America’s Nursing Shortage:
It’s Real, and It’s Back
KEY POINTS
•
USr Healthcare has compiled vacancy and hiring data on
50 healthcare facilities from January 2014 through June 2015.
The sample consists of a blend of small, medium and large
July 2015
50 FACILITIES – 10 STATES – 18
MONTHS: THE RESULTS ARE IN!
facilities in both urban and rural markets in the for-profit and notfor-profit sectors that are located in 10 states, across the southern
part of the United States.
• In this report, more recent data will be presented that shows a
closer correlation between projections from 2008 – 2010 than
those presented by the Bureau of Labor and Statistics (BLS) in
December 2014.
ABSTRACT
Nurses make up the single largest
health profession in the U.S. (1)
Since 2008, there has been an ongoing debate as to whether
• Job requisitions across the 50 facilities sampled increased by
the U.S. nursing shortage was over. During this time, projections
73.09% over the past 18 months, which is higher than the 41.23%
have been put forth by various federal government agencies and
monthly BLS reported increase in new healthcare postings for the
healthcare industry groups that offer compelling data on both
same period.
sides of the debate. The majority of data comes from census
• Findings from the USr sample group indicate that the increase in
data, industry specific surveys and individual state healthcare
job requisitions could have been more severe had hiring remained
data. All of these data elements should be considered accurate
flat during the 18-month analysis period. Hiring increased by
within the context of the data gathering methodology and have
14.01% in 2014 when the same facilities were compared during
been used to present the most accurate projection possible.
2013. Further, hiring for the first six months of 2015 is 53.47%
higher when compared to the same time period in 2014 and
69.03% higher when compared to 2013.
Most of the data utilized to formulate projections in the most
recent reports and quoted in publications during the first quarter
• Since 1998, information on a projected registered nurse shortage, or the
of 2015 draw from 2012 baseline numbers. The methodology
elimination of the forecasted shortage, has been regularly examined by
used to develop projections is sound, but as the healthcare
government agencies and departments, as well as healthcare industry
industry has learned over the past 18 months, the projections
groups. While this data is often dated or incomplete, several factors
between 2008 and 2010 are proving to be far more accurate.
have emerged that most groups agree will have an impact on hiring
needed clinical staff in the near and long-term.
This report is designed to highlight more recent data captured
• The workforce has grown overall, but this growth is concentrated
from a 50-hospital sample. Data will be presented that shows a
in the older and younger ends of the age spectrum, and there are
closer correlation between projections from 2008 – 2010 than
actually fewer RNs aged 36 to 45 working today than nine years
those presented to the healthcare community in 2014.
ago. However, the tremendous growth of RN cohorts nearing
retirement age is still a cause for concern. Over the next 10 to 15
years, the nearly 1 million RNs older than 50—about one-third of
the current workforce—will reach retirement age.
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2
Introduction
The purpose of this analysis is to provide hospitals
Care Act accounts for a demand of an additional 28,000 RNs.
and healthcare groups with a wider range of current data for
The greater growth rate of supply (33 percent) over that of
comparison when analyzing the increase in vacancy rates,
demand (21 percent) will result in an excess of 340,000 RNs
turnover, time-to-fill and escalation in hard-to-fill position areas.
by 2025.” (4)
The problem in relying on the data analysis and projections
As stated in the excerpts below, from 2008 to 2011
provided by recently released studies is that almost all rely on
many healthcare experts believed that the recession was
data that was gathered two to seven years prior to the release
only delaying an eventual shortage, possibly making
of the supply-and-demand projections. Also missing, or not
it much worse.
delivered in a timely basis, is trending from actual facilities
across a wide spectrum, which could provide a more accurate
snapshot of trends at hospitals across the United States.
In the HRSA analysis published in December 2014, the analysis
was based on the nursing environment remaining static to the
2012 base. However, a variety of alternative scenarios was also
presented in the event that the 2012 baseline changed over time.
(2) In the HRSA analysis published in April 2013, data was used
from the 2008-2010 American Community Survey of all registered
nurses working in hospital settings. Also included in that report
was data from the 2000 Census. (3)
Another area of concern is inconsistency in the data that has
“The recession may have
given some hospitals a
temporary reprieve from
chronic shortages, but it
isn’t curing the longer-term
problem… and it might be
making it worse.” (5)
– Robert Wood Johnson Foundation
been published over the last eight years.
In December 2014, HRSA published the document The
Future of the Nursing Workforce: National- and State-Level
“Registered nurse (RN) employment has increased during the
Projections, 2012-2025. The projection, based on 2012 baseline
current recession, and we may soon see an end to the decade-
figures remaining consistent, was for a surplus of 340,000
long nurse shortage. This would give hospitals welcome relief
registered nurses by 2015.
and an opportunity to strengthen the nurse workforce by
“Based on 2012 healthcare delivery and staffing patterns and
addressing issues associated with an increasingly older and
assuming the current RN demand equals the current RN supply
foreign-born workforce. The recent increase in employment is
of approximately 2.9 million, the demand for RNs is projected
also improving projections of the future supply of RNs, yet large
to reach 3.5 million in 2025, an increase of 612,000 RNs. A
shortages are still expected in the next decade. Until nursing
growth in disease burden attributable to changing patient
education capacity is increased, future imbalances in the nurse
demographics contributes to an increased demand of 584,000
labor market will be unavoidable.” (6)
RNs, and expanded insurance coverage under the Affordable
PAGE
3
“Currently, nearly 900,000 RNs (out of an estimated 2.6 million
were used, but rather an examination of actual data from
working RNs) are over the age of 50, and large numbers of these
facilities (hospitals) in urban and rural markets, represented by
RNs are expected to retire in the years ahead (independent of
a mixture of small, medium, and large facilities in the for-profit
the pace and intensity of a jobs recovery).” (7)
and not-for-profit sectors.
