Addressing the Predicted Nursing Shortage

  1. There is a predicted nursing shortage coming as the baby boomers continue to retire in droves. What are some solutions?

    Addressing the Predicted Nursing Shortage

    allnurses.com staffers were recently fortunate to interview Audrey Wirth, MSN, RN-BC, CVRN-BC adjunct clinical instructor at Aurora University's School of Nursing and Allied Health. She has published in the Journal of Nursing Administration and Nursing.com as well as a presentation training the trainer for end of life care. We discussed the predicted nursing shortage.

    According to the latest (2017) HRSA report regarding supply and demand:

    - Looking at each state's 2030 RN supply minus its 2030 demand reveals both shortages and surpluses in RN workforce in 2030 across the United States. Projected differences between each state's 2030 supply and demand range from a shortage of 44,500 FTEs in California to a surplus of 53,700 FTEs in Florida.

    - If the current level of health care is maintained, seven states are projected to have a shortage of RNs in 2030, with four of these states having a deficit of 10,000 or more FTEs, including California (44,500 FTEs), Texas (15,900 FTEs), New Jersey (11,400 FTEs) and South Carolina (10,400 FTEs).

    - States projected to experience the largest excess supply compared to demand in 2030 include Florida (53,700 FTEs) followed by Ohio (49,100 FTEs), Virginia (22,700 FTEs) and New York (18,200 FTEs).

    With the ever increasing costs of college, how would you convince a young just graduated from high school person to commit to a nursing education?

    A college education is an investment. It is an investment in oneself and in one's future. A simple ROI (return on investment) conversation would quickly silence this concern. With diligent financial planning and discipline post-graduation, student loans can be paid off rather quickly. I would also discourage a student's parents from paying for their child's education, as this can delay their own retirement. An education can be financed, a retirement cannot.

    As for committing to nursing specifically, first of all, I believe nursing is a calling. Nursing is not a profession for everyone. The student must show true and compassionate interest in the field. Once this was evident, I would vouch for what a career in nursing has to offer. Some benefits include a very flexible schedule, opportunity to pick up extra shifts for extra money, and later on the possibility of advancing into the business and management side of nursing if desired. There are also nursing positions such as school nurses, which would match schedules with the nurse's children, allowing for optimal family balance and avoidance of childcare costs. Furthermore, there are even work at home opportunities in nursing that may prove ideal for some individuals throughout various stages in their life.

    Above all, the best reason to go into nursing is making a difference for your patients and having an impact on their health, comfort, and well-being. The reward of helping fellow humans through some of the best and worst times in their life is one that cannot be quantified. Personally, I choose to continue having a bedside presence while teaching nursing for this very reason. The positive humanistic reward is immensely indescribable.

    AN recently reported on this topic in our 2017 Student Survey: Demographics

    As the nursing population ages, many nurses are not BSN-prepared. What do you see as incentives that hospitals could offer in order to "grow their own" BSN nurses?

    In my experience, there are two main barriers for ADN (Associate Degree in Nursing) nurses to continue on to their BSN, the first being the cost of the degree and the second being the time to complete it. Many nurses have home life commitments such as children, spouses, adult parents they may be caring for etc. Hospitals can offer a salary incentive to their nurses if they hold a BSN degree or higher. They can also offer tuition reimbursement to their employees predicated on their completion of the degree and a defined employment retention period. If hospitals considered not only paying for the degree but offering to pay the nurses their hourly wage for their classroom time, they would likely have more interest. If the degree was integrated into their nurses' normal weekly schedule, then there would be virtually no reason for the nurses not to complete the degree. It could fall under an education budget.

    Above all, hospitals need to convey the reasoning and rationale for encouraging nurses to continue their education. The WIIFM (What's In It For Me) factor of a BSN degree could include gaining knowledge of research article interpretation and leading, disseminating, and integrating evidence-based best practices to their area of nursing. Another would be acquiring knowledge specific to nursing leadership and management. Some nurses may disclose having no interest in climbing the management ladder, however, understanding the avenues of leadership and the organizational structure is still important if one wants to influence change.

    If nurses want to have an impact, they need to understand the processes behind the scenes of a hospital. For example, if a unit manager brings a change to his/her staff, part of gaining the staff's buy-in is helping them to understand why the change is being brought upon them. If a nurse has an understanding of how a nursing unit is managed, funded, staffed, etc. then the nurse will likely see the proposed change as making sense and will have a true understanding of the "Why".

