Politics, Economics, and Nursing Shortages: A Critical Look at United States Government Policies

Rob Elgie, BSN, RN, BC


Nurs Econ. 2007;25(5):285-292. 

In This Article


Recent data show that enrollment in colleges of nursing has increased for 5 years straight; however, the increased enrollment falls far short of current and projected demand for nurses with a national shortage of 800,000 expected by 2020 (AACN, 2006). The recent small increases in enrollment are attributed to outreach efforts, media campaigns, and federal funding initiatives, but the economics of the nurs ing shortage remain un changed.

In a recent analysis of the RN workforce in the United States (Buerhaus et al., 2006), perceptions of the nurse shortage and the nursing profession within the nursing workforce seem to have improved slightly compared to 2004 analyses. This is important because, like any commodity, positive perceptions are powerful marketing tools that can lead young men and women to invest educational time and money in that professional commodity as their livelihoods — their careers. However, if government policies — even those backed by good intentions — remain in place exerting downward pressure on nursing workforce wages and benefits, then the shortage of nurses today will persist indefinitely.

While our society embraces the idea of free market economics, there is also an unfounded notion that government policies are needed to regulate market forces. Government regulations are certainly needed to ensure worker and patient safety or such things as building codes, but market regulation becomes a problem when it is done for political reasons, perhaps in response to public outcry or to please special-interest groups. Many economists consider labor markets that are free of government interference to be perfectly competitive, meaning labor markets respond very well to rules of supply, de mand, and price (Bunzel, 2000). Therefore, without politically mo tivated government subsidies, the supply of nurses and nurse educators may have responded very well to normal cycles of market forces long ago to achieve and maintain equilibrium.

If there had not been decades of government interference with market forces, a shortage of faculty would have led to increased compensation for faculty long ago that would have served to attract and retain faculty. Similarly, without interference the shortage of nurses in general would have applied upward pressure for employers to improve compensation long ago that would have attracted and retained more individuals in the profession. There may be social reasons to subsidize nurse education, such as intent to redistribute minority workers toward nursing or to redistribute nurses toward extreme areas of nursing shortage such as geriatrics; however, subsidies that disrupt the market equilibrium on a large scale should be eliminated.


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