“We are going to have a major shortage within five years,”
said Dr. Lucy Marion, the dean of Medical College of Georgia’s
School of Nursing. “We will be reaching crisis proportions
again if our economy grows again as predicted, certainly
within 10 years.” (8)
In this analysis, a comparison will be made between the most
recent government and healthcare association projections and
the actual opening and placement data from 50 hospitals across
a 10-state sampling. This is not a scientific analysis. No surveys
“We are going
to have a major
shortage within
five years”
–D
r. Lucy Marion, Dean of Medical College
of Georgia’s School of Nursing, February 8, 2011
METHODOLOGY
USr has compiled data on 50 facilities where recruitment support was provided
from January 2014 through June 2015. The facilities are a blend of small,
medium and large facilities in both urban and rural markets in both the forprofit and not-for-profit sectors and are located in 10 states that extend from
the east coast to the west coast across the southern part of the United States.
This group is not a complete roster of the USr served facilities but a
representative cross mixture to achieve an even balance between facility size
and geography.
1 U.S. Department of Labor, Bureau of Labor Statistics. (2012). Occupational Outlook Handbook, 2012-13 Edition. Washington, D.C.: GPO, U.S. Bureau of Labor Statistics.
Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm; http://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm
2 HSRA report: The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025, published 12-2014
3 HSRA report: The U.S. Nursing Workforce: Trends in Supply and Education, published 4-2013
4 HSRA report: The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025, published 12-2014
5 Robert Wood Johnson Foundation April 17, 2009
6 Nurse Employment by Peter I. Buerhaus, David I. Auerbach, and Douglas O. StaigerHealth Affairs 28, no 4 June 12, 2009
7 Joint Statement from the Tri-Council for Nursing on Recent Registered Nurse Supply and Demand Projections: American Association of Colleges of Nursing (AACN),
American Nurses Association (ANA), American Organization of Nurse Executives (AONE), National League for Nursing (NLN) 9/2010
8 Colleges attempting to stem nursing shortage; The Augusta Chronicle February 8, 2011
PAGE
USr Data: Observations from
a 50-Hospital Sampling
Since 2002, USr Healthcare has worked with more than
220 facilities in 26 states delivering RPO (Recruitment Process
Outsourcing) solutions for talent management and acquisition.
In simple terms, USr places talent acquisition teams on-site at
hospitals and healthcare facilities. These teams perform fullcycle recruitment of staff by deploying a customized version of
the USr model.
In USr’s sample group, new requisitions have risen by 73.09%
from the beginning of 2014 through the end of June 2015, while
In USr’s sample group, new
requisitions have risen by
73.09% from the beginning
of 2014 through the end of
June 2015, while hires have
increased by 53.47% during
the same period.
hires have increased by 53.47% during the same period. An
average of more than one-third of the total requisitions have
been placed during this same period with little to no effect on the
growing need for new clinical staff to meet the needs of the 50
facilities (hospitals) sampled over the last 18 months.
What does this mean? The indication is that the shortage that
has been slowly increasing in media coverage and acceptance
since the spring of 2014 is here. The data and results in this
section are not based on “scientific” models or projections, but
are instead actual results from 50 facilities across 10 states.
Readers will need to compare their own facilities’ experience and
current need and draw their own conclusions.
Increase in open requisitions from
January 2014 through June 2015
The data presented is not specific to nursing, rather it is
a broader picture of the requisition flow and hiring across
all clinical areas. However, the data is relevant because
nursing represents more than 50% of the total openings and
placements across the entire sample group. USr is presenting
this data as a sampling without a facility roster because of
client confidentiality agreements.
Openings by Month
January-141,453
February-141,472
March-141,525
April-141,520
May-141,570
June-141,575
July-141,730
August-141,829
September-141,872
October-142,464
November-142,482
December-142,445
January-152,038
February-152,107
March-152,202
April-152,310
May-152,499
June-152,515
4
PAGE
Requisitions across the 50
facilities increased by 73.09%
over the past 18 months, which
is higher than the 41.23%
monthly increase in new
healthcare postings reported by
the Bureau of Labor Statistics
as shown on the chart below. One reason for the variance is that many
facilities will not list all open positions. Instead, they will post only a
few per department. This practice is common and designed to avoid
alarming current or potential employees to a wider need in certain units
being staffed by contracted personnel.
Bureau of Labor Statistics Healthcare Open
Positions by Month
Month
Total Positions
Jan-14616,000
Feb-14628,000
Mar-14619,000
Apr-14654,000
May-14736,000
Jun-14717,000
Jul-14742,000
Aug-14809,000
Sep-14803,000
Oct-14786,000
Nov-14735,000
Dec-14832,000
Jan-15801,000
Feb-15813,000
Mar-15760,000
Apr-15910,000
May-15870,000
5
PAGE
Increased placements January 2014
through June 2015
Further data from the sample group indicates that the increase in
requisitions could have been more severe had hiring remained flat
during the 18-month analysis period. Hiring increased by 14.01%
in 2014 when compared to hiring at the same facilities during 2013.
Further, hiring for the first six months of 2015 exceeded 2014 hiring
by 53.47% when compared to the same period in 2014 and by 69.03%
when compared to 2013 totals. It should be noted that some facilities
supported by USr Healthcare increased the number of recruiters at the
beginning of 2015 to meet the rising demand.
Placements by Month
Month
201320142015
January
605578861
February
557548813
March
523575913
April
466487785
May
394533872
June
620 7651106
July
631650
August
607691
September 663836
October
656807
November 607755
December 608684
Hiring for the first six months of 2015 exceeded 2014
hiring by 53.47% when compared to the same period
in 2014, and by 69.03% when compared to 2013 totals.
6
PAGE
Placements as a percentage
of open positions
In January 2015, Modern Healthcare reported that the upswing
in healthcare hiring would bypass hospitals. However, USr’s data
from the first six months of 2015 reveals that is not the case. (9)
The Modern Healthcare projection does not seem accurate in
the 50 USr facility results as open requisitions raised at a rate of
23.40% from January 2015 thru June 2015 while hires averaged
39% of open positions during the same six month period. This
trend in filling open requisitions in 2015 is slightly ahead of the 18
month average placement rate which was at a pace of 37% over
the 18 month sample period.
