NURSING US INTO THE FUTURE
The nursing profession faces another shortage in the 21st century that promises to be more complex.
Written by Alexia Green
The nursing profession has a long history of cyclic shortages, which have been documented since World War II. The acute shortage impacting the nation during the late 1990s and the early 2000s is a direct result of the struggle to implement managed care as a means of controlling the escalating cost of health care. As we move further into the 21st century, the profession faces another shortage, one that promises to be more complex, long lasting, and will dwarf all shortages to date.
While the U.S. nursing population is aging and more nurses are moving into primary care settings, a multitude of aging baby boomers is resulting in an increasing demand for quality health care. As a result, there is a need for more nurses, especially those who deliver specialized care. Professional nursing is the largest U.S. health care occupation and according to the Bureau of Labor Statistics, employment opportunities for professional nurses will grow more rapidly than all other U.S. occupations through 2008.
Planning for an adequate work force will be one of the most critical challenges of the new century. A closer look at several variables provides insight into the complexity of the shortage and the need for an array of actions.
One factor in the aging of the nursing work force is that younger birth cohorts, those born after 1955, are smaller in population size as well as significantly less likely to choose nursing as a career. According to the American Association of Colleges of Nursing, national nursing school enrollments have dropped by 20.9 percent over the past five years. One explanation for this trend is that students have other options as many are seeking opportunities in technology or management, leaving traditional service-based jobs like teaching and nursing unfilled.
Texas is unique in that it has not seen the significant decline in applicants as other states have. In fact, Texas schools of nursing turned away 3,000 qualified applicants in 2000, primarily related to a lack of funded faculty positions and a shortage of faculty.
One of the most critical problems facing nursing and nursing work force planning is the aging of nursing faculty. In 1999, the median age of nursing faculty in Texas was 51, while only 7.3 percent of nursing faculty were younger than 40. Almost 57 percent of the Texas nurse faculty work force will retire in the next 15 years. Both the aging of nursing faculty and overall flat enrollment in doctoral programs that produce nurse educators has impacted the capacity of nursing schools to educate sufficient numbers of registered nurses to meet the future demand.
The nation, and Texas in particular, has a long history of insufficient numbers of registered nurses to work in the long-term care setting. According to a recent report by the Institute of Medicine, a serious shortage exists in the long-term care work force. The aging of the U.S. population and the projected growth of the oldest age bracket (85 years and older) will have a major effect on the demand for and supply of long-term care nursing services. The Institute of Medicine further reports that the population aged 85 years and older is the fastest growing group among the elderly population (65 years and older). Most of the increase in demand for long-term care services is expected to occur when the baby boom generation enters the elderly ages. The first of this generation will reach age 65 in 2011 and the last will do so around 2030. Unfortunately, only 10 percent of the nursing work force is younger than 30, while more than 60 percent of current nurses are older than 40 and will retire and become elderly themselves over this same time frame.
The evolving nursing shortage has significant implications for all of us - nurses, patients, health care providers, educators and the public. The Texas Tech School of Nursing has put into place several strategic initiatives to begin addressing this critical need. The school is actively recruiting qualified faculty, while creating innovative development activities for current faculty in an attempt to expand the expertise in teaching and research related to the aging. And the undergraduate and graduate curriculums have been redesigned to address the needs of graduates in a rapidly changing health care environment. The School of Nursing is working with community leaders to identify specific strategies to address the shortage in West Texas. Efforts are under way to identify additional resources to increase student scholarships and to support recruitment and retention of nursing faculty.
When it comes to recruiting and encouraging young people into nursing as an attractive profession, support from policy makers, the public and the health care community is critical. We need to increase the number of faculty and students in nursing, but more importantly, we need to prepare a nursing workforce with the right educational mix to be prepared for a health care environment that has grown increasingly complex. Alexia Green, Ph.D., is dean of the Texas Tech School of Nursing and is president of the Texas Nurses Association.
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