December 6th, 2011
The number of young people entering the nursing profession is surging, providing relief from the recent nursing shortage, according to an article in the December Health Affairs, released yesterday. Aggressive efforts to make nursing a more attractive career choice have helped spur a 62 percent increase in the number of younger nurses (ages 23–26) entering the field between 2002 and 2009. As a result, rather than declining as previously projected, the registered nurse workforce is now expected to grow at roughly the same rate as the population through 2030.
“This is a very welcome and surprising development,” says lead author David Auerbach, a health economist at RAND Health. “Instead of worrying about a decline, we are now growing the supply of nurses.” Auerbach and his colleagues say the trend of many more young people entering the field of nursing isn’t guaranteed to persist into the future, but it will have to continue if the United States is to have an adequate nursing supply in the future.
In addition, a separate study reported in the December Health Affairs, by Christine Kovner of New York University and colleagues at that institution and the State University of New York, examined the low “mobility” of new RNs after they complete their training. A survey of newly licensed RNs in fifteen states found that more than half (52.5 percent) work within forty miles of where they attended high school. The results raise concerns about maintaining an adequate distribution of nurses around the country.
You can hear Health Affairs editor-in-chief Susan Dentzer discuss the new research in an interview on WTOP radio.
Surge in New RNs
In their study, Auerbach—along with coauthors Peter Buerhaus of Vanderbilt University and Douglas Staiger of Dartmouth—investigated recent employment trends in the number and age of RNs. They drew on more than thirty-five years of annual survey data from two Census Bureau surveys, the Current Population Survey and the American Community Survey. The use of data from the second survey provided a broader picture because it offers researchers large samples of RNs, enables them to analyze trends in the number of young RNs, and permits projections in the future age and supply of RNs per capita through 2030.
A Historic Growth Rate
According to the authors’ analysis, there were approximately 165,000 full-time equivalent RNs ages 23–26 in the workforce in 2009, up significantly from a low of 102,000 in 2002. Since 2002, the number of young RNs has grown at a rate not seen since the 1970s. If these nurses remain in the profession until they reach middle age, this could be the largest cohort of young nurses ever to enter the field, far surpassing those born in the 1950s, says the article.
The change appears to have reserved the trend seen ten years ago, when there was a dramatic drop in the number of women ages 23–26 becoming RNs. Instead, they migrated to other careers. In fact, between 1983 and 1998, the proportion of the RN workforce under age thirty dropped by more than half, from 30 percent to 12 percent. At the same time, the average age of working RNs increased from 37.4 to nearly 42 years. Experts warned that without a reversal of these trends, the country would face a serious shortfall of nurses because large numbers of RNs would soon retire without being replaced by younger nurses.
Improving Nursing’s Image
There are several reasons for the sharp turnaround since then. Young people have been drawn to nursing thanks to aggressive national recruitment campaigns, such as one launched by Johnson & Johnson in 2002. “This campaign was very effective. It really changed the momentum and provided a positive image of nursing and information on the opportunities that the profession offers,” says Buerhaus.
In addition, more people are now becoming nurses somewhat later in their careers (in their late twenties or early thirties). This trend is spurred by the offering of two-year associate degrees and accelerated nursing degrees aimed at those in other fields. These efforts had a much larger impact than anticipated. The recession and the decline in manufacturing jobs have also triggered a new interest in nursing since health care is one of a handful of industries that is continuing to grow and add workers. Federal support for nursing workforce development also helped, rising threefold, from $80 million in 2001 to $240 million in 2010. Although federal support and state workforce development efforts have been expanding, it isn’t clear whether those will continue or how key they will be to sustaining enrollment growth, according to Auerbach and Buerhaus.
Another key issue is whether the nursing workforce will be suited for population needs. Two recent reports from the Institute of Medicine noted a strong need for RNs who are trained in geriatrics and who can work in ambulatory settings, where most patients receive care. “It is great to have the quantity, but if we don’t educate nurses for the positions that the health care delivery system requires, then this is a problem that needs to be addressed,” says Buerhaus.
Addressing Low Mobility
One way to address long-term nursing supply issues would be to focus on the low mobility of new RNs, according to the study by Kovner and colleagues. They write that, next to teaching, nursing is one of the least mobile professions for women and also draws from a relatively local labor force.
To make sure that underserved areas have an adequate RN workforce, the authors say policy makers should:
- Expand the number of educational programs in underserved areas, which could take the form of off-campus “registered nurse to bachelor’s degree in nursing” programs or increased use of distance learning;
- Target educational support such as scholarships and loan forgiveness programs to local students, so they have incentives to pursue nursing education and will commit to serving local populations;
- Urge state and university leaders to review admission policies for nursing programs and the financial aid they offer, possibly giving preference to in-state applicants; and
- Fund programs and policies such as the National Health Services Corps that offer financial incentives to attract RNs to underserved areas and offset the low mobility of new RNs.