While this data is not a scientific or a statistical study it does
indicate that the projections from 2008 – 2010 seem to have been
a more accurate forecast of a coming shortage.
2014 - 2015 YTD
Month
Openings Placements % Filled
January-14 1453 57840%
February-141472 54837%
March-14 1525 57538%
April-14 1520 48732%
May-14 1570 53334%
June-14 1575 76549%
July-14
1730 65038%
August-14 1829 69138%
September-141872
836 45%
October-14 2464 80733%
November-142482 755 30%
December-142445 684 28%
January-15 2038 86142%
February-152107 81339%
March-15 2202 91341%
April-15 2310 78534%
May-15 2499 87235%
June-15
2515 110644%
Total
35608 1325937%
(9) Modern Healthcare: Healthcare hiring boom will bypass hospitals By Melanie Evans and Rachel Landen, January 17, 2015
7
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8
Stress Points and Future Shortage Drivers
Since 1998, information on a coming registered nurse
shortage, or the elimination of the forecasted shortage, has
older adults can be attributed to the entire baby boomer cohort
joining the older adult population (ages 55+) by 2020.
been regularly examined by government agencies, as well as
With larger numbers of older adults, there will be an
healthcare industry groups. While this data is often dated or
increased need for geriatric care. Older adults will have to deal
incomplete, several factors have emerged that most groups
with more chronic diseases. (12)(13) Experts suggest that the
agree will have an impact on hiring needed clinical staff in the
number of geriatricians will have to triple to meet the demands
near and long-term.
of the rising elderly. (14) There is expected be a similarly
The biggest reason for the inconsistency in data is that there
increased demand in other healthcare professionals, such
are several drivers which could affect the analysis, and each
as nurses, physical therapists and dentists. (14) In addition,
agency or organization is likely focusing on a specific driver
there is expected to be an increasing demand over common
when conducting its analysis. The potential for a shortage,
geriatric care consumption needs, such as medications, joint
however, is driven by multiple, evolving pressure points.
replacements and cardiovascular operations. (14)
“The Baby Boomers are basically going to implode the
Aging Population
healthcare system. The rate of people over 65 is growing five
The phenomenon of the expected flood of baby boomers
times faster than any other age group” said Capt. Deborah
into retirement gained a popular nickname several years ago
Scott, MS, RN, Regional Administrator of Health Resources and
of “The Silver Tsunami.” Experts project that the tsunami of
Services Administration (HRSA). (15)
individuals living longer will put an additional strain on a
healthcare system that is already facing a shortage of clinical
personnel.
According to the Bureau of Labor Statistics, as of April
2014, the labor force participation rate was 62.8%. (10) The
overall labor force participation rate is expected to decline for
the remainder of the decade and is projected to fall to 62.5%
in 2020. By the year 2020, the subpopulation of older adults
in the United States is expected to reach 97.8 million people,
“The baby boomers are
basically going to implode
the healthcare system.”
– Capt. Deborah Scott, MS, RN, Regional Administrator of Health Resources
and Services Administration (HRSA)
comprising 28.7% percent of the entire U.S. population, a rise
from the 24.7% in 2010. (11) This increase in proportion of
(10) U.S. Bureau of Labor Statistics (July 26, 2012). “Bureau of Labor Statistics Data”. Retrieved 2012-07-26.
(11) Jump up to: Toossi, Mitra (January 2012). “Labor force projections to 2020: a more slowly growing workforce”. Monthly Labor Review 135 (1): 43–64.
(12) Bob Shepard, The University of Alabama at Birmingham (December 30, 2010). “Beware the “silver
tsunami” - the boomers turn 65 in 2011”. The University of Alabama at Birmingham. Retrieved 2012-07-25.
(13) Schwatka, Natalie V.; Butler, Lesley M.; Rosecrance, John R. (2012), “An aging workforce and injury in the construction industry”, Epidemiologic Reviews 34: 156–167
(14) Dong, Xiuwen S.; Wang, Xuanwang; Daw, Chrstina; Ringen, Knut (2011), “Chronic disease and functional limitations among older construction workers in the United States: a 10-year
follow-up study”, Journal of Occupational and Environmental Medicine 53 (4): 372–380
(15) Genesis Health: Healing the QC Nursing Shortage, October 29, 2010
PAGE
The Affordable Care Act and the
growing demand
9
The projections are not new and started in earnest in the
months following the March 2010 passage of the ACA.
The passage of the Affordable Care Act of 2010 (ACA) is
“Since the passage of the healthcare law in March 2010,
projected to expand health insurance coverage to an estimated
much has been said about the coming swarm of millions of
30 million to 34 million people. However, expansion of coverage
retiring baby boomers and the strain they will put on the nation’s
is not an expansion of actual care, and the distinction is
healthcare system. That’s only half the problem. Overlooked in
becoming clear. (16)
the conversation is a particular group of boomers: doctors and
When Congress enacted the national health law, it unleashed
nurses who are itching to call it quits. Healthcare economists
a potential tsunami of newly insured patients, flooding a delivery
and other experts say retirements in that group over the next 10
system that was already strained and fragile. The American
to 15 years will greatly weaken the healthcare workforce and
healthcare infrastructure has had workforce shortages for
leave many Americans who are newly insured under the new
decades and is not prepared to meet such a vast influx of
legislation without much hope of finding a doctor or nurse.” (18)
patients effectively or efficiently. (17)
The Aging RN Workforce and Retirement
In the HSRA report, The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses
from March 2010 (whose data was also used the in HSRA report, The U.S. Nursing Workforce: Trends in Supply and Education,
published in April 2013) it showed the coming retirement danger.
(16) Stephen M. Petterson et al., “Projecting US Primary Care Physician Workforce Needs: 2010–2025,” Annals of Family Medicine, Vol. 10, No. 6 (November/December 2012), pp.
503–509, and Kathleen Sebelius, “ACA Gets Care to Those in Most Need,” Albuquerque Journal, September 19, 2012, http://www.hhs.gov/secretary/about/opeds/aca_care_to_those.
html (accessed October 7, 2013).
