Commentary on Health Affairs Article: Registered Nurse Supply- shortage not over

  1. American Association Colleges of Nursing (AACN) commentary/talking points regarding journal Health Affairs article: Registered Nurse Supply Grows Faster than Projected Amid Surge in New Entrants Ages 23-26. NRSKarenRN

    Read: Registered Nurse Supply:
    On December 5, 2011, the journal Health Affairs published an article titled Registered Nurse Supply Grows Faster than Projected Amid Surge in New Entrants Ages 23-26, which focused on a large cohort of younger nurses entering the profession and the impact this may have on the future workforce. Funded by the Gordon and Betty Moore Foundation, this study was conducted by Drs. David Auerbach, Peter Buerhaus, and Douglas Staiger who found a 62% increase in the number of 23-26 year olds who became registered nurses (RNs) between 2002 and 2009. Though welcome news given the rapid aging of the nursing workforce, the study authors do not conclude that nursing shortage is over given the growing demand for nursing care by older adults, new opportunities for nurses through healthcare reform, and the need for more highly educated RNs.
    To this point, the authors recognize the following in the article:

    * Considerable uncertainty persists about whether or not interest in nursing will continue to grow in the future.
    * The aging of the population is likely to increase demand for RN at a greater rate than in the past.
    * Full implementation of the Affordable Care Act and expanding roles for nurses in primary care will likely increase demand for RNs and result in future shortages.
    * Ongoing bottlenecks in nursing education (i.e. faculty shortages, insufficient clinical training sites) could narrow the future pipeline of nurses below optimal levels.

    Dr. Auerbach and colleagues also were concerned that though the number of RNs prepared each year is increasing, schools of nursing many not be “preparing the workforce ideally suited for population needs.” .....
    Interesting read. What do you think? (Please do not comment before actually reading the entire "Talking Points" article. Thank you.)


    This is the link to the Talking Points article: - This is free and requires no registration.

    This is the original abstract that the Talking Points is referring to:


    Registered Nurse Supply Grows Faster Than Projected Amid Surge In New Entrants Ages 23–26
    • David I. Auerbach,
    • Peter I. Buerhaus,
    • and Douglas O. Staiger

    Health Aff December 2011 30:2286-2292; doi:10.1377/hlthaff.2011.0588

    Last edit by NRSKarenRN on Dec 9, '11 : Reason: Added article title and links
  2. Visit VickyRN profile page

    About VickyRN

    Joined: Mar '01; Posts: 12,046; Likes: 6,497
    Nurse Educator; from US
    Specialty: 16 year(s) of experience in Gerontological, cardiac, med-surg, peds


  3. by   Wise Woman RN
    To read the article requires registering and paying for it.. so...
  4. by   VickyRN
    Quote from Wise Woman RN
    To read the article requires registering and paying for it.. so...
    This is the link to the Talking Points that I was referring to: No registration required, freely available.
  5. by   chuckster
    This talking points summary concentrates on the possibility of a future shortage of nurses and does not weigh on the present argument regarding an oversupply - or shortage - of nurses. The authors speculate that the aging population and the implementation of the Affordable Care Act (sometimes derisively referred to as "Obamacare") are likely to increase demand for nurses. While there may be some data to back up the former assertion, there is none for the second. Quite frankly, it looks to me as if large segments of the Affordable Care Act will be neutralized in the very near future, if not by invalidation by the Supreme Court then by legislation after the 2012 elections. Unlike the authors of the article however, I freely admit that is speculation on my part.

    The authors also claim that the this speculative shortage will be exacerbated by a potential decline in nursing students, either as a result of a loss of interest by future nursing students or because of the "ongoing bottlenecks" in nursing education. The authors identify nursing faculty shortages and insufficient clinical training sites as the culprits behind the bottlenecks. I would be interested in seeing the data that lead the authors to conclude this. The data I see show nursing enrollment increasing, which to say the least, would seem to obviate the argument that there is a faculty shortage. With respect to clinical site shortages, the authors may be on firmer ground but only because the number of sites available have not kept pace with the increased numbers of nursing students requiring clinical rotations. Actually, given the flood of hospital closings, the number of clinical sites may well have declined. To me however, this argument seems somewhat similar to the one made by the child who, after murdering both of his parents, begs the court for mercy because he is an orphan.

