Nursing Shortage Fact Sheet

The United States is in the midst of a nursing shortage that is expected to intensify as baby boomers age and the need for health care grows. Compounding the problem is the fact that nursing colleges and universities across the country are struggling to maintain enrollment levels which remain insufficient to meet the projected demand for nursing care.

The American Association of Colleges of Nursing (AACN) is concerned about the nursing shortage and is working with member schools, policy makers, kindred organizations, and the media to bring attention to this health care crisis. AACN is directing its efforts toward enacting legislation, identifying strategies, and forming collaborations to address the nursing shortage. To keep stakeholders abreast of current statistics related to the shortage, this fact sheet has been developed and will be updated on a regular basis. A companion Web resource has also been created.

Current and Projected Shortage Indicators

According to a July 2002 report by the Health Resources and Services Administration, 30 states were estimated to have shortages of registered nurses (RNs) in the year 2000. The shortage is projected to intensify over the next two decades with 44 states plus the District of Columbia expected to have RN shortages by the year 2020. The report, Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020, is available online at http://bhpr.hrsa.gov/healthworkforce/rnproject/default.htm.


According to the latest projections from the U.S. Bureau of Labor Statistics published in the November 2001 Monthly Labor Review, more than one million new and replacement nurses will be needed by 2010. The U.S. Department of Labor projects a 21% increase in the need for nurses nationwide from 1998 to 2008, compared with a 14% increase for all other occupations. www.bls.gov


According to the National Council of State Boards of Nursing, the number of first-time, U.S. educated nursing school graduates who sat for the NCLEX-RNŽ, the national licensure examination for registered nurses, decreased by 31.3% from 1995-2002. A total of 30,152 fewer students in this category of test takers sat for the exam in 2002 as compared with 1995.www .ncsbn.org
Number of Candidates Taking the NCLEX-RNŽ Exam
First-Time, U.S. Educated Candidates Only
Program 1995 1996 1997 1998 1999 2000 2001 2002
Diploma 7,335 6,346 5,240 3,978 3,161 2,679 2,310 2,223
Baccalaureate 31,195 32,278 31,828 30,142 28,107 26,048 24,832 24,421
Associates 57,908 55,554 52,396 49,045 45,255 42,665 41,567 39,642
Total 96,438 94,178 89,464 83,165 76,523 71,392 68,759 66,286

According to American Hospital Association's June 2001 TrendWatch, 126,000 nurses are needed now to fill vacancies at our nation's hospitals. Today, fully 75% of all hospital vacancies are for nurses. www.aha.org

According to a study by Dr. Peter Buerhaus and colleagues published in the Journal of the American Medical Association on June 14, 2000, the U.S. will experience a 20% shortage in the number of nurses needed in our nation's health care system by the year 2020. This translates into a shortage of more than 400,000 RNs nationwide. http://jama.ama-assn.org
Contributing Factors Impacting the Nursing Shortage

Schools of nursing are reporting a decline in student enrollment which translates into fewer nurses in the educational pipeline.

According to the fall 2002 survey by the American Association of Colleges of Nursing, enrollment in entry-level baccalaureate programs in nursing increased by 8% nationwide since fall 2001. Despite this increase, enrollment is still down by almost 10% or 11,584 students from 1995. On average over the last five years, the number of graduates from entry-level baccalaureate programs in nursing declined by 1,030 each year. The 1998-2002 cohort contains 363 schools that reported data every year for each of t he past five years. www.aacn.nche.edu

A shortage of nursing school faculty is restricting nursing program enrollments.
According to a survey by the American Association of Colleges of Nursing, 2000-2001 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, more than a third (38.8%) of schools who responded pointed to faculty shortages as a reason for not accepting all qualified applicants into entry-level baccalaureate programs. www.aacn.nche.edu


According to a study released by the Southern Regional Board of Education (SREB) in February 2002, a serious shortage of nursing faculty was documented in 16 SREB states and the District of Columbia. Survey findings show that the combination of faculty vacancies (432) and newly budgeted positions (350) points to a 12% shortfall in the number of nurse educators needed. Unfilled faculty positions, resignations, projected retirements, and the shortage of students being prepared for the faculty role pose a threat to the nursing education workforce over the next five years. www.sreb.org