(17) Amy Anderson, DNP, RN, CNE: The Impact of the Affordable Care Act on the Health Care Workforce’ The Heritage Foundation, Backgrounder March 18, 2014
(18) Retirements by baby-boomer doctors, nurses could strain overhaul, By Darryl Fears Washington Post Monday, June 14, 2010
PAGE
10
Adjusting to 2015 without the addition of the new, and larger, pool of graduate registered nurses, the data shows a growing
potential for an experience gap at the top third of the registered nurse population.
Looming Retirements
The aging population and aging workforce further complicate
the ACA’s implementation. Of the estimated 2.8 million
registered nurses (RNs) and the 985,375 physicians currently
working, one-third will likely retire in the next decade. (19)
Workforce projections anticipate a critical shortage of
between 91,500 to 130,000 physicians and the need for an
additional 300,000 to 1.2 million registered nurses by 2020. (20)
The workforce has grown overall, but this growth is
Of the estimated 2.8 million
registered nurses (RNs)
and the 985,375 physicians
currently working, one-third
will likely retire in the next
decade.
concentrated in the older and younger ends of the age spectrum,
In the most recent HSRA report from December 2014, the
and there are actually fewer RNs aged 36 to 45 working today
projection was that if retirement remained consistent with
compared with nine years ago. However, the tremendous
the 2012 base year, a surplus of registered nurses would be
growth of RN cohorts nearing retirement age is still a cause for
realized by 2025. However, this is not consistent with most data
concern. Over the next 10 to 15 years, the nearly 1 million RNs
released over the past 18 months, which projects an accelerated
older than 50—about one-third of the current workforce—will
retirement rate at the top end of the nursing cohort list with the
reach retirement age. (21)
economy coming out of a five- to six-year recession.
(19) Ibid. and Heisler, “Physician Supply and the Affordable Care Act.”
(20) American Medical Association, “Adequate Funding of Graduate Medical Education (GME) Critical to Ensure Access to Current and Future Medical Services,” 2013, http://www.ama-assn.org/
resources/doc/washington/graduate-medical-education-action-kit.pdf(accessed October 25, 2013); Atul Grover and Lidia M. Niecko-Najjum, “Building a Health Care Workforce for the Future:
More Physicians, Professional Reforms, and Technological Advances,” Health Affairs, Vol. 32, No. 11 (November 2013), pp. 1922–1927; Stephen P. Juraschek et al., “United States Registered
Nurse Workforce Report Card and Shortage Forecast,” American Journal of Medical Quality, Vol. 27, No. 3 (May/June 2012), pp. 241–249; and American Association of Colleges of Nursing,
“Sequestration: Estimating the Impact on America’s Nursing Workforce and Health Care Discoveries,” http://www.aacn.nche.edu/government-affairs/AACN-Sequestration-Factsheet.pdf
(21) The U.S. Nursing Workforce: Trends in Supply and Education HSRA 4/2013, Page 22
PAGE
11
Impact of the recession on
reprieve from chronic shortages, but it isn’t curing the longer-
nursing, known and unknown
term problem… and it might be making it worse. (23)
The start of the recession in 2008 and 2009 began a period of
Still to be determined is the impact a surge of experienced
slowing, and in some cases eliminating, the immediate threat
nurses back into the workforce and delayed retirements will
of the previously forecasted shortage. Many nurses who had
have on younger, new graduate cohorts in the future. USr has
left the field re-entered the work force to compensate for a
yet to see new graduate nurse hiring return to pre-recession
spouse’s lost income or health benefits, the study said. About
levels at most clients serviced during the past six years.
half the increase over the period came from nurses over age 50.
A look at the distribution of nurses not working in nursing
“This surge of employment is basically knocking out the
from the HSRA 2010 report showed a cohort that could be
shortage,” said Peter Buerhaus, the study’s lead author and a
possibly mirrored by new nurses who were unable to find a
professor at Vanderbilt University in Nashville, Tenn. (22)
hospital position after graduation.
The recession may have given some hospitals a temporary
The 30-39 cohort from the HSRA 2010 report are shown in red above. These individuals left nursing by 1997 or earlier, when
they were in their 20s and 30s. During the mid-1990s, RN employment rates were somewhat lower, and the percentage of nurses
employed in hospitals declined. Data suggests that nurses who were under age 40 at that time left the profession and never
returned to nursing work. (24)
It is important to note that with the increase in graduate nurses over the past few years that another hole in the nursing cohort
range may not happen or be minimized.
(22) Nursing Shortage Eases with Recession’s Help, By Kelly Evans, The Wall Street Journal, June 12, 2009
(23) Robert Wood Johnson Foundation, April 17, 2009
(24) The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses from HSRA Report March 2010
PAGE
12
“However, this is the oldest that nurses have ever been in two
Education
education
decades. It is estimated that 75 percent of the current nursing
institutions are unable to graduate the number of workers
faculty will have retired by 2020,” said Capt. Deborah Scott, MS,
needed to guarantee broad access to medical care. Even with
RN, Regional Administrator of Health Resources and Services
recent enrollment increases, demand will still outweigh the
Administration (HRSA) as a keynote speaker in 2010. (28)
Educational
Pipeline:
Currently,
medical
supply by 2025. (25) The training pipeline is backlogged, and
In the HSRA 2010 report, (29) academic education was the
qualified applicants are not gaining entrance to professional
smallest setting for nurses working in the nursing field. The
schools. Insufficient numbers of instructors, limited clinical
impact of up to 75% of such a small number retiring over the
sites and budgetary constraints contribute to the rejection of
next five years, as predicted, could reduce the output of new
qualified applicants. (26)
registered nurses into the healthcare workforce to the lowest
The faculty shortage and concern over pending retirements
levels in two decades.
is another factor that has been discussed for years with
insufficient gains being made in the needed faculty.
Aging faculty also poses a threat to medical education. The
average age of associate nursing professors is 52, and the
average assistant professor is 49, while the average age of
medical school faculty is between 50 and 59. (27) Retirements
are on the horizon, and any additional losses of faculty will
increase the backlog in the educational pipeline.
