 2030. In this article, only two states—Massachusetts and South Dakota—are predicted to have a surplus of RNs in 2030.
Individual State RN Projections
A website called Projections Central gathers data on 2012 to 2022 projections for all states from the labor market information sections of each State Employment Security Agency. By selecting “registered nurses” and each individual state, you can see the base 2012 employment level, the projected change through 2022 (ranging from 11%-31% for all states and the District of Columbia), and the average annual job openings for RNs. Although not provided on this site, some states’ Nursing Workforce Centers also analyze RN supply information to make detailed supply and demand projections, but the timeframe and amount of detail for the projections varies by state.
Several important additional factors are difficult to pinpoint and enumerate within RN workforce projection models, but could have a significant impact on the demand for nurses. Some of these are covered below.
Aging RN Workforce and Delayed Retirement
Before the recession, there were widespread concerns within the healthcare industry that many members of the aging RN workforce would be retiring. At the time, the nursing education system was not keeping pace with this anticipated increase in demand on top of an already increasing need for RNs. But the number of new graduates entering the RN workforce more than doubled from 2001 to 2012, increasing from 68,000 to 150,000 nationally. In the meantime, expected increased RN retirement levels did not materialize. RNs delayed retirement, re-entered the workforce because of the recession, or simply switched to less physically taxing roles away from bedside care. There has also been a general trend toward baby boomers and older Americans remaining in the workforce longer. But older RNs will need to exit the workforce eventually, and it is impossible to predict the extent to which mass retirements could increase demand beyond the current projection levels.
Trends in Nursing Education
Some states suffered funding cuts to their nursing programs during the recession, including North Carolina, one of the states consistently predicted to have an ongoing RN shortage. The American Association of Colleges of Nursing (AACN) reports that, across the U.S., 53,667 qualified applicants from entry-level baccalaureate nursing programs were turned away in 2013. In many cases, there are just not enough faculty, clinical sites, and/or classroom space to increase the size of nursing programs. Enrollment growth is also slowing for entry-level BSN programs, up by only 2.6% from 2012 to 2013, according to the AACN. This is the lowest enrollment increase in the past five years. Although it may not yet be a significant concern, if nursing program enrollment begins trending down, the assumptions made by RN workforce projection models will not hold.
The HRSA’s state-level projections assume that nurses will enter practice in the states where they have been trained. The accuracy of this assumption varies widely by state and area. For instance, border areas in some cases have enough nursing demand that they draw nurses from across state lines. Such commuting patterns between states and cities can be quantified, but not easily by profession. Some states’ boards of nursing capture and share data on where nurses live and work, but others do not. Also, some nursing students go away to school with the intention of returning to their home state or area to practice after graduation. Finally, Census data clearly shows a five-year mover rate to a different state of between five and ten percent for each five-year period since 1965. This state-to-state mover rate was at its lowest point in the 2005-2010 timeframe, with the recession and other factors causing many to remain in their state of residence. But it is likely that the five-year mover rate will return to its pre-recession levels of eight to ten percent in the future.
The HRSA’s The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025 may summarize it best:
“… since the 1980s, the annual number of nurse graduates has been cyclical and characterized by high growth, followed by declines of up to 25%. In an alternative supply and demand scenario, if nurses begin retiring two years earlier than pre-recession levels, and there is a 10% drop in new graduates, future supply would fall below projected demand–resulting in a shortfall of 86,000 RNs in 2025.”
Ultimately, there are no easy or definitive answers to the question of whether there will be a nursing shortage in the future. However, it is clear that nursing remains a high-demand career. If you are interested in becoming a nurse, let us help you find a nursing program near you or in a high-demand location where you would like to move.
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