HealthBond - Anne Marie Talbott, MA, MBA

Nursing Shortage: Mirage or Menace? Discussion

Recently, discussion has been focused on the nursing shortage. Nurses are turning from their field, specializing or getting out of healthcare altogether. Many nurses, especially RNs, are complaining that they're working longer and harder hours now than ever before. Work satisfaction and morale have taken hits over the long hours and lowered benefits, and some see a serious shortage developing in the numbers of nurses available to the United States healthcare consumer in the near future.

Is there really a shortage, or is it merely a matter of selective distribution? If there is a shortage, what are some of the reasons for it? How can we, as a healthcare community, deal with it in a positive manner, and meanwhile avoid the pitfalls of over- and under-reaction? If we over-react, then the numbers of nursing students will balloon, leading in the long run to a surplus in the nurse labor market. If we under-react, then we'll be facing a shortage for a long time, as America grays. Can we afford this?

Some of the shortage has been offset to some degree by the movement in healthcare to transfer patients as soon as possible to healthcare facilities outside the hospital setting. Some people in the nursing profession welcome this change, notes Peter Buerhaus and Douglas Staiger, in their article, "Trouble in the Nurse Labor Market? Recent Trends and Future Outlook", (Health Affairs, 1999, vol. 18, n.1). The explosion in growth of the non-acute care settings for patients has also led some of these people to look for a similar expansion in the employment opportunities for nurses. Nurses who are leaving hospitals for other settings are leaving for a multitude of reasons, though.

Downsizing, budget cutbacks, layoffs, career changes, the shift of patient care to non-acute settings... all of these are reasons nurses are leaving their traditional labor market; nursing schools are trying to redo their curriculum to reflect the changing labor market for their graduates. But are we facing a shortage? The numbers are still out there...

Buerhaus and Staiger, analyzing employment data, think that the growth of managed care has slowed down the nursing labor market dramatically. Emerging trends included leaving the nursing field for management and leaving acute care for home healthcare nursing. "Despite these emerging trends, the national impact on nurse employment and earnings was slight. Since 1994, there has been a surge in the growth of managed care, and it is likely that the national impact on the nurse workforce has grown." (Health Affairs, 1999, vol. 18, n.1).

The authors analyzed recent employment data, and found that between 1983 and 1994, growth in the nursing employment field averaged between 3 and 4 percent a year. This was dramatically slowed down in the mid-1990s, slowing down to just under 2 percent per year since 1994. Buerhaus and Staiger believe that the recent slowdown in nursing is "largely the result of lack of employment growth in hospitals, a sector that until recently employed more than 2/3rds of RNs... In contrast, hospital employment of LPNs and aides, which declined sharply throughout the 1980s and early 1990s, declined less (and even increased for aides) after 1994." (Health Affairs, 1999, vol. 18, n.1). They feel that hospitals are hiring less skilled workers and replacing RNs with them.

A decrease in earnings has accompanied the decrease in employment for RNs. "RNs experienced strong yearly growth in inflation-adjusted hourly wages through 1990...but wage growth leveled off between 1990 and 1994 and then fell 1.5 percent annually over the next three years." (Health Affairs, 1999, vol. 18, n.1) This would indicate the market has been saturated with RNs, and is adjusting itself; managed care, with its emphasis on cost reduction and smaller hospitals, certainly has lent a hand here, too. The authors found this shift especially noticeable in states that had high HMO enrollment, a likely indicator of the role managed care is playing in this trend. Buerhaus and Staiger note that what happens in the states with high HMO enrollment is likely to happen in the rest of the country, too, over time; the high enrollment states serving as trend-setters.

What does the future look like for RNs, according to the authors? Declines in hospital staffing, a slowdown in the home healthcare market, and a decline in overall RN earning power are the portents they see. Why, then, are nursing schools increasing their recruitment efforts? Why would anyone go into a high-stress, highly technical field, knowing that their chances of employment in the traditional sector--hospitals and acute care settings--are lower now than ever before? Knowing that the home healthcare system is slowing down markedly, reducing employment there, too? Knowing that wages are decreasing?

Or are they? In the next few articles this month's In Focus has scheduled, we'll look at the picture from other viewpoints, including interviewing people working in the field, as well as teaching nursing students now. We'll look at what the government forecasts for the nursing labor market, and see if these numbers jive with Buerhaus and Staiger's research. Information is power, in any field, and nursing is no exception to the rule. We'll see if there's a nursing shortage, or if it's a perception problem, and what people working in the field today think about the future of nursing tomorrow. Stay tuned, and as always, if you have comments to make, please do so! Your input is welcome!

Discussion

Anne Marie Talbott, atalbott@healthbond.com

May's In Focus looks at Consumers in Healthcare