Nursing: The Now-You-See-It-Now-You-Don't Shortage

Is there a shortage of nurses in the US? It depends on how you look at it, and where you look. But everyone agrees more nurse educators are needed.

Predictions that the US is facing a looming nurse shortage are widespread. Most cite demographic trends: the population is aging, nurses are retiring, and there simply won’t be enough caregivers in a few years.

But those forecasts are at odds with one fact: currently, there is no shortage of nurses, says Sue Hassmiller, PhD, RN, FAAN.

Hassmiller is senior advisor for nursing and the director of the Robert Wood Johnson Foundation’s “Future of Nursing: Campaign for Action.”

There is no overall shortage of nurses, though there are regional shortages, she says

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"There may be a shortage in one area of a state, or even in a county, but there are no overall national shortages at this moment,” she adds.

Some nursing specialties are also seeing shortfalls in staffing, nurses who have training to work in the operating room, recovery room, and in some cases there more emergency department nurses are needed.

An infographic produced by NursingSchoolHub.com backs up Hassmiller’s findings. The site’s chart finds that in many geographic areas there are 1200+ nurses for every 100,000 residents.

That’s more than enough, nursing researchers at Boise State University have reported.

Dartmouth researchers have even turned up evidence that the number of new nurses is growing—at least in some parts of the country.

“States in the South and Midwest have a greater supply of younger-aged RNs available to replace fewer numbers of older-age RNs compared to other regions. In contrast, the Northeast and West have fewer younger RNs currently in their workforce yet a relatively larger number of older age RNs to replace, Peter Buerhaus and colleagues reported in Nursing Economics.

One reason for the disconnect is that discussion about numbers of nurses often leaves out a critical factor, and that is the fact that the healthcare system in the United States is changing, and therefore, the roles of providers are changing. The passage of the Affordable Care Act (ACA) may well stimulate the “nurse-managed health centers, and reform of the care delivery system, in which payment is to be linked to quality,” David Auerbach, Ph.D. and colleagues wrote in a recent New England Journal of Medicine article.

Hassmiller notes that as the healthcare system changes, new roles for nurses are being created. For example, she said, that might be “a transitional-care nurse, who could help you when you get out of the hospital and can’t manage your medications.” Transitional care is one of many new roles that consumers demand and nurses are increasingly choosing to fill, she said.

The problem that the profession faces is not that there will not be enough people who would like to become nurses. It is that there may well not be enough educators to train them .

The number of nurses who are willing to become faculty members is dropping, and with good reason. “The crushing and considerable shortage is in nursing faculty,” she says.

“People are retiring because being a faculty member is a very hard job, they are being asked to produce a lot more nurses, and there’s no money in teaching,” says Hassmiller.

So, at a time when the nation needs more educated nurses, who know emerging technologies, such as 3-D printing, and are comfortable in roles where they are responsible for clinical support decision-making, among other higher-level skills and tasks, there are fewer people to educate and train them.

It is possible to avoid a shortfall of nurse educators, she adds.

One solution to the lack of educators is to change the model career arc for nurses who hold advanced degrees. Now, most nurses expect to become educated, then do the jobs they were trained to do. Physicians, on the other hand, usually take faculty positions as well as practice, which allows them to more easily keep up with current research and stay fresh.

Nurses ought to be able to do that too.

She calls on institutions to let “nurses fill joint appointments where they can work in whatever setting they happen to work in, be it a hospital, a home health care facility, a technology firm, and also serve as a faculty member,” Hassmiller says.