Nursing in America
About the profession and the impact of a changing health care system
Building a 21st Century Nursing Workforce
In a changing health care system, nurses are central to good health. Nurses are positioned across the health care system to provide high quality health care, increase access to health care services, and keep costs down.
Yet, as our population ages and requires more complex health care, we’re facing a shortage of nurses – 260,000 over the next 15 years (Buerhaus, P., 2009).
State-by-State Ratio of Registered Nurses to Population (per 100,000)
Source: The Registered Nurse Population: Findings from the 2004 National Sample Survey of Registered Nurses, Table 51. Registered nurse population in each State and geographic area by activity status: March 2004 (HRSA)
Supporting Evidence
In 2007, there were approximately 116,000 unfilled nursing jobs in American hospitals and nearly 25,000 unfilled nursing jobs in our nation’s nursing homes. (AHA 2007 and AHCA 2007)
In 2008,home health agencies report an average 11 percent nursing vacancy rate. (Cushman and Ellenbecker 2008).
The than 5,000 community health centers that serve those without adequate insurance experienced an average vacancy rate of 10 percent for RNs and nine percent for nurse practitioners (Rosenblatt, et al 2006).
Like other sectors of the workforce, the severe downturn in the economy has affected the supply of and demand for nurses. Many nurses who had planned to retire are staying in their jobs; part-time nurses are seeking more hours; and non-working nurses with spouses who have lost jobs are returning to work. These trends have filled slots for nurses left previously vacant and in a few states, some recent nursing school graduates are having difficulty finding jobs. Yet, in rural, underserved areas, there exists a significant need for nurses.
Various surveys report that over half of today’s employed nurses plan to retire in the next 15-20 years, just at a time when the demand for nursing care will reach an all time high (AACN 2008).
Nurses Are Critical to Providing Quality Care
We need to pay special attention to this looming shortage because having enough nurses with the right skills is a critical part of keeping patients healthy and safe.
Nurses save lives and improve patient outcomes. In fact, Americans treated in hospitals that don’t have enough nurses experience more complications, such as infections, and longer hospital stays.
Nurses prevent medical errors and improve patient safety. Studies indicate that patients who have surgery in hospitals with fewer nurses per patient have up to a 31 percent increased chance of dying than those in hospitals with more RNs (Aiken, 2002). Nurses also help patients and families safely manage medication.
Supporting Evidence
Increases in RN staffing are associated with reductions in hospital-related mortality and failure to rescue as well as reduced lengths of stays, according to a meta-analysis of existing studies (AHRQ 2007).
Americans treated in hospitals with more RNs per patient had lower rates of five adverse outcomes (pneumonia, shock, upper gastrointestinal bleeding, longer hospital stay and urinary tract infection) than patients in hospitals with fewer RNs. (AHRQ 2007)
A higher proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are associated with better outcomes for hospitalized patients, according to a study published in the New England Journal of Medicine in 2002 (Needleman, et al. 2002).
Patients treated in hospitals with more hours of nursing care per patient had up to 25 percent fewer serious adverse outcomes. (AHRQ 2007)
A 2003 study found that surgical patients had a “substantial survival advantage” if treated in hospitals with higher proportions of nurses with a BSN or higher degree. Every 10 percent increase in proportion of BSN nurses in hospitals had a resulting four percent decrease in risk of death (Aiken 2003; 2008).