Nursing Shortage, USA: Why It’s Happening, & How It Can Be Resolved

by Tera Tuten on October 26, 2011

We call them “angels of mercy.” We call them the “glue that holds the medical system together.” We call them “front lines” of American healthcare; “unsung heroes” of the medical profession.

Yet, our so-called angels of mercy are in a bad situation: they’re facing a dire nursing shortage that shows no sign of improving. If we have such glorified opinions of nurses, why are they dropping like flies? If nursing is one of the most secure and well-paid job markets in the country, why are we struggling to fill and keep nursing positions?

To start digging our way out of the shortage, we’ve got to first understand what’s currently causing the American nursing shortage—and what’s at stake.

Types of Shortages Plaguing American Nurses

  1. “Physical Nurse” shortage. There simply aren’t enough trained nurses.
  2. “Willing Nurse” shortage. Whether from burnout, low pay, or an overtaxed schedule, 20% of trained, able-bodied nurses no longer work in nursing.
  3. Educator/Education shortage. There aren’t enough educators or space for all nursing applicants, causing schools to turn away willing students.
  4. Financial Shortage. Even if hospital staffing personnel understand that a floor may need six nurses, they may only have the money for four.
  5. Young Nurse Shortage. The median age of nurses is 42.5, meaning more are closer to retirement than the beginning of their career.
  6. A Shortage of Understanding. Not all hospitals understand the importance of having nurses, preferring to delegate care giving to less-trained personnel.

Dangers of Nurse Understaffing

  • A AHRQ study revealed that lower nurse staff levels caused significant spikes in:
      • UTIs
      • Upper gastrointestinal bleeding
      • Shock
      • Longer hospital stays
      • Pneumonia
  • The same study found that just an additional 30 minutes of R.N. staffing can reduce pneumonia occurrences by 4%.
  • A .25 nursing increase per day can reduce a 30-day mortality rate by 20%.
  • Peter Berhaus, a Vanderbilt University nursing work force expert, found that increased nursing levels could prevent 6700 patient deaths and save 4 million days of hospital care.
  • Statistics project a shortage of 1 million nursing jobs by 2020. The number of nurses is expected to grow by 6%…but the number of needed nurses is expected to grow by 40%.

What Caused the Modern Nursing Shortage?

Several colliding factors snowballed to contribute the current shortage. Here are some of the biggest causes to blame:

Education Shortfalls

The modern nursing education system can’t keep up with the current staffing and applicant demands. In 2008, nursing schools turned away 50,000 qualified applicants–including 6,000 applicants looking for master’s or doctorate degrees.

Nursing education salaries are pretty dismal: nursing faculty make only 75% of what faculty in other disciplines make, and practicing nurses make nearly $15,000 more each year than nurses who teach.

Bad Working Conditions

Of nearly 13,500 nurses surveyed in Pennsylvania, 40% were dissatisfied with their career. To put that in perspective, the average job dissatisfaction rates for other professions range from 10 to 15%. Short-staffing, burnout and increased patient levels cause many nurses to leave the profession. New nurses don’t fare any better: the Associated Press reports that one in five new nurses quit within 12 months.

A Swelling Healthcare System

A growing population needs a growing healthcare system, especially as the population ages and baby boomers clog the overworked system. Increasing medical technology also creates a higher demand for trained nurses.

Shifting Gender Roles

Nursing is still largely considered a women’s career. Modern women have more career choices available than the women of 30 years ago, so fewer women are entering the nursing profession–and men still shy away from the field. Only 6% of nurses are male and that number doesn’t show signs of growing.

Fixing the Nursing Shortage

A problem as massive as this one isn’t going to be solved with one hard-and-fast solution. Here’s what the U.S. needs to start doing to start getting more nurses into our overworked hospitals.

  1. Restructure Nursing Education. We need nursing schools, teachers, and student space.
  2. Implement Nursing Residencies or Similar Transitional Programs. Doctors enjoy a 3-4 year structured residency after graduation to help transition into physicians. Nursing grads are thrown into the fray with little or no training. As a result, 20% of new nurses quit within the first year. Several hospitals have nursing residencies, such as the Versant RN Residency program, used in 70 hospitals across the US. One hospital reported lowering their turnover rate from 22% to 10% after 18 months.
  3. Encourage Kids and Males to Become Nurses.
    Groups such as Nurses for a Healthier Tomorrow raise interest in nursing groups for high school and middle school students—targeting male students would also help.

The Future of the American Nurse

American healthcare can’t survive without nurses…and the medical system is already operating over max-capacity. We need skilled nurses and we need them now. If the shortage continues on its projected spiral, the healthcare system will collapse entirely–and that’s a risk our nation can’t afford to take.


{ 11 comments… read them below or add one }

Maureen Kavanagh 10.28.11 at 4:13 pm

There is no nursing shortage. If we want nurses let’s hire student nurses straight from the schools and not go on and on about their lack of “experience”! That is the problem, no one wants to train new nurses…no they all prefer nurses from South Korea, or Jamaica where they worked for a few years on a Med-Surg unit and they don’t need to be trained! Please let’s stop the game… you all just want foreigners working on your units because they are cheap and don’t ask to join unions…and yes I know I used to be a student nurse!!!!