    Along that same line, what steps could hospitals take to engage and retain older, more experienced nurses that perhaps would like to continue working bedside but on a part-time or PRN basis?

    Bedside nursing can be quite demanding, both physically and mentally. Oftentimes, aging nurses may struggle to meet the physical demands of bedside nursing. Offering shorter and less frequent shifts may help with this. Developing clinical nurse specialist roles where senior nurses can mentor and guide younger nurses through chart reviews, bedside assessments, etc. is a way to keep them and their expertise at the bedside, but also pass it along to novice nurses.

    With the ever-increasing physician shortage, NPs are becoming the primary care provider in many areas, especially the rural ones. How would you propose to keep BSN nurses at the bedside versus continuing their education?

    In all honesty, I would never encourage any nurse not to advance their education. I believe this would be shooting our profession in the foot. Mid-level providers are an excellent avenue for healthcare and when partnered with a physician practice they have proven to have better patient outcomes. Instead, I would encourage young nurses to pursue their BSN degree from the start of their college education. Many nursing schools are turning away qualified applicants because they do not have the faculty capacity to teach more students. So, I believe we should be looking here, at the potential student nurse population to grow the number of bedside nurses. If we want to grow the population of nurses, we need more nursing faculty.

    What are you seeing in your area? Is it easy to get a nursing job? Difficult? Have you thought about furthering your education?
    Last edit by Joe V on Jun 14
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  3. by   OldDude
    I enjoyed the article. I have a few thoughts - since you asked. I think a push toward BSN nursing is "BS." I am an ADN nurse and I didn't think I would finish that program and the reason was the focus on subjects not associated with "nursing." Kinda like someone going to school to become a mechanic and most of the required classes are attached to some social element or being assigned a research paper about whooping crane migration patterns. For this reason the thought of further nursing education makes me nauseous.

    Regardless, ADN nursing provides the biggest bang for the buck; 2 years and you're working versus 4. Another thing we all know; you don't learn anything about nursing until you start to "work" so I don't think BSN education enhances one's ability to be a competent nurse. So I think the BSN push is a distraction from what the core of the problem is - and that is the hospitals. They are the culprit.

    When I graduated from nursing school I went to work for a local pediatric hospital ER. Benefits were great, premiums were affordable and any health care your children needed was provided at no charge. Adult employees and spouses could get lab work or x rays for no charge. That gradually went by the wayside over the years until 10 years later my own employer assigned a debt collector to me for being 14 days late on an exorbitant post concussion MRI for one of my kids.

    Fast forward to today...benefits are chipped away every year, salaries are stagnant, nurses are worked into the ground with no equipment or limited equipment while admin offices are renovated with posh furniture, carpeting, and decorations. I could go on but most of you know what I'm talking about.

    So my cure for the nurse staffing problem is to return to taking care of the one who is out there generating the income. Without the nurses and other licensed healthcare staff there would be no shark for the remora to attach themselves to. This is the reason I think nurses are drying up.

    Thanks for listening...
  4. by   Tencat12
    BSN is nice but not necessarily what is needed. Nursing is so struck on theories and theorists in the education phase for BSN. It's even worse when one gets into the MSN. A good provider needs to know HOW to give care and WHY that care is given. Theories don't teach that. Also I agree with Old Dude. Treat your employees well rather than a necessary evil and you will see the quality of care go up.
  5. by   CaffeinePOQ4HPRN
    The nursing shortage is a fallacy. If there was a shortage there wouldn't be thousands of nurses who are unemployed or unable to obtain secure employment. We are graduating and lisencing more nurses than there are available jobs. Hospitals are not hiring and staffing enough nurses, and have adopted offering nurses contract/ precarious positions which have forced nurses, out of frustration and risk of poverty and low employment, to defect to other states/provinces/countries to secure employment. Hospitals are keeping nurse staffing levels low to suit a bottom line. Any appearances of a shortage are either propaganda or man-made by hiring corporations, like mega hospitals. There is no way to lure people into the thankless, stagnant pay, backbreaking, abusive incarnation that is the current state of the nursing profession. However, we can try to keep the good nurses who actually want to do this difficult work. Corporations, government, and nursing organizations could do their part to buffer against a hypothetical shortage by focusing on RETENTION! Improve working conditions for nurses, create stable/secure jobs, and increase nursing wages to match inflation... there's the bloody solution.

