Parsing out the variables that make up nursing shortage numbers will help nurse leaders make sense of the shortfall. It's really all about the details.
"The 30,000-foot view" is a popular phrase used to encourage others to see the big picture. But is assessing the nursing shortage from a Mount Everest-like vantage point a good idea? Yes and no.
While understanding national trends in the nursing workforce and nursing education is necessary, overlooking the finer details, such as what's occurring in specific geographic areas or specialties, ignores the complexities of nurse supply and demand.
"The shortage is not just one thing. There are a lot of different things that are playing into what the shortage is," says Heidi Sanborn, DNP, RN, CNE, clinical assistant professor and interim director of the RN-BSN, and concurrent enrollment program in the College of Nursing and Health Innovation at Arizona State University in Phoenix.
Sanborn shares five observations on the nursing shortage that should be considered in the shortage forecasts.
1. There's No Standard Shortage
"The shortage will not hit all areas the same. In some states, it is very regional, and some states are projected to have worse shortages than others. Some states are predicted to have a glut of nurses so there will be no shortages there at all. [Based on] the latest data, the big predictions for the shortage in the next 10 years are California, Texas, surprisingly New Jersey, and South Carolina. They are really the top at the moment for predicted shortages. We are still bracing for shortages here in Arizona, but we are now hearing that it may not be as bad as we thought it was originally predicted to be."
2. It's Not Just Acute Care
"When we think nursing, we tend to think of a nurse going into a hospital in the morning, reporting for his or her 7 a.m. to 7 p.m. shift at the bedside, and we tend to call that bedside nursing. Nursing is shifting, so the shortage isn’t necessarily happening in that traditional [hospital] market. A lot of new worlds are opening up, and those new worlds are really struggling to attract nurses [to work] away from the bedside, particularly BSN-prepared nurses. Some of the emerging markets that we are seeing in nursing are areas like assisted living and senior housing.
Reimbursement is shifting away from the hospital, and what that means is that everybody benefits from keeping patients out of the hospital. As a result, we have less patients staying in the hospital or [their stays are shorter]. But those patients still have complex care needs.
Assisted living, senior housing, retirement communities—they [all] want BSN nurses who are prepared to manage these patients autonomously, working independently outside an environment where you might have a physician or nurse practitioner sitting right next to you to write an order. Those markets are struggling to attract nurses.
When I talk to new grads or prospective students they say, "I am going to work in a hospital in a pediatric intensive care unit." But those aren’t where all the jobs are. So, nursing itself is going through a shift, and that is what is shifting our definition of what the nursing shortage looks like."
3. Schools of Nursing Are Affected
"When we talk about the nursing shortage, we talk about baby boomers. Nursing is an aging workforce that is preparing for retirement. This is particularly hitting nurse faculty hard. [Nursing Schools] by default, have an older workforce than the traditional bedside nursing workforce, so we are being hit much more strongly with a retirement boom.
The pipeline for getting a new faculty member into a faculty position [takes longer]. They need to have clinical experience. They need to have a master’s degree, at a minimum, if not a doctoral degree. So by default, we attract older nurses to be nursing faculty.
With retirements, we do not have enough nurses coming up through the career pipeline to fill the [faculty] shortages that are going to happen. Without nursing faculty, we are going to struggle to get new nurses to the bedside who can fill that pipeline."
4. Specialty Makes a Difference
"The nursing shortage encompasses nurse practitioners as well. One interesting example is behavioral health providers. They are all lumped into one group, so nurse practitioners or nurses who are certified in behavioral health are not [counted as] a separate group. When you separate out nurses and nurse practitioners from that [group] we realize we do not have enough [behavioral health] providers.
And, of course, there is an increased focus at the national level [with] the opioid crisis and medication- assisted therapy, [and] nurse providers and nurse practitioners treating patients with mental health issues and substance abuse issues. We do not enough providers to do that right now.
When you break the nursing shortage down by discipline or by bedside practice or advanced practice, it looks very different when you examine those populations of nurses separately from a larger group. So, the nursing shortage numbers that we see don't always adequately explain where the shortages are."
5. It Could Further Diversity
"Nursing schools and nursing employers are looking at increasing diversity in our workforce. Our patient population is extremely diverse, but our nursing care providers are not. We struggle to attract men. We struggle to attract racially and culturally diverse providers. In the faculty realm, we struggle with that as well. Nursing researchers are overwhelmingly white and female.
We have got to do something, and we are trying hard to change that mix. With the shortage we have a great opportunity to get creative about who are we attracting. How can we increase those markets of potential nurses and engage them in the profession?"
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.
Not all geographic areas may face a nursing shortage.
Multiple factors play a role in the nursing shortage.
Nursing faculty shortages are expected to emerge.