The Scope of the Shortage
For the past 20 years, hospitals across the United States have struggled to attract and retain an adequate workforce of registered nurses. The extent of the shortage has varied over this period: Crises were followed by pay increases, managerial reforms or fluctuations in the market. While the problem was never solved, the sense of crisis among hospital administrators has ebbed and flowed since the early 1980s.
In the past few years, however, the nation's hospitals have faced a nursing shortage crisis of a different kind. The current problems result largely from the widespread practice of layoffs and downsizing during the 1990s. This time the shortages are nationwide, and their roots are structural rather than cyclical. Secretary of Health and Human Services Tommy Thompson has warned that the country is facing "a severe nursing shortage," and a wide range of experts agree that, unless major reforms occur in the way hospitals do business, the current nursing shortage will explode into an even more serious crisis over the next 15 years.32 "Unlike past shortages," explains Vanderbilt University Nursing Dean Peter Buerhaus, "the coming RN shortage will be driven by fundamental, permanent shifts in the labor market that are unlikely to reverse in the next few years."33
The nursing shortage is not only a subject of concern for nurses and policy-makers; top-level management throughout the industry has identified the shortage as a crisis confronting hospitals across the country. In early 2002, the American Hospital Association warned of unprecedented danger on the horizon: "Hospitals face a severe shortage of workers that threatens their ability to meet community needs. It is a long-term shortage that is much broader and more severe than the periodic shortages that have been experienced at various times over the past four decades."34 "We have an impending public health crisis sitting out there just waiting to happen," stated American Hospital Association President Richard Davidson.35 Indeed, 89 percent of hospital CEOs reported "significant workforce shortages" in 2001. Of the occupations for which hospitals are short-staffed, nursing is far and away the most understaffed job category.36 Similarly, CEOs report that shortages of nursing staff are growing faster than those of any other type of hospital staff.37 In 2001, nurse executives identified the "availability of qualified nurses" as their top problem, with a majority stating that they were dissatisfied with progress on this issue.38
Percentage of CEOs Reporting Workforce
|Occupation||CEOs Reporting A Shortage|
|Entry level (general)||7%|
|Source: American Hospital Association. Commission on Workforce for Hospitals and Health
Systems. In Our Hands: How Hospital Leaders Can Build a Thriving Workforce, 2002.