This essay examines the nursing shortage currently affecting the United States, beginning with a definition of what constitutes a nursing shortage and a distinction among the various categories of nursing professionals. It explores the multiple causes driving the shortage — including inadequate nursing school capacity, an aging workforce, and declining job satisfaction — and analyzes the effects on patient care, healthcare access, and nursing demographics. The paper reviews state-level projections from the National Center for Health Workforce Analysis through 2030 and concludes by evaluating potential strategies to prevent or mitigate future shortfalls, including salary adjustments and workforce redistribution.
There is a nursing shortage in the United States. A nursing shortage means that there are not enough nurses to fill available nursing positions. The nursing shortage is the result of a number of different factors — some that are within the control of the nursing profession, and others that are caused by factors outside of it. The nursing shortage has led to a number of different impacts on the medical profession, from a negative impact on patient care to a positive impact on nursing salaries in the highest-demand areas. Understanding the current and projected future impact of the nursing shortage requires examining the relevant statistics. Once those are understood, it becomes easier to consider what can be done to prevent nursing shortages in the future.
With an aging population, the demand for nurses is only going to increase, and failure to solve the nursing shortage will inevitably lead to an overall decline in patient care. Solving the nursing shortage is going to require a multi-faceted approach — one that addresses all of the causes of the nursing shortage without compromising the professional standards for nurse education and training.
A nursing shortage refers to a deficit of nurses relative to available nursing positions. In other words, if there are not enough professional nurses to fill available nursing positions, then there is a nursing shortage. However, this issue can be difficult to understand because several different professions fall under the general label of "nurse." Many people use the term nurse to describe any non-MD medical professional who handles some aspect of patient care, but this is an incorrect use of the term. Some medical professionals are paraprofessionals or assistants and do not have the same background, experience, or education as nurses.
Further complicating the issue is the fact that, in the United States, nurses can hold several different licenses and credentials: licensed practical nurses (LPN), licensed vocational nurses (LVN), registered nurses (RN), advanced practice registered nurses (APRN), and nurse practitioners. The differences in these positions reflect differences in educational requirements. LPN and LVN nurses hold technical degrees with specialized education in healthcare but have limited abilities in terms of diagnosing and treating patients. RNs hold bachelor's or associate degrees in nursing and have a greater ability to diagnose and treat patients. APRNs hold master's degrees and possess specialized skills that allow them to provide services beyond traditional nursing (LeBoeuf, 2018). In this essay, the term nursing shortage specifically refers to a shortage of RNs, though many of the same factors would also affect other components of the nursing profession.
Describing why there is a nursing shortage is difficult because there is no single root cause. Instead, a variety of different factors have combined to create the shortage. One cause is that nursing school enrollment is not growing fast enough to meet projected demand for nurses (Rosseter, 2018). However, it is not simply a matter of admitting more students into nursing programs. Because of the nursing shortage, there are not enough qualified instructors to teach in those programs, which limits the number of students who can enroll. In addition to faculty limitations, nursing schools face other constraints — insufficient classroom space, limited availability of clinical sites and clinical preceptors, and budget restrictions. Therefore, even though a significant shortfall in nurses is projected, current nursing programs are not sufficient to remedy that problem.
Although the nursing shortage is directly tied to the limited capacity of nursing programs, several other factors also contribute. The aging baby boomer population means there is a projected increase in demand for nursing services. The current nursing workforce skews older than many other professions, which means that many nurses are approaching retirement — further deepening the shortage. The shortage itself exacerbates the problem: without enough nurses to fill positions, those who are employed are expected to take on additional duties, which increases stress and decreases job satisfaction. As a result, some nurses are leaving the profession entirely, worsening an already difficult situation.
The nursing shortage affects not only the quality of healthcare people can access but also the demographics and dynamics of the nursing profession itself. The shortage is, in many ways, self-perpetuating. Because understaffing decreases job satisfaction and drives people out of the profession, it increases stress on remaining nurses, prompting more departures. The shortage of working nurses also contributes to a shortage of nurse educators, making it even harder to train new nurses. One potential positive effect of the shortage is that it may help increase diversity within the nursing profession, as intensified recruitment efforts reach males and members of cultural groups that have not traditionally been well represented in nursing.
In addition, the nursing shortage has broadly affected access to healthcare. While hospitals and large patient-care facilities may still be able to attract and retain enough nurses, they are not the only settings that require trained nursing staff. Assisted living facilities, retirement communities, and senior housing facilities all need access to high-quality healthcare services — including RNs capable of handling routine patient care at a level beyond what nursing assistants can provide.
The most significant impact of the nursing shortage, however, is on patient care. Without enough registered nurses, patient care suffers, often dramatically. Nursing shortages mean increased workloads, and increased workloads can have deadly consequences: a significant increase in the risk of patient death; higher hospital readmission rates after discharge; increases in preventable complications such as urinary tract infections and surgical site infections; longer hospital stays; and higher failure-to-rescue rates (Rosseter, 2019). Outside of hospital settings, a shortage of nurses similarly degrades the quality of care. Nurses are frontline providers of medical care and, in many cases, control whether patients gain access to a physician. Well-trained nurses are better able to identify emergency situations, assess patient health, and notify physicians of medical concerns. Replacing RNs with non-nurses or lower-level nursing staff means that some patients who require a higher level of care will be diverted away from the services they need.
While the nursing shortage has increased demand for nurses across many types of healthcare facilities, it is worth noting that this shortage has not produced the expected rise in median nurse income. Basic supply-and-demand economics would suggest that nurse salaries should rise in response to the shortage. However, that increase has not materialized, which may further compound the original problem by reducing the financial incentive to enter or remain in the nursing profession.
"State-level projections of RN and LPN supply"
"Solutions including pay increases and relocation"
Currently, the United States is experiencing a nursing shortage. Put succinctly, there are too few qualified nurses to fill all available nursing positions. The shortage has produced a range of effects — from increasing diversity within the nursing profession to an overall decline in patient care as nurses are expected to handle growing workloads due to chronic understaffing. Notably, the shortage has not produced some of the outcomes that economic logic would predict, such as a significant rise in nurse salaries commensurate with increased demand.
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