American Association of Colleges of Nursing

On June 3, 2015 the United States Bureau of Labor Statistics reported that the healthcare industry increased its number of employees by 44,600 from April to May of that year. Among these new healthcare professionals, Registered Nurses made up almost a fifth of the employees hired during this one-month period, leading some to believe that there is no longer a nursing shortage (Bureau of Labor and Statistics, 2015). However, the fact that there are somewhere between 150,000 to 200,000 available nursing jobs at present that need to be filled strongly supports that there is in fact a nursing shortage (American Association of Colleges of Nursing, 2016). While this appears to be the case, as is believed by medical professionals, students, patients and registered nurses that are unemployed believe that if there really were a nursing shortage, they would have a job. A shortage by definition, is a condition that exists when demand exceeds supply because of lack of equilibrium in a market (The American Heritage New Dictionary of Cultural Literacy, 2013).

In regards to a nursing shortage, the definition is not much different, as it states that, A nursing shortage, is a condition in which the delicate balance of nurse supply and nurse demand are not at equilibrium. It is defined as a situation in which the demand for employment of nurses exceeds the available supply of nurses willing to be employed at a given salary. A nursing shortage is not just a matter of understanding which can occur in conditions of shortage, equilibrium, or surplus. (Huber, 2016, p.587). If the demand for nurses is in fact greater than the actual supply, as suggested by the AACN, then what is the cause behind this shortage. Several theories exist as to why there may be a nursing shortage. Some people believe that it is because of the lack of educators, while others believe it has to do with funding. It is also possible that there is a shortage due to high employee turnover, lack of job applicants, or strict hiring guidelines. Any or all of these issues could be contributing factors to the nursing shortage, and each deserves a closer look so that a cause may be determined.

A lack of nurse educators in colleges is, without a doubt, an issue. A survey done in 2015 by the Michigan Center for nursing determined that almost a fifth of the current nurse educators intend to retire over the next few years, and more than a third of the nursing programs surveyed are claiming to have a hard time filing these job openings (Beeke, 2016). Another issue facing college nursing programs is the shortage of clinical placements, which allows nursing students to gain the hands-on and work experience they need before starting their career as a nurse. Without the cooperation of a hospital, the students cannot fulfill all of the program requirements, which leads to the programs suspension or elimination. Funding is a problem facing both, schools and hospitals. Teacher funding is an issue that needs a resolution, since additional education is necessary to become a nursing instructor. This extra and expensive cost is one that does not result in a pay increase and, since nurses make more money working in hospitals, there is no incentive for them to transition to educators (Tieman, 2017). So, even if schools could obtain more funding for nursing programs, they still would not be able to hire the necessary number of instructors because they would still not be comparable to that of nurses. In regards to medical facilities, some have made drastic cutbacks, or closed down because of new insurance policies and reduced pay out amounts, despite increased premiums for consumers. This reduces the overall supply of healthcare and increases the demand, which makes the shortage even worse.

Medical facilities also have a height turnover rate, especially in the Nursing department. Nurses work long hours, often they put in a lot of overtime, and have to process stacks of paper work on top of attending to patients. Some nurses skilled at dealing with patients and families grow frustrated with a system that promotes them into dealing with paperwork and administration and leave the field (Beeke, 2016). The most recently reported turnover rate for Registered Nurses working in a hospital setting is 14 percent or 12,700 job openings (AACN, 2016). The demands of this job tend to be overwhelming and not everyone can handle the stress, especially those just starting out in this field. Medical facilities are very strict about who they hire, which is another possible reason for this alleged nursing shortage. Despite going to college and obtaining an Associate or Bachelor's Degree in Nursing, graduates do not always become nurses. Some candidates receive poor performance reviews, others are not able to pass the background check or the licensing exam, and a small handful never bother to utilize their education.