See also our Nursing Faculty Shortage Fact Sheet.
With fewer new nurses entering the profession, the average age of the RN is climbing.
According to the National Sample Survey of Registered Nurses released in February 2002 by the Division of Nursing within the Bureau of Health Professions, the average age of the working registered nurse was 43.3 in March 2000, up from 42.3 in 1996. The RN population under the age of 30 dropped from 25.1% of the nursing population in 1980 to 9.1% in 2000. http://bhpr.hrsa.gov/dn/dn.htm


According to a July 2001 report released by the Government Accounting Office, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), 40% of all RNs will be older than age 50 by the year 2010. www.gao.gov
The total population of registered nurses is growing at the slowest rate in 20 years.

According to the latest The National Sample Survey of Registered Nurses, the total RN population has increased at every 4-year interval in which the survey has been taken since 1980. Although the total RN population increased from 2,558,874 in 1996 to 2,696,540 in 2000, it was the lowest increase (5.4%) reported since the survey began in 1980. Of the total RN population in 2000, an estimated 58.5% work full-time in nursing, 23.2% work part-time, and 18.3% are not employed in nursing. http://bhpr.hrsa.gov/

Changing demographics signal a need for more nurses to care for our aging population.


According to a July 2001 report released by the Government Accounting Office, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), "a serious shortage of nurses is expected in the future as demographic pressures influence both supply and demand. The future demand for nurses is expected to increase dramatically as the baby boomers reach their 60s, 70s, and beyond." www.gao.gov


According to a May 2001 report, Who Will Care for Each of Us?: America's Coming Health Care Crisis, released by the Nursing Institute at the University of Illinois College of Nursing, the ratio of potential caregivers to the people most likely to need care, the elderly population, will decrease by 40% between 2010 and 2030. Demographic changes may limit access to health care unless the number of nurses and other caregivers grows in proportion to the rising elderly population. www.kaisernetwork.org/healthcast/nursing/may01.
Job burnout and dissatisfaction are driving nurses to leave the profession.

According to a study released in the Journal of the American Medical Association in October 2002, nurses reported greater job dissatisfaction and emotional exhaustion when they were responsible for more patients than they can safely care for. Lead researcher Dr. Linda Aiken concluded that "failure to retain nurses contributes to avoidable patient deaths." www.nursing.upenn.edu/news/detail.asp?t=2&id=23


According to a study published by Dr. Linda Aiken and colleagues in the May/June 2001 issue of Health Affairs, more than 40% of nurses working in hospitals reported being dissatisfied with their jobs. The study indicates that 1 out of every 3 hospital nurses under the age of 30 are planning to leave their current job in the next year. www.healthaffairs.org


According to a study commissioned by the Federation of Nurses and Health Professionals in April 2001, The Nurse Shortage: Perspectives from Current Direct Care Nurses and Former Direct Care Nurses, currently 1 out of every 5 nurses currently working is considering leaving the patient care field for reasons other than retirement within the next five years. www.aft.org/fnhp/publications/index.html
High nurse turnover and vacancy rates are affecting access to health care.
According to a February 2002 report on health workforce shortages prepared by First Consulting Group for the American Hospital Association and other trade groups, the average nurse vacancy rate in U.S. hospitals was 13%. Over one in seven hospitals reported a severe RN vacancy rate of more than 20%. High vacancy rates were measured across rural and urban settings and in all regions of the country. Survey respondents indicated that a shortage of personnel is contributing to emergency department overcrowding and ambulance diversions. www.aha.org


According to the report Acute Care Hospital Survey of RN Vacancies and Turnover Rates in 2000 released in January 2002 by the American Organization of Nurse Executives, the average RN turnover rate in acute care hospitals was 21.3%. The average nurse vacancy rate was 10.2% with the highest rates found in critical care units (14.6%) and medical-surgical care (14.1%). Nurse executives surveyed indicated that staffing shortages are contributing to emergency department overcrowding (51%) and the need to close beds (25%). www.aone.org
Impact of Nurse Staffing on Patient Care

Many recent studies point to the connection between adequate levels of registered nurse staffing and safe patient care.

