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Facts About the Nursing Shortage

JULY 2001

Introduction: The Growing Need for Nurses
Underlying Causes: The Changing Reality of Nursing
Hospital acuity
Declining enrollments
Baby boom bubble
Frequently Asked Questions About the Nursing Shortage
Is it a shortage or just an increased demand for certain specialties?
What's driving the nursing shortage?
Will we see a salary war?
How is this shortage different from the previous shortages?
Is the shortage an international problem?
Have any studies been done on the shortage?
More Key Facts on the Nursing Shortage
Resources on the Nursing Shortage

Introduction: The Growing Need for Nurses

Just as the legion of baby boomers is about to swell the need for quality health care, America's nursing population is aging and more nurses are moving into primary care settings. The result: America's hospitals and other institutions need more nurses, especially those who deliver specialized care.

Front-page newspaper stories paint a picture of a nursing shortage born of increased patient loads and escalating pressure to treat more people, more quickly, for less money. Second, highly visible patient and professional complaints about managed care in the early 1990s have discouraged young people from entering the nursing profession. These complaints have led many guidance counselors to advise students not to enter the profession. Just as the health care needs of an aging population are increasing, some segments of the public are encouraging students to choose alternative careers.

Underlying Causes: The Changing Reality of Nursing

While shortages have occurred in health care throughout history, and especially since World War II, experts are finding that the developing nursing shortage is uniquely serious. It is considered both a supply and a demand shortage, combining a broad range of issues that include: steep population growth in several states, a diminishing pipeline of new students to nursing, an aging workforce and a baby boom bubble that will require intense health care services. These issues are occurring just as the majority of nurses are retiring and job opportunities within health care are expanding.

The shortage is worldwide. Already Canada, the Philippines, Australia and Western Europe are reporting significant nursing shortages. Reports of shortages are also coming from Africa and South America.

Hospital acuity
Acuity in hospitals has been rising rapidly, due to the declining average length of stay and to new technology that allows rapid assessment, treatment and discharge. Hospitals are increasingly becoming large intensive care units, with cardiac monitoring, respiratory assistance and intense treatment a growing part of the average patient's plan of care. Thus, skilled and specialized nurses are in great demand.

Declining enrollments
Complicating matters is the fact that hospitals are increasingly looking for nurses with at least a baccalaureate degree, and enrollment in baccalaureate programs is on the decline. According to the American Association of Colleges of Nursing, entry-level BSN enrollment fell 2.1 percent in fall 2000, dropping for the sixth year in a row.

Baby boom bubble
The baby boom of 1946 to 1964 was followed by the 11-year baby bust, when the birth rate fell to a low of 146 births per 1,000. As of the 1990 census, there were 77 million American boomers compared with just 44 million Generation Xers, creating the smallest pool of entry-level workers since the 1930s. Now employers must worry about finding enough good people for needed positions. This holds true in health care and specifically nursing. Projections from the U.S. Census Bureau show as one generation grows and the other shrinks, the boomer-to-buster ratio may fall from 1.74 in 1990 to 1.6 in 2010.

Frequently Asked Questions About the Nursing Shortage

  • Is it a shortage or just an increased demand for certain specialties?
    It's both. Health care organizations say it's both a demand and a supply shortage. Experienced nurses in key specialties are in short supply, but so are nurses in just about every arena. Shortages are regional, but intense.

  • What's driving the nursing shortage?
    The shortage is caused by a wide range of factors including:
    • Growing demand. During the nation's economic slump, many people put off getting health care because of financial troubles or a lack of insurance. With the economy up, so is the demand.
    • Without the new graduate pipeline, there are fewer nurses available to replace those who retire or leave for other opportunities. Currently, the ratio of RNs in their 40s to RNs in their 20s is four to one.
    • Lower baccalaureate enrollment. In fall 2000, entry-level BSN enrollment fell by 2.1 percent, dropping for the sixth year in a row, according to the American Association of Colleges of Nursing.
    • Higher hospital census and greater acuity. Modifications in managed care and a new push for competitive quality is increasing patient days, hours of nursing care and the recognition of the role of the RN.
  • Will we see a salary war?
    Probably. Already, sign-on bonuses up to $14,000 are being offered and some hospitals are advertising significant salary increases for key specialties, such as intensive care. In allied health, pharmacists, nuclear medical technicians and respiratory therapists are in short supply and can command impressive salaries.

  • How is this shortage different from the previous shortages?
    Unlike the shortage of the 1980s, this one is not about sheer numbers of nurses, but about having nurses with the needed specialties, skills and experience. Nurses are in particular demand if they can lead multidisciplinary teams, serve as patient educators and managers of care across the continuum, or demonstrate a high level of skill in the operating room, recovery room, emergency room, intensive care unit, critical care unit, pediatrics, newborn intensive care unit, pediatric intensive care unit, and labor and delivery.

  • Is the shortage an international problem?
    Yes. Several other countries report problems similar to the United States. The Toronto Star reported in June 2001 that Ontario, Canada, expects to lose 14,000 of its 81,000 nurses due to retirement by 2004. Almost a third of Canada's nurses are over age 50, and only 10 percent are under 30. In December 2000, the World Health Organization reported that 10 years ago Poland was graduating more than 10,000 new nurses annually. That figure has fallen to 3,000. And in Chile, out of 18,000 nurses in the country, only 8,000 are working in the field.