    Insinuating and pushing towards the BScN as a mandatory requirement to work as a nurse accomplishes NOTHING. I have worked as both a diploma and a degree nurse. I can confirm for myself and my peers who made the transition from diploma to degree nurse that is has had little impact on our abilities as bedside nurses. What it has done has increased our debt and forced us to engage in rhetoric writing papers/research that have zero practical application in the clinical setting or real world. Would you rather have a nurse with years of extensive hands-on experience in many specialties and settings? Or, would you rather have one who has the ability to write a flashy research paper but couldn't manage, for example, an ICU patient's plethora of IV lines to save their life? Or, has the BScN but can't effectively manage care for a violnent and non-compliant dementia patient? Or, can't manage complicated family dynamics? That is the kind of **** that cannot be taught in school. It is learned and finessed by seasoned nurses who has paied his/her dues in the dirty, thankless trenches of bedside care.

    There is no decrease in enrolment into nursing programs. Stop disseminating the propaganda and lies, there is no nursing shortage!
    Last edit by dianah on Jan 9 : Reason: Spelling
  6. by   CaffeinePOQ4HPRN
    Nothing will correct this purported nursing shortage without focusing on retention, correcting institutional/systemic issues, making positive contributions towards the way the profession is handled (ex pay equity r/t inflation and overtime, staffing). Increasing enrollment into nursing porgrams as a means to ameliorate a hypothetical shortage in a destructively flawed and unsafe system (that won't increase hiring anyways) as a solution is painfully naive. It does nothing towards paitient safety and overall improvement. It just increases the volume of regulated health care professionals who are out of work, competing for the same small pool of jobs (most of which are contact/precarious/ per dime). Ignoring rention and systemic improvement creates another problem.... because working conditions will likely remain poor, rife safety issues and stagnant pay, the new nurses added into the profession en masse will all leave en masse.
  7. by   elkpark
    A few thoughts -- I, too, am unconvinced that there is going to be anything like a real nursing "shortage" in the forseeable future.

    Hospitals should consider paying nurses to attend classes for a BSN? Why on earth? They can hire scads of nurses who chose to get BSNs on their own. If people are so uninterested in furthering their education that the only way to entice them to do so is to actually pay them for classroom time, above and beyond tuition reimbursement, I say fine. That's their choice (not to return to school, I mean), and it's a perfectly legitimate one.

    And one way to keep older, more experienced nurses at the bedside is by "developing" "clinical nurse specialist roles"? Hospitals have largely chosen to get rid of their CNS roles. And is she talking about these older, more experienced RNs returning to school to get graduate degrees in order to become actual CNSs, or is she talking about co-opting the title to mean something else? It's not clear from her statement.
    Last edit by elkpark on Jan 10
  8. by   traumaRUs
    Quote from OldDude
    I enjoyed the article. I have a few thoughts - since you asked. I think a push toward BSN nursing is "BS." I am an ADN nurse and I didn't think I would finish that program and the reason was the focus on subjects not associated with "nursing." Kinda like someone going to school to become a mechanic and most of the required classes are attached to some social element or being assigned a research paper about whooping crane migration patterns. For this reason the thought of further nursing education makes me nauseous.

    Regardless, ADN nursing provides the biggest bang for the buck; 2 years and you're working versus 4. Another thing we all know; you don't learn anything about nursing until you start to "work" so I don't think BSN education enhances one's ability to be a competent nurse. So I think the BSN push is a distraction from what the core of the problem is - and that is the hospitals. They are the culprit.

    When I graduated from nursing school I went to work for a local pediatric hospital ER. Benefits were great, premiums were affordable and any health care your children needed was provided at no charge. Adult employees and spouses could get lab work or x rays for no charge. That gradually went by the wayside over the years until 10 years later my own employer assigned a debt collector to me for being 14 days late on an exorbitant post concussion MRI for one of my kids.

    Fast forward to today...benefits are chipped away every year, salaries are stagnant, nurses are worked into the ground with no equipment or limited equipment while admin offices are renovated with posh furniture, carpeting, and decorations. I could go on but most of you know what I'm talking about.

