A Shortage of Registered Nurses: Is It on the Horizon or Already Here?

Publication Date: August 2002

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

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Abstract:

Labor shortages in various occupations and industries were reported during the late stages of the nation's longest economic expansion, which ended in early 2001. The unemployment rate in some fields (e.g., nursing) has remained virtually unchanged despite the advent of the recession, which suggests that there are factors unrelated to the business cycle affecting them. For example, the increasing longevity and wealth of the population combined with a growing share of elderly persons are putting added pressure on the health care delivery system, and these trends are expected to continue. Moreover, although women continue to account for the majority of workers in many health care occupations, their career opportunities have widened over time. And, among women who already are licensed RNs, many are expected to retire in the not-too-distant future while others have chosen to work in non-nursing occupations.

Thus, health care providers who previously might have thought their supply of labor was fairly well assured must now compete for the interest of students based on nursing's attractiveness vis-a-vis other occupations. They also could become more concerned about retaining their aging RN workforce and about appealing to licensed RNs who are otherwise employed. During the mid-1990s, however, earnings growth among RNs slowed compared to earlier in the decade, and their wage increases were smaller than those of all professional workers. This could partly explain the drop in nursing program graduates that began in the 1995-1996 academic year and the greater share of RNs not employed in nursing in 2000 as compared to 1992 and 1996.

Trends such as these underlie the supply and demand projections for RNs released by the U.S. Health Resources and Services Administration (HRSA). While the agency's own 1996 projections and those of analysts based in part on them strongly suggested the likelihood of a shortage of RNs beginning in 2007 or shortly thereafter, HRSA's July 2002 projections push forward the overall RN shortage to 2000. If current trends continue and ameliorative actions are not taken, HRSA projects that the aggregate shortfall could worsen at an accelerating rate -- from 6% in 2000 to 12% by 2010; then rising to 20% by 2015; and climbing to 29% by 2020.

Not all states currently are sharing in the RN shortage, nor are those with shortages sharing equally, according to HRSA's latest projections. Thirty states were estimated to have a shortfall of full-time equivalent (FTE) RNs in 2000, and the severity of shortages varied widely -- from under 4% in Iowa, Minnesota, and Oregon to at least 13% in Arizona, New Jersey, and Tennessee. By 2005, perhaps seven states (Alabama, Florida, Idaho, Maryland, North Dakota, Oklahoma, and Wyoming) could experience a shortage as well. Another three states by 2010 (Illinois, Michigan, and South Carolina) and seven more by 2015 (Louisiana, Minnesota, Montana, North Carolina, South Dakota, West Virginia, and Wisconsin) could have an inadequate supply. If Mississippi moves into a shortage situation by 2020, just six states might remain with more FTE RNs than are demanded (Hawaii, Iowa, Kansas, Kentucky, Ohio, and Vermont).