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Go back to SSA PROGRAM
CONTACT:
Robert J. Rosseter, (202) 463-6930, x231
rrossete@aacn.nche.edu
Nursing Shortage Fact Sheet
The United States is in the midst of a nursing shortage that is expected to intensify as baby
boomers age and the need for health care grows. Compounding the problem is the fact that
nursing colleges and universities across the country are struggling to expand enrollment levels
to meet the rising demand for nursing care.
The American Association of Colleges of Nursing (AACN) is concerned about the nursing
shortage and is working with schools, policy makers, kindred organizations, and the media to
bring attention to this health care crisis. AACN is working to enact legislation, identify
strategies, and form collaborations to address the nursing shortage. To keep stakeholders
abreast of current statistics related to the shortage, this fact sheet has been developed along with
a companion Web resource:
www.aacn.nche.edu/Media/shortageresource.htm.
Current and Projected Shortage Indicators
According to the latest projections from the U.S. Bureau of Labor Statistics published in the
February 2004 Monthly Labor Review, more than one million new and replacement nurses
will be needed by 2012. For the first time, the U.S. Department of Labor has identified
Registered Nursing as the top occupation in terms of job growth through the year 2012.
www.bls.gov/news.release/ecopro.toc.htm
According to a July 2002 report by the Health Resources and Services Administration, 30
states were estimated to have shortages of registered nurses (RNs) in the year 2000. The
shortage is projected to intensify over the next two decades with 44 states plus the District
of Columbia expected to have RN shortages by the year 2020. The report, Projected
Supply, Demand, and Shortages of Registered Nurses: 2000-2020, is available online at
http://bhpr.hrsa.gov/healthworkforce/reports/rnproject/default.htm
According to the National Council of State Boards of Nursing, the number of first-time,
U.S. educated nursing school graduates who sat for the NCLEX-RNR, the national
licensure examination for registered nurses, decreased by 10% from 1995-2004. A total of
9,353 fewer students in this category of test takers sat for the exam in 2004 as compared with 1995.
www.ncsbn.org
Number of Candidates Taking the NCLEX-RNR Exam
First-Time, U.S. Educated Candidates Only |
| Program | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 |
| Diploma | 7,335 | 6,346 | 5,240 | 3,978 | 3,161 | 2,679 | 2,310 | 2,424 | 2,565 | 3,162 |
| Baccalaureate | 31,195 | 32,278 | 31,828 | 30,142 | 28,107 | 26,048 | 24,832 | 25,806 | 26,630 | 30,648 |
| Associates | 57,908 | 55,554 | 52,396 | 49,045 | 45,255 | 42,665 | 41,567 | 42,310 | 47,423 | 53,275 |
| Total | 96,438 | 94,178 | 89,464 | 83,165 | 76,523 | 71,392 | 68,709 | 70,540 | 76,618 | 87,085 |
In March 2005, the Bernard Hodes Group released the results of a national poll of 138 health care
recruiters to determine turnover rates, cost-per-hire and vacancy rates for a range of health care
professionals, including registered nurses. The survey found that the average RN turnover rate was
13.9%, the vacancy rate was 16.1% and the average RN cost-per-hire was $2,821.
www.hodes.com
According to a report published in November 2004 as a Web exclusive of Health Affairs, Dr. Peter
Buerhaus and colleges found that "despite the increase in employment of nearly 185,000 hospital RNs
since 2001, there is no empirical evidence that the nursing shortage has ended. To the contrary,
national surveys of RNs and physicians conducted in 2004 found that a clear majority of RNs (82%)
and doctors (81%) perceived shortages where they worked."
http://www.healthaffairs.org
According to American Hospital Association's June 2001 TrendWatch, 126,000 nurses are needed
now to fill vacancies at our nation's hospitals. Today, fully 75% of all hospital vacancies are for nurses.
www.aha.org
Contributing Factors Impacting the Nursing Shortage
Enrollment in schools of nursing is not growing fast enough to meet the projected demand for
nurses over the next ten years.
