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Where Will We Find Nurses?
The nursing shortage ebbs and flows over the decades. When I graduated from nursing school in 1980, the lack of adequate nursing staff was significant, forcing the hospitals to provide sign-on bonuses, and one hundred percent tuition reimbursement during employment.
Due to Title VIII, nurse practitioner (NP) programs have significantly expanded resulting in one-seventh of the entire clinical workforce comprised of NPs1. The growth in advanced practice nursing education has resulted in an unprecedented number of NPs across all geographical areas of the US. Generally, this rapid growth of nurse practitioners has significant implications for the supply of RNs and even more specifically for long-term care facility registered nurses (RN).
In a Health Affairs study2, Auerbach and colleagues examined the supply of NPs from 2010-2017 and found that the number doubled over this period from 91,000 to 190,000. The NPs tended to work primarily in hospitals, physician’s offices, and outpatient centers. Commensurate with the expanded responsibilities was an increase of 5.5%.
In addition to the concern that the supply of RNs will be depleted as increased numbers of nurses become NPs, is the realization that the baby-boomer nurses born between 1946-1964 and totaling one million are likely to retire in the next several years. Nurses aged 30-34 comprised the highest levels of NPs with nurses aged 65-69 with the lowest levels of nurse practitioners.
The principle concern of this rapid and sustained movement from RN to NP is the impact on the health delivery system from hospitals to ambulatory care settings. This shift will likely lead to a shortage of acute care hospital nurses which threatens the supply of RNs in long-term care as active recruitment by hospitals may divert RNs from the long-term care setting back to the hospital, particularly if salaries in the hospital are substantially greater than those in the nursing home. This is even more profound if the RN has significant student loan payments contributing to financial pressures.
Hospital nurse executives report concern that new graduates work for up to two years, then leave after they become NPs, increasing the turnover of staff in a relatively short period of time. This has long been the complaint of long-term care Directors of Nursing, identifying that hospitals generally avoided hiring new nurses who would then work in nursing homes for experience and leave after one to two years.
Auerbach and colleagues noted that the growth of NPs outpace the supply of RNs. We may quickly find an oversupply of NPs, a shortage of acute care RNs, and a critical deficit of long-term care RNs.
We need to find creative ways to attract and retain RNs in our facilities and look ahead to the impact of a worsening shortage of qualified staff including LPN to RN program reimbursement, journal club, leadership programs and providing the staff with a sense of satisfaction in working in the long-term care setting.
Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration.
References:
- Hassmiller, Susan B. Legacies and lessons: A final conversation with Fitzhugh Mullan. 2020 Health Affairs 39:2; 334-338.
- Auerbach, David I., Buerhas, Peter I. and Staiger, Douglas O. Implications of the Rapid Growth of the Nurse Practitioner Workforce in the US. 2020 Health Affairs 39:2; 273-288.