    Despite these doubts, I do believe that the authors are right to be worried about a future shortage of nurses, but for very different reasons than the ones expressed in the talking points. Since about 2008, new grad RN's, especially those from ADN programs, have been having a very difficult time find nursing employment. This trend seems poised to continue for some time. It is well-recognized that there is a "expiration" date for new RN's, generally about 12 months after passing the boards. After this date, these RN's become essentially unemployable and so will move to other careers. This is worrisome because it means that the nursing student has invested a significant amount of money and time in training, as has the institution that they attended, and to no effect. It is also worrisome because, should this trend continue, it will have that dampening effect on attracting new nursing recruits that the authors mention.

    It is ironic that the authors conclude that
    taking actions now that would stop the flow into the nursing profession would be a very risky and unwise gamble
    I submit that doing nothing to ameliorate the oversupply of new nurses - and by this I mean increasing the numbers of new RN's that are hired - will have precisely the effect of staunching the flow into the profession that the authors worry about.

    Just my two cents. And full disclosure: I'm one of those new RN's now well past the usual sell-by date.
    Last edit by chuckster on Dec 9, '11
  6. by   netglow
    I tell everybody I can not to go into nursing. To wait at least 5 years before reconsidering. Simply there will not be a job most likely for them and taking a debt of college knowing this would be ridiculous. I tell them to go into something broad and non-healthcare based, then in 5 years, reassess the situation for NG nurses and residencies and then think about it again. I also tell them... go a head and mix some science into your curriculum while you in college for that other degree if you can... your chems, bios... wait on the A&P.
  7. by   caroladybelle
    Another issue that should be considered is that many of those going to nursing school have no intention of being "bedside" nurses for any length of time.

    There is a greater number of students using RN as a stepping stone to NP or CRNA or nonbedside positions. Witness the large number of posters here seeking nonbedside positions or positions involving limited inpatient care.

