The first indicators of a nursing shortage began to appear on America’s radar at the turn of the new century. Health care facilities experienced a high vacancy rate among registered nursing positions and those opening new units were unable to find enough RNs to staff them adequately.

“A shortage is termed ‘critical’ any time the nurse vacancy rate reaches seven percent,” said Patricia Starck, DSN, RN, FAAN, and dean of The University of Texas School of Nursing at Houston. “In 2000, the nurse vacancy rate across the country exceeded eight percent.”

In that same year, there were an estimated 2.69 million RNs registered in the U.S., 700,000 more than needed to fill the nation’s 1.99 million RN jobs, according to the U.S. General Accounting Office. However, the U.S. Department of Health and Human Service’s National Center for Workforce Analysis noted this nation also had a shortfall of 110,707 nurses in 2000.

An article published in the Spring 2004 issue of the Labor Studies Journal reported 35.4 percent of all RNs in 2000 left the profession for better salaries. Another 45.7 percent reportedly left for more convenient hours and more than 11,000 (8.4 percent) left nursing because they felt they were unable to practice nursing on a professional level.

The National Sample Survey of Registered Nurses (NSSRN), conducted by the Department of Health and Human Services – Bureau of Nursing in March 2004, discovered 16.8 percent of all registered nurses – or 488,006 – were not employed in nursing.

Even more compelling are the demographics of nurses who have remained in nursing. In 1980, according to research conducted by the Robert Wood Johnson Foundation, 40 percent of all RNs working in nursing were under age 35.  In 2004, 24 years later, 16.6 percent of RNs employed as nurses were under age 35 and RNs who were 54+ represented 25.5 percent of all nurses. Adding momentum to the shortage, the pool of potential nurses had grown smaller by 2004, due to dwindling birth rates following the post-World War II Baby Boom. 

“Realistically, nurses who are 55 years of age or older, can’t be expected to work a 12-hour shift,” Dean Starck said, “and the older they get, the harder the work becomes and the more they drop out of the workforce.”

Data for Texas in the nursing survey estimated 23,032 RNs (13.7 percent) not employed in nursing, which Dean Starck pointed out was lower than the national average. “But, we’re about the same in age distribution as the national numbers, which means 29.6 percent of our RNs who are not in nursing have not worked in nursing for 6-10 years,” she said. “Another 28.5 percent of the RNs had not worked in 11-15 years, yet these nurses all have been continuously licensed.”

The survey found, as a national average, an additional 10,000 RNs will leave nursing for every five years they age.  For example, when nurses hit 40-44, an estimated 47,999 left the bedside.  At age 45-49, 58,910 RNs left nursing and at age 60-64, 74,006 RNs dropped out of the workforce.  This number spiked to 109,949 when nurses reached age 65 and older. 

Typically, and perhaps unique to the nursing profession, RNs will keep their license until death because of the pride nurses traditionally take in earning their license. To renew a license every two years, an RN in Texas must only pay a renewal fee and take 20 hours of continuing education. Some states don’t require CE, which is how one widower managed to continue renewing his wife’s nursing license long after she had died. His reason? “I did it because she was always so proud of it.”

The dean is quick to point out, “Registered nurses who have been out of the workforce for one year will need a brush-up before returning to practice. If out for five years, they will need intensive re-orientation. You can’t stay out of the workforce long as an RN without becoming obsolete,” she pointed out.

Without question, resolving the critical nursing shortage in Houston, Texas or the United States, cannot be accomplished by simply bringing licensed nurses out of retirement or non-nursing employment.

“We’ve been singing this shortage song for quite a while and we’re not finding the solutions we need,” Starck admitted. “Ultimately, we will need to develop a multi-pronged solution and funding from private philanthropy and industry to achieve the numbers of RNs needed at the bedside.”

This solution can’t come soon enough, particularly with candidates for the 2008 presidential election publicizing programs to increase national access to health care. With 26 percent of all Texans currently uninsured, the question becomes: “Who will provide that health care when we don’t have enough nurses or health care providers.”

“With universal health care, our system will definitely be severely strained,” the dean concluded.

—Alice Adams, for Institutional Advancement

Date Posted: 07/15/2008