United States
According to the American National Council of State Boards of Nursing, the number of U.S. trained nurses has been increasing over the past decade: In 2000, 71,475 U.S. trained nurses became newly licensed. In 2005, 99,187 U.S. trained nurses became newly licensed. In 2009, 134,708 U.S. trained nurses became newly licensed. Therefore, a 9.8% annual increase of newly licensed U.S. nurses has been observed each year over the past 9 years. It is clear that, nursing enrollment in the U.S. has significantly increased over the past decade relative to the 1.19% annual U.S. population growth.While the number of U.S. trained licensed nurses has increased each year, the projected nursing demand growth rate from 2008–2018, as reported by the U.S. Bureau of Labor Statistics is anticipated to be a 22%, or 2.12% annually. Therefore, the 9.8% annual growth of new R.N.'s exceeds the current new position growth rate by a net of 7.7% per year with the assumption of consistent growth figures over the next decade.
The US population is projected to grow at least 18% over two decades in the 21st century, while the population of those 65 and older is expected to increase three times that rate.The current shortfall of nurses is projected at over 1 million by the year 2020.
Professional and related occupations are expected to rapidly increase between years 2000–2012. The demand for healthcare practitioners and technical occupations will continue to increase. It is projected that there will be 1.7 million job openings between 2000 and 2012. The demand for registered nurses is even higher. Registered nurses are predicted to have a total of 1,101,000 openings due to growth during this 10 year period. In a 2001 American Hospital Association survey, 715 hospitals reported that 126,000 nursing positions were unfilled.
However, other research findings report a projection of opposite trend. Although the demand for nurses continues to increase, the rate of employment has slowed down since 1994 because hospitals were incorporating more less-skilled nursing personnel to substitute for nurses. With the decrease in employment, the earnings for nurses also decreased. Wage among nurses leveled off in correlation with inflation between 1990 and 1994.The recent economic crisis of 2009 has further decreased the demand for RN's.
Comparing the data released by the Bureau of Health Professions, the projections of shortage within two years have increased.
| Year | Supply | Demand | Shortage | Percent |
|---|---|---|---|---|
| 2000 | 1,889,243 | 1,999,950 | -110,707 | -6% |
| 2005 | 2,012,444 | 2,161,831 | -149,387 | -7% |
| 2010 | 2,069,369 | 2,344,584 | -275,215 | -12% |
| 2015 | 2,055,491 | 2,562,554 | -507,063 | -20% |
| 2020 | 2,001,998 | 2,810,414 | -808,416 | -28.8% |
Source: Data from the Bureau of Health Professions (2002)
Some states are have a surplus of nurses while other states face a shortage. This is due to factors such as the number of new graduates and the total demand for nurses in each area. Some states face a severe shortage (such as the Northwestern states, as well as Texas and OK), while other states actually have a surplus of registered nurses.
| Year | Supply | Demand | Shortage | Percent |
|---|---|---|---|---|
| 2000 | 1,890,700 | 2,001,500 | -110,800 | -6% |
| 2005 | 1,942,500 | 2,161,300 | -218,800 | -10% |
| 2010 | 1,941,200 | 2,347,000 | -405,800 | -17% |
| 2015 | 1,886,100 | 2,569,800 | -683,700 | -27% |
| 2020 | 1,808,000 | 2,824,900 | -1,016,900 | -36% |
Source: Data from the Bureau of Health Professions. (2004).
Patching up the shortage
Nursing shortages can be consistent or intermittent depending on the current number of patients needing medical attention. Retention and recruitment are important methods to achieve a long-term solution to the nursing shortage. Recruitment is promoted through ways of making nursing attractive as a profession, especially to younger workers to counteract the high average age of RNs and therefore future waves of retirement. Additionally, financial opportunities such as signing bonuses can attract more nurses.To assist the health sector, Congress approved the Nurse Reinvestment Act passed in 2002 to provide funding to advance nursing education, scholarships, grants, diversity programs, loan repayment programs, nursing faculty programs, and comprehensive geriatric education.Currently, mandatory overtime for nurses is prohibited in nine states, hospital accountability to implement valid staffing plans in seven states, and only one state implement the minimum staffing ratio.
In order to respond to fluctuating needs in the short term, health care industries have utilized float pool nurses and agency nurses. Float pool nurses are nursing staffs employed by the hospital to work in any unit within the organization. Agency nurses are employed by an independent staffing organization and have the opportunity to work in any hospitals on a daily, weekly or contractual basis. Similar to other professionals, both types of nurses can only work within their licensed scope of practice, training, and certification.
Float pool nurses and agency nurses, as mentioned by First Consulting group, are currently used in response to the current shortage. Use of the said services increases the cost of healthcare, decreases specialty, and decreases the interest in long-term solutions to the shortage.