Though AACN reported a 14.1% enrollment increase in entry-level baccalaureate programs in nursing in
2004 over the previous year, this increase is not sufficient to meet the projected demand for nurses. In a
report published in the November/December 2003 issue of Health Affairs, Dr. Peter Buerhaus and his
colleagues found that "because the number of young RNs has decreased so dramatically over the past two
decades, enrollments of young people in nursing programs would have to increase at least 40 percent
annually to replace those expected to leave the workforce through retirement."
www.healthaffairs.org
A shortage of nursing school faculty is restricting nursing program enrollments.
According to AACN's report on 2004-2005 Enrollment and Graduations in Baccalaureate and
Graduate Programs in Nursing, U.S. nursing schools turned away 32,797 qualified applicants from
baccalaureate and graduate nursing programs in 2004 due to insufficient number of faculty, clinical
sites, classroom space, clinical preceptors, and budget constraints. Three quarters (76.1%) of the
nursing schools responding to the 2004 survey pointed to faculty shortages as a reason for not
accepting all qualified applicants into nursing programs.
www.aacn.nche.edu/IDS
According to a study released by the Southern Regional Board of Education (SREB) in February
2002, a serious shortage of nursing faculty was documented in 16 SREB states and the District of
Columbia. Survey findings show that the combination of faculty vacancies (432) and newly budgeted
positions (350) points to a 12% shortfall in the number of nurse educators needed. Unfilled faculty
positions, resignations, projected retirements, and the shortage of students being prepared for the
faculty role pose a threat to the nursing education workforce over the next five years.
www.sreb.org
With fewer new nurses entering the profession, the average age of the RN is climbing.
According to the National Sample Survey of Registered Nurses released in February 2002 by the
Division of Nursing within the Bureau of Health Professions, the average age of the working
registered nurse was 43.3 in March 2000, up from 42.3 in 1996. The RN population under the age of
30 dropped from 25.1% of the nursing population in 1980 to 9.1% in 2000.
http://bhpr.hrsa.gov/healthworkforce/reports/rnsurvey
According to a July 2001 report released by the Government Accounting Office, Nursing Workforce:
Emerging Nurse Shortages Due to Multiple Factors (GAO-01-944), 40% of all RNs will be older than
age 50 by the year 2010.
www.gao.gov
The total population of registered nurses is growing at the slowest rate in 20 years.
According to the latest The National Sample Survey of Registered Nurses, the total RN population has
increased at every 4-year interval in which the survey has been taken since 1980. Although the total RN
population increased from 2,558,874 in 1996 to 2,696,540 in 2000, it was the lowest increase (5.4%)
reported since the survey began in 1980. Of the total RN population in 2000, an estimated 58.5% work
full-time in nursing, 23.2% work part-time, and 18.3% are not employed in nursing.
http://bhpr.hrsa.gov/healthworkforce/reports/rnsurvey
Changing demographics signal a need for more nurses to care for our aging population.
According to the July 2001 report, Nursing Workforce: Emerging Nurse Shortages Due to Multiple
Factors (GAO-01-944), "a serious shortage of nurses is expected in the future as demographic
pressures influence both supply and demand. The future demand for nurses is expected to increase
dramatically as the baby boomers reach their 60s, 70s, and beyond."
www.gao.gov
According to a May 2001 report, Who Will Care for Each of Us?: America's Coming Health Care
Crisis, released by the Nursing Institute at the University of Illinois College of Nursing, the ratio of
potential caregivers to the people most likely to need care, the elderly population, will decrease by
40% between 2010 and 2030. Demographic changes may limit access to health care unless the
number of nurses and other caregivers grows in proportion to the rising elderly population.
www.kaisernetwork.org/healthcast/nursing/may01
Job burnout and dissatisfaction are driving nurses to leave the profession.
In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that
more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their
work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking
forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on
nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%).
www.ajj.com/services/pblshng/nej/nejmain.htm
According to a study in the October 2002 Journal of the American Medical Association, nurses
reported greater job dissatisfaction and emotional exhaustion when they were responsible for more
patients than they can safely care for. Researcher Dr. Linda Aiken concluded that "failure to retain
nurses contributes to avoidable patient deaths."
www.nursing.upenn.edu/news/detail.asp?t=2&id=23
According to a study published by Dr. Linda Aiken and colleagues in the May/June 2001 issue of
Health Affairs, more than 40% of nurses working in hospitals reported being dissatisfied with their
jobs. The study indicates that 1 out of every 3 hospital nurses under the age of 30 are planning to
leave their current job in the next year.
www.healthaffairs.org
High nurse turnover and vacancy rates are affecting access to health care.
