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Executive Summary

For the past 20 years, hospitals across the United States have struggled to attract and retain an adequate workforce of registered nurses. Recently, Secretary of Health and Human Services Tommy Thompson warned that the country is facing "a severe nursing shortage."1 

The failure to recruit new nurses, coupled with a rapidly aging population, has led to the shortage. Just as the baby boom generation enters its own retirement years, tens of thousands of nurses will retire, creating a massive increase in demand for nursing care.2 The collision between increased demand and decreased supply of nurses portends a shortage of crisis proportions.

However, the surprising truth is that at the moment there is not a genuine shortage of nurses. Instead, there is a shortage of nurses willing to work under the conditions currently offered by the hospital industry. In the year 2000, nearly 500,000 registered nurses in the United States were choosing not to work in the profession for which they trained. This number includes 136,000 nurses employed in non-nursing occupations and nearly 120,000 unemployed nurses who are under the age of 60 and have no children living at home. Together, these two groups constitute a reserve of more than 250,000 licensed registered nurses who are potentially available for work if the conditions were right — a lot more than the total size of the current nurse "shortage."3

In brief, there is no shortage of nurses. The health care industry has created its own Catch-22: As working conditions worsen, more nurses opt out of the profession, creating shortages on hospital floors and resulting in even greater speedups, stress, safety worries and similar conditions that drive additional nurses out of the industry. As long as work conditions do not improve, the industry will fail to retain qualified RNs. On the other hand, if conditions improve, there are enough RNs in the country who are qualified and most likely prepared to return to work, so that the so-called "shortage" could evaporate in little time.