    And more so, how many are going in with expectations that unrealistic and will leave when those expectations are not fulfilled. Increasingly, I deal with precepting new grads or students that do not realize the physical work involved.
  8. by   kcmylorn
    I too tell everyone not to go into nursing. Why- because of the dragging down of the profession that the financial mogals have done. The my hospital is better than yours philosopy and the heck with the patient survival. This ridiculous notion of "cusomer satisfaction" How many people you know who had any of their organs cut out of them rated the experience right up there with a all expense paid trip to Disney?Illness is uncomfortable, nursing tasks are uncomfortable- I don't know of too many MI's wanting to see the beautifully appointed lobby before they are wisked off to the cath lab.
    Then there is their stop at nothing ( even murder by another's hand through short staffing ) to maintain that multi million dollar salary with perks and bene's.
    How many new grads in the most recent years are going to hang around without a paycheck to pay off all that student loan debt-I don't think too many of them have a mommy or daddy CEO to foot the bill.
    These Nursing academia's need to first figure out how nursing can take back it's profession and protect it's license from these charlatans for profit( their own)
    They need to stop wasting paper and precious research time expounding on the obvious.
  9. by   gettingbsn2msn
    Nursing is going down the tubes, so to speak. Hospitals are talking customer satisfaction and having the Ritz Carlton train their nurses (if you do not believe, google it). Healthcare is done as far as I am concerned. I will be moving on after I get my masters. I also have a Bachelor of Science in Business so I can move to other fields as well. So done with all of this.
  10. by   Chico David RN
    From the standpoint of policy and planning, we really are in a bind right now.
    On the one hand, we probably do have a long term structural shortage of nurses brought about by the retirement and aging of the Baby Boom generation. On the other hand, we have an acute over supply right now. It seems highly likely that the oversupply in the short run will discourage people from going into the field and worsen the shortage in the long run.
    It also seems apparant that the source of the article - AACN - is the organization for people in the business of educating nurses and they are desperately anxious not to cut their business by allowing people to understand how severe the current oversupply really is - their desire to talk up long term shortage is clearly in their own self-interest.
    The best answer is a real, broad based economic recovery as fast as possible, but with neither party having a real plan to promote that and one party doing all they can to prevent it, I can't see that happening any time soon. It's important to understand that the nursing glut is not quite the same as unemployment in other fields. In other lines of work there are actually fewer jobs. That's not the case in nursing - the number of nurses employed is about the same as before the recession. What has created the glut is people coming back into the nursing work force who were (or would like to be) out of it: Nurses who were working in another field and lost their jobs, Nurses who were being supported by a spouse and went back to work when the spouse lost their job, Nurses who were retired or on the point of retirement who were forced to delay retirement or come back to work because their retirement funds were decimated, Nurses who were working part-time who went to full time when a spouse lost their job.
  11. by   kcmylorn
    I think these academia prophets need to stop focusing on this "nursing shortage" and start focusing on the problem of why hospitls are closing their doors. We ( the healthcare community, the US) can not continue to shell out the multi millions to top management in salaries, bonuses, perks and pensions. Ultimately, no healthcare system will be able to keep their doors open. Small hospitals are taken over by larger ones, larger ones are taking them over and so on. This runaway gravey train for the execs needs to stop. Pretty soon Humpty Dumpy is going to fall down. Then it won't matter how many nurses we have and don't have.
    Temple University Hospital announced yesterday that it's current CEO- Sue Gromberg, the reining queen who was in power during the Temple Unive. nursing strike of April 2010 will be stepping down and a Mr Kaiser( oh brother don't tell me this is one in the same from California) Temple sited that it is $84 million in the red ink and partly due to the 1 month nursing strike?? Again- it's nursing's fault. First- I don't think it was the nursing strike that put Temple in it's red ink. Second- how much moolah does anyone want to guess Madam Gromberg will get as a parting gift. Give her a watch and a goodbye dinner- cut her pension( my guess it will be greater than the $12,000-$13,000 given to the CEO thugs of Westchester in NY state) and any other pay out she feels she is ENTITLE$D to. Temple is a very large healthcare system that also has a medical school attached to it and various degree levels of nursing programs. She was only CEO for a little over 1 yr= gravey train indeed!
    Last edit by kcmylorn on Dec 11, '11
  12. by   netglow
    About the compare/contrast nursing with other professions in this down economy...