In December 2004, hospital CEOs identified "Personnel Shortages" as their leading concern
according to the American College of Healthcare Executives' survey on the Top Issues Confronting
Hospitals: 2004. Among all personnel shortages, 87% of hospital executives cited the shortage of
registered nurses as their top staffing concern.
www.ache.org/PUBS/Research/ceoissues.cfm
The American College of Healthcare Executives reported in October 2004 that 72% of hospital CEOs
were experiencing a nursing shortage at their facilities. The American Society for Healthcare Human
Resources Administration reported that though the time to fill registered nurse vacancies at small to
medium facilities decreased by 18% in 2003, the average time to fill RN vacancies increased from 60
to 61 days this year.
http://www.ache.org and http://www.ashhra.org
According to a February 2002 report on health workforce shortages prepared by First Consulting
Group for the American Hospital Association and other trade groups, the average nurse vacancy rate
in U.S. hospitals was 13%. Over one in seven hospitals reported a severe RN vacancy rate of more
than 20%. High vacancy rates were measured across rural and urban settings and in all regions of the
country. Survey respondents indicated that a shortage of personnel is contributing to emergency
department overcrowding and ambulance diversions.
www.aha.org
According to the report Acute Care Hospital Survey of RN Vacancies and Turnover Rates in 2000
released in January 2002 by the American Organization of Nurse Executives, the average RN
turnover rate in acute care hospitals was 21.3%. The average nurse vacancy rate was 10.2% with the
highest rates found in critical care units (14.6%) and medical-surgical care (14.1%). Nurse executives
surveyed indicated that staffing shortages are contributing to emergency department overcrowding
(51%) and the need to close beds (25%).
www.aone.org
Impact of Nurse Staffing on Patient Care
Many recent studies point to the connection between adequate levels of registered nurse
staffing and safe patient care.
In November 2004, results from the National Survey on Consumers' Experiences with Patient Safety
and Quality Information were released and found that 40% of Americans think the quality of health
care has worsened in the last five years. Consumers reported that the most important issues affecting
medical error rates are workload, stress or fatigue among health professionals (74%); too little time
spent with patients (70%); and too few nurses (69%). This survey was sponsored by the Kaiser
Family Foundation, the Agency for Healthcare Research and Quality and the Harvard School of Public Health.
www.kff.org/kaiserpolls/pomr111704pkg.cfm
In March 2004, the Agency for Healthcare Research and Quality (AHRQ) issued a synthesis of
nursing research studies that details the impact that staffing levels, staff mix, and education levels
have on patient outcomes. The report, titled Research in Action: Hospital Nurse Staffing and
Availability of Care, cited studies showing that hospitals with lower nurse staffing levels and fewer
registered nurses compared with licensed practical nurses or nurses' aides tend to have higher rates of
poor patient outcomes.
www.ahrq.gov/research/nursestaffing/nursestaff.htm
A shortage of nurses prepared at the baccalaureate level may be affecting health care quality and
patient outcomes. In a study published in the September 24, 2003 issue of the Journal of the
American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of
Pennsylvania identified a clear link between higher levels of nursing education and better patient
outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if
treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree
level. In hospitals, a 10 percent increase in the proportion of nurses holding BSN degrees decreased
the risk of patient death and failure to rescue by 5 percent.
http://jama.ama-assn.org
A survey reported in the December 12, 2002 issue of the New England Journal of Medicine found that
53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical
errors. Overall, 42% of the public and more than a third of U.S. doctors reported that they or their
family members have experienced medical errors in the course of receiving medical care.
http://content.nejm.org
According to a study published in the October 23/30, 2002 issue of the Journal of the American
Medical Association, more nurses at the bedside could save thousands of patient lives each year.
Nurse researchers at the University of Pennsylvania determined that patients who have common
surgeries in hospitals with high nurse-to-patient ratios have an up to 31% increased chance of dying.
