Cause for Optimism
Cause for Optimism  | Peter Buerhaus, Nursing Workforce Shortage, Registered Nurses, David Auerbach, Doug Staiger

Dr. Peter Buerhaus
 New Nursing Study Improves Workforce Outlook

A perfect storm of increased patient need and decreased supply in the nursing workforce has loomed over the healthcare delivery system like a dark, ominous cloud. A new study, however, considerably clears away the gloom of the past decade and offers a ray of optimism, as significantly more young people are choosing nursing as a career.

The study, released in the December 2011 issue of Health Affairs, finds a 62 percent increase in the number of young professionals, aged 23-26, who became registered nurses between the years 2002 and 2009. This type of growth hasn’t been seen since the 1970s, according to the research team of David Auerbach, PhD, RAND Corporation health economist; Doug Staiger, PhD, an economics professor at Dartmouth College; and Peter Buerhaus, PhD, RN, Vanderbilt University School of Nursing.

The investigators have published numerous articles based on their nursing workforce research in both Health Affairs and the Journal of the American Medical Association over the years and were among the first to sound the alarm when it became apparent that the nation’s nursing workforce would not be able to meet the rising demands of an aging population.

“It’s been pretty bleak for a long, long time … then a little better … and now something very positive,” Buerhaus said of the situation. Rather than a steady decline, as was previously projected, the new numbers indicate the nursing workforce will grow at roughly the same rate as the population through 2030.

Director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center and the Valere Potter Professor of Nursing, Buerhaus said he and his colleagues first noticed the potentially positive trend almost four years ago while analyzing data from the Census Bureau’s Current Population Survey. However, that data used by the federal government to gauge unemployment trends, includes only a very small sampling of nurses. The small numbers made it difficult to say with certainty whether or not the observed gains in nursing were real or an anomaly.

Recently, however, the federal government released data from the American Community Survey with characteristics … including age … of more than 30,000 nurses. This much larger, more complete data set affirmed the gains seen in the Current Population Survey.

“Two different data sources are showing this trend,” noted Buerhaus. “We see the same information but now with large enough numbers that we could perform the appropriate statistical tests that would verify this is a true trend.”

A Little Background

As the baby boom generation came of age, the population segment produced a large number of young professionals entering nursing. Buerhaus said the ranks of registered nurses between the ages of 23 and 26 swelled by 160,000 for several years running.

However, as the boomers gave way to generation X and then Y, the numbers dropped significantly. In addition to being much smaller in size, there were many more career options for women in these later generations. By the mid-1990s, only about 50,000-60,000 young nurses were entering the workforce annually.

“Why that was so alarming,” explained Buerhaus, “was because if these trends continued, all the baby boomer nurses would retire, and they wouldn’t be replaced.”

In 2000, Buerhaus, Auerbach and Staiger published their findings in the Journal of the American Medical Association. Soon, the story garnered worldwide attention. “If nothing changed, we predicted the shortage of nurses by the year 2020 would be 400,000, which is four times larger than any shortage ever in our country … and it would bring the healthcare system to a standstill.”

Congress then commissioned a study of its own study to assess the situation. While the workforce numbers came back almost identical, according to Buerhaus, the Congressional study provided new estimates on the demand side. The result was that federal officials doubled the prediction to a shortage of 800,000 nurses within 20 years.

“We haven’t found a good substitute for nurses. Nurses are pretty unique, and they are hard to replace,” Buerhaus pointed out. “We were facing mindboggling shortages without a good solution.”

Turning the Tide

The silver lining in the nursing shortage situation was that everyone took the news seriously. “It’s a pretty neat example of a social problem, that when made public, a lot of people picked up on it,” Buerhaus said.

He noted Congress began to increase funding for nurse education and introduced new loan forgiveness programs. Nursing schools expanded offerings and partnered with community colleges to make it more affordable to turn a two-year nursing degree into a bachelor’s or master’s degree. A weak economy also highlighted the relative stability of the nursing profession. During the recession of 2001, healthcare continued hiring, making nursing an attractive option for undergrads considering career choices.

However, Buerhaus opined, “The biggest of all these factors was the development of the Johnson & Johnson Campaign for Nursing’s Future. That campaign started in 2002. They’ve spent about $56 million … it’s still going … on a message that really encouraged people to consider nursing as a profession.”

Buerhaus, who readily disclosed he receives funding from Johnson & Johnson, said the company’s investment in the campaign opened the doors for other corporations and foundations to follow suit. The attention has spotlighted the breadth of opportunities available to today’s nurses and highlighted the fact that surveys consistently show nearly 85 percent of nurses report being ‘very satisfied’ with their career choice.

Crisis Averted?

Does the new research mean that the workforce shortage has been completely averted? Buerhaus said the answer is a little more complicated than a simple ‘yes’ or ‘no.’

On the plus side, not only is the nurse workforce growing, but the profession is adding about 150,000 nurses in the coveted 23- to 26-year old age bracket annually. Those numbers rival what was happening in the 1970s. “We thought we would probably never, ever see the number of young people coming into the nursing profession at those levels again,” said Buerhaus.

Although the growth rate is exciting, it is still unknown if the supply will be enough to keep up with demand. “There are a lot of factors that are going to be driving the demand for healthcare up,” Buerhaus pointed out. “The government has traditionally provided the estimates for the demand for future nurses,” he continued. “But they no longer do that. The last estimates were from 2004, which are not very helpful now, so we’re flying blind.” 

What is known is that the number of people with chronic conditions is rising; an additional 32 million consumers are expected to gain healthcare coverage under current reform law beginning in 2014; and the population is aging.

“It is great to have the quantity, but if we don’t educate nurses for the positions that the healthcare delivery system requires, then this is a problem that needs to be addressed,” Buerhaus stated.

Clearly pleased but still vigilant, Buerhaus concluded, “We’ve got to keep this production of young people going into nursing. We’ve got to sustain it … at least until we have some better estimates of demand.”