Why this hospital nursing shortage is different.

HE UNITED STATES IS IN THE MIDST OF A SERIOUS MAjor shortage of registered nurses (RNs). This shortage will culminate in the largest deficit of hospital nurses at a time when the demand for their services will be the greatest, ie, after 2010. Nursing shortages have been a relatively common phenomenon in the United States, occurring on a periodic basis—in the late 1950s, early 1970s, late 1980s, and reemerging at the beginning of this decade. In prior years the solution to the crisis was higher wages, better benefits (including changes in scheduling), and overseas recruitment. However, this nursing shortage is different and the emerging challenge will be much greater. This article describes the quantitative dimensions of the emerging nursing shortage and discusses policy solutions currently advanced for dealing with the problem. This contribution is not intended to provide new data or analysis, but rather is meant to draw new conclusions from the existing data and deepen the analysis. The Current Nursing Shortage It has become commonplace to note that hospital-based nurses “love” their work and “hate” their jobs. This seems to be true for England, Canada, and other countries as well as the United States, as Aiken and colleagues 1 have recently reported. To the extent that this sentiment accurately reflects the dominant view of hospital nursing issues, it seems to indicate that structural features of clinical nursing are serious barriers to job satisfaction. Therefore, attempts to deal with the current nursing shortage simply by increasing the supply of nurses is not likely to be successful. In past nursing shortages, the nub of the problem seemed to be a mismatch between the demands of the market and the difficulties that hospitals encountered in raising wage levels and the willingness of nurse graduates to work for those wages. Today’s problem is more complex because it is really 3 separate, but ultimately related, problems that must be addressed: a declining number of new nurses entering the workforce; attracting new nurses to stay in hospitals; and nurses retiring or leaving the workforce early. The combination of these factors forms the basis of the emerging nurs