Despite the current 2.7-million-strong nursing workforce, the United States is in the midst of a nursing shortage, with nearly 315,000 positions needing to be filled. Projections paint a far worse picture, with the country expected to face a shortage of 1.2 million nurses by 2030, according to the U.S. Registered Nurse Workforce Report Card.
[Above: Students in the School of Nursing at Rasmussen College practice taking the pulse of a dummy in a lab.]
Much of this issue comes down to one large segment of the population: baby boomers. Nearly 10,000 individuals between ages 52 and 70 are retiring each year, and many of those are nurses; in fact, close to half of the nursing workforce is composed of baby boomers. Furthermore, the medical needs of this sizable, rapidly aging population continue to increase.
Not all communities are experiencing this shortage, however. The true problem is the distribution of nurses across the country. Per 100 residents, the U.S. has 0.85 registered nurses (RNs) in rural areas compared with 0.93 in urban areas, according to 2014 data from the American Nurses Association. Additionally, RNs in urban areas tend to have higher levels of education than those in rural areas.
Since the early 2000s, when the shortage peaked, U.S. nursing schools have more than doubled the number of graduates and maintained that figure ever since, according to Joanne Spetz, PhD, a professor at the University of California San Francisco School of Nursing and Health Professions and the Philip R. Lee Institute for Health Policy Studies.
“The national forecast from the federal government estimates that overall, as a nation, we are graduating slightly more than enough nurses to deal with baby boomers’ retirement. It’s easy to say we have enough nurses all over the country, but that doesn’t mean they are where they are most needed or where the most jobs are,” Spetz says, adding that in some parts of the country, the shortage never went away, and in other areas, there is a glut of nurses who can’t find jobs. “It varies a lot both within and across states.”
This “uneven” distribution of nurses, Spetz says, has led to too few nurses in rural, low-income, and some inner-city areas and too many in higher-income, more densely populated regions.
Another issue facing the profession is that as older nurses retire, “they are taking with them decades of experience and clinical expertise,” Spetz says. “There’s been some concern that employers don’t want to hire the new graduates because they think they don’t have enough experience to fill [certain roles], but if no one hires the new graduates, they will never become the experienced nurses that [employers] want.”
To help provide nurses with more in-depth experience, many hospitals are investing in new-graduate onboarding processes, in which recent nursing school graduates are hired — sometimes temporarily — into programs similar to those of residencies for doctors.
“The pay isn’t quite as good as a normal full-time job, and there’s an intensive training component to it [that varies depending on specialty],” Spetz says. “They typically don’t guarantee that they will hire you at the end of it because they’re not sure how many job openings there will be, but worst-case scenario, the student gains more skills.”
In an effort to meet localized needs, some employers are working with schools to ensure students take specific elective courses. For example, if an area has a shortage of labor and delivery nurses, hospitals may collaborate with nearby colleges to create an elective that brings students in to train in their labor and delivery unit.
Joan Rich, the vice president of the for -profit Rasmussen College School of Nursing and a registered nurse, says the problem isn’t confined to practicing nurses. According to her, the country is also experiencing a significant shortage of nursing faculty.
While becoming a nursing professor usually requires a master’s degree, and sometimes a doctorate, Rich says that those positions typically pay less than nurse practitioner jobs, which call for less education and are therefore more attainable.
“In Minnesota, for example, you can make $71,000 a year as a new registered nurse, whereas faculty might earn $55,000 to $60,000,” Rich says. “And when [faculty] go home, they usually have more work to do. If you are a good educator, you’ve got papers to grade and students calling you. When you’re in practice, once you’re done with your shift, you go home and that is it.”
To ensure there are enough nurses and nursing faculty from all backgrounds, schools and employers are offering a variety of incentives to attract them to the field.
At Allen College in Waterloo, Iowa, for instance, if someone without a doctorate degree joins the nursing faculty, the school — with its partner, UnityPoint Health — will provide financial support of up to $5,250 per year to help that individual earn a doctorate at the institution of his or her choice.
“[Allen College] is a small institution … with 620 students enrolled, so in order to attract and keep stable faculty, we have to provide special incentives and rewards for those who make a career here,” says Jerry Durham, PhD, the chancellor of Allen College and a professor of nursing. “Even with all the financial help we give, our graduate students tend to graduate with an average debt of more than $40,000.”
Furthermore, professors who come to the college with a doctorate receive financial assistance to repay federal loans they used to fund their degree.
In addition, the college receives up to $60,000 annually from the Health Resources and Services Administration (HRSA) to distribute to its master of science in nursing (MSN) students who are on the path to becoming nursing educators. The funds vary from year to year, and Durham says larger schools typically receive substantially more. However, the funding is only distributed in areas deemed by HRSA to be in greater need of nursing faculty.
“If [MSN students] teach in a nursing education program full time, 85 percent of their loan is forgiven,” Durham says. “The worst they’ll have to do is pay back the full loan if they don’t get a job.”
Because Waterloo is a small city, new nursing graduates can expect sign-on bonuses at area hospitals. “Allen Hospital, which would like to hire more of our graduates, provides a sign-on bonus of about $10,000 for individuals right out of nursing school,” Durham says. “A lot of other hospitals are trying to match that as well, because of the shortage.”
Spetz says new graduates should not expect sign-on bonuses in more densely populated areas. However, she says that nurses who have several years of experience may be offered bonuses from new employers in those areas.
While graduating more nurses overall is a large focus for many schools, recruiting and retaining those from underrepresented groups is another fundamental goal.
“Research over the years suggests that caregivers who look like their patients can better connect with them, and there may be stronger trust,” Durham says.
In an effort to ensure the nursing workforce reflects the diverse patient population, Allen College sponsors a six-week nursing camp for up to 40 students every summer to generate interest in college and healthcare careers. Durham says that underrepresented students are given priority consideration.
“Almost all the students are ethnic minorities or first-generation college students,” he says. “[During the camp], guest speakers discuss a range of careers in nursing as well as other healthcare fields. One day a week, they go on a field trip and visit various healthcare facilities in Cedar Valley. They’re exposed to a range of activities that we hope will pique their interest in college and a career in nursing.”
Through this annual camp, Durham says, Allen College has made significant progress toward increasing the diversity of its nursing student body. “Eleven years ago, we had 5 percent men and almost no minority students,” he says. “Currently, we have more than 10 percent men and almost 5 percent ethnic minorities.”
Rasmussen College, which has campuses in several states across the country and offers online nursing courses, is also helping improve diversity in the nursing field. However, Rich says that the extent of this work varies by location.
“Looking mostly … at race and ethnicity, there is a stronger opportunity to increase diversity in a state like Florida, where faculty and students are 30 and 47 percent diverse, respectively, than [in a state] like Kansas, where faculty and students are only 7.9 and 18 percent diverse,” Rich says.
She believes that cultural understanding and respect are essential aspects of nursing education. Most schools now offer cross-cultural courses for this reason.
“We recognize that the U.S. and the world is a very diverse and complex global healthcare unit,” she says. “We need to have as much knowledge and education as we can as we care for our patients across the U.S. and globally. The more education and insight we have on the totality of diversity, the better off faculty, nurses, and patients will be.”●
Lauren Healey is a senior staff writer for INSIGHT Into Diversity.