“It is estimated that
75 percent of the current
nursing faculty will have
retired by 2020.”
– Capt. Deborah Scott, MS, RN, Regional Administrator of Health
Resources and Services Administration (HRSA)
(25) Association of American Medical Colleges, “Recent Studies and Reports on Physician Shortages in the US.”
(26) American Association of Colleges of Nursing, “New AACN Data Show an Enrollment Surge in Baccalaureate and Graduate Programs amid Calls for More Highly Educated Nurses,”
http://www.aacn.nche.edu/news/articles/2012/enrollment-data (accessed October 18, 2013).
(27) American Association of Colleges of Nursing, “Strategies to Reverse the New Nursing Shortage,” http://www.aacn.nche.edu/publications/position/tri-council-shortage (accessed
October 18, 2013).
(28) Genesis Health: Healing the QC Nursing Shortage, October 29, 2010
(29) The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses from HSRA Report March 2010
PAGE
13
RNs outpaced by increases in demand, resulting in shortages.” (30)
Geography
Even with an expected surplus of nurses, HRSA notes
However, this data is also in conflict with projections from
“substantial state variation in the projected supply and demand for
other sources. In a brief online search, it quickly became
the RN workforce in 2025. Despite projections of an excess of RNs
apparent that clinical talent availability at the state level is
at the national level, 16 states are expected to see their supply of
varied and rapidly becoming an increased concern.
Projected Shortages in 2030, by State
<1,000
1,000 - 4,999
5,000 - 9,999
10,000 - 14,999
15,000 - 24,999
> 25,000
No Data
Expanded Opportunities
and Opt Outs
Expanded opportunities for nurses are another area that will
surveys stood out:
• 13% of newly registered nurses changed principal jobs
after one year.
lead to shortages across the board. When compared to 2005
• 37% said they were ready to change jobs.
and 2010, there are significant increases in areas outside what
The survey also found that almost half (44%) of all nurses
were once considered traditional areas as seen on the graphic
plan to make a career change over the next three years and
on page 12.
that more than one-third of the respondents experience job
Another change that has not received widespread analysis
dissatisfaction. Almost 50% of the respondents were nurses
since 2010, is that both new and older nurses are choosing
between the ages of 40-49, and 59% of the nurses currently
to leave the profession. In 2010, the following results from
hold a position on their hospital’s permanent staff. (31)
(30) HRSA report: The Future of the Nursing Workforce: National-and State-Level Projections, 2012-2025, published 12-2014
(31) Half of nurses plan career change, says survey, Sarah Kearns, Health Leaders Media February 2010
PAGE
14
Conflicting Data
The HSRA report released in December 2014, (The Future of
of 584,000 RNs, and expanded insurance coverage under the
the Nursing Workforce: National- and State-Level Projections,
Affordable Care Act accounts for a demand of an additional
2012-2025) received minimal publication in the media and
28,000 RNs. The greater growth rate of supply (33 percent) over
trade journals but was widely discussed within the healthcare
that of demand (21 percent) will result in an excess of 340,000
community. The forecast read:
RNs by 2025.”
“Based on 2012 healthcare delivery and staffing patterns
What was missed by most of the reporting and those who
and assuming the current RN demand equals the current RN
only viewed a summary of the results was that the report varied
supply of approximately 2.9 million, the demand for RNs is
greatly from other data sources. Additionally, it contained
projected to reach 3.5 million in 2025, an increase of 612,000
several alternate scenarios and limitations that were not widely
RNs. A growth in disease burden attributable to changing
published or acknowledged.
patient demographics contributes to an increased demand
Limitations
HRSA’s Health Workforce Simulation Model, published in December, 2014, operates under several assumptions regarding
the current status and future trends in healthcare utilization and workforce supply.
1. The HRSA Model, like most other health workforce projection models, assumes that the labor market for nurses is
currently in balance (i.e., supply and demand in the base year are equal). (32) Therefore, the results in this brief reflect
changes in the nursing workforce over time relative to a balanced 2012 baseline.
2. The HRSA Model also assumes that the future production of nurses will remain consistent with the current rate. However,
there have historically been large swings in enrollment and the resulting labor supply, which, if repeated in the future,
would affect the results reported here.
3. State-level projections require assumptions about the geographic mobility of nurses. Results presented here assume
that nurses will practice in states where they have been trained. As a result, many states are projected to have nursing
shortages in 2025 despite the fact that, on a national level, there is projected to be an excess of both RNs and LPNs.
4. Although there is evidence that some very specialized settings may be facing nurse shortages, (33) this report looks at
the nursing profession as a whole and does not look at individual nursing specialty areas (e.g., public health, home health
care, etc.) or sites of practice (e.g., nursing homes, ambulatory settings, etc.).
5. This brief’s projections do account for increased utilization of healthcare services due to expanded insurance coverage
under the Affordable Care Act. However, because of the uncertainties in its effects on staffing patterns and the evolving
roles of different health professionals on care teams, changes in healthcare service delivery are not incorporated into
the model. If the growing emphasis on care coordination, preventive services, and chronic disease management in care
delivery models leads to a greater need for nurses, this brief may underestimate the projected nurse demand.
PAGE
15
One very large disparity is found in the forecast by state and
the American Journal of Medical Quality projects 48 states
the overall shortage for the U.S. In the HSRA December 2014
to have shortages by 2030 and an overall shortage of 923,629
report, 16 states are projected to have shortages by 2025 with
registered nurses. (See Chart 2 on page 18) What these
an overall surplus of 340,000 registered nurses. (See Chart 1
conflicting reports demonstrate is that no one is sure what the
on page 17) Conversely, the United States Registered Nurse
real shortage or surplus will be and the HSRA report is cautious
Workforce Report Card and Shortage Forecast published by
in its conclusions:
Conclusions
• The supply and demand projections presented assume that care use and delivery patterns will remain unchanged.