A survey reported in the December 12, 2002 issue of the New England Journal of Medicine found that 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors. Overall, 42% of the public and more than a third of U.S. doctors reported that they or their family members have experienced medical errors in the course of receiving medical care. The survey was conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation. www.kff.org/content/2002/20021211a


According to a study published in the October 23/30, 2002 issue of the Journal of the American Medical Association, more nurses at the bedside could save thousands of patient lives each year. Nurse researchers at the University of Pennsylvania determined that patients who have common surgeries in hospitals with high nurse-to-patient ratios have an up to 31% increased chance of dying. Funded by the National Institute for Nursing Research, the study found that every additional patient in an average hospital nurse's workload increased the risk of death in surgical patients by 7%. Having too few nurses may actually cost more money given the high costs of replacing burnt-out nurses and caring for patients with poor outcomes. www.nursing.upenn.edu/news/detail.asp?t=2&id=23


In Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis, a report released in August 2002 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the authors found that a shortage of nurses in America's hospitals is putting patient lives in danger. JCAHO examined 1609 hospital reports of patient deaths and injuries since 1996 and found that low nursing staff levels were a contributing factor in 24% of the cases. www.jcaho.org


According to a study published in the New England Journal of Medicine in May 2002, a higher proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are associated with better outcomes for hospitalized patients. This extensive study was conducted by Drs. Jack Needleman and Peter Buerhaus. http://content.nejm.org/cgi/content/abstract/346/22/1715
Strategies to Address the Nursing Shortage
The Call to the Profession is a group of top leaders from national nursing organizations who are working together to ensure safe, quality nursing care for consumers and a sufficient supply of registered nurses to deliver that care. The group released an action plan called Nursing's Agenda for the Future in April 2002. www.ana.org


The TriCouncil for Nursing, an alliance of four autonomous nursing organizations (AACN, ANA, AONE, NLN) each focused on leadership for education, practice and research, issued a joint policy statement in January 2001 on Strategies to Reverse the New Nursing Shortage. www.aacn.nche.edu/Publications/positions/tricshortage.htm


The Nurse Reinvestment Act was signed by the President on August 1, 2002 and has been sent back to Congress for appropriations. Provisions of this new law include scholarship money to attract new students into nursing, a Faculty Loan Cancellation Program to remove financial barriers to faculty careers, funding to promote best practices in nursing care, and public service announcements to champion nursing careers. All stakeholders are encouraged to contact their federal legislators and indicate support for funding this legislation. www.aacn.nche.edu/Media/shortageresource.htm#legislation


In April 2001, a coalition of 23 national nursing organizations issued a joint call to Congress to stem the nursing shortage. The group released a comprehensive plan to address the shortage entitled Assuring Quality Health Care for the United States: Supporting Nurse Education and Training that outlined funding priorities and called for new initiatives to recruit and retain nurses. www.aacn.nche.edu/Media/NewsReleases/consensus.pdf


Two national media campaigns have been launched to help polish the image of nursing. Nurses for A Healthier Tomorrow is a coalition of 40 nursing and health care organizations working together to raise interest in nursing careers among middle and high school students. The coalition has conducted nationwide focus groups with students ages 6-15 years; secured over $600,000 in sponsorship; launched a Web site; created a televised public service announcement, and designed print ads that can be downloaded for free from the Web. In February 2002, Johnson & Johnson launched the Campaign for Nursing's Future, a multimedia initiative to promote careers in nursing that includes paid television commercials, a recruitment video, a Web site, and brochures mailed to schools across the country. www.nursesource.org and www.discovernursing.com
The American Association of Colleges of Nursing is the national voice for university and four-year-college education programs in nursing. Representing 570 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.