Trends in Nursing: 2004 and Beyond

Laura Stokowski, RN, MS


Topics in Advanced Practice Nursing eJournal. 2004;4(1) 

In This Article

Trends in Nursing

Trends in nursing are closely tied to what is happening to healthcare in general. Trends are fascinating phenomena, but they do not exist in vacuums. Most are interrelated; one trend often spawns another. Although trends are more than fads, they are far from money-back guarantees. We watch to anticipate the direction that a particular trend will take us, to remove the element of surprise. When we look back on trends, however, some will have heralded permanent changes, but others might have been no more than blips on the radar screen.

Trend #1: Where Art Thou, Nurse?

There are nearly 2.7 million nurses in the United States, comprising the largest division of the healthcare workforce. Yet in 2004, we continue to face a slowly growing shortfall of nurses. Although this is not the first nursing shortage our nation has faced, there are some worrisome differences this time. This shortage is not caused by any single factor in isolation, such as the voluntary cutbacks in the nursing labor force of the 1990s, which could be solved by ramping up recruitment efforts. This shortage is caused by a convergence of many pressures, including financial constraints, a dissipating workforce, and an increasingly complicated and stressful work environment. Furthermore, the global nature of this shortage makes it impractical to recruit nurses from other countries to fill vacancies in the United States.

Many registered nurses (RNs) have left nursing for better opportunities and higher paying jobs. In 2002, there were nearly half a million licensed nurses not employed in nursing.[1] When experienced nurses leave their positions after only a few years in the profession, they are often replaced with recently graduated and inexperienced staff members. This is the revolving door syndrome, the worst possible model of workforce replacement for a profession such as nursing. Notwithstanding the tragic loss of nursing expertise that occurs when a nurse leaves the profession, new nurses who are usually mentored by the older, experienced nurses after graduation must then learn to cope without such guidance.

Job dissatisfaction and wages have both been cited as factors contributing to the nursing exodus. A 2000 survey of nurses found lower levels of job satisfaction, particularly among staff nurses, than in surveys of previous years.[1] Nurses are in the best position to evaluate the quality of care, and they believe that it is declining. In addition, wage growth of RNs in the United States is, on average, relatively flat. After adjusting for inflation, RNs have seen no real increase in purchasing power of their salaries over the last 9 years.[2]

Another important factor relating to the nursing shortage is the "aging RN factor" -- the demographic that paints the gloomiest picture of our healthcare future:

  • The average age of the RN population in 2000 was 45.2 years (in 1983 it was 37.7 years)[1]

  • Only 9% of RNs are under the age of 30 years[1]

  • Only 18.3% of RNs are under the age of 35 years[1]

  • Only 37.7% of RNs are under the age of 40 years.[1]

Retirement is looming for baby-boomer nurses (those born between 1946 and 1964). More than a million new and replacement nurses will be needed in the United States by the year 2010.[3] It is estimated that we will lack 29%, or more than 434,000 nurses by 2020.[2] The situation is just as dire in Canada. The Canadian Nurses Association predicts that by 2011, they will be short 78,000 RNs and by 2016, they will be short 113,000 nurses.[4]

Fewer college students are choosing nursing as a profession now compared with several decades ago. New graduate RNs declined by 26% from 1995 to 2000.[5] Nursing's negative image and low status, relatively low pay, and a wealth of alternative opportunities for women are among the reasons for the decline. Right now, there are not enough students in the educational pipeline to replace the number of nurses leaving the workforce.[6]

This year will bring more efforts to improve the image of nursing to encourage more young people to choose nursing as a career. Are we already too late to avert a crisis in patient care? Will demographics be our downfall? Much depends on whether employers and policymakers pay as much attention to retaining the current experienced workforce as they do to increasing enrollments. Everyone has to care about the nursing shortage, both now and in the future, because everyone will be affected by it at some point in time.


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