The Nursing Shortage: Its Impact on the Care of Children

Deborah Shelton, PhD, RN, CNA


NAINR. 2003;3(1) 

In This Article

Abstract and Introduction

The nursing shortage is likely to have a serious impact on the various roles of pediatric nursing and the care of children. An earlier perception that there were too many "specialty" nurses is simply untrue. The future demand for pediatric nurses is expected to increase dramatically as the gap between the number of elderly people needing care and those available to provide services shifts resources away from children. Vulnerable pediatric populations at risk for poor outcomes will be adversely affected first. Short-term solutions to the nursing shortage will not directly impact pediatric nursing. Many of the roles pediatric nurses fill, such as the pediatric intensive care unit, require up to 2 years of experience. Pediatric nurses who work in the community in expanded roles require advanced practice training beyond the BSN. Given these particular workforce issues, recovery of pediatric nursing is expected to lag behind other nursing specialties.

Today's nursing shortage is very real and different from any experienced in the past. This shortage is exacerbated by fewer nurses entering the workforce, acute nursing shortages in certain geographic areas, and a shortage of nurses adequately prepared to meet certain areas of patient need in a changing health care environment.[1] As a result, there is a growing realization that the supply of appropriately prepared nurses is inadequate to meet the needs of clients and that this shortfall will grow more serious over the next 20 years. A model constructed by Buerhaus et al[2] projects that the number of full-time registered nurses (RNs) per capita will peak in 2007 and then begin to decline in 2012. By 2020, the nurse workforce supply will be 20% below the Health Resources and Services Agency (HRSA) projected need.[3] This article describes the characteristics of the current shortage, pending legislation, and health policy implications for pediatric and neonatal nursing.

The shortage of RNs has reached critical levels across the United States. This trend is caused primarily by the aging of the nurse workforce and the declining enrollment in schools of nursing to counterbalance the number of nurses that are retiring or leaving the profession.[4] Faculty shortages fuel the overall decline in new enrollments, as some schools of nursing are turning away qualified students because of insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.[5] Declining enrollments are also caused by the wider range of career options for women that offer better pay for less demanding work. Stress and job dissatisfaction have been identified as major factors contributing to the current crisis.[6] Inadequate staffing, heavy workloads, increased use of overtime, a lack of adequate support staff, and the inadequacy of wages are contributing factors.

Job dissatisfaction and the demand for nurses have been directly influenced by changes in the structure, organization, and delivery of health care service.[7] Hospitals, the major employer of nurses, were once the traditional provider of acute care services. Advances in technology and a greater emphasis on cost-effectiveness combined with a decline in the number of hospital admissions and lengths of stay, shifted care from inpatient to ambulatory or community-based settings. Those patients remaining in the hospital had higher acuity levels while the medical complexity of patients in the community increased. The result was to double the demand for nurses that now work within hospital settings and in the newer community settings. This change contributed further to the inadequate staffing, heavy workloads, and increased use of overtime.

Although most nursing shortage reports focus on the nursing shortage in the hospital environment, the decreased number of individuals entering the nursing workforce also has a significant impact on the number of nurses who choose to advance their education and pursue advanced practice roles.[8] A review of the Bureau of Health Professions' Division of Nursing's National Sample Survey of Registered Nurses (NSSRN)[9] reveals that nurses who work outside hospitals have a baccalaureate in nursing or higher. Thus, the shortage of nurses impacts the primary care arena, especially in the medically underserved areas, federally underserved areas, and rural and urban health professional shortage areas. As an example of this phenomenon, rural geographic areas that historically lack pediatric services will have an even tougher time competing.[10] Dr. Mueller, Director for the Center for Rural Health Policy Analysis, predicts that rural hospitals are likely to be hard hit.

For hospitals and agencies that provide specialty care to children and adolescents, the competition for nurses is even fiercer. Specialty practice requires specialty training and seasoned professionals. The workforce data noted in the NSSRN report has limited published data on nursing specialties such as the estimated number of pediatric nurses in the United States. Of all nurses graduated, it is estimated that 6.6% work in pediatrics.[11] Of these, approximately 38% work in community settings, such as school health, ambulatory care, physician's offices, and health departments. The data fail to present detail on other pediatric nursing roles, such as child and adolescent behavioral health nursing. The importance of these roles has gained importance since the terrorist attack on September 11, 2001. Attention to stress reactions and anxiety are necessary to avoid future physical illness and to reduce the influence of stress on the learning and future of children across the nation.


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