Funded by the National Institute for Nursing Research, the study found that every additional patient in
an average hospital nurse's workload increased the risk of death in surgical patients by 7%. Having
too few nurses may actually cost more money given the high costs of replacing burnt-out nurses and
caring for patients with poor outcomes.
www.nursing.upenn.edu/news/detail.asp?t=2&id=23
In Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis, a report
released in August 2002 by the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), the authors found that a shortage of nurses in America's hospitals is putting patient lives in
danger. JCAHO examined 1609 hospital reports of patient deaths and injuries since 1996 and found
that low nursing staff levels were a contributing factor in 24% of the cases.
www.jcaho.org
According to a study published in the New England Journal of Medicine in May 2002, a higher
proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are
associated with better outcomes for hospitalized patients. This extensive study was conducted by Drs.
Jack Needleman and Peter Buerhaus.
http://content.nejm.org
Strategies to Address the Nursing Shortage
In July 2005, Reps. Nita Lowey (D-NY), Peter King (R-NY), and Lois Capps (D-CA), introduced the
Nurse Education, Expansion and Development (NEED) Act (H.R. 3569) to assist schools of nursing
in increasing the number of students and faculty. The bill calls for capitation grants for schools to hire
new and retain current faculty, purchase educational equipment, enhance audiovisual and clinical
laboratories, expand infrastructure, or recruit students. Sens. Jeff Bingaman (D-NM) and John Cornyn
(R-TX) also introduced the Nurse Faculty Education Act (S. 1575) to increase the number of
doctorally-prepared nurses serving as faculty. Grant funding would be used by schools to hire new or
retain existing faculty, purchase educational resources, and support transition into the faculty role.
www.aacn.nche.edu/Government
In June 2005, the U.S. Department of Labor (DOL) awarded more than $12 million in grant-funding
through the President's High Growth Job Training Initiative, $3 million of which will help to
address the nurse faculty shortage. This latest round of funding brings the DOL's commitment to
health care workforce through the High-Growth program to more than $43 million. Details on all
grant-funded programs are posted on the Web.
www.doleta.gov/BRG/Indprof/Health.cfm.
In 2002, the Nurse Reinvestment Act (P.L. 107-205) expanded existing law in Nursing Workforce
Development (Title VIII, Public Health Service Act) to create new and expanded programs targeted to
resolving the nursing shortage. Every year Congress must fund these programs through the
appropriations process to maintain or expand the Nurse Faculty Loan Program, Nurse Scholarship
Program, and other critical nursing education programs.
www.aacn.nche.edu/Media/shortageresource.htm#legislation
Two national media campaigns have been launched to help polish the image of nursing.
Nurses for Healthier Tomorrow is a coalition of 44 nursing and health care organizations working together to
raise interest in nursing careers among middle and high school students. The coalition has conducted
nationwide focus groups with students ages 6-15 years; secured over $600,000 in sponsorship;
launched a Web site; created a televised public service announcement, and designed print ads that can
be downloaded for free from the Web. In February 2002, Johnson & Johnson launched the Campaign
for Nursing's Future, a multimedia initiative to promote careers in nursing that includes paid
television commercials, a recruitment video, a Web site, and brochures, and other visuals.
www.nursesource.org and www.discovernursing.com
The Call to the Profession is a group of top leaders from nation nursing organizations who are
working together to ensure safe, quality nursing care for consumers and a sufficient supply of
registered nurses to deliver that care. The group released an action plan called Nursing's Agenda for
the Future in April 2002.
www.ana.org
The TriCouncil for Nursing, an alliance of four autonomous nursing organizations (AACN, ANA,
AONE, NLN) each focused on leadership for education, practice and research, issued a joint policy
statement in January 2001 on Strategies to Reverse the New Nursing Shortage .
www.aacn.nche.edu/Publications/positions/tricshortage.htm
The American Association of Colleges of Nursing is the national voice for university and four-year-
college education programs in nursing. Representing more than 585 member schools of nursing at public
and private institutions nationwide, AACN's educational, research, governmental advocacy, data
collection, publications, and other programs work to establish quality standards for bachelor's- and
graduate-degree nursing education, assist deans and directors to implement those standards, influence
the nursing profession to improve health care, and promote public support of baccalaureate and graduate
nursing education, research, and practice .
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