Nurses have been in high demand for decades, with supply rarely fully meeting demand, but demand has never outstripped supply as much as now. As of June 2021, the Bureau of Labor Statistics (BLS) reported that there were over 3 million open jobs in nursing in the US. The demand for nurses is expected to increase by 9% between 2020 and 2030. This means that an estimated 1.2 million new registered nurses (RN) will be needed this decade. Forecasts for demand for nursing professionals are high for a range of reasons. According to LinkedIn, RN was the fourth most in-demand job in the US in 2021. Shortages of nursing staff are not evenly distributed. Some states have severe shortages, with fewer than 10 RNs per 1,000 of the population, including California, Nevada, South Carolina and Texas, as reported by the National Center for Health Workforce Analysis. For example, in California, 85% of hospitals have reported that the demand for RNs is not being met by the supply.
Why is the demand for nurses so high?
The current high level of demand for nurses has been caused by a range of factors. Nurses have always been in demand since the profession was first developed during the 19th century. However, the shortfall in the number of nurses available to fill the open roles across the US has now reached crisis levels.
Impact of the Covid-19 pandemic on nursing
There was already a shortage of nurses before Covid-19, and the pandemic simply aggravated the existing problem. It put a huge strain on healthcare professionals, particularly nurses and doctors working on the frontline. Some people left the profession due to ongoing health issues such as long Covid or stress. Consequently, an already understaffed sector lost even more personnel.
A study into the impact of Covid-19 by the American Nurses Foundation found that 52% of nurses were planning to leave or thinking about leaving their job. They also found that 89% of participants in the study were employed in organizations that were experiencing a shortage of nursing staff.
Population changes
The changing demographics of the US is also having a significant impact on the demand for nurses. Life expectancy has increased, so on average, an individual requires healthcare services for more years, thereby putting more strain on current healthcare provision.
In addition to this, the US has an aging population. The baby boomer generation born between 1946-1964 is now having a major impact on the nation’s demographics. The percentage of the population that is aged 65+ is at an all-time high, and this trend is set to continue. In 2011, there were 41 million people aged over 65. By 2019, this figure had grown to 71 million, and it is expected to rise further to a projected 73 million by 2030. Age-related conditions mean that more healthcare services are required.
The aging population also impacts the demand for new nurses as more current nurses reach retirement age and leave the profession. The 2020 National Nursing Workforce Survey found that the median age of RNs was 52. Over 20% of nurses planned to retire within five years, with a total of over 30% expecting to retire within 15 years.
Shortage of faculty
Across the country, universities have been experiencing a shortage of faculty in recent years. In some cases, this has resulted in a reduction in overall student capacity for some programs, which in turn leads to a reduction in the number of graduates. According to the American Association of Colleges of Nursing (AACN), nursing schools in the US had to turn away over 80,000 applicants for baccalaureate and degree nursing programs in 2019 due to a shortage of instructors, both faculty and clinical. Median age and approaching retirement are factors for nursing education as well. When there are insufficient numbers of nurses entering the profession, this has an impact on the numbers of nurses who will later choose to move into nursing education, so the cycle of shortages continues.
Affordable Care Act
Introduced in 2010 under President Obama’s administration, the Affordable Care Act (ACA) transformed the US healthcare system. Sometimes referred to as “Obamacare”, the law was designed to reduce health insurance costs and ensure that all Americans could have access to health insurance. The law required every family to have a healthcare plan, and families who failed to arrange healthcare could incur a penalty. Other provisions under the ACA included increasing access to Medicare and allowing young people up to the age of 26 to be included in their parent’s healthcare plan. Subsidies were to be made available to people on lower incomes to make healthcare affordable. The law also stipulated that health insurance companies could not raise costs or deny coverage to individuals who had pre-existing conditions.
The ACA expanded access to healthcare and also enhanced the quality and scope of care available. More chronic health conditions, including mental health disorders, are now covered by health insurance. It also promotes preventative care, for example through cancer screenings and flu shots, encouraging people to take responsibility for their health to avoid sickness and prevent conditions from arising where possible.
How has the ACA impacted the nursing profession?
The ACA has made healthcare accessible to more people, and it has expanded the amount of healthcare available to each individual. This has inevitably increased demands on the healthcare system, adding to the already significant need for nurses.
The ACA has also shifted the emphasis in healthcare from delivery to outcomes, so there is more focus on the quality and effectiveness of outcomes. One impact of this is that there has been increased demand for nurses with more advanced skills and qualifications. Approximately 41% of healthcare employers now require at least a Bachelor of Science in Nursing (BSN) for new hires, while twice that number of employers state that a BSN is desirable although not mandatory.
Estimated future demand for nurses
The Bureau of Labor Statistics predicts there will be 194,500 new job vacancies per year for RNs. Demand for APRNs is expected to grow even more, with an estimated 45% growth between 2020 and 2030, generating 29,400 jobs.