  • Have any studies been done on the shortage?
    Yes. A study by Peter Buerhaus, PhD, RN, Douglas Staiger, PhD, and David Auerback, MS, was published in the June 14, 2000 Journal of the American Medical Association. The study reveals:
    • Between 1983 and 1998 the average age of working RNs increased by 4.5 years to 41.9.
    • Thirty-five percent fewer full-time RNs are observed today when compared to similar age groups of RNs entering the workforce 20 years ago.
    • Within 10 years, 40 percent of working RNs will be 50 years or older.
    • As those RNs retire, the supply of working RNs is projected to be 20 percent below requirements by the year 2020.

    Another survey released in early 1999 found the nursing shortage is due to an increased demand for experienced RNs in specialized areas. The survey, sponsored by the American Organization of Nurse Executives and the American Nurses Association also found:

    • Urban hospitals reported that filling nursing vacancies was significantly more difficult.
    • Small hospitals experienced increased difficulty in recruiting obstetrics nurses, and the time to recruit them has substantially increased.
    • Larger and urban facilities reported increased use of agency and contract nurses.

    More Key Facts on the Nursing Shortage...

    • The Bureau of Labor Statistics reports that jobs for RNs will grow 23 percent by 2008. That's faster than the average for all other occupations.

    • About half of the RN workforce will reach retirement age in the next 15 years.

    • The average age of new RN graduates is 31. They are entering the profession at an older age and will have fewer years to work than nurses traditionally have had.

    • RN enrollments in schools of nursing are down. In fall 2000, entry-level BSN enrollment fell by 2.1 percent, dropping for the sixth year in a row, according to the American Association of Colleges of Nursing.


    The Honor Society of Nursing, Sigma Theta Tau International recognizes the nursing shortage as a major threat to the future of the world's health care system. We recommend several steps to reverse this trend now instead of later. Sigma Theta Tau International recommends the following initiatives:

    • Demonstrate to health care leaders that nurses are the critical difference in America's health system.
    • Reposition nursing as a highly versatile profession where young people can learn science and technology, customer service, critical thinking and decision-making.
    • Construct practice environments that are interdisciplinary and build on relationships between nurses, physicians, other health care professionals, patients and communities.
    • Create patient care models that encourage professional nurse autonomy and clinical decision making.
    • Develop additional evaluation systems that measure the relationship of timely nursing interventions to patient outcomes.
    • Establish additional standards and mechanisms for recognition of professional practice environments.
    • Develop career enhancement incentives for nurses to pursue professional practice.
    • Evaluate the effects of the nursing shortage on the preparation of the next generation of nurse educators, nurse administrators and nurse researchers and take strategic action.
    • Implement and sustain a marketing effort that addresses the image of nursing and the recruitment of qualified students into nursing as a career.
    • Promote nurses of all educational levels to pursue higher education.
    • Develop and implement strategies to promote the retention of RNs and nurse educators in the workforce.

    Sigma Theta Tau International is a 79-year-old honor society with more than a quarter million inducted members. Members include practicing nurses, instructors, researchers, policy makers, executives, entrepreneurs and others.

    The mission of the society is dedicated to developing excellence in practice, education, research and leadership to enhance world health. The society promotes nursing excellence through its initiatives in research, leadership, an electronic library, programming, and publications and develops and distributes nursing knowledge for use in practice.

    Resources on the Nursing Shortage

    Cynthia Caroselli, associate hospital director, Mount Sinai Medical Center, New York, 212/241-8802 or

    Sister Rosemary Donley, professor of nursing, The Catholic University of America, Washington, DC, 202/319-6469 or

    Jo Ellen Koerner, Jo Ellen Koerner & Associates, Sioux Falls, SD, 605/332-1242 or

    Pamela Levi, dean and professor, School of Health Sciences, Georgia College and State University, Milledgeville, GA, 912/445-4004 or

    Renatta Loquist, University of South Carolina College of Nursing, Columbia, SC, 803/777-4499 or

    Marla Salmon, associate vice president, Woodruff Health Sciences Center and CEO, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 404/727-7976 or

    Connie Sobon Sensor, New Jersey City University, Jersey City, NJ, 201/200-3135 or

    Kathleen Sanford, vice president of nursing, Harrison Memorial Hospital, Bremerton, WA, 360/792-6702 or

    Linda Aiken, professor of nursing and sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, 215/898-9759 or

    Margaret Sovie, University of Pennsylvania School of Nursing, Philadelphia, PA, 215/898-9927 or

    Carol Bradley, vice president, Patient Care Services, Huntington Hospital, Pasadena, CA, 626/397-5555 or

    Claire Fagin, project leader, Burden of Care, Milbank Foundation, New York, NY, 212/581-4752.

    Peter Buerhaus, director of Harvard Nursing Research Institute, 617/432-0217 or

    Nancy Dickenson-Hazard, chief executive officer, Sigma Theta Tau International, 1-888/634-7575 or

    Patricia Thompson, president, Sigma Theta Tau International, 1-888/634-7575 or

    Amy Macke, public relations specialist, Sigma Theta Tau International, 1-888/634-7575 or


    American Association of Colleges of Nursing, "Graduations of New Nurse Practitioners See Strong Increase," March 1999.

    American Demographics, "When Boomers Meet the Reaper," September 1993.

    American Organization of Nurse Executives, "Nurse Staffing Survey," February 1999.

    Buerhaus, P., Staiger, D., & Auerback D. "Implications of an Aging Registered Nurse Workforce," Journal of the American Medical Association, June 14, 2000.

    Gray, Barbara Bronson. "The Nursing Shortage: Key Facts and Findings," NurseWeek, 1999.

    Losyk, Bob. "Generation X What They Think and What They Plan To Do," The Futurist, March/April 1997.

    Nurse Administrators of Nursing Education Programs Task Force, "Arkansas Nurse Educator Shortage and its Impact on Registered Nurse Workforce Shortage," May 1999.

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