    A big problem that having an RN license gives one is that you often cannot work below your license level. So, those "little jobs" others can easily take that they know and their employer knows they are very much overqualified for, BUT ARE STILL AN OPTION, are not an option for us. As well as the idea that nurses don't "fit" in business (unless you used to be in business in a previous career). Nursing can really screw you as far as options go, if you can't get employment as a nurse.
  13. by   Tankweti
    yet another piece of the intricate puzzle that is the “nursing shortage”
    i have been doing a great deal of thinking about this as it affects all of us, but new and recent grads in particular who have been unable to complete the training which they began in nursing school. the inertia of nursing schools, other than to enroll more and more students, only contributes to the problem. by inertia, i mean that nursing schools should be looking into collaborating with health care agencies and institutions to devise bridge programs for all these students so that they can successfully transition to practice rather than languishing as an employee of starbucks, or some similar organization, as their hard-won skills atrophy over time. however, there is a good reason that such programs have not been implemented and never will be. implementing such programs would, by definition, imply that there are positions in existence for all these graduates – which there are not.
    this brings us to the next point of my little “opinion piece”. the mass graduation of new nurses is not going to solve the nursing shortage, contrary to what conventional wisdom is preaching. let us take my state, new york, as an example. i have calculated that new york state, over all its nursing schools, graduates about 2,500 new nurses per year. i have been keeping track of the number of new graduates hired by certain local health organizations over the past year; i have obtained this information by various different means – mostly by word of mouth as none of this is openly published. these numbers have been obtained from institutions in poughkeepsie, new york all the way down to institutions in new york city. no institution that i have been able to gather information on has hired more than 20 new grads per year. most hire an average of 10 and those are selected from within, from the pool of people who have been c.n.a.’s.
    if these numbers are indicative of a solution to the nursing shortage, i would like to know what that solution is. if each institution is accepting, for completion of training, 10 new grads per year this will not even make a dent in the nursing shortage. instead, what you have is a bottle-neck of a tremendous number of new grads trying to force their way thru a small hole to join the small population of employed new grads. just like the sperm who do not make it into the egg, once one has already penetrated, they will languish and die on the outside; the nursing shortage will not be improved by this method currently in place.
    in addition, there are other forces on the horizon which nursing schools are either unaware of or choose to ignore. if they are unaware of these forces, then one must question their masters and doctoral degrees if they are not even aware of what is about to descend on their own profession.
    i would direct all of you to look at one of the recent advance for nurses magazines that many of us get free in the mail, dated 11/7/11 vol 11, no 18 northeast. on page 6, there is an editorial entitled “virtual nurses: will you be replaced by a computer?” there is now, apparently, a virtual discharge nurse computer program that is available now for “deployment in hospitals”. mass institute of tech published an update on this technology on one of their websites at the beginning of november. a clinical trial of the software has been in progress for 3 years at boston medical center. the program is an interactive one wherein the patient punches computer keys and answers programmed questions and is also educated about their disease, any after care and is given discharge instructions by the computer. the computer will also “confirm that the patient understands key concepts”. the computer is even programmed to make conversation with the patient to make them feel more at ease. the software is already licensed and is currently available to be leased by institutions. what is really damaging for all of us is that “the system has proved to reduce readmissions by over 30% and reduce costs by over 33%”. the magazine article also states that “patients using the device display a more thorough understanding of their condition than after traditional interactions.”
    the article finishes with the following comment, “…it comes back to saving money by eliminating the need for nurses. about 60% of the cost of delivering healthcare comes from human resources, so even if you can train more people, it is not an ideal way to improve costs.”
    in addition, i am attaching a you tube address to view a video on japanese nurse-robots which will further replace even more of us.
    there is also a video called “robonurse cares for the elderly”. like the u.s., japan also has a burgeoning crop of elderly and this video depicts their response and solution to this massive financial problem:
    just like we were told in nursing school, “it is all about the money”. in addition, keep in mind that medicare and medicaid will be experiencing severe cuts over the next 10 years or so. some of these are already happening and are hitting nursing homes and home care. these cuts will mean nurses being saddled with untenable and unsafe patient loads. one article i read stated that a nursing home facility would be laying off nurse’s aides and requiring the nurse to perform all the tasks of an aide as well as those of a nurse, to save money. the alternative will be to lose one’s job. type in medicare/medicaid cuts and the effect on nursing homes as a search term and see what comes up. of course, the cuts to medicare and medicaid will be made at the state level, meaning that the fed government will provide less and less funding to each state. it will give them a lump sum and expect them to make due with it. therefore, as this situation unfolds, you will see some states being harder hit than others (at first) but eventually all states will suffer to the same degree.
    i know, i know, this is negativity, but it is also fact. i also know that some people will say that medicine needs a human touch which indeed it does. customer service, by definition, should have a human touch and many of us protested against companies putting automated systems in place to answer phones and direct customers to the right area. but, despite our protests, these systems were put in place all the same. i doubt there is very much we can do about any of this. protesting will not make corporations change their minds, especially when study results seem to report the fact that not only is money being saved but that patients have a better understanding of key concepts than when human nurses teach them.
    one wonders what will be next? will robots have to be licensed? take boards? and if an error is made through the computer’s software and the patient is given wrong info, who will the patient sue? the hospital for buying the equipment? the manufacturer of the hardware? the manufacturer of the software? the programmer who inadvertently created a programming glitch? or all of the above?
  14. by   netglow
    You sure are right. Every effort is being made to figure out how to reduce the hospital RN census.