The stronger emphasis on education is also causing medical facilities to seek out candidates with Bachelor's or Master's degrees, overlooking those with Associates's degrees. The problem with this is that 34% of Registered Nurses have no education beyond their Associate's degree yet 60% of all nursing students obtain an Associate's, not a Bachelor's degree(Mahaffey, 2015). While most believe there is a nursing shortage, these are people who believe that the supply meets or even exceeds the demand. Unemployed nurses feel that if there really were a nursing shortage, they would not be without jobs. Others believe that if a shortage did exist, hospitals would not not be making cutbacks and laying off staff. Some people wonder how a shortage could exist when nurses are trained overseas and hired before they even come to the United States. By training nurses overseas, it eliminates the funding and educational problems that nursing students are experiencing here and allows the hospitals the opportunity to hire qualified applicants but its increases unemployment numbers of nurses in this country. To resolve the educational issues at hand, medical and educational facilities should form partnerships so that intern, external, and residency programs are ongoing. Employers should not only promote continuing education, but also require its employees to participate in learning field advancements and procedural changes. Universities and hospitals should work together to encourage educational advancement by creating programs that allow nurses with Associates's degrees to work and go to school to obtain their Bachelor's or Master's degree (Mahaffey, 2015).

Nurse educators should be more active in the college recruitment process because they know what it takes to be a good and successful nurse. Attempting to turn these solutions into realities, the Robert Wood Johnson Foundation came up with a policy full of innovations that address the nursing shortage. One suggestion contained in the policy is that all new nurses must obtain their BSN within ten years of obtaining their nursing license (AACN, 2016). In an effort to identify the reasons for the nursing shortage and come up with a solution, academic and medical professionals from 47 states met at the Nursing Education Capacity Summit. They shared strategies, talked about increasing faculty, and restructuring the curriculum, along with policies and regulations (AACN, 2016). In regards to funding, during World War II, the government gave out grants to nursing students as an incentive too help meet the high demand. These grants covered the cost of nursing school and provided a living stipend. The incentive worked and the country went from a nursing shortage to a state of equilibrium. Unfortunately, the government funding only lasted for five years, after which time, nursing students had to find other means of obtaining money for their education or they were on their own. Some organizations, consumer groups, and foundations did help out, but they also seem to have vanished over the years (Mahaffey, 2015).

Today, there are student loans, grants, scholarships, and donations that allow students to attend school but apparently this is not enough, even as a current nursing student I can say that it even takes me two jobs to try and pay off my tuition so I can remain in the college, let alone the program. The government needs to implement a new grant specifically for nurses so that the shortage ends and employment increases, as task that Illinois senator Richard Durban plans to take on. The senator wants his Nurse Education, Expansion, and Development Act, or NEED Act, to pass so that the number of grants given to nursing schools increases, allowing for more teachers and students. Additionally, the governor of Pennsylvania, Edwards G. Rendell got the state to invest $750,000 to resolving the nursing shortage and obtained another $870,000 from private sectors. The money from this partnership has already allowed nursing programs to hire more educators and accept more students (AACN, 2016). Despite these efforts more solutions need to be implemented and at an accelerated rate.

The BLS projects that, between 2018 and 2028 the healthcare sector will add 582,000 nursing jobs to meet the growing demand of patients (BLS, 2018). This number could easily snowball into a nursing shortage of of one million by 2030 (PBS, 2017). As things are right now, many expect these jobs to remain vacant. If this holds true, then the country will experience a nursing shortage, though many believe a nursing shortage already exists, including William C. Goodman. Mr. Goodman works for the Office of Employment and Unemployment Statistics at the BLS as a social science research analyst and his research says there is a nursing shortage. His studies show that the number one reason for the shortage is that women now have options, whereas 30 years ago, they did not.

More women are choosing business careers where the demands are sometimes less and the pay is sometimes higher than in the nursing profession. The other top reason for a lack of nurses is job dissatisfaction, leading to a high turnover rate (Goodman, 2016). These are the true causes of the nursing shortage, which will continue if these issues, high are very personal, remain without a resolve. If the cause of the nursing shortage was funding, money would fix the problem but how do you resolve a problem that is occurring based on personal choice? The only option is incentive and, since registered nurses already receive generous salaries, what more can an employer offer them? A lack of employees means no one to cover a shift, minimal time off, many extra hours, and too many patients that all demand care. This leaves employer's option less, therefore maintaining the high levels of turnover, and continuing the nursing shortage.

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