International recruitment is often used to fill the nursing gap but gives rise to concern of late now that the U.S. Homeland Security has stopped the issuance of the H-1C visa, which was deemed specifically for Nurses. "Obama Health Care Reform", which will result in every American being insured, it is estimated that there will be an even greater need for Nurses. U.S. trained nurses are concerned, however, that this recruitment initiative impedes on their ability to obtain positions in the field after completing their training. A nursing shortage does not translate to new nursing jobs. Any increase in demand will likely increase the nurse patient ratio and risk patient safety. It is predicted by the National Healthcare Organization, that the entire U.S. Healthcare system will come crumbling down because nurses are the core foundation of all healthcare. The issue is not in the supply of nurses, but the number of positions available in U.S. hospitals to cover the high nurse to patient ratios. Recruitment focus should geared toward under-served areas.
A growing response to the nursing shortage is the advent of travel nursing a specialized sub-set of the staffing agency industry that has evolved to serve the needs of hospitals affected by the increasing nursing shortage. According to the Professional Association of Nurse Travelers, there are an estimated 25,500 Registered Nurse Travelers working in the U.S. The number of LVN/LPN Nurse Travelers is not known.
There is a nursing recruitment initiative and nursing workforce development program for residents of the United States originally from foreign countries, who were professional nurses in their countries but are no longer in that profession in the United States. This initiative helps these nurses get back into the nursing profession, especially getting through credentialing and the nursing board exams.The original model was developed in 2001 at San Francisco State University in cooperation with City College of San Francisco ("The San Francisco Welcome Back Center") and there are centers in many cities, such as Los Angeles, San Diego, and Boston, Massachusetts, where it is called a "Boston Welcome Back Center for Internationally Educated Nurses". It is a program meant for residents of the United States only, not others who are overseas wishing to practice in the United States. The Boston Welcome Back Center was opened in October 2005 with a $50,000 seed grant from the Board of Higher Education’s Nursing Initiative.
Legislation
In September 2007, in the 110th Congress, Senator Richard Durbin of Illinois introduced S.2064: Nurse Training and Retention Act of 2007 on the floor of the Senate. It was a bill to fund comprehensive programs to ensure an adequate supply of nurses. It was referred to committee for study but was never reported on by the committee.In April 2008, in the 110th Congress, H.R. 5924: Emergency Nursing Supply Relief Act was introduced as a bill to the House of Representatives by Robert Wexler of Florida. If it had passed, it would have amended the American Competitiveness in the Twenty-first Century Act of 2000 and would have given up to 20,000 visas per year to nurses and physical therapists until September 2011. Immediate family members of visa beneficiaries would not be counted against the 20,000 yearly cap. The bill was referred to committees for study in Congress but was never reported on by the committees.
On February 11, 2009, legislation was introduced by Representatives John Shadegg (R-AZ), Jeff Flake (R-AZ), and Ed Pastor (D-AZ) in the 111th Congress to the House of Representatives, HR 1001 ("The Nursing Relief Act of 2009" : To create a new non-immigrant visa category for registered nurses, and for other purposes) making a new non-immigrant "W" visa category for nurses to be able to work in the United States. This was to relieve the nursing shortage still considered to be a crisis despite the economic problems in the country. The proposed bill was referred to the Committee on the Judiciary but was never reported on by Committee.
Immigration Process to U.S.
Nurses seeking to immigrate to the U.S. can either apply as direct hires or through a recruitment agency. For entry to the U.S. a foreign nurse must pass a Visa Screen which includes three parts of the process. First they must pass a creditable review, followed by a test of nursing knowledge called the Commission on Graduates of Foreign Nursing Schools examination (CGFNS), and finally a test of English-language proficiency.Foreign nurses compete amongst themselves, with professionals, and other skilled workers for 140,000 employment-based viases (EB) every year. The Filipino nurses are only allocated 2,800 visas per year, thereby creating a backlog among applicants. For example, in September 2009, 56,896 Filipinos were waiting for EB-3 visa numbers. This number contrasts with the 95,000 nurses licensed in 2009, many of whom want to migrate to the U.S. Once a nurse obtains a visa number and is approved for a visa and authorized to work in the U.S., they must pass the National Council Licensure Examination to qualify for U.S. nursing standards.
Scholars point out that the use of foreign nurses prolongs the underlying issues of the nursing shortage. As a result, many of the problems with the U.S. health system will continue until addressed by a more long-term solution. For example, the unemployment rate in the Philippines was 7.5% in 2009 according to the CIA World Factbook; it was 10.6% in the US as of February 2009 according to the U.S. Bureau of Labor Statistics. Thousands of U.S. licensed newly trained nurses remain unemployed and are forced to leave the profession while thousands of seasoned nurses return to the profession to help their families make ends meet.
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