Is the Shortage of Hospital Registered Nurses Getting Better or Worse? Findings from Two Recent National Surveys of RNs

Peter I. Buerhaus; Karen Donelan; Beth T. Ulrich; Linda Norman; Robert Dittus


Nurs Econ. 2005;23(2):61-71,96. 

In This Article


During the 1990S, hospitals experienced two national shortages of RNs. The first occurred in 1990 and 1991 and was marked by an increase in the hospital RN vacancy rate (the percent of unfilled, full-time RN positions which hospitals are actively trying to fill) to a national average of 11% (Buerhaus, 1995). The duration of this shortage, however, was brief: by 1992, the shortage had ended and observers of the nurse labor market declared that the demand and supply of RNs would be in balance for the foreseeable future, with some even predicting an oversupply in the near future (Pew Health Professions, 1995).

Only 5 years later, in 1998, hospitals began to experience the second shortage of the decade. Initially, reports of the shortage were confined to intensive care units and operating rooms, but by 2000 the shortage had spread to general medical and surgical units (Buerhaus, Staiger, & Auerbach, 2000). In 2001, the national average hospital RN vacancy rate was estimated at 13%, and nearly one-fifth of hospitals reported vacancy rates averaging over 20% (American Hospital Association, 2001). A survey conducted for the American Hospital Association found that 126,000 full-time RN positions were unfilled in 2001 (First Consulting Group, 2002). A year later the federal government reported that 30 states were experiencing shortages and estimated that demand for RNs exceeded supply by 110,000 in 2002 (U.S. Department of Health and Human Services, 2002). State and national surveys reported that nurses felt "burned out," stressed, and many were not satisfied with their jobs (Aiken et al., 2001; Buerhaus, Donelan, DesRoches, Lampkin, & Mallory, 2001; Kaiser Family Foundation and Harvard School of Public Health, 1997). Unlike the shortage of hospital RNs that occurred in the early 1990s, this shortage did not resolve quickly. In 2005, the current shortage entered its 8th year, easily becoming the longest lasting nursing shortage in half a century.

Findings of a recent analysis of the U.S. nurse labor market suggest that this long-lasting shortage may be easing. National employment data showed that hospitals raised RN wages substantially (5% above the increase in inflation in 2002, and 1.8% above inflation in 2003) and hired an additional 185,000 RNs from 2001 to 2003. This unusually large increase in employment was supplied by RNs over the age of 50, foreign-born RNs, and younger RNs under age 35 (Buerhaus, Staiger, & Auerbach, 2004). This sudden expansion in RN employment resulted from a combination of wage increases, a weakening national economy that threatened the employment and earnings of many RN spouses, rising public awareness of both the shortage and the opportunities afforded by a career in nursing, and increasing enrollment and graduations from nursing education programs.

Although the nurse labor market has been the subject of extensive analysis, few studies have sought the input and perspective of national, random samples of RNs. The recent increases in employment and earnings of hospital RNs raise several questions regarding how RNs perceive the shortage. Do nurses think the shortage is easing? How do RNs perceive the shortage is affecting nursing practice and hospitals? Is the workplace environment in hospitals improving? What do RNs think are the causes and solutions to the ongoing nursing shortage? These questions and other issues concerned with the nursing shortage are addressed by comparing results of two national surveys of RNs. The first was completed in 2002 during the height of the current shortage, and the second survey was conducted in 2004 following the increase in earnings and employment of hospital RNs.


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