General medical and surgical hospitals are the biggest employers of RNs, with approximately 1.75 million RN positions as of May 2021. This equates to around 31% of the workforce for this sector. There are also high numbers of RNs employed in the following healthcare settings:
- Outpatient care centers: 15%
- Home healthcare services: 11%
- Nursing care facilities: 9%
- Physician offices: 7%
Other areas of health are expanding, including the telehealth sector, which saw a dramatic rise in usage during the Covid-19 pandemic. As of July 2021, usage had plateaued at a level 38 times higher than the pre-pandemic baseline, with demand looking set to continue now that people have become familiar with using this type of healthcare facility.
Risks from nursing shortages
There is an urgent need to address the problem of nurse shortages, as there are many risks associated with having too few nurses in the workforce.
For patients:
- Patient demand for healthcare cannot be met, which leads to increased waiting times or people being unable to access healthcare at all. This results in untreated conditions and deterioration of health in the population.
- When nurses are working in healthcare settings where there are staff shortages, they may be expected to or feel obliged to take on a workload that is too high and work longer hours. When nurses are over-stretched, there is an increased risk of errors being made, as well as higher morbidity and mortality rates.
For nurses:
- Staff shortages inevitably mean that nurses in employment are overworked, which can lead to stress and burnout. Nurses are highly responsible workers, and knowing that their workload is too large and that they are at greater risk of making errors is very stressful for them. The caring nature associated with the profession often means that nurses are reluctant to refuse to take on extra work or longer hours, because they know that this will have an impact on patients.
- Over the long term, stress becomes unsustainable, and there is a danger that more nurses will choose to leave the profession, further adding to the problem of shortages.
Why nursing is still a popular career choice
Nursing is highly rewarding work, and as such, it will always attract new people to join the profession. Despite the problems of pressures due to current shortages, as well as the impacts of the Covid-19 pandemic, the majority of nurses are still happy with their choice of career. According to the Medscape Nurse Career Satisfaction Report, 93% of nurses are happy with their choice or career. In addition, a study by the American Nurse Journal in November 2020 found that 85% of nurses in the US would still choose a career in nursing if they had the chance to go back and make their career choice again. In 2021, the role of Nursing Practitioner was ranked the number 3 most popular job in the US.
For people from further afield considering a career in nursing in the US, there are additional requirements to take into consideration. You can find out more here.
Nursing pay
Levels of pay in the nursing profession are generally good, with plenty of scope for career advancement, particularly for those who are willing to complete further studies, such as a postgraduate degree. The median salary for an RN was $75,330 in 2020, while Advanced Nurse Practitioners earned a median salary of $117,670, according to the Bureau of Labor Statistics.
Meeting demand for nurses in the future
Policymakers, schools and the media will need to work together to find solutions to the nursing shortage. There will need to be a strong focus on attracting more people into the healthcare sector and retaining nurses who are already in employment.
Healthcare settings will need to ensure they have strong leadership teams in place to manage the current shortage situation and put plans in place for addressing the shortfall as quickly as possible. Healthcare organizations and schools will need to demonstrate the benefits of joining the nursing profession in order to persuade talented people to embark on nursing programs. They will need to make sure they are creating opportunities for career development in nursing so that people can see that paths of progression are open to them as they gain more skills and experience.
The education sector will need to be quick to adapt to change. Online nursing degrees are expected to become increasingly in demand because of the convenient and flexible nursing education they offer. These have already seen huge growth due to the pandemic, and the demand looks set to continue. Nursing education will need to harness technology in order to deliver programs in the most efficient and effective way while managing a faculty shortage. Virtual simulations may be used to transform nursing teaching and assist with instructing students in a range of skills, from charting patient health to using and maintaining medical equipment.
Nursing programs
There is a vast range of schools providing nursing programs in the US. Look out for schools that have the appropriate accreditations as well as a good reputation for their nursing faculty. With so many online nursing degrees available, you have many options open to you wherever you live. For example, Walsh University offers several online nursing and healthcare programs, including Master of Science in Nursing degrees and an MBA in Healthcare Management. Walsh University is ranked number 6 in the Nursing Schools Almanac of the Best Nursing Schools in Ohio and is accredited by several bodies, including the Commission on Collegiate Nursing Education (CCNE) and the Higher Learning Commission.
With the current unprecedented demand for nurses and the projected demand for nursing jobs to be filled through this decade, there has never been a better time to start a career in nursing. The many options for achieving the required qualification, such as an online nursing degree, make a career in nursing accessible to you wherever you are located. With shortages of nurses being experienced in all nursing sectors and at varying levels across the US, you are certain to find secure nursing job opportunities in your area once you have graduated.
