Why Is There a Nursing Shortage?

By Kristen Hamlin, Contributor and Writer for NurseJournal
Twitter: @nursejournal

The U.S. faces a nursing shortage due to an aging population and retiring nurses, creating abundant opportunities for nurses nationwide.

The need for nurses aligns with all-time highs in increased demand for healthcare. The American Nurses Association estimates that more than a million new nurses need to join the workforce over the next few years to prevent a critical nursing shortage.

As the nursing shortage in the United States intensifies, there will be an unprecedented number of opportunities at the forefront of the changing healthcare landscape. If you have ever considered becoming a nurse or are currently working in healthcare and want to advance your career, it’s an ideal time to start on that path.

The U.S. Bureau of Labor Statistics (BLS) lists nursing as one of the top fields for job growth from 2021-2031, projecting a 6% increase in nurse employment. Retiring nurses are projected to leave more than 203,000 job openings per year in the same period.

The COVID-19 pandemic has highlighted the effects of the nursing shortage and hurt the nursing workforce. At the height of the pandemic, nurse-to-patient ratios skyrocketed to as high as 1-to-4 due to staff shortages. This caused high levels of stress and burnout, increasing turnover and open positions in hospitals nationwide.

Even as the pandemic wanes, the impact of the nursing shortage remains. Higher staffing levels are associated with better patient outcomes, shorter hospital stays, and reduced mortality rates. Strong staff figures also reduce nurse stress and burnout. Nurses are at the frontlines of our healthcare system, and we must address the shortage soon to prevent a full-blown crisis.

What Are the Main Factors Contributing to the Nursing Shortage?

Several factors have contributed to the lack of qualified staff, including:

• Rising demand to provide care for an aging population
• Older nursing workforce approaching retirement
• Shortage of trained nurse educators and faculty
• High turnover rate

An Aging Population
As Americans age, demand for healthcare continues to increase at an unprecedented rate. The U.S. Census Bureau reports that by 2030, the entire baby-boom generation — 73 million people — will be age 65 or older. These older adults require more health services as people are living longer than ever before.

The Centers for Disease Control and Prevention also reports that 19% of people over age 55 have three or more chronic conditions. Caring for these conditions puts additional strain on healthcare resources.

Not all regions are equally affected by an aging population. Areas with older-than-average individuals, like Florida and Maine, will see more age-related healthcare demand than younger states.

An Aging Workforce
An aging population also means that the average age of nurses is also increasing. The median RN age is 52 years old, with 19% of RNs aged 65 or older. Within the next decade, many of these nurses will retire, leaving vacancies.

Faculty Shortages
Maintaining a steady supply of new nurses to fill open positions requires resources for training and education. However, even with nursing school applications reaching record levels, programs had to turn away more than 91,000 qualified applicants in 2021 due to a lack of nurse educators, clinical space, classroom space, and clinical preceptors.

The shortage of qualified educators is attributed to a wave of faculty retirements. Competition for faculty from clinical and private sector employers, which may offer better pay and working conditions, also draws qualified educators away from traditional nursing programs. And since master’s and doctoral programs are not producing qualified educators quickly enough to replace those leaving the field, the educator shortage is only expected to increase.

Nurse Turnover
Stress and burnout among nurses is a serious issue. A 2022 survey from Forbes reported that COVID-19 only worsened an already serious problem, estimating that 47% of healthcare workers left or are considering leaving the profession.

Research from McKinsey & Company reveals that staffing levels, demanding work, and the emotional toll of nursing contribute to a nurse’s decision to leave the field. With the nursing shortage leading to higher patient ratios, many nurses feel they simply cannot keep up with the demands of the work. This only worsens the crisis, leaving the remaining nurses with more patients as vacancies go unfilled.

Which States Have the Largest Nursing Shortage?

The nursing shortage does not affect the entire United States equally. The Health Resources and Services Administration (HRSA) calculates demand for nurses based on the number of full-time RNs necessary to provide the level of care consistent with what was provided in 2014. Using that methodology, some states, like Florida, Ohio, and Virginia, are projected to have a surplus of nurses by 2030.

However, many states will not have enough nurses to meet demand. States with the largest projected nursing shortage in 2035 include Washington, California, Georgia, Oregon, Michigan, Idaho, Louisiana, Texas, New Jersey, South Carolina, and North Carolina. Looking at the demand for nurses as calculated by the number of nurses per 1,000 people, Nevada joins the list of states with a shortage. Other areas, primarily the southern and western regions, are also in need of more qualified healthcare professionals.

How Are We Addressing the Nursing Shortage?

Reversing the nursing shortage requires schools and healthcare providers to recruit new nurses and support working conditions that reduce turnover. With this goal in mind, federal and state governments, as well as career and health advocacy organizations, have developed programs to attract and retain nurses.

• The CARES Act provides additional funding and support for underserved areas. Nurses working in areas with critical shortages identified by the HRSA qualify for training and educational financial aid.
• The Nursing Education Loan Repayment Program repays up to 85% of educational loans for nurses who work in qualifying facilities in areas with critical nursing shortages.
• Many states offer incentive programs for qualifying nurses, including loan repayment programs, scholarships, and tax credits.
• Nursing schools continue to develop partnerships with public and private agencies to increase student capacity.
• Public relations campaigns continue to promote careers in nursing.
• Facilities are adopting improved staffing policies, higher wages, and other initiatives designed to improve working conditions. For example, some hospitals seek the American Nurses
• Credentialing Center’s magnet recognition, which supports excellence in nursing and policies for improved patient care and safety.

Is Now a Good Time to Become a Nurse?

If you have been considering a career in nursing, now is an excellent time to join the field. The BLS projects a 6% increase in demand for RNs, and a 40% increase in demand for advanced practice RNs (APRNs).

This increased demand for qualified healthcare providers demonstrates the availability of opportunities, especially in states and regions where demand is even greater. Nurses with bachelor’s degrees or higher will have the most opportunities, especially as facilities focus on achieving magnet status and the need for APRNs grows.

This article was originally published on the NurseJournal Blog and is republished here with permission.