    So my cure for the nurse staffing problem is to return to taking care of the one who is out there generating the income. Without the nurses and other licensed healthcare staff there would be no shark for the remora to attach themselves to. This is the reason I think nurses are drying up.

    Thanks for listening...
    Totally agree with most of what you are saying. Its a double edged sword: I remember also the "good old days" as I too was an ADN grad. Getting a BSN didn't make me a better nurse. However, the MSN was the big boost for my education and mobility.

    Thanks
  9. by   traumaRUs
    Quote from Tencat12
    BSN is nice but not necessarily what is needed. Nursing is so struck on theories and theorists in the education phase for BSN. It's even worse when one gets into the MSN. A good provider needs to know HOW to give care and WHY that care is given. Theories don't teach that. Also I agree with Old Dude. Treat your employees well rather than a necessary evil and you will see the quality of care go up.
    Agree that theory doesn't teach care. In my MSN program, I did a concentration of management and leadership - my clinical component was very useful as was the clinical experiences for my two post-MSN certs.

    Thanks
  10. by   traumaRUs
    Quote from CaffeinePOQ4HPRN
    The nursing shortage is a fallacy. If there was a shortage there wouldn't be thousands of nurses who are unemployed or unable to obtain secure employment. We are graduating and lisencing more nurses than there are available jobs. Hospitals are not hiring and staffing enough nurses, and have adopted offering nurses contract/ precarious positions which have forced nurses, out of frustration and risk of poverty and low employment, to defect to other states/provinces/countries to secure employment. Hospitals are keeping nurse staffing levels low to suit a bottom line. Any appearances of a shortage are either propaganda or man-made by hiring corporations, like mega hospitals. There is no way to lure people into the thankless, stagnant pay, backbreaking, abusive incarnation that is the current state of the nursing profession. However, we can try to keep the good nurses who actually want to do this difficult work. Corporations, government, and nursing organizations could do their part to buffer against a hypothetical shortage by focusing on RETENTION! Improve working conditions for nurses, create stable/secure jobs, and increase nursing wages to match inflation... there's the bloody solution.

    Insinuating and pushing towards the BScN as a mandatory requirement to work as a nurse accomplishes NOTHING. I have worked as both a diploma and a degree nurse. I can confirm for myself and my peers who made the transition from diploma to degree nurse that is has had little impact on our abilities as bedside nurses. What it has done has increased our debt and forced us to engage in rhetoric writing papers/research that have zero practical application in the clinical setting or real world. Would you rather have a nurse with years of extensive hands-on experience in many specialties and settings? Or, would you rather have one who has the ability to write a flashy research paper but couldn't manage, for example, an ICU patient's plethora of IV lines to save their life? Or, has the BScN but can't effectively manage care for a violnent and non-compliant dementia patient? Or, can't manage complicated family dynamics? That is the kind of **** that cannot be taught in school. It is learned and finessed by seasoned nurses who has paied his/her dues in the dirty, thankless trenches of bedside care.

    There is no decrease in enrolment into nursing programs. Stop disseminating the propaganda and lies, there is no nursing shortage!
    Totally understand your viewpoint. Thanks.
  11. by   traumaRUs
    Quote from elkpark
    A few thoughts -- I, too, am unconvinced that there is going to be anything like a real nursing "shortage" in the forseeable future.

    Hospitals should consider paying nurses to attend classes for a BSN? Why on earth? They can hire scads of nurses who chose to get BSNs on their own. If people are so uninterested in furthering their education that the only way to entice them to do so is to actually pay them for classroom time, above and beyond tuition reimbursement, I say fine. That's their choice, and it's a perfectly legitimate one.

    And one way to keep older, more experienced nurses at the bedside is by "developing" "clinical nurse specialist roles"? Hospitals have largely chosen to get rid of their CNS roles. And is she talking about these older, more experienced RNs returning to school to get graduate degrees in order to become actual CNSs, or is she talking about co-opting the title to mean something else? It's not clear from her statement.
    Like you, I'm a CNS. However, I'm in the APRN role and we do make money for the hospital. Agree that keeping the experienced nurses is the key to success.

    Thanks.
  12. by   Oldmahubbard
    Some 30 years ago, I was considering nursing as a second career. After having found the job market ridiculous in my first career (teaching).

