Countries around the world are facing critical nursing shortages. From North America to Africa and Europe, communities are challenged with growing health care needs and diminishing numbers of nurses.

Why is there a nursing shortage?

Many factors are contributing to the current shortage. They include:

  • Steep population growth resulting in a growing need for health care services.
  • A diminishing pipeline of new students in nursing.
  • An aging nursing workforce.

In addition, with improved technology and managed-care issues, only the sickest patients require hospital stays and intense treatment. Thus, skilled and specialized nurses are in great demand.

These issues are occurring just as the majority of nurses are retiring and job opportunities within health care are expanding. The result: Hospitals and other institutions need more nurses, especially those who deliver specialized care.

How do we know there is a shortage?

Research demonstrates what nurses and health care organizations already know: The nursing shortage is very real.

  • According to a study by STTI board member Peter Buerhaus, RN, PhD, and colleagues published in the Journal of the American Medical Association (June 14, 2000):
    • The average age of working registered nurses increased by 4.5 years to 41.9 between 1983 and 1998.
    • Within 10 years, 40 percent of working RNs will be 50 years or older.
    • As those registered nurses retire, the supply of working RNs is projected to be 20 percent below requirements by the year 2020.
  • The March 2000 National Sample Survey of Registered Nurses (NSSRN) conducted by the Division of Nursing of the U.S. Department of Health and Human Services Bureau of Health Professions revealed that:
    • Although the number of licensed registered nurses increased 5.4 percent to nearly 2.7 million in 2000, it's the lowest reported annual increase by the department since data collection began in 1977.
    • The number of registered nurses under the age of 30 is decreasing. The RN population under 30 dropped from 25.1 percent in 1980 to only 9.1 percent in 2000.
    • Between 1996 and 2000, the average age of registered nurses increased from 42.3 to 43.3.
  • The Bureau of Labor Statistics reports that jobs for registered nurses will grow 23 percent by 2008. That's faster than the average for all other occupations. About half of the RN workforce will reach retirement age in the next 15 years. The average age of new graduates is 31. They are entering the profession at an older age and will have fewer years to work than nurses traditionally have had. Enrollments in entry-level nursing programs increased in the fall of 2001, ending a six-year period of decline, according to the American Association of Colleges of Nursing. However, the enrollment increase is not enough to meet the projected need for new nurses.
  • According to a national poll released in February 2002 by the Vanderbilt University Medical Center's School of Nursing and Center for Health Services Research in Nashville, Tenn., a majority of Americans are concerned about the impact the nursing shortage may have on their ability to gain proper medical care. It also confirms that Americans overwhelmingly trust, respect and admire nurses and would encourage family and friends to consider a nursing career. However, a general lack of knowledge of the many opportunities nursing offers is a significant barrier to nursing recruitment efforts. The study shows that:
    • 81 percent of Americans recognize there is a nursing shortage; 65 percent believe it is either a major problem or a crisis.
    • 93 percent agree (80 percent strongly agree) that the nursing shortage jeopardizes the quality of health care in the United States.
    • Seniors, aged 55 and older, are particularly sensitive to the shortage's impact on the quality of the health care system.

How is the shortage affecting patients?

According to a 2002 report by the Joint Commission on Accreditation of Healthcare Organizations, inadequate nurse staffing has been a factor in 24 percent of the 1,609 cases involving patient death, injury or permanent loss of function reported since 1997. The report also says:

  • In hospitals across the country, 126,000 nursing positions remain unfilled, while 90 percent of long-term care facilities don't have enough nurses to provide even the most basic care. Some home-health care agencies are being forced to refuse new patients.
  • By 2020, there will be at least 400,000 fewer nurses available to provide care than will be needed.
  • However, the report notes that there are 50 "magnet hospitals" nationwide that have successfully avoided or overcome shortages. Improved working conditions and increased federal money may help other hospitals.

How is the shortage affecting nurses?

To attract much-needed nurses, some organizations are offering large sign-on bonuses and are advertising significant salary increases for key specialties, such as intensive care.

However, increased stress levels and growing stories of nurse burnout make incentives like these only a short-term solution. Job dissatisfaction is on the rise due to increased workloads, longer hours and not having the resources to provide the highest quality care to patients.

What is being done to alleviate the shortage?

  • STTI helped spearhead the formation of Nurses for a Healthier Tomorrow, a coalition of 40 national nursing and health care organizations working to address the nursing shortage. The coalition has created a website, created an advertising campaign and secured media coverage to spread the word about the nursing shortage and to encourage young people to enter the profession. More than $1 million in monetary and in-kind contributions have been raised. The campaign has received news coverage nationwide and the coalition's public service announcements and print ads are running nationwide.
  • The Honor Society of Nursing joined Johnson & Johnson to reduce the nursing shortage through the $20 million multi-year Campaign for Nursing's Future to attract more people to nursing in hospitals and extended-care facilities.
  • The Nurse Reinvestment Act signed by President Bush on August 1, 2002, is intended to alleviate the nation's severe nursing shortage by making it more attractive to train for and work in the profession.

Recommendations from the Honor Society of Nursing, Sigma Theta Tau International

STTI recognizes the nursing shortage as a major threat to the future of the world's health care system. We recommend several steps to reverse this trend now instead of later.

  • Demonstrate to health care leaders that nurses are the critical difference in America's health system.
  • Reposition nursing as a highly versatile profession where young people can learn science and technology, customer service, critical thinking and decision-making skills.
  • Construct practice environments that are interdisciplinary and build on relationships among nurses, physicians, other health care professionals, patients and communities.
  • Create patient care models that encourage professional nurse autonomy and clinical decision-making.
  • Develop additional evaluation systems that measure the relationship of timely nursing interventions to patient outcomes.
  • Establish additional standards and mechanisms for recognition of professional practice environments.
  • Develop career enhancement incentives for nurses to pursue professional practice.
  • Evaluate the effects of the nursing shortage on the preparation of the next generation of nurse educators, nurse administrators and nurse researchers and take strategic action.
  • Implement and sustain a marketing effort that addresses the image of nursing and the recruitment of qualified students into nursing as a career.
  • Promote higher education to nurses of all educational levels.
  • Develop and implement strategies to promote the retention of RNs and nurse educators in the workforce.