Stephen R.Keister M.D. 10.29.11 at 11:10 am

At aged 90 I well remember the three year hospital based R.N. programs. I, and my older colleagues that remember these nurses, agree that these were the most efficient, most compassionate nurses of current times. The third year students on floor duty, under supervision, surely supplied which is now decreased patient care and compassionate attention. Of course, the current nursing shortage is merely another symptom of our severely broken health care system, which can never be corrected in the present amoral political climate. Only when we have single payer health care as envisioned by Physicians For A National Health Program will we become one of the international leaders in health care. I see little encouragement within the oligarchy, and cult of greed, that exists in our country today.

Hosea W. McAdoo, M.D. 10.29.11 at 1:57 pm

Parade Magazine used to have a poll of most respected professions and nurses were at or near the top all of the time. If so, then why don’t we pay them to show it? Nurses have to lift, deal with people in distress who are not at their personal best. They work doubles and yet lawyers who rate near the bottom of the scale make many times as much.

Hospitals would have a much easier time doing without physicians than nurses. I hear complaints from patients (called clients in todays world) usually due to nurse understaffing. They are a convenient way for hospitals to save on salaries but at a cost of quality patient care.

I don’t know about today, but the Navy I served in trained corpsmen extremely well. The VA used to hires these people as nursing assistants and they did much of the work very well. Why can’t we make the use of this training to both fill out patient care positions as well as give veterans a long term job opportunity?

I have been a physician for many years and hold nurses and corpsmen in very high esteem. Chasing them away at a time of greatest need seems foolish at best.

Scott Tyson 10.29.11 at 4:27 pm

Sadly, in a single generation, it is not possible to create a shortage, unless you “kill off” the entity or they choose not to work in the field. If we paid nurses better, didn’t ask them to put their licenses on the line with longer and dangerous hours, had an appropriate patient to nurse ratio, and had a less toxic environment, all as Dr. Keister alluded to in a single payer system, we would have the nurses we need. They would rejoin the field that most gave up because of all the factors above.

Barbara Broz 10.31.11 at 9:15 am

I was an LVN for 10 years. I gave up my license because I felt I was no longer able to give the standard of care to which patients were entitled. “Decentralization” (overcharging patients for everything, including Tylenol), under-staffing (unreasonable nurse-to-patient ratios) and lack of oversight regarding infection controls were only some of my concerns. I was dedicated to quality care; the ‘system’ is dedicated to minimal maintenance care. I realized I could not ‘fight the system’ and my personal integrity and principles are such that I felt I could not continue in the profession under these conditions.

Ms. V 11.05.11 at 2:02 am

Stop making it hard for potential nurses to go to school. There are all these entrance exams before you are even consider in a program. Your GPA can be 2.9 and the individual may be nervous taking tests and score low, should this be a major factor for keeping this person from entering into the program. Nursing is stressful enough. This is one of the reason for the shortage the other is that nurses are burned out, let the students in so there can be more nurses on the floor.

Claudette Jackson 11.22.11 at 3:07 pm

I am looking forward to become a register Nurse, how can I get started.

Fran 11.23.11 at 8:16 am

Let’s stop rejecting qualified young Americans from nursing school because they may have shoplifted or gotten into a domestic dispute and have it on their record. What do we know about the foreign nurses that they allow in? They know how to “play ball” with administration but render lousy nursing at the same time.

ChristineC 02.23.12 at 10:41 pm

Less input from the universities and corporations when it comes to education, and MORE input from the nurses who are actually out there doing the job! More input from the nurses when it comes to staffing, patient ratios, and safety-not the corporate guy 2 states away. While I am all for not wasting time or money, I get tired of the constant struggle of trying to make my patients and their families comfortable and confident that we will care for their loved one when I have to count every cotton ball, allow them only one cup of coffee during a long night, and constantly say “I’m sorry” because my girls have 18 patients a piece because census is low. I isn’t a good feeling when equipment is broken, and the paint is peeling. Things will not improve until someone actually listens to the nurses.

susan 03.01.12 at 8:56 pm

i have been a nurse struggling to cont giving good nurseing care to those in my charge for 40years. I make 21.50 an hour no work no pay get cancelled with no pay want full time hours maybe get 26 a week if im lucky and i am managed or work with or in charge of people who have little education especially in nursing i have no retirement so DO NURSES REALLY EVER RETIRE? i am still very capable so would i recommend this profession to others? no i would not

Tanya 04.02.12 at 2:40 pm

I’m an RN on a medical floor. There really doesn’t seem to be a problem of “not enough nurses”. There are not enough nursing jobs available for all the students that are swarming. If the economy were better, maybe older nurses could retire (as it is now, they can’t afford to). If the economy were better and hospitals weren’t as greedy, maybe the staffing ratio could be fixed. Patients seem to be sicker and need more care; our staffing ratios should reflect this change. Our patient loads should be decreased, instead of increased. There’s a lot wrong with the system, but “too few nurses” doens’t seem to be the main problem.


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