    I went to see some male professor about a related program, and he said that there would be no "nursing shortage" if all the nurses were still in the field. This was 1989.

    Then, as now, most of the "shortage" is night shift, and weekend work.

    Just food for thought. I became an NP, so there you have it.
  13. by   Tacomaboy3
    I don't quite understand the dissident when it comes to pursuing a BSN, or at least increasing the proportion of BSN-prepared RNs. Does it make you a better and more skillful registered nurse? That's debatable, but the commenters on the post seem to think not.

    I think pursuing higher levels of academic education is a great thing, and it's really only those who do who really impact the profession in nursing research and policy.

    Mad about wasting your time on unnecessary classes? Big whoop. You think lawyers and physicians are better in their fields because they took an Underwater Basketweaving class in undergrad? No. But those are the academic hoops you gotta jump through. EVERY SINGLE person who's earned a bachelor's degree has likely taken a course unrelated to their major or profession of choice. Pull up those big girl panties. Nursing school isn't trade - it's a profession.
  14. by   CaffeinePOQ4HPRN
    Quote from Tacomaboy3
    I don't quite understand the dissident when it comes to pursuing a BSN, or at least increasing the proportion of BSN-prepared RNs. Does it make you a better and more skillful registered nurse? That's debatable, but the commenters on the post seem to think not.

    I think pursuing higher levels of academic education is a great thing, and it's really only those who do who really impact the profession in nursing research and policy.

    Mad about wasting your time on unnecessary classes? Big whoop. You think lawyers and physicians are better in their fields because they took an Underwater Basketweaving class in undergrad? No. But those are the academic hoops you gotta jump through. EVERY SINGLE person who's earned a bachelor's degree has likely taken a course unrelated to their major or profession of choice. Pull up those big girl panties. Nursing school isn't trade - it's a profession.
    Ok stable genius, that's cute. On a side, lawyers and physicians actually see financial returns on their educational investments. Nurses do not. So, put on your adult underpants honey... then, go to the library like us COBs did waaaay back when, and brush up on history and evolution of nursing. You're doing this trade-profession a disservice by dismissing negative trends and telling others to basically shut up and drink up the poison. Nursing is a trade-profession, open a textbook and review its history. No one is declaring that extended education is valueless. All education is valuable. I should know I have 3 degrees. If I was independently wealthy I'd obtain more (degrees). The crux of most people's discord with the push for mandatory BScN is that it's an irrationally formalized requirement that doesn't match employment trends or translate into real world skills. Moreover, the promise that a BScN degree will pay off rests on some questionable assumptions. Many BScN graduates have yet to earn back on their investment, and many stats demonstrate they may never earn the value back over a lifetime. One important caveat is that it is the norm to go into exorbitant debt on one's education: just ask the hundreds of thousands of nursing graduates who have not found work as nurses, or those suffering with precarious employment trends... or borrowers who are either crippled by student loan payments or have defaulted their federal student loans within a few years of graduating. The BScN is not required to perform nursing skills. The detraction from hands-on clinical skill in favour of increased theoretical study does not solve or improve any of the increasingly disturbing issues we're seeing emerge in nursing.

    Many nurses would not react so strongly against obtaining more and more education if it actually translated into improving the quality of their work, employment options, and increased income. What we're seeing is a push towards higher and higher credentials, at increasingly unaffordable costs to nurses with no employment guarantees to earn back on their investment. Nurses are not martyrs, and to encourage nurses to martyr themselves and risk poverty is asinine. It is in the "bean counters" interest to push towards inflating enrollment because education is a big bu$iness that theyre reaping most of the benefits from, just ask all the struggling nursing graduates. If they want to declare a new credentials standard, when research/reality are increasingly showing it's a low return investment... yes, then hospitals/facilities should pay or at the very least subsidize part of it. Forcing people to go into debt to obtain more credentials (which aren't required to perform the job) for imaginary employment is ludicrous.

    The sentiment being communicated to nurses (by corporations, hospitals, academia) is that they have no interest in making things better, nor are they making tangible efforts to make things better. Instead, they're basically saying...The beatings will continue until morale improves.
    Last edit by CaffeinePOQ4HPRN on Jan 9 : Reason: typos, added details

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