The Nursing Shortage: A Call to Action

Eloise E. Schwarz, RN, CCM, MBA


Topics in Advanced Practice Nursing eJournal. 2003;3(2) 


Nursing shortages have come and gone over the last 30 years with little more than a few adjustments and realignments within the healthcare field. However, history has shown that the growth of the nursing supply has not kept pace with the evolving needs of the healthcare industry. Reasons are far reaching but basically center on the issue that nursing itself has done little to advocate for itself until now.[1]

The Department of Health and Human Services (DHHS) projected that the current nursing shortage will deepen over the next 2 decades as registered nurses (RNs) retire and fewer enter the profession. DHHS analysts have noted that the shortage is expected to more than double by 2010, based on historical patterns of available RNs and service expectations. The problem is one of simple supply and demand. Demand for nurses will grow by 40% between 2002 and 2020, while the supply will increase by only 6% over that same period. Factors that drive the growth in demand for nurses include an 18% growth in the population, a larger number of the elderly, and medical advancements. Alternative job opportunities have contributed to the slow growth of people entering the nursing profession as well.[2]

Releasing their public policy action plan in August 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) stated that the US nursing shortage was a "prescription for danger."[3] Citing their own findings that, "lack of nurses contributed to nearly a quarter of all unexpected problems resulting in death or injury," JCAHO has added its outcomes and action plan to a growing body of evidence that links the shortage to ill health for all citizens.[4]

Staggering statistics mirror the pervasiveness of this shortage's impact and capriciousness:

  1. The Bureau of Labor Statistics identified a staggering 1 million job openings that will need to be filled between 2000 and 2010, due to an increased demand and new replacements for those leaving the workforce.[5]

  2. The National League of Nursing identified that enrollments in nursing programs have been declining at a yearly rate of 4.2%.[5]

  3. The number of nursing graduates who took the licensure exams declined 29% since 1995, as noted by the National Council of State Boards of Nursing.[5]

  4. The American Nurses Association (ANA) found that nearly 55% of their members (7300 nurses) would not recommend the profession to others, even their own children.[6]

  5. Between 1992 and 2000, The Health Resources and Service Administration's research identified a 36% increase in the number of nurses exiting the profession.[5]

  6. The Federation of Nurses and Health Professionals cited the number one problem nurses identified was staffing.[7]

These results reflect the cultural shift, demographic trends, and image problems that will require a major remake of the profession. The gravity of the nursing shortage defies simple solutions. Since the profession is unable to totally fix the problem, strategic directions and goals will need to be solicited from other professionals and government resources.[8]

One answer that would apply a jump-start to the transformation of the profession would be the enactment of the Nurse Reinvestment Act (NRA) (H.R. 3487), signed by President George W Bush on August 1, 2002, after the House and Senate approved it in late July 2002. This law was designed to encourage people to enter and remain in nursing careers, thus helping to alleviate the nation's growing nursing shortage.[9] The law provides scholarships and loan repayment programs, retention grants, and other incentives.[10] This Act would appropriate and fund the following activities and services:

  1. Facilities that retain experienced nurses and help to develop "best practices" in nursing;

  2. Educational grants for geriatric training in nursing;

  3. Full-time students who agree to serve in a nursing school faculty position after graduation; and

  4. Public service announcements to promote the nursing career.

"[Incentives] are essential to the kind of quality care the American people deserve," stated DHHS Secretary Tommy G. Thompson after the NRA was passed.

Though the key measures of the NRA would help to solve part of the problem, Congress has only funded a portion of the Act. The American Health Care Organization, the ANA, the American Hospital Association, and many other professional organizations continue to urge Congress to appropriate as much of the $250 million needed to make the intent of the law a reality.[11]

All nurses are encouraged to become familiar with their state senators and representatives and voice their opinions via email letter or postal letter. Offer your personal experiences with the nursing shortage and ask for legislators' support for further appropriations of the NRA.

The US Senate funded $20 million of the NRA on January 24, 2003 as part of the omnibus bill in 2003. At the present time, the amendment has been given to the conference committee of the House of Representatives for review and approval. Further positive feedback from all nurses to their elected representatives is needed. You can find contact information for members of Congress and further information about bills at and[12]


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