By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Nurse leaders have voiced frustration over the past decade about nursing workforce models. Workforce researchers may reassuringly predict that the supply of nurses will meet the demand. When CEOs study the data, they have challenges understanding why it may not reflect their local workforce supply. Nurse leaders often find themselves on the defensive. Last week, JAMA released the latest nursing workforce supply derived from population census data. It comes at a time when nurse leaders in acute care settings in most of the US still see a significant shortage of nursing candidates.
The Findings
- The total number of RN FTE (including ARNPs) is 6% higher than in 2019, reaching 3.35 million.
- The 3.35 million RNs are all employed RN FTE, including ARNPs aged 29 to 69 in all settings.
- Based on historical trends, the RN workforce is projected to increase by roughly 1.2 million FTEs to 4.56 million by 2035, close to pre-pandemic forecasts.
- Future workforce growth will be primarily driven by nurses 35 to 49 years of age.
- Although there is an increase in RN FTE, there has been a significant drop in RNs choosing hospital employment from 60.3% to 57.8% from pre-pandemic levels.
- There has been a dip in enrollment in nursing programs since 2022.
- The forecasted growth will be significant enough to replace RNs who will retire and further expand the workforce by roughly 1.2 million RNs by 2035 to a total of 4.56 million nurses.
On the surface, these findings seem very optimistic. A challenge with workforce models is that they are built using historical data on how RNs have moved through their nursing careers and other societal trends. They often fail to consider many of the following factors:
- Current birthrate declines in the US population could lead to fewer students in nursing programs.
- Changes in societal attitudes about college education could lead to fewer enrollments in nursing programs.
- University and college financial issues could make nurse faculty salaries less appealing, exacerbating the faculty shortage.
- An aging US population is leading to increased utilization of healthcare services, especially hospital services.
- Changes in how generational cohorts view their professional work and may be able to apply their nursing skills in other occupations.
- The physician shortage is driving the need for more advanced practice nurses.
- Increased nurse employment in fields supporting healthcare services, such as insurance companies, technology, and medical supply firms.
- Changes in immigration policies and a drop in foreign-educated nurses who work longer in their careers and stay in acute care settings.
- The impact of societal violence, incivility, and bullying on career choice.
- Population migration due to economic reasons or climate impact.
Workforce studies provide essential data for nurse leaders to track, but they do not paint the full picture of what is happening with nursing employment. The drop in hospital employment at a time when volumes are surging is alarming. The authors acknowledge whether this forecasted growth will satisfy the needs for the types of healthcare services provided by RNs or match healthcare delivery organizations’ demand for RN labor remains to be seen.
Reference
Auerbach DI, Buerhaus PI, Donelan K, Staiger DO. Projecting the Future Registered Nurse Workforce After the COVID-19 Pandemic. JAMA Health Forum. 2024 Feb 2;5(2):e235389. doi: 10.1001/jamahealthforum.2023.5389. PMID: 38363560; PMCID: PMC10873770. Available at https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815057
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