Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000. I set out to debunk a number of popular myths surrounding the current nurse shortage at a recent meeting convened in Washington, D.C. on the future of nursing. The September 20-21 meeting was sponsored by Health Affairs, the Robert Wood Johnson Foundation, and the John A. Hartford Foundation.
• Myth: We can continue to “muddle through” present and future nurse shortages without serious consequences. The lack of nurses has substantial impacts on emergency preparedness, quality of care, patient safety [2-week free access], access to needed health care services (especially for vulnerable populations), and economic growth.
• Myth: Not enough Americans want to be nurses. Tens of thousands of qualified nursing school applicants were turned away last year because U.S. nursing schools lacked educational capacity, particularly with respect to faculty.
• Myth: The U.S. nurse shortage can be solved by opening our borders to nurses from other countries. The U.S. long-term nurse shortage is too large to be solved through immigration [2-week free access]. The nurse shortage isn’t confined to the U.S. — it’s global. Extracting nurses from other countries would simply bankrupt the international supply of nurses, affecting global health.
• Myth: The U.S. nurse shortage can be solved by substituting unskilled labor. Research shows that substituting licensed practical nurses or aides for registered nurses in hospitals results in much higher mortality rates and worse patient outcomes.
• Myth: Expanding roles and demands for nurses will be constrained by opposition from practicing physicians. Because of factors such as the changing demography of the physician workforce, regulation of hours, and increasing demand for services, doctors need nurses to be able to “work upstream” in the medical division of labor.
• Myth: Care will increasingly shift to out-of-hospital settings, reducing the demand for nurses. Although inpatient days have fallen dramatically in the past 20 years, inpatient acuity has increased — meaning that more intensive services are needed within a shorter hospital stay. In addition, demand for nurses in nonhospital settings is growing rapidly because of the rising burden of chronic illnesses.
• Myth: We don’t know how to solve the nurse shortage. The solutions are out there. More and smarter federal investment in nurse education is needed. Hospitals and other nurse employers also need to support the education of new nurses. In addition, they need to increase nurse efficiency, so that nurses are actually doing nursing, and take steps to reduce high levels of burnout among nurses. The education community needs to create more innovative and efficient educational pathways to BSN and graduate nursing education, and needs to provide more incentives for faculty recruitment. Finally, payers need to recognize the impact of nursing care on ensuring health care quality and safety — and pay for it.