• While these projections are consistent with findings in recent studies on RN supply, (34) historical experience demonstrates
how sensitive enrollment in training programs and the resulting labor supply of nurses are to the job market and economic
conditions. (35) For example, the growth of new entrants into the RN workforce is susceptible to the fragile supply of nurse
educators. (36)
The few articles published in the first quarter of 2015 differ greatly from articles
published during the second quarter of 2015. During the first quarter much credence was given
to the December 2014 HSRA report with a surplus of registered nurses at 340,000
being widely accepted as a future projection.
No more nurse shortage? Surplus projected for 2025
Staffing Industry Analysis, January 7, 2015
http://www.staffingindustry.com/Research-Publications/Publications/Healthcare-Staffing-Report/Jan.-8-2015/No-morenurse-shortage-Surplus-projected-for-2025
Goodbye shortage: Feds now predicting a 340,000-nurse surplus by 2025
Healthcare Traveler, January 29, 2015
http://healthcaretraveler.modernmedicine.com/healthcare-traveler/news/goodbye-shortage-feds-now-predicting-340000nurse-surplus-2025
Is the Nursing Shortage Real?
Find Nursing Schools, February 4, 2015
HTTP://FINDNURSINGSCHOOLS.COM/BLOG/IS-THE-NURSING-SHORTAGE-REAL/
Nursing Workforce Continues to Grow, but Profession’s Future Is Uncertain
Nursing programs remain popular but professionals are unsure if the market is slated for
growth or saturation.
USNews & World Report, March 20, 2015
http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2015/03/20/nursing-workforce-continues-to-growbut-professions-future-is-uncertain
PAGE
16
However, the message started to change as the number
of healthcare job postings continued to increase as shown on page 5
of this report. Media reports began to reference the shortage a
gain with regularity in March 2015.
Nursing Shortage Looms
Benefits Pro, March 10, 2015
http://www.benefitspro.com/2015/03/10/nursing-shortage-looms
The Nursing Shortage: Real or Imagined?
Hospital Career Portal, March 25, 2015
http://www.hospitalcareers.com/blog/2015/03/25/the-nursing-shortage-real-or-imagined/
The Nursing Shortage Is Not Over (Despite What You May Have Heard)
Working Nurse, April 2015
http://www.workingnurse.com/articles/the-nursing-shortage-is-not-over-despite-what-you-may-have-heard
Why the nursing shortage differs from the physician shortage
FierceHealthcare, June 5, 2015
http://www.fiercehealthcare.com/story/why-nursing-shortage-differs-physician-shortage/2015-06-05
Healthcare Jobs Just Grew At Fastest Pace Since 1991
Forbes, June 5, 2015
http://www.forbes.com/sites/dandiamond/2015/06/05/hospitals-jobs-growth-is-suddenly-booming/
U.S. sees surge in hospital jobs growth
Healthcare Dive, June 8 2015
http://www.healthcaredive.com/news/us-sees-surge-in-hospital-jobs-growth/400351/
The U.S. Economy Can’t Hire Healthcare Workers Fast Enough
Bloomberg, June 9, 2015
http://www.bloomberg.com/news/articles/2015-06-09/the-u-s-economy-can-t-hire-health-care-workers-fast-enough
(32) Ono, T., Lafortune, G., Schoenstein, M. (2013). Health workforce planning in OECD countries: a review of 26 projection models from 18 countries. OECD Health Working Papers, No.
62. France: OECD Publishing; 2013:8-11.
(32) Yang, W., Williams, J.H., Hogan, P.F., Bruinooge, S.S., Rodriguez, G.I., Kosty, M.P, Bajorin, D.F., Hanley, A., Muchow, A., McMillan, N., Goldstein, M. (2014). Projected supply of and
demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage. J Oncol Pract., 10(1):39-45.
(33) American Association of Colleges of Nursing. (2014, April 24). Nursing shortage fact sheet. Retrieved August 21, 2014, from http://www.aacn.nche.edu/media-relations/fact-sheets/
nursing-shortage.
(34) Auerbach, D. I., Buerhaus, P. I. & Staiger, D. O. (2014). Registered nurses are delaying retirement, a shift that has contributed to recent growth in the nurse workforce. Health Affairs,
33(8):1474-1480.
(34) Auerbach, D. I., Buerhaus, P. I. & Staiger, D. O. (2011) Registered nurse supply grows faster than projected amid surge in new entrants ages 23-26 Health Affairs, 30(12):2286-2292.
(35) Buerhaus, P.I., Auerbach, D.I., & Staiger, D.O. (2009). The recent surge in nurse employment: causes and implications. Health Affairs, 28 (4): w657-w668.
(35) Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2012). Registered nurse labor supply and the recession —are we in a bubble? NEJM, 366(16):1463-1465.
(36) American Association of Colleges of Nursing (2014). Nursing faculty shortage fact sheet. Retrieved September 30, 2014 from http://www.aacn.nche.edu/media-relations/factsheets/nursing-faculty-shortage.
Chart 1: Projected Nurse Shortages in 2030, by State
PAGE
17
State
Shortage
Shortage per 100,000 Population
Alabama..............................................................................8,212..........................................................................................168
Alaska.................................................................................2,961..........................................................................................341
Arizona...............................................................................56,781.........................................................................................530
Arkansas.............................................................................8,545..........................................................................................264
California..........................................................................193,100........................................................................................416
Colorado.............................................................................12,550.........................................................................................217
Connecticut.........................................................................3,259...........................................................................................88
Delaware............................................................................. 616.............................................................................................61
Georgia..............................................................................43,075.........................................................................................358
Hawaii.................................................................................6,617..........................................................................................451
Idaho...................................................................................6,830..........................................................................................347
Illinois.................................................................................18,240.........................................................................................136
Indiana................................................................................9,112..........................................................................................134
Iowa....................................................................................1,243...........................................................................................42
Kansas................................................................................3,827..........................................................................................130
Kentucky.............................................................................3,244...........................................................................................71
Louisiana............................................................................10,249.........................................................................................213
Maine..................................................................................1,824..........................................................................................129
Maryland............................................................................12,894.........................................................................................184
Massachusetts..................................................................–9,690........................................................................................–138
Michigan............................................................................25,725.........................................................................................241
Minnesota...........................................................................2,750...........................................................................................44
Mississippi..........................................................................4,551..........................................................................................147
Missouri..............................................................................1,757...........................................................................................27
Montana.............................................................................3,479..........................................................................................333
Nebraska.............................................................................. 238.............................................................................................13
Nevada...............................................................................19,398.........................................................................................453
New Hampshire..................................................................3,091..........................................................................................188
New Jersey........................................................................23,358.........................................................................................238
New Mexico......................................................................12,884.........................................................................................614
New York...........................................................................39,696.........................................................................................204
North Carolina...................................................................20,851.........................................................................................171
North Dakota....................................................................... 811............................................................................................134
Ohio.....................................................................................3,630...........................................................................................31
Oklahoma...........................................................................11,120.........................................................................................284
Oregon...............................................................................11,321.........................................................................................234
Pennsylvania.......................................................................4,091...........................................................................................32
Rhode Island........................................................................ 354.............................................................................................31
South Carolina...................................................................15,477.........................................................................................301
South Dakota.....................................................................–1,692........................................................................................–211
Tennessee...........................................................................8,770..........................................................................................119
Texas.................................................................................109,779........................................................................................329
Utah....................................................................................10,416.........................................................................................299
Vermont...............................................................................2,149..........................................................................................302
Virginia...............................................................................32,464.........................................................................................330
Washington.......................................................................20,609.........................................................................................239
West Virginia......................................................................2,480..........................................................................................144
Wisconsin..........................................................................10,530.........................................................................................171
Wyoming.............................................................................1,689..........................................................................................323
U.S. Total923,629
Source: Stephen P. Juraschek et al., “United States Registered Nurse Workforce Report Card and Shortage Forecast,”
American Journal of Medical Quality, Vol. 27, No. 3 (May/June 2012),
207
Chart 2: Baseline and Projected Supply of and Demand
for RN Workforce 2012-2025
PAGE
U.S. Total
2,897,000
3,509,000
3,849,000
340,000
HSRA report: The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025, published 12-2014
2012
2025 Projected
State
Supply & Demand
Demand
Supply
Difference
Alabama...................................... 50,200................................ 55,700.....................................70,100..................................14,400
Alaska.......................................... 5,600.................................. 7,300.......................................4,600................................... -2,700
Arizona........................................ 53,000................................ 87,200.....................................59,100................................. -28,100
Arkansas..................................... 27,600................................ 31,800.....................................47,700..................................15,900
California................................... 277,000.............................. 393,600..................................389,900................................. -3,700
Colorado...................................... 42,900................................ 59,000.....................................46,100................................. -12,900
Connecticut................................. 37,100................................ 41,500.....................................45,200...................................3,700
Delaware.................................... 10,600................................ 12,500.....................................16,200...................................3,700
Florida........................................ 171,600.............................. 225,500..................................229,700..................................4,200
Georgia....................................... 77,300............................... 101,400...................................94,700.................................. -6,700
Hawaii......................................... 10,700................................ 13,400.....................................13,200....................................-200
Idaho........................................... 11,700................................ 15,400.....................................16,100.................................... 700
Illinois......................................... 126,900.............................. 140,100..................................149,800..................................9,700
Indiana........................................ 66,400................................ 71,400.....................................91,600..................................20,200
Iowa............................................ 34,600................................ 35,300.....................................56,600..................................21,300
Kansas........................................ 30,300................................ 32,800.....................................47,600..................................14,800
Kentucky..................................... 47,300................................ 51,000.....................................67,500..................................16,500
Louisiana..................................... 41,300................................ 46,500.....................................64,700..................................18,200
Maine.......................................... 16,200................................ 17,500.....................................15,800.................................. -1,700
Maryland..................................... 60,600................................ 72,000.....................................59,900................................. -12,100
Massachusetts........................... 78,800................................ 85,500.....................................85,900.................................... 400
Michigan..................................... 96,300............................... 104,600..................................116,000.................................11,400
Minnesota................................... 59,300................................ 66,500.....................................84,900..................................18,400
Mississippi.................................. 32,200................................ 35,800.....................................47,000..................................11,200
Missouri...................................... 61,600................................ 67,700.....................................85,000..................................17,300
Montana..................................... 10,700................................ 12,100.....................................11,300....................................-800
Nebraska..................................... 20,900................................ 21,900.....................................22,100.................................... 200
Nevada........................................ 19,400................................ 32,400.....................................24,600.................................. -7,800
New Hampshire.......................... 15,700................................ 18,000.....................................18,500.................................... 500
New Jersey................................. 84,600................................ 98,500....................................119,400.................................20,900
New Mexico............................... 15,900................................ 22,100.....................................18,700.................................. -3,400
New York................................... 191,200.............................. 212,400..................................235,800.................................23,400
North Carolina............................ 95,800............................... 120,000..................................107,100................................ -12,900
North Dakota............................... 7,400.................................. 7,600......................................10,400...................................2,800
Ohio............................................ 130,600.............................. 137,400..................................212,800.................................75,400
Oklahoma.................................... 32,200................................ 37,300.....................................55,000..................................17,700
Oregon........................................ 31,300................................ 40,100.....................................34,100.................................. -6,000
Pennsylvania.............................. 145,000.............................. 152,600..................................178,400.................................25,800
Rhode Island............................... 12,900................................ 14,000.....................................11,900.................................. -2,100
South Carolina............................ 44,600................................ 54,600.....................................54,000....................................-600
South Dakota.............................. 10,000................................ 10,600.....................................14,500...................................3,900
Tennessee................................... 65,000................................ 76,100.....................................92,200..................................16,100
Texas.......................................... 192,000.............................. 278,300..................................284,400..................................6,100
Utah............................................. 19,700................................ 25,400.....................................31,200...................................5,800
Vermont........................................ 7,400.................................. 8,100.......................................8,800..................................... 700
Virginia........................................ 69,900................................ 87,300....................................106,700.................................19,400
Washington................................ 57,800................................ 75,100.....................................68,100.................................. -7,000
West Virginia.............................. 20,600................................ 21,100.....................................29,000...................................7,900
Wisconsin................................... 63,300................................ 68,800.....................................78,100...................................9,300
Wyoming...................................... 4,300.................................. 4,900.......................................6,800....................................1,900
18
PAGE
19
Additional State Results:
• Arkansas - http://thecabin.net/news/2015-05-12/chdc-seeking-solutions-solve-significant-nursing-shortage#.VZ_NTvlVhBc
• Washington DC - https://cew.georgetown.edu/wp-content/uploads/Nursing-Supply-Final.pdf
• Georgia - http://www.macon.com/2015/04/05/3678770/nursing-shortages-continue-as.html
• Idaho - http://www.washingtontimes.com/news/2015/feb/28/idahos-nursing-shortage-is-over-except-where-it-is/?page=all
• Illinois - http://www.morrisherald-news.com/2015/05/26/survey-looming-statewide-nursing-shortage-as-baby-boomers-readyto-retire/anl4exp/, http://chicago.suntimes.com/business/7/71/636287/new-survey-suggests-nursing-shortage-looming-illinois
• Massachusetts - http://www.boston.com/jobs/news/2015/02/06/nurse-actually-the-most-demand-job/
CCJzhAQSzkKc5yhBzN2jiP/story.html
• Michigan - http://woodtv.com/2015/02/12/a-need-for-nurses-in-west-michigan/
• Missouri - http://columbiabusinesstimes.com/25059/2015/01/25/facing-the-nursing-shortage/
• Montana - http://www.ktvq.com/story/29141845/on-special-assignment-montanas-nursing-shortage
• Nebraska - http://www.knopnews2.com/home/headlines/Nursing-Shortage-299381941.html, http://www.nebraska.tv/
story/27936922/nebraska-braces-for-nursing-shortage
• New Jersey - http://www.dailycommercial.com/news/article_2b8e3f1c-2c25-5ce3-83a1-1ad7faab7142.html
• New York - http://www.nytimes.com/2015/05/28/opinion/we-need-more-nurses.html?_r=0
• Oklahoma - http://www.okcfox.com/story/27808164/oklahoma-facing-shortage-of-registered-nurses
• Texas - http://cbs4local.com/news/features/el-paso-news/stories/School-seeks-to-end-El-Paso-nursing-shortage-111281.
shtml#.VZ_OXflVhBc, http://www.chron.com/jobs/article/Outlook-for-nursing-jobs-continues-to-look-6004526.php, https://
www.americantraveler.com/travel-nursing-blog/texas-compact-nursing-state-has-big-rn-shortage, http://www.ktxs.com/news/
abilene-regional-feeling-effects-of-nurse-shortage/27381254
• Virginia - http://www.nbc29.com/story/28097584/hospitals-facing-nursing-shortage
• Washington - http://www.yakimaherald.com/news/local/need-for-more-nurses-growing-around-valley-across-nation/
article_696ae123-8fd6-586c-b111-aed0d86784cc.html
• Wisconsin - http://www5.uwm.edu/news/2015/04/21/ziemers-donate-1-million-to-uwm-to-help-fill-growing-nursing-shortagein-wisconsin/#.VZ_L2PlVhBc, http://www.wkow.com/story/28192286/2015/02/24/country-dealing-with-a-nurse-shortage
• Wyoming - http://www.wyomingnews.com/articles/2015/04/26/news/19local_04-26-15.txt#.VZ_M1vlVhBc
• U.S. - http://wallethub.com/edu/best-states-for-nurses/4041/
• U.S. - http://www.rasmussen.edu/degrees/nursing/blog/nursing-shortage-by-state/ (Click on each state to see shortage info)
PAGE
20
Summary
Is the nursing shortage back?
That is a question that will continue to be examined going
Looking to the future, many factors will continue to affect
forward, but the hard numbers USr has reported over the past
the demand and supply of the nurse workforce including
18 months would indicate that projections from 2008 through
population growth and the aging of the nation’s population,
2010 appear more accurate than those published by HSRA
overall economic conditions, aging of the nursing workforce,
just seven months ago.
new care delivery models and demand for health services
USr data from the 50-hospital sample is not scientific, as
broadly and within specific healthcare settings, and
stated earlier, but it is a fair representation that seems to be
changes in healthcare reimbursement. (38) The Affordable
confirmed by increased demand from new facilities for its
Care Act (ACA) is designed to expand the number of people
services at levels not seen since the beginning of 2008.
with health insurance coverage and to encourage new
The 2014 HSRA report described the Evolving Role of the
Nursing Workforce in cautious terms:
value-based models of care.
Dr. Peter Buerhaus has adjusted projections to more positive
The rapidly changing healthcare delivery system is redefining
forecasts several times since 2010 (and is widely held to be
how care is delivered and the role of the nursing workforce.
the most knowledgeable expert on national healthcare staff
Supply and demand will continue to be affected by numerous
levels) but a quote from that year should still serve as a
factors including population growth and the aging of the
cautionary warning:
nation’s population, overall economic conditions, aging of the
nursing workforce, and changes in healthcare reimbursement.
Research to model the demand implications of trends in care
delivery is ongoing and health workforce projection models
will be updated as needed. (37)
The projections as written in 2014 appear very similar
“Moving into the future, we see a very large shortage of
nurses, about 300,000,” said Peter Buerhaus, a nurse
and healthcare economist and a professor at Vanderbilt
University. “That number does not account for the demand
created by reform. That’s a knockout number. It knocks the
system down. It stops it.” (39)
to those from 2008 which suggest that the problem needs
additional and timelier data to be useful for ongoing planning
to meet future demand.
“Moving into the future, we see a very large shortage of nurses, about
300,000. That number does not account for the demand created by reform.
That’s a knockout number. It knocks the system down. It stops it.”
– Peter Buerhaus, nurse and healthcare economist; Professor, Vanderbilt University, June 14, 2010
(37) HSRA: The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025
(38) Institute of Medicine. (2008). Retooling for an aging America, building the health care workforce. Washington (DC): National Academies Press.
(39) Retirement by baby-boomer, nurses could strain overhaul, Washington Post June 14, 2010