Nursing Shortages Past and Present

Nursing shortages have occurred throughout nursing's history. The shortages are unique in their circumstances but they do have similarities. Looking back through history is one way to help understand the current nursing shortage and potentially find solutions that can help the current shortage and prevent future ones. Nurses General Nursing Article

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Nursing Shortages Past and Present

Nursing shortages are almost as old as nursing itself. If we look back to the beginning of modern nursing over one hundred and fifty years ago, we find varying technological and economical reasons that the demand for nurses has often been higher than the supply. Let’s explore nursing shortages over time to get perspective on the current nursing shortage and discover if the same solutions for previous shortages can help us today or if we can find more lasting solutions this time around.

The origin of modern nursing (and subsequent nursing shortages) stretches back to about the time of Florence Nightingale in the 1850s. We all learned about her in nursing school and much of the idea for formal training for nurses and advocating for their importance is due to her. In the United States, the Civil War in the 1860s demonstrated the importance of skilled nurses to care for the injured and ill. Until then, family and close friends primarily provided nursing care to people in their homes.

By the 1930s, much of the nursing care in the country was provided by nurses who had trained in hospital programs. While nursing students provided most of the nursing care in hospitals during their two to three years of training, the majority of nursing graduates still worked as private duty nurses outside the hospital. It was during this time that one of the first nursing shortages came about.

Throughout the 1930s the country was recovering from the Great Depression and it was very difficult to find work. So how could there be a shortage of nurses when nurses could actually get a paying job at this economically challenging time? Much of it came down to a higher demand for nurses because of more complex technology and increased use of hospitals as a place to receive nursing care. The shortage continued until WWII accentuated how important nurses were to the modern delivery of medical care.

Many nurses were involved in the war and they were very important to the wartime effort. The use of nurses in the war took even more away from the civilian population at home. Once the war ended, many expected nurses to return to their pre-war jobs but the nursing shortage only got worse.

This post-WWII nursing shortage is very interesting compared to the current one which has been worsened by the COVID pandemic. They are not the same, but there are many similarities:

  • A major worldwide event calls upon nurses more than ever
  • Technological changes continue to drive the need for skilled nurses
  • After the worst of the crisis ends nurses do not return to their previous jobs in the numbers expected

After WWII, the shortage appeared serious enough that the U.S. Department of Labor commissioned a study in 1947 to find out the cause of this nursing shortage. Results from the study indicated that poor working conditions, low salaries and long hours, especially compared to other professions at the time, discouraged people from entering and remaining in the profession. This data reinforced findings from previous similar studies earlier in the twentieth century.

The solutions to try to fix this nursing shortage were not, however, to increase salaries and improve working conditions.  The solutions hospitals used were similar to the ones they had used in the past.

These solutions included:

  • Increasing the number of nurses by shortening their training
  • Increasing the supply of nurses by increasing enrollment in schools of nursing
  • Using less educated and less trained personnel instead of or in addition to trained nurses

These solutions did provide temporary relief from nursing shortages. However, nursing shortages have continued to occur periodically for various reasons since the implementation of the solutions listed. One aspect that all these nursing shortages have in common is that even if they improve for some time, the shortage returns in one way or another.

Now we find ourselves in the midst of another nursing shortage, one that may be felt for many years to come. The US Bureau of Labor Statistics projects 194,000 job openings for registered nurses annually from 2020 to 2030.  This is an increase of 9% and is cited as the average for other occupations. However, this data does not take into account the most recent loss of nurses from burnout, career changes, or early retirement brought about by the pandemic. Add to that a report in May 2021 that more than 40% of nurses were thinking about leaving the profession and we have many factors that show us a nursing shortage is likely to get worse. Hospitals, nursing schools, and private companies are taking some action to address the current nursing shortage.

These actions include:

  • Improving processes of applications to ensure all vacancies in nursing schools are filled
  • Nursing schools forming strategic partnerships to increase enrollment
  • Media campaigns promoting careers in nursing

These are important and worthy goals to pursue. They do address important aspects of the nursing profession and might help improve the nursing shortage for a short period of time in a specific location. However, are they creative solutions or are they different versions of the attempts to fix nursing shortages used in the past? A simple solution these lists do not address is:  compensate nurses for what they are truly worth and value the specialized, stressful, and difficult work they do every day.  There have been major improvements in the profession of nursing since it was established over 150 years ago. Nursing has developed into a skilled profession that many respect. Nurses are paid better and working conditions in the hospital have improved, although some would say not to an acceptable level. Nurses also have more opportunities than ever beyond the bedside because their training and experience teach them much more than only how to care for a patient in a hospital.

An encouraging fact is that applications to nursing schools increased in 2022. In order to continue to attract more to the profession and retain our very valuable experienced nurses, we have to be truly valued for what we do and be compensated well. Nurses are excellent at advocating for their patients and I hope we can advocate for ourselves and our profession in the same way.

References

University of Pennsylvania School of Nursing. (2011). Nursing, History, and Health Care.

Winkelstein, W. (2009). Florence Nightingale, Epidemiology. 20(2), 311. doi:10.1097/EDE.0b013e3181935ad6

Buhler-Wilkerson, K. and D'Antonio, Patricia. (2022, March 1). Nursing. Encyclopedia Britannica.

American Association of Colleges of Nursing. (2020, September). Fact Sheet: Nursing Shortage. 

American Nurses Association. Nurses in the Workforce. Retrieved May 6, 2022 

Haddad LM, Annamaraju P, Toney-Butler TJ. (Updated 2022 Feb 22). Nursing Shortage. StatPearls. 

Bhakta, Parth. (2021, May 3).One Year In What’s Next for America’s Healthcare Workers. Vivian. 

US Department of Labor (1947, December 9). The Economic Status of Registered Professional Nurses.

Pfeifer, G. (2022, February). Defying the Pandemic, Applications to Nursing Schools Increase. American Journal of Nursing. 122 (2), 14.

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Ellen Grover

About Ellen Grover, MSN, RN

Ellen Grover MS, RN, currently works in cardiology and as a freelance health content writer. She has worked in a wide variety of clinical settings and as a nurse educator. Her passion is educating patients and students to help them achieve their fullest potential and reach their goals.

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Specializes in Psych (25 years), Medical (15 years).

I quote "improve working conditions... value the specialized, stressful, and difficult work we do every day" because therein lies the essence of a solution.

I did not go into nursing to make a lot of money and believe I was well paid for my services. However, it was the lack of support from the Powers That Be which was the ultimate cause of my early demise.

In my younger days I was something of a people pleaser. If you threw me a bone, I'd be your Dawg for life. If I wasn't supported, I learned to appreciate doing a good job of being a nurse was a reward in and of itself.

However, we can be worn down if we never receive external validation. External validation needs not be the ultimate reason for the work we do, but it sure can give us a lift.

Back in the late 80's I worked as an LPN in a community hospital that housed a CD treatment program staffed with other professionals, such as therapists, provided by a corporation.

Both are now defunct, but the support from the corporation for its staff and the hospital's staff was outstanding. That experience was one of the greatest, if not the greatest, of my career. And it all boiled down to great working conditions and being valued.

Good article, Ellen Grover.

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Specializes in hospital, clinical, and educational settings.

Thank you for your comment and sharing your experience. I believe there are many ways we should be valued as nurses. I agree that is what will ultimately will keep people and draw them to the profession.

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Specializes in NICU.

There will never be a solution because it has to be fluid and match the changing demands on the patient side.Most places act blind when it comes to addressing increased census,staff illness,staff vacations,time off,category of patients from quiet to combative and dangerous.Instead they diminish the important role of the bedside nurse and glorify some incompetent  mgrs with the white name embroidered lab coats,who cant even put in an IV ,roll up their sleeves to help when needed.The bedside nurse is harangued for not pre requesting OT ,no lunch break,no rest break,thereby refusing to pay her an honest days wages.The nurse can not even get an uninterrupted rest period at work,forced to come in on her day off,disciplined for calling in sick ..while the elephant is very much in the middle of the room.I commend the bedside nurse ,they are our future.

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Specializes in Med nurse in med-surg., float, HH, and PDN.
33 minutes ago, Leader25 said:

There will never be a solution because it has to be fluid and match the changing demands on the patient side.Most places act blind when it comes to addressing increased census,staff illness,staff vacations,time off,category of patients from quiet to combative and dangerous.Instead they diminish the important role of the bedside nurse and glorify some incompetent  mgrs with the white name embroidered lab coats,who cant even put in an IV ,roll up their sleeves to help when needed.The bedside nurse is harangued for not pre requesting OT ,no lunch break,no rest break,thereby refusing to pay her an honest days wages.The nurse can not even get an uninterrupted rest period at work,forced to come in on her day off,disciplined for calling in sick ..while the elephant is very much in the middle of the room.I commend the bedside nurse ,they are our future.

AMEN!  

I absolutely feel your post in the middle of my gut. Powerful, legitimate  feelings. How many times in my long career have I been told, "I couldn't ever do what you do!"

It really isn't a wonder why so many leave the profession. I think sometimes that in "The Business of Medicine" ---> $,$$$,$$$ <--- is The Most Important Thing. The-Powers-That-Be have been schooled in How To Be Obtuse In The Face of Truth and Facts. Ppfftt!!

Let's start a "Take-A-Business-Person-To-Work" Program. They must shadow you n your day, exactly. If you don't have time to pee, they are not allowed to pee; same for meals, so-called-breaks, etc. How can we OPEN THEIR EYES?

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If you throw money at me, I will work extra hours. Currently I work part-time but when bonus shifts are offered, I will work extra. 
 

I do firmly believe that there really isn’t a nursing shortage. There is a shortage of nurses willing to take crap pay, crap